北京大学医学部机构知识库
Advanced  
IR@PKUHSC  > 北京大学第一临床医学院  > 学位论文
学科主题: 妇产科学
题名:
中国城市和农村地区部分医疗机构早产发生及影响因素分析研究
作者: 张小松
答辩日期: 2016-11-21
导师: 杨慧霞
专业: 妇产科学
授予单位: 北京大学
授予地点: 北京大学第一临床医学院
学位: 博士
关键词: 早产 ; 早产发生率 ; 农村地区 ; 城市地区 ; 影响因素
其他题名: Analysis on incidence and influencing factors of preterm birth at rural and urban areas in China
分类号: R714.21
摘要:

研究目的:1.分别了解城市和农村地区医疗机构早产发生率和早产的分布特点及差异;2.分别了解市和农村地区医疗机构不早产发生的影响因素及差异;3.为今后开展不同地区医疗机构早产的预防提供一定的依据。

一、西部农村地区早产病例对照研究

研究方法:在陕西省的扶风县、凤翔县和眉县以及重庆市的綦江县和铜梁县15家县级医疗机构和8家乡级医疗机构进行现况研究和病例对照研究。现况研究内容为了解研究地点2010年11月1日至2011年10月31日全年所有的活产数、产妇数和早产数。病例对照研究为在研究地点院分娩的早产的活产产妇,在分娩后3天内经知情同意后填写调查问卷了解研究对象的人口学信息、孕前体重、孕期保健情况、孕期并发症/合并症的发生情况、孕期生活习惯、性生活以及饮食情况等,对照组按1:1成组配比,配比标准为分娩日期在早产病例分娩后±7天内,同医院、同性别的最近一例足月、出生体重2500克-3999克的新生儿。研究期间所有分娩医疗机构共分娩477例早产,实际收集病例459例,收集比例为96.2%。数据使用SPSS16.0进行统计学分析。对于计数资料采用均数±标准差表示,数据正态分布采用t检验,非正态分布采用秩和检验。计数资料采用单因素卡方检验,多因素分析采用logistic多元回归,P<0.05有统计学意义。

研究结果:所有研究地点医疗机构的早产发生率为2.02%。早产分娩孕周最小孕周为22+5周,其中极度早产(20周~27周+6)1例,占0.2%;重度早产(28周~3l+6周)15例,占3.3%;中度早产(32周~33周+6)52例,占11.3%;轻度早产(34周~36+6周)391例,占85.2%。单因素分析显示与早产有关的单因素包括(早产组与对照组比较):年龄≥35岁[16.1%(74/459)与9.8%(45/459),χ2=8.120,P=0.004]、文化程度初中及以下[74.9%(343/459)与67.5%(309/459),χ2=6.152,P=0.013]、家庭月收入≤2000元[46.0%(210/459)与36.7%(167/459),χ2=40.457,P=0.005]、产妇本人是早产儿[3.3%(15/459)与0.2% (3/459),χ2=349.801,P=0.000]、产妇有不良产史[1.7%(8/459)与0.4%(2/459),χ2=12.009,P=0.001]、产妇有早产史[3.7%(17/459)与1.1%(5/459),χ2=6.706,P=0.040]、产前检查次数≤4次[35.3%(189/459)与22.6%(103/459), χ2=37.855,P=0.000]、孕期饮酒[4.6%(21/459)与2.2%(10/459),χ2=4.065,P=0.044]、孕期未服用叶酸[49.1%(224/459)与40.8% (186/459),χ2=6.398,P=0.011]、孕期鱼肉类摄入频次小于1次/周[20.4% (93/459)与14.0% (64/459),χ2=11.066,P=0.026]、孕期有生殖道感染症状[20.9% (96/459)与13.7% (63/459),χ2=8.284,P=0.004]、胎膜早破[35.1% (,161/459)与11.1% (51/459),χ2=74.214,P=0.000] 、子痫前期[15.6% (23/459)与5.2% (4/459),χ2=5.207,P=0.022] 、前置胎盘[14.0% (18/459)与4.4% (3/459),χ2=4.257,P=0.039]。经多因素分析发现与早产有关的危险因素为:产前检查次数≤4次(OR=3.6,95%CI:1.442~9.086),前置胎盘(OR=10.5,95%CI:1.186~92.644)和胎膜早破(OR=3.3,95%CI:1.029~10.684)

二、城市医疗机构早产流行病学调查

研究方法:选择在北京、广东、湖南、湖北、四川和陕西15家省市级医疗保健机构分娩的孕周在37周以下的活产产妇,于每个季度第3个月的10日至19日共10天收集分娩的所有病例。即2012年6、9、12月以及2013年3月的10日至19日收集病例,共计40天时间,回收合格问卷9143份,其中早产病例958份(早产组),足月分娩病例8185份(足月分娩组)。经知情同意填写调查问卷,内容包括:产妇人口学特征、妊娠史、孕产期保健情况、孕产期并发症/合并症等。此外,收集各医院产科2012年度分娩情况,包括产妇数、活产数、早产数、早产儿数以便计算早产发生率。数据使用SPSS16.0进行统计学分析。对于计数资料采用均数±标准差表示,数据正态分布采用t检验,非正态分布采用秩和检验。计数资料采用单因素卡方检验,多因素分析采用logistic多元回归,P<0.05有统计学意义。

研究结果:15家医疗机构早产发生率为9.9%(10986/111095)。最小孕周为22周,其中极度早产(<28周)11例,占1.1%;重度早产(28周~3l+6周)95例,占9.9%;中度早产(32周~33周+6)133例,占13.9%;轻度早产(34周~36+6周)719例,占75.1%。单因素分析显示与早产有关的单因素包括(早产组与足月组比较):年龄≥35岁[14.6%(116/958)与10.1%(677/8185),χ2 =15.943,P=0.000]、汉族[97.7%(919/941)与96.3% (7811/8115),χ2=4.819,P=0.028]、文化程度初中及以下[27.1%(257/950)与14.9%(1 215/8 132),χ2=91.879,P=0.000]、家庭月收入<5000元[40.5%(380/939)与30.8% (2 479/8060),χ2=40.457,P=0.000]、产妇本人是早产儿[14.2%(134/942)与2.6% (211/8099), χ2=349.801,P=0.000]、产妇有不良产史[12.9%(72/958)与8.5%(346/8185),χ2=12.009,P=0.001]、产妇有早产史[50.0%(36/958)与17.1%(59/8185),χ2=79.928,P=0.000]、辅助受孕[7.7%(72/930)与2.1%(172/8 037) χ2=98.816,P=0.000]、产前检查次数≤4次[21.0%(195/925)与12.0%(966/8037),χ2=68.634,P=0.000]、孕期被动吸烟[24.5%(235/958)与19.6%(1603/8185),χ2=13.573,P=0.000]、孕期遭遇负性生活事件[27.6%(264/956)与22.0%(1802/8177),χ2=15.213,P=0.000]、孕前及孕期单纯服用叶酸[孕前:39.6%(375/947)与49.3% (4007/8131);孕期:61.2%(586/945)与67.0% (5485/8122),χ2=31.842、11.667,P=0.000、0.001]、孕期服用多种维生素[43.4% (416/947)与48.1% ((3937/8122),χ2=7.393,P=0.007]、孕期并发症或合并症(包括、胎膜早破、宫内感染、妊娠合并心脏病、胎盘早剥、前置胎盘、胎儿窘迫、子痫前期、多胎等)[59.9% (574/958)与38.9% (3184/8 185), χ2=156.471,P=0.000]。经多因素分析发现与早产有关的危险因素为:产前检查次数≤4次(OR=1.9,95%CI:1.060~3.462),重度子痫前期(OR=11.2,95%CI:1.041~2.149),前置胎盘(OR=6.6,95%CI:2.919~14.801),宫内感染(OR=5.4,95%CI:1.723~17.176),胎膜早破(OR=3.2,95%CI:1.916~5.305)。

结论:1.城市与农村地区医疗机构早产率有差异,农村医疗机构的早产率明显低于城市地区。农村地区极度早产和重度早产的比例明显低于城市医疗机构,主要与农村地区的医疗机构高危孕产妇转诊有关。2.影响农村和城市地区医疗机构早产发生的主要是产前保健的次数和孕期严重的并发症/合并症。3.在城市医疗机构中需要进一步提高孕期保健的质量,及时处理孕期并发症/合并症,预防早产的发生。4.在农村地区应加强孕期保健服务水平,提高孕期相关疾病得筛查率,促进孕期规范的保健,及时发现异常病例及时转诊。

英文摘要:

Objectives:1.To know the incidence and influencing factors of preterm in rural and urban  areas. 2. To know the differences of preterm situation between rural and urban  areas.3. to provide evidences for intervention in different areas in the future.

1.Case-control study on preterm birth in rural areas

Methods: The cross-section study and case-control study were used in 15 county level and 8 township level hospitals in 5 west counties(Fufeng, Fengxiang and Mei County in Shaanxi province, and Qijiang and Tongliang County in Chongqing municipality). The cross-section study required that the number of preterm birth, live birth from study health facilities should be reported from Nov. 2010 to Oct. 2011.  The contents of case-control study were subjects of case group are pregnant women of preterm birth; the subjects of control group are 1:1 matched pregnant women of normal birth. The standard criteria of cases ed into control group include: the date of birth within ±7d of the date of the preterm/LBW infants, delivery in the same hospital, with the same gender, and the term infants with birth weight from 2500g to 3999g. In totally, 459 pairs of pregnant women and their newborns were collected by means of questionnaire after inform consent. The questionnaire was including the general situation, smoking and drinking, history of pregnancy, prenatal examinations, reproductive health infection (RTI) symptoms, pregnancy complications, and nutritional status during pregnancy, physical and sexual activities, et al. Univariate and multivariate regression analyses were performed to identify the possible risk factors.

Results: The incidence of preterm birth was 2.02%. The samllest  delivery  gestation age was 22+5weeks, extremely preterm 1 case, the percentage was 0.2%, severe preterm were 15 cases,the percentage wa 3.3%, monderately preterm were 52 cases, the percentage was 11.3%,mildly preterm were 391cases, the percentage was 85.2%. The influencing factors related to preterm birth were including: mother’s age≥35years old[16.1%(74/459)VS 9.8%(45/459), χ2=8.120, P=0.004], low education level(junior high school or under junior high school) [74.9%(343/459)VS 67.5%(309/459), χ2=6.152, P=0.013],  family income≤2000RMB/month[46.0%(210/459)VS 36.7%(167/459), χ2=40.457, P=0.005], mother was preterm birth infant[3.3%(15/459)VS 0.2% (3/459), χ2=349.801, P=0.000], abnormal child-bearing history [1.7%(8/459)VS 0.4%(2/459), χ2=12.009, P=0.001], preterm delivery history [3.7%(17/459)VS 1.1%(5/459), χ2=6.706, P=0.040], antenatal visiting≤4times[35.3%(189/459 )VS 22.6%(103/459),  χ2=37.855, P=0.000], drinking during pregnancy[4.6%(21/459)VS 2.2%(10/459), χ2=4.065, P=0.044], without supplementing folic acid during pregnancy [49.1%(224/459)VS 40.8% (186/459), χ2=6.398, P=0.011], he supplement frequency about fish or meat < 1 time/week [20.4% (93/459) VS 14.0% (64/459), χ2=11.066, P=0.026], reproductive tract infection  symptoms during pregnancy [20.9% (96/459) VS 13.7% (63/459), χ2=8.284, P=0.004], PROM [35.1% (161/459)VS 11.1% (51/459), χ2=74.214, P=0.000] , pre-ecplasia [15.6% (23/459)VS 5.2% (4/459), χ2=5.207, P=0.022] , placenta previa [14.0% (18/459)VS 4.4% (3/459), χ2=4.257, P=0.039]。Logistic regression analysis showed that three factors were significantly associated with preterm birth: antenatal visiting≤4times(OR=3.6, 95%CI:1.442~9.086), placenta previa(OR=10.5, 95%CI:1.186~92.644) and PROM(OR=3.3, 95%CI: 1.029~10.684).

2. Investigation  on prevalence and risk factors of preterm in 15 urban hospital

Methods: Between 1. April 2012 and 31. March 2013, we ed 10 days every 3 months to collect data, all the postpartum women(delivery week ≦37 gestational weeks) got investigation questionnaire after inform consent in the 15 urban hospitals from 6 provinces. Finally, there were 9143 cases totally, which of 958 preterm birth cases and 8185 term birth.Demographics, pre-pregnancy body weight, prenatal care, and incidences of complication and/or comorbidities, lifestyles and dietary habits during pregnancy were collected. And also collecting  the number of preterm birth, live birth from study health facilities from April 2012 and 31. March 2013.  Univariate and multivariate regression analyses were performed to identify the possible risk factors.

Results: The incidence of preterm birth was 9.9% in 15 hospitals。The samllest  delivery  gestation age was 22weeks, extremely preterm 11 case, the percentage was 1.1%, severe preterm were 95 cases,the percentage wa 9.9%, monderately preterm were 133 cases, the percentage was 13.9%,mildly preterm were 719cases, the percentage was 75.1%. The influencing factors related to preterm birth were including: mother’s age≥35 years old[14.6%(116/958)VS 10.1%(677/8185), χ2 =15.943, P=0.000], ethnic Han [97.7%(919/941) VS 96.3% (7811/8115), χ2=4.819, P=0.028],  low education level(junior high school or under junior high school) [27.1%(257/950)VS 14.9%(1 215/8 132), χ2=91.879, P=0.000], family income≤<5000RMB/month [40.5%(380/939)VS 30.8% (2 479/8060), χ2=40.457, P=0.000], mother was preterm birth infant [14.2%(134/942)VS 2.6% (211/8099), χ2=349.801, P=0.000], abnormal child-bearing history [12.9%(72/958)VS 8.5%(346/8185), χ2=12.009, P=0.001], preterm delivery history[50.0%(36/958) VS 17.1%(59/8185), χ2=79.928, P=0.000]、assisted reproduction [7.7%(72/930)VS 2.1%(172/8 037), χ2=98.816, P=0.000], antenatal visiting≤4times[21.0%(195/925)VS 12.0%(966/8037), χ2=68.634, P=0.000], passive smoking during pregnancy [24.5%(235/958)VS 19.6%(1603/8185), χ2=13.573, P=0.000], negative life events during pregnancy [27.6%(264/956)VS 22.0%(1802/8177), χ2=15.213, P=0.000], without supplementing folic acid before and during pregnancy [before pregnancy: 39.6%(375/947)VS 49.3% (4007/8131); during pregnancy: 61.2%(586/945)VS 67.0% (5485/8122), χ2=31.842,11.667; P=0.000, 0.001], without supplementing multivitamin during pregnancy [43.4% (416/947)VS 48.1% ((3937/8122),χ2=7.393,P=0.007], regnancy complications (includingPROM, intro-uterus infection, cardic disease, placental abruption, pre-ecplasia, pre-ecplasia fetal ditress, polyembryony, et al)[59.9% (574/958)VS 38.9% (3184/8 185),  χ2=156.471, P=0.000]. Logistic regression analysis showed that five factors were significantly associated with preterm birth: antenatal visits ≤4 times (OR=1.9,95%C.I.1.060-3.462), intro-uterus infection (OR=5.4,95%C.I.1.723-17.176), pre-ecplasia(OR=11.2,95%C.I.1.041-2.149), PROM (OR=3.2,95%C.I.1.916-5.305) and placenta previa (OR=6.6,95%C.I.20949-14.801).

Conclusions: 1.There was difference between urban and rural areas, the preterm incidence in rural areas was lower tha that in urban areas obviously. And the percentage extremely preterm and severe preterm were also lower than that in urban areas. It had relationship with high risk pregnancy women  should be transport into higher level hospitals. 2.The main influencing factors were including antenatal visiting under 4times and serious complications. 3. In urban health facilities, it need to improve the quality for mangment complications to prevent preterm birth. 4. In rural health facilities, it should enhance ablity of perinatal health care service,  identify the serious complications and transfer to higher level  hospitals immediatly .

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/125271
Appears in Collections:北京大学第一临床医学院_学位论文

Files in This Item:

There are no files associated with this item.


作者单位: 北京大学第一临床医学院

Recommended Citation:
张小松. 中国城市和农村地区部分医疗机构早产发生及影响因素分析研究[D]. 北京大学第一临床医学院. 北京大学. 2016.
Service
Recommend this item
Sava as my favorate item
Show this item's statistics
Export Endnote File
Google Scholar
Similar articles in Google Scholar
[张小松]'s Articles
CSDL cross search
Similar articles in CSDL Cross Search
[张小松]‘s Articles
Related Copyright Policies
Null
Social Bookmarking
Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit
所有评论 (0)
暂无评论
 
评注功能仅针对注册用户开放,请您登录
您对该条目有什么异议,请填写以下表单,管理员会尽快联系您。
内 容:
Email:  *
单位:
验证码:   刷新
您在IR的使用过程中有什么好的想法或者建议可以反馈给我们。
标 题:
 *
内 容:
Email:  *
验证码:   刷新

Items in IR are protected by copyright, with all rights reserved, unless otherwise indicated.

 

 

Valid XHTML 1.0!
Copyright © 2007-2017  北京大学医学部 - Feedback
Powered by CSpace