2021 年第 9 期 第 16 卷

医院近十年孕产妇死亡因素分析

Analysis of mortality factors of maternal in hospital in the past 10 years

作者：龚静包照亮李燕娜张军

英文作者：Gong Jing Bao Zhaoliang Li Yanna Zhang Jun

单位：首都医科大学附属北京安贞医院妇产科100029

英文单位：Department of Obstetrics and Gynecology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：R714

英文关键词：Maternal;Mortalityfactors;Cardiacdisease

• 摘要：

• 目的 分析首都医科大学附属北京安贞医院近10年孕产妇死亡因素，为育龄期女性孕前妊娠风险评估和妊娠期母儿健康风险评估提供参考意见。方法 回顾性分析2009年1月1日至2019年9月30日于首都医科大学附属北京安贞医院妇产科就诊的29例孕产妇死亡病例的临床资料。分析患者疾病史及手术史、疾病确诊时间、妊娠终止方式和死亡原因。结果 29例死亡孕产妇中，1例无心脏病，其余28例妊娠合并心脏病的孕产妇产前心脏病妊娠风险分级评估Ⅲ级 2例、Ⅳ级26例。17例妊娠前确诊患有心脏病、9例妊娠期确诊患有心脏病、2例分娩后确诊患有心脏病；8例有心血管手术史、21例无心血管手术史。孕产妇妊娠风险评估分级结果显示，红色27例（93.1%）、红色+紫色2例（6.9%）。23例行子宫下段剖宫产术分娩、5例自然分娩，1例妊娠晚期死亡。死亡原因分为妊娠合并心脏病和妊娠合并其他疾病，妊娠合并心脏病包括肺动脉高压（PAH）危象、PAH、恶性心律失常、肺动脉瘤破裂，妊娠合并非心脏病包括感染、羊水栓塞、肺栓塞。结论 近10年本院孕产妇的主要死因为妊娠合并心脏病、感染、羊水栓塞、肺栓塞。对于妊娠合并心脏病的患者，临床应严格进行规范的围产期保健和管理，改善母婴结局。

• Objective To analyze the mortality factors of maternal in Beijing Anzhen Hospital, Capital Medical University in the past 10 years, and to provide references for the pre-pregnancy risk assessment of women of childbearing age and maternal and fetal health of pregnancy. Methods From January 1, 2009 to September 30, 2019, data of 29 maternal deaths in Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University were collected. The medical and surgical histories, time of disease diagnosis, method of pregnancy termination, and cause of death were analyzed. Results Of the 29 maternal deaths, 1 case had no cardiac disease, other 28 cases of pregnancy complicated with cardiac diseases including 2 cases with maternal antenatal cardiac disease risk classification grade Ⅲ and 26 cases with grade Ⅳ. There were 17 cases diagnosed with cardiac disease before pregnancy, 9 cases diagnosed with cardiac disease during pregnancy, and 2 cases diagnosed with cardiac disease after childbirth; 8 cases had a history of cardiovascular surgery and 21 cases did not. Grade of risk assessment for maternal pregnancy showed that 27 cases (93.1%) were red and 2 cases (6.9%) were red+purple. There were 23 cases delivered by cesarean section in the lower uterine segment, 5 cases delivered naturally, and 1 case died in the third trimester of pregnancy. Causes of death were classified as pregnancy complicated with cardiac disease and pregnancy complicated with other diseases. Pregnancy complicated with cardiac disease included pulmonary hypertensive (PAH) crisis, PAH, malignant arrhythmia, and ruptured pulmonary aneurysm; pregnancy complicated with non cardiac diseases included infection, amniotic fluid embolism, and pulmonary embolism. Conclusions In the past 10 years, pregnancy complicated with cardiac disease, infection, amniotic fluid embolism and pulmonary embolism were main causes of death in maternal in the hospital. The clinic should strictly perform normative perinatal care and management for pregnancy complicated with cardiac disease, and improve maternal and fetal outcomes.