Rivera Rueda M A, Coria Soto I, Zambrana Castañeda M, Castelazo Morales E, Ahued-Ahued J R
Instituto Nacional de Perinatología, México, D.F. México.
Ginecol Obstet Mex. 1999 Dec;67:578-86.
The purpose of this study is to address the yearly fetal, neonatal, crude death rates observed at the Instituto Nacional de Perinatología from 1987 through 1997, and the specific death rates for birth weight, gestation age, cause of death, avoidability, and structure and process failures as proxy to quality of medical care. Data come from death certificates following the WHO criteria which includes the maternal medical history, pregnancy follow up, birth attendance, newborn characteristics, autopsy findings, microbiological results, basic cause of death (of both maternal and fetal/neonatal origin), death avoidability, and structure and process issues. The death certificates were analyzed by the Perinatal Mortality Committee and registered into a computerized database. The fetal mortality rate during 1987 was 17.67 per 1000 births, whereas in 1997 it was 21.5 per 1000 births. There was an increasing tendency from 1987 to 1992, with the highest rate being 34.13 during 1992. After 1992 this rate shows a decreasing tendency. The neonatal mortality rate decreased from 42.82 in 1987 to 17.34 per 1000 live births in 1997. The highest rates were observed among the newborns with the lowest birth weights and at the youngest gestational ages. The most frequent cause of death of maternal origin, in both fetal and neonatal deaths, was premature rupture of membranes. As for the most frequent fetal cause of death was antepartum hypoxia, and among neonatal deaths prematurity and immaturity. The percentage of avoidable perinatal deaths has declined dramatically from 27% in 1987 to less than 10% in 1996. Perinatal mortality at the Instituto Nacional de Perinatología has decreased during the period under assessment, due to the reduction of the neonatal mortality rate. Improving the quality of medical care focusing mainly on process issues will help lowering avoidable mortality rates.
本研究的目的是探讨1987年至1997年期间在国家围产医学研究所观察到的年度胎儿、新生儿、粗死亡率，以及出生体重、胎龄、死因、可避免性以及作为医疗质量代理指标的结构和过程失误的特定死亡率。数据来自符合世界卫生组织标准的死亡证明，其中包括产妇病史、孕期随访、分娩情况、新生儿特征、尸检结果、微生物学结果、基本死因（包括产妇和胎儿/新生儿源性）、死亡可避免性以及结构和过程问题。围产儿死亡委员会对死亡证明进行了分析，并将其录入计算机数据库。1987年的胎儿死亡率为每1000例出生17.67例，而1997年为每1000例出生21.5例。1987年至1992年呈上升趋势，1992年最高为34.13例。1992年后该率呈下降趋势。新生儿死亡率从1987年的42.82例降至1997年的每1000例活产17.34例。出生体重最低和胎龄最小的新生儿死亡率最高。在胎儿和新生儿死亡中，最常见的产妇源性死因是胎膜早破。胎儿最常见的死因是产前缺氧，新生儿死亡中最常见的是早产和不成熟。可避免的围产儿死亡百分比已从1987年的27%大幅下降至1996年的不到10%。在评估期间，国家围产医学研究所的围产儿死亡率有所下降，这是由于新生儿死亡率的降低。主要关注过程问题来提高医疗质量将有助于降低可避免的死亡率。
