[2007 - 2013年中国艾滋病高流行地区HIV阳性孕妇的分娩方式]

[Mode of delivery among HIV-positive pregnant women in areas with high prevalence of HIV in China, 2007-2013].

作者信息

Wang Q, Wang L H, Wang A L, Wang F, Wang X Y, Qiao Y P, Su M, Dou L X, Fang L W

机构信息

National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100010, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2016 Jul 6;50(7):620-4. doi: 10.3760/cma.j.issn.0253-9624.2016.07.011.

DOI:10.3760/cma.j.issn.0253-9624.2016.07.011

PMID:27412839

Abstract

OBJECTIVE

To describe the changing demographic profile over time of pregnant women diagnosed with HIV infection, and trends in mode of delivery and pregnancy outcome.

METHODS

An observational investigation was conducted based on a population of 1 128 HIV-positive pregnant women at eight sites in China in provinces with high prevalence of HIV among pregnant women and children between 2007 and 2013. The study area included Shangcai and Weishi counties in Henan province; Ruili and Longchuan counties and Linxiang prefecture in Yunnan province; Yining County in Xinjiang; and Lingshan county and Babu district in Guangxi province. Main outcome measures were maternal characteristics, mode of delivery, and related trends over time by Cochram-Mantel-Haenszel(CMH) χ(2)-test.

RESULTS

A total hospital delivery rate of 96.4% was reported. For each year during the period 2007-2013, hospital delivery rates were 95.1% (253/266), 94.8% (188/198), 93.7% (164/175), 98.8% (159/161), 98.6% (141/143), 97.4% (114/117), and 100.0% (68/68), respectively (χ(2)CMH=7.68, P=0.006). The neonatal survival rate increased by 0.7% incrementally from 2007 to 2013, with 98.5% (262/266), 99.0% (196/198), 99.4% (174/175), 99.4% (160/161), 100.0% (143/143), 100.0% (117/117), and 100.0% (68/68), respectively (χ(2)CMH=4.58, P=0.030). The proportions of vaginal deliveries in those years were 62.2% (166/266), 54.8% (109/198), 59.9% (105/175), 61.7% (100/161), 66.7% (96/143), 58.8% (69/117), and 66.7% (46/68), respectively (χ(2)CMH=1.19, P= 0.276). The average rate for midwives skilled in procedures such as artificial rupture of membranes and episiotomy was 37.8% (261/691), with proportions decreasing during the study period at 39.2% (65/166), 47.4% (52/109), 35.9% (38/105), 46.0% (46/100), 25.5% (25/96), 31.2% (22/69), and 28.3% (13/46), respectively (χ(2CMH)=6.76, P=0.009).

CONCLUSION

The annual rate of reported hospital delivery increased between 2007 and 2013, with a declining rate of skilled midwifery over the same period. Survival of neonates born to HIV-infected mothers in China has increased to nearly equivalent levels as those of developed countries.

摘要

目的

描述经诊断感染艾滋病毒的孕妇的人口统计学特征随时间的变化情况，以及分娩方式和妊娠结局的趋势。

方法

基于2007年至2013年间中国孕妇和儿童艾滋病毒高流行省份8个地点的1128名艾滋病毒阳性孕妇群体进行观察性调查。研究区域包括河南省上蔡县和尉氏县；云南省瑞丽市和陇川县以及临翔区；新疆伊宁县；广西壮族自治区灵山县和八步区。主要结局指标为孕产妇特征、分娩方式以及通过 Cochr an - Mantel - Haenszel（CMH）χ²检验得出的随时间变化的相关趋势。

结果

报告的总住院分娩率为96.4%。2007 - 2013年期间各年的住院分娩率分别为95.1%（253/266）、94.8%（188/198）、93.7%（164/175）、98.8%（159/161）、98.6%（141/143）、97.4%（114/117）和100.0%（68/68）（CMHχ² = 7.68，P = 0.006）。2007年至2013年新生儿存活率逐年递增0.7%，分别为98.5%（262/266）、99.0%（196/198）、99.4%（174/175）、99.4%（160/161）、100.0%（143/143）、10百.0%（117/117）和100.0%（68/68）（CMHχ² = 4.58，P = 0.030）。这些年份的阴道分娩比例分别为62.2%（166/266）、54.8%（109/198）、59.9%（105/175）、61.7%（100/161）、66.7%（96/143）、58.8%（69/117）和66.7%（46/68）（CMHχ² = 1.19，P = 0.276）。熟练掌握诸如人工破膜和会阴切开术等操作的助产士平均比例为37.8%（261/691），在研究期间比例呈下降趋势，分别为39.2%（65/166）、47.4%（52/109）、35.9%（38/105）、46.0%（46/100）、25.5%（25/96）、31.2%（2%（22/69）和28.3%（13/46）（CMHχ² = 6.76，P = 0.009）。