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目的 了解剖宫产产妇死亡原因及剖宫产潜在危险性 ,以降低剖宫产产妇死亡率。方法 对上海市 1978～ 1997年间剖宫产产妇死亡病例资料进行回顾性分析。结果 (1) 1978～ 1987年的剖宫产率为 15 .5 5 % (2 5 815 8/ 16 5 9892 ) ,显著低于 1988～ 1997年的 2 9.39% (36 5 376 / 12 43337) ,两者比较 ,差异有极显著性 (P <0 .0 1)。(2 ) 2 0年间产妇死亡 430例 ,其中剖宫产产妇死亡 15 0例 ,占全部死亡产妇的 34 .88%。 (3)剖宫产产妇的死亡率为 2 4.0 5 / 10万 (15 0 / 6 2 35 34 ) ,显著高于阴道产产妇的 12 .2 8/ 10万 (2 80 / 2 2 796 95 )的死亡率 ,两者相比 ,差异有极显著性 (P <0 .0 1)。当剖宫产率大于30 .0 0 %时 ,剖宫产产妇死亡相对危险性上升。 (4)剖宫产产妇死亡原因依次为妊娠高血压综合征 (妊高征 )、心脏病、栓塞 (肺栓塞及羊水栓塞 )、产科出血、肝脏疾病和产褥感染。 (5 )前、后 10年因妊高征死亡的产妇中 ,其剖宫产与阴道产相对危险性有显著降低。 (6 ) 15 0例剖宫产产妇死亡病例中 ,与剖宫产直接相关的死亡有 43例 (2 8.6 7% ) ,其中栓塞最多 ,其次为产科出血、产褥感染及麻醉意外。结论 加强对妊高征、妊娠合并心脏病和栓塞的防治 ,正确掌握剖宫产指征 ,提高手术质量 ,重视术前、
Objective To understand the causes of cesarean section maternal mortality and the potential risk of cesarean section in order to reduce the maternal mortality rate of cesarean section. Methods The data of cesarean section maternal deaths from 1978 to 1997 in Shanghai were analyzed retrospectively. Results (1) The cesarean section rate from 1978 to 1987 was 15.5 5 % (2 5 815 8/16 5 9892), which was significantly lower than the rate of 2 9.39% (36 5 376/12 43337) from 1988 to 1997. Comparing the two, the difference was extremely significant (P < 0.01). (2) There were 430 maternal deaths in 20 years, including 150 maternal deaths in cesarean section, which accounted for 34.88% of the total maternal deaths. (3) The maternal mortality rate for cesarean section was 2 4.0 5 / 100,000 (15 0 / 6 2 35 34), which was significantly higher than that of vaginal mothers (12.28/100,000) (2 80 / 2 2 796 95). The mortality rate was significantly different between the two (P < 0.01). When the cesarean section rate is greater than 30.0%, the relative risk of maternal death in cesarean section increases. (4) The causes of maternal mortality in cesarean section were pregnancy induced hypertension syndrome (PIH), heart disease, embolism (pulmonary embolism and amniotic fluid embolism), obstetric hemorrhage, liver disease and puerperal infection. (5) The relative risk of cesarean section and vaginal birth was significantly lower among the mothers who died of pregnancy-induced hypertension within the first 10 years. (6) Of the 150 cases of maternal deaths due to cesarean section, 43 cases (28.67%) were directly associated with cesarean section, with the most embolism, followed by obstetric hemorrhage, puerperal infection, and anesthetic accident. Conclusion Strengthen the prevention and treatment of pregnancy-induced hypertension, pregnancy complicated with heart disease and embolism, correctly grasp the indications of cesarean section, improve the quality of surgery, and pay attention to preoperative and