[Epidemiological analysis of maternal death in Beijing from 1995 to 2010].

OBJECTIVE: To analysis the trend of maternal death time and explore the impact of the variety of death causes and birth place to maternal death time. METHODS: According to the data provided by Beijing Maternal and Children Health Hospital, the 372 death cases of pregnant and lying-in women from 1995 to 2010, a retrospective study was performed to analyze the death causes, maternal death time and the influencing factors. RESULTS: The MMR declined from 27.9 per 100 000 live births from 1995 to 2000 to 14.8 per 100 000 live births from 2006 to 2010, with a decline of 46.9%. Among the maternal death within 24 hours of delivery, 79.7% (106/133) died of obstetric hemorrhage, hypertensive disorder complicating pregnancy and amniotic fluid embolism. It took up 47.8% (64/134) from 1995 to 2000, reduced to 37.5% (45/120) from 2006 to 2010. At the same time, the maternal mortality ratio within 24 hours reduced from 40.2%(54/134) to 28.3% (34/120), the variation of death time was consistent with the causes of maternal mortality (χ² = 59.109, P < 0.05). Indirect obstetric causes increased significantly from 2006 to 2010, 53.2% (33/62) of pregnant women with heart disease, cerebrovascular disease and pulmonary embolism died in prenatal or more than 120 hours postnatal. Among the maternal death delved in hospital, 29.0% (29/100) died within 24 hours, 52 cases delved at home or in private clinics, 43 cases (82.6%) died within 24 h postnatal. There were significant differences between birth place and death time (χ² = 24.500, P < 0.05). CONCLUSION: Maternal death time changed from 24 hours of delivery to prenatal or postnatal a long time. The maternal mortality causes and hospital delivery is an important factor affecting maternal time.

[Study on maternal deaths in Beijing, from 1996 to 2010].

OBJECTIVE: To provide evidence for further reducing the maternal mortality rate (MMR) through analyzing the causes of death and influencing factors on the issue. METHODS: Every maternal death from 1996 to 2010 was audited by experts and relevant information was collected and analyzed, retrospectively. RESULTS: (1) The overall MMR among Beijing residents was 20.2 per 100 000 live births in 1996 - 2000 while decreased to 14.2 per 100 000 live births from 2006 to 2010. At the same time, the MMR of migrating people decreased from 47.7 to 15.2 per 100 000 live births. (2) The proportion of women having received middle school education and above, increased from 59.8% to 78.8% and the non-prenatal care maternal ratio decreased from 39.1% to 12.7%. (3) Among the 349 deaths in the period of 1996 - 2010, 209 (59.9%) were caused by direct obstetric reasons. Proportion of obstetric hemorrhage declined from 14.4% to 9.2% and the amniotic fluid embolism declined from 20.7% to 15.0%. Prolific, non-prenatal care and private clinics/home deliveries were important factors on direct obstetric reasons. 71.4% maternal mortality of indirect causes appeared abnormal during pregnancy. (4) The WHO twelve-grade classification standard on maternal deaths was adopted. Our data showed that the main reasons causing maternal deaths of Beijing residents were related to the skills of medical staffs (62.4%) and healthcare management (19.7%). The main reasons of maternal deaths among migrating people would include: poor knowledge (41.4%), inappropriate attitude (32.3%) and resources of the families (24.0%). CONCLUSION: The MMR in Beijing continuously declined from 1996 to 2010. However, in order to keep up with the changing causes related to maternal deaths as well as to the increasing service requirements, it is necessary to develop a new model on service and management of the issue.

[Study on the maternal mortality ratio from 1995 to 2004 among residential and migrant women in Beijing].

OBJECTIVE: To analyze the maternal mortality ratio (MMR) of residential and migrant women in Beijing. METHODS: A retrospective study from 1995 to 2004 was performed to analyze data from the maternal death cases. RESULTS: The MMR of resident and migrant of Beijing from 1995 to 2004 were 17.9 and 51.3 per ten thousand respectively. The main reasons of maternal deaths among residents were embolism (21.2%), hypertensive disorder complicating pregnancy (18.3%), postpartum hemorrhage (14.4%) and ectopic pregnancy/heart disease (9.6%). The main reasons of migrant maternal deaths were postpartum hemorrhage (25.2%), embolism (19.7%), hypertensive disorder complicating pregnancy (17.3%) and liver disease (9.5%). The avoidable deaths were accounted for 18.9%. CONCLUSION: The MMR in Beijing local residents was close to that in developed countries. To further reduce MMR in Beijing would depend on the better administration of related issues among floating population. Poor quatily delivery must be banned together with strengthening the training programs on health workers. It is also important to improve the knowledge and skills of medical staff for rescuing the complications of pregnancy and ectopic pregnancy.

[Study on intrapartum service model during normal labor].

OBJECTIVE: To study the availability of humanized service and healthy birth and it's effect on maternal and neonatal outcomes. METHODS: A multicenteral prospective randomized control study was carried out in 9 maternity hospitals from Nov. 2000 to June 2001. 6,758 laboring women were randomly divided into study group and control group. In study group (n = 3,437), midwives accompany laboring women in whole course of birth until two hours after delivery. According WHO "Monitoring rules for normal birth" medical staff support the mothers in physiological, psychological and physical aspects. In control group (n = 3,321) mothers receive traditional management. Midwives visit and check the mothers discoutinually. In two groups husbands can company laboring women according women's requirement. A questionnaire will be filled on the second day after birth. RESULTS: In study group the spontaneous delivery rate was significant higher than that of control group (85.5% vs 66.0%, P < 0.01). The cesarean section rate, postpartum hemorrhage rate, neonatal asphyxia rate and neonatal morbidity were marked lower in study group than those of control group (P < 0.01 and P < 0.05). CONCLUSIONS: Appropriate mode of intrapartum care can decrease the cesarean section rate and promote the vaginal delivery, also it can improve the maternal and neonatal outcomes.