Luo Xiao-Lin, Zhang Wei-Yuan
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
Chin Med J (Engl). 2015 May 5;128(9):1137-46. doi: 10.4103/0366-6999.156076.
No national research on maternal and fetal complications and outcomes has been carried out in the mainland of China in recent years. This study was to provide a scientific basis for better control of obstetrical and neonatal diseases and better allocation of medical resources by analyzing the epidemiological characteristics of obstetrical diseases in the mainland of China.
Hospitalized obstetrical cases from 19 tertiary and 20 secondary hospitals in 14 provinces (nationally representative) during the period January 1, 2011 to December 31, 2011 were randomly selected. The general condition, pregnancy complications, and perinatal outcomes of the patients were studied.
The top five medical and surgical complications of pregnant women in the mainland of China were anemia (6.34%), uterine fibroids (2.69%), thyroid disease (1.11%), thrombocytopenia (0.59%), and heart disease (0.59%). The incidences of premature rupture of membranes (PROM), preterm birth, prolonged pregnancy, hypertensive disorders complicating pregnancy (HDCP), multiple pregnancy, intrahepatic cholestasis of pregnancy (ICP), placenta previa, placental abruption, postpartum hemorrhage, and amniotic fluid embolism were 15.27%, 7.04%, 6.71%, 5.35%, 1.57%, 1.22%, 1.14%, 0.54%, 3.26% and 0.06%, respectively. The incidences of anemia and prolonged pregnancy were significantly lower in tertiary than secondary hospitals (P < 0.001), whereas the incidence of uterine fibroids, thyroid diseases, thrombocytopenia, heart disease, PROM, preterm birth, HDCP, multiple pregnancy, ICP, placenta previa, and placental abruption were significantly higher in tertiary than secondary hospitals (P < 0.001). The cesarean section (CS) rate was 54.77%. The newborn sex ratio was 119:100, and 1.03% of the neonates were malformed. The percentages of low birth weight and fetal macrosomia in full-term babies were 2.10% and 7.09%, respectively.
The incidence of some obstetrical diseases is still high in the mainland of China. The CS rate is much higher than World Health Organization recommendations, in which CS delivery by maternal request (CDMR) accounted for a large proportion. The government should propose solutions to reduce CS rate, especially the rate of CDMR. Most obstetrical complications have higher incidence in tertiary hospitals compared with secondary hospitals. It is important to manage the health of pregnant women systematically, especially those with high-risk factors.
近年来中国大陆尚未开展关于孕产妇和胎儿并发症及结局的全国性研究。本研究旨在通过分析中国大陆产科疾病的流行病学特征，为更好地控制产科和新生儿疾病以及更合理地分配医疗资源提供科学依据。
随机选取2011年1月1日至2011年12月31日期间来自全国14个省（具有全国代表性）的19家三级医院和20家二级医院的住院产科病例。对患者的一般情况、妊娠并发症和围产期结局进行研究。
中国大陆孕妇的前五大内科和外科并发症依次为贫血（6.34%）、子宫肌瘤（2.69%）、甲状腺疾病（1.11%）、血小板减少症（0.59%）和心脏病（0.59%）。胎膜早破（PROM）、早产、过期妊娠、妊娠期高血压疾病（HDCP）、多胎妊娠、妊娠期肝内胆汁淤积症（ICP）、前置胎盘、胎盘早剥、产后出血和羊水栓塞的发生率分别为15.27%、7.04%、6.71%、5.35%、1.57%、1.22%、1.14%、0.54%、3.26%和0.06%。三级医院贫血和过期妊娠的发生率显著低于二级医院（P < 0.001），而三级医院子宫肌瘤、甲状腺疾病、血小板减少症、心脏病、胎膜早破、早产、妊娠期高血压疾病、多胎妊娠、妊娠期肝内胆汁淤积症、前置胎盘和胎盘早剥的发生率显著高于二级医院（P < 0.001）。剖宫产（CS）率为54.77%。新生儿性别比为119:100，1.03%的新生儿存在畸形。足月婴儿低出生体重和巨大儿的比例分别为2.10%和7.09%。
中国大陆一些产科疾病的发生率仍然较高。剖宫产率远高于世界卫生组织的建议，其中因产妇要求的剖宫产（CDMR）占很大比例。政府应提出降低剖宫产率的解决方案，尤其是降低因产妇要求的剖宫产率。与二级医院相比，大多数产科并发症在三级医院的发生率更高。系统管理孕妇的健康非常重要，尤其是那些有高危因素的孕妇。
