A Survey Of High-risk Pregnancy Status In SanMing City And Coping Strategies Under The Background Of Comprehensive Two-child Policy

Objective:To investigate and analyze the differences in high-risk pregnancy,adverse pregnancy and maternal health care status of pregnant women in SanMing city before-and-after three years against the implementation of two-child policy in 2016.And to explore appropriate high-risk pregnancy management strategies to reduce the occurrence of adverse pregnancy outcome,improve maternal and infant health level and ensure maternal and infant safety.Methods:Adopting all maternal information which provided by medical institutions in SanMing from October 1st,2014 to September 30 th,2017.To do the retrospective study about SanMing maternal situation before-and-after the implementation of two-child policy.Based on the percentage to analyze the situations of high-risk pregnancy,the conditions and outcomes of adverse pregnancy,maternal health care status.Results:(1)In 2016 the high-risk pregnancy rate grown from 29.9% to 38.3%before-and-after the implementation of comprehensive two-child policy(from the year of 2015 to 2017),elderly parturient rate from 9.5% to 15.4%,gestational diabetes rate from 4.9% to 11.3%,gestational hypertension incidence rate from 1.5%to 2.7%,pregnancy with liver disease rate from 1.0% to 1.3%,twins and multiple births rate from 1.0% to 1.2%,placental previa rate from 0.4% to 0.7%,placental abruption rate from 0.3 to 0.1%,pregnancy with heart disease rate from 0.1% to0.2%.(2)In 2017,for the third degree medical institutions the incidence of common high risk factors including elderly parturient(18.1%),gestational diabetes mellitus(11.3%),gestational hypertension(2.7%),twins and multiple births(2.4%),placenta previa(2.3%),placental abruption(0.6%),gestational heart disease(0.7%),and gestational diabetes mellitus(0.7%).All these rates higher than the secondary medicalinstitutions and also higher than the Primary medical institutions.Incidence of pregnancy with liver disease in secondary medical institutions was the highest(3)In 2016 the high-risk pregnancy rate grown from 27.7% to 29.7%before-and-after the implementation of comprehensive two-child policy,the incidence of neonatal pneumonia increased from 0.5% to 0.9%,the incidence of postpartum hemorrhage(4.2%),uterine rupture(0.1%),cervical laceration(0.6%),etc,in 2016 were the highest.The incidence of prolonged labor,neonatal asphyxia and stillbirth rates decline gradually,neonatal deaths within 7 days of kept the level of 0.1% during three years.(4)In 2017,adverse pregnancy rates of third degree medical institutions higher than the secondary medical institutions such as cesarean section rate(33.0%),postpartum hemorrhage rate(6.1%),neonatal pneumonia rate(2.3%),neonatal asphyxia rate(1.5%),stillbirth rate(0.6%).And the secondary medical institutions higher than the Primary medical institutions.(5)The number of maternity persons in 2015,2016 and 2017 were 45,793,42,955 and 45,044.The number of live births were 46,205,43,253 and 45,444.The number of maternal deaths were 15.3 per 100,000 population,11.6 per 100,000 population and 13.3 per 100,000 population.From 2015 to 2017,the rate of maternal card construction and birth examination was around 97%,the rate of birth examination before 13 weeks was around 93%,the rate of 5 birth examination was around 94%,the rate of system management was around 91%,from 2015 to 2017 the rate of prenatal screening from 47.3% to 99.6%.The rate of prenatal diagnosis from15.6% to 1.6%,and the rate of high-risk pregnancy management and in-hospital delivery during three years was 100%.Conclusion:(1)After the comprehensive two-child policy,there was no significant increase in the number of pregnant women and live births in SanMing city,but the incidence of high-risk pregnancy increased.The top five risk factors in the incidence rate were advanced maternal age,gestational diabetes,gestational hypertension,pregnancy complicated with liver disease,twins and multiple births,and the increase of elderly pregnant women was the main reason.(2)Cesarean section rate and adverse pregnancy outcomes increased in SanMing city after the comprehensive two-child policy.(3)The incidence of high-risk pregnancy and adverse pregnancy outcome in tertiary medical institutions was most affected by the comprehensive two-child policy,while the incidence in first-class medical institutions was least affected.(4)The maternal health care overall situation of SanMing city is good,such as pregnant card rate,birth test rate,high-risk pregnancy management rate is high.But some aspects need to be strengthened such as birth test before 13 weeks,more than 5birth test rate,system management rate.