MacLeod J, Rhode R
Bagamoyo District Hospital, Tanzania.
Trop Med Int Health. 1998 Feb;3(2):130-7. doi: 10.1046/j.1365-3156.1998.00174.x.
To determine the maternal mortality rate in a rural district of Tanzania and to measure the incidence of causes of maternal mortality, the presence of risk factors and the relationship with social and demographic factors.
From January to December 1993 a retrospective recording of maternal deaths was completed using verbal autopsy and networking.
A total of 76 deaths were found which is equivalent to a maternal mortality ratio of 961 per 100,000 live births for this 12-month period of time. The leading causes of death were postpartum haemorrhage with retained placenta, anaemia, postpartum haemorrhage without retained placenta, AIDS complex and obstructed labour (in descending order of frequency). Maternal deaths were seen irrespective of group factors such as access to a main road, presence of antenatal risk factors and contact with health care personnel or a nearby facility before death. Mortality was also present both in home and hospital deliveries (excluding hospital referrals). Antenatal care had been received by 97.2% of the mothers who died after the second trimester. The referral rate even in the presence of a known antenatal risk factor was 34.6%. Patient compliance to the referral was only 44.4%. Mothers and their families followed strong cultural beliefs even when they were detrimental to the mother's health. Maternal deaths were proportionately higher among women > 40 who were also gravid > or = 5, but there was no significant increase in deaths in women < 19 years of age.
Effective antenatal care, appropriate emergency treatment of complications, access to transportation and competent referral level care with adequate equipment encompass the most effective answers to reduction of maternal deaths at a district level.
确定坦桑尼亚一个农村地区的孕产妇死亡率，衡量孕产妇死亡原因的发生率、危险因素的存在情况以及与社会和人口因素的关系。
1993年1月至12月，采用口头尸检和网络方式完成了孕产妇死亡的回顾性记录。
共发现76例死亡，相当于这12个月期间每10万例活产的孕产妇死亡率为961。主要死亡原因依次为胎盘残留的产后出血、贫血、无胎盘残留的产后出血、艾滋病综合征和产程梗阻（按发生频率降序排列）。无论诸如是否靠近主干道、是否存在产前危险因素以及死亡前是否与医护人员或附近医疗机构有接触等分组因素如何，均有孕产妇死亡情况发生。家庭分娩和医院分娩（不包括医院转诊）中均有死亡情况。孕中期后死亡的母亲中有97.2%接受了产前护理。即使存在已知的产前危险因素，转诊率也仅为34.6%。患者对转诊的依从率仅为44.4%。母亲及其家人即使在文化信仰对母亲健康不利时仍严格遵循。40岁以上且怀孕≥5次的女性中孕产妇死亡比例相对较高，但19岁以下女性的死亡人数没有显著增加。
有效的产前护理、对并发症的适当紧急治疗、交通便利以及具备足够设备的合格转诊护理，是在地区层面降低孕产妇死亡的最有效应对措施。
