Analysis Of Maternal Mortality In Bijie City From 2010 To 2020 And Discussion On The Effect Of Step-based Subspecialty Training Mode In The Treatment Of Severe Pregnant Women

The first part Analysis of maternal mortality in Bijie City,Guizhou Province from 2010 to 2020 Research objectives:To understand the main causes and trends of maternal death in Bijie City,Guizhou Province through retrospective analysis of maternal death surveillance data(231 cases)from 2010 to 2020,and to provide reference for proposing effective intervention measures to reduce maternal death.Research objects and methods:The death report cards,death survey data,pregnancy care manuals,inpatient medical records,and expert review data at all levels of 231 dead pregnant and lying-in women from 2010 to 2020 in all counties and districts of Bijie City(including:Qixingguan District,Dafang County,Weining County,Zhijin County,Nayong County,Hezhang County,Jinsha County,and Qianxi County)were collected.According to the national maternal death surveillance program,maternal death data were collected through the Bijie Maternal and Child Health Tertiary Health Network.All deaths were reported according to the township(town)hospital – county maternal and child health hospital – municipal maternal and child health hospital.The maternal and child health care institutions of all counties in Bijie City shall be specifically responsible for on-site investigation,verification of maternal death cases,filling in death report cards and photocopies of original medical records.Organize the review of maternal death at county level,analyze the causes of death,summarize the review data and report to Municipal Maternity and Child Health Care Hospital;Municipal Maternity and Child Health Care Hospital then organize the review of maternal death at municipal level,and statistically analyze the results.Implement step-by-step quality control,so as to ensure the accuracy and reliability of data.Excel2010 software was used for data processing,enumeration data were expressed as relative numbers,and statistical tables were used for descriptive analysis.Results:1.There were 231 maternal deaths in Bijie City from 2010 to 2020,and 196 avoidable deaths(84.85%).2.From 2010 to 2020,the maternal mortality rate in Bijie City generally showed a decreasing trend.3.The causes of maternal death in Bijie City are changing from 2010 to 2020,the proportion of maternal death caused by direct obstetric causes is decreasing year by year,and indirect obstetric causes are increasing year by year.4.Dead pregnant women are generally characterized by low education level,high income,most multiparous women and a history of multiple pregnancies.5.The place of delivery and the place of death among dead pregnant women are relatively concentrated in county-level hospitals.Conclusion:1.By analyzing the maternal death rate in Bijie City,Guizhou Province from2010 to 2020,the maternal mortality rate showed a downward trend,benefiting the improvement of the comprehensive strength of politics,economy and medical treatment in Bijie City.2.In today’s society with full political and cultural development,further deep-seated reduction of maternal death requires starting from improving the medical treatment level of medical staff,continuously improving the professional technical level of critically ill pregnant and lying-in women at all levels and strengthening the ability of multidisciplinary cooperation.The second part Discussion on the effect of stepped subspecialty training model in the treatment of severe pregnant and lying-in womenResearch background: Obstetric emergency is characterized by unpredictable and rapidly developing conditions that can occur at any time and anywhere.This requires high requirements for specialist physicians and requires long-term training to independently complete the relevant work,so it is urgent to establish training in the subspecialty of severe maternal treatment to improve obstetricians’ recognition and treatment ability for critically ill pregnant and lying-in women and reduce maternal mortality.The standardized training system for subspecialists in Europe and the United States has certain reference value,but it cannot be copied blindly due to the differences in the environment and educational system.At present,the subspecialty training for obstetrical critical care in China has a short starting time,the treatment level of hospitals at all levels is uneven,the practical experience is insufficient and there are great differences,the number of grassroots doctors is large,the work pressure is high,and it is difficult to comprehensively spread and realize the homogenization of medical treatment for the time being.The model of subspecialty training conducted by the "Further Development of Doctors" implemented since the last century has played a better role in a certain period of time,but it also has many shortcomings and era limitations,and the overall training effect is slightly poor,which cannot fully meet the professional needs of the subspecialty for the treatment of critically ill pregnant and lying-in women in the new era.In addition,various academic conferences derived in recent years are also a mode for subspecialty training at present,which alleviates the limitations of previous promotion and exchange of new technologies and new projects and plays a positive role in the academic prosperity of subspecialties.However,specialist training in the form of meetings has shortcomings such as short training time,lack of communication and thinking,and lack of opportunities for operating practice.Therefore,we urgently need to establish a feasible training model for obstetricians and gynecologists in line with China’s national conditions,continuously improve the post competence of obstetricians and gynecologists in China,improve the treatment ability of critically ill pregnant and lying-in women,and reduce maternal mortality.In this study,based on Bijie demonstration area,we carried out the training model of subspecialists in the treatment of severe pregnant and lying-in women,in order to explore the evaluation of the training effect of layered stepped-oriented training model in primary care physicians and the observation of the clinical effect of local treatment of severe pregnant and lying-in women.Research objectives: With the help of the national poverty alleviation policy,to implement the stepped subspecialty training model for the treatment of severe pregnant and lying-in women in Bijie demonstration area,and to explore the clinical effect of this model for the training effect of clinicians and the treatment of local severe pregnant and lying-in women.Research objects and methods: 1.Subjects 1.1 Key teachers’ information Under the leadership of provincial teachers(the Third Affiliated Hospital of Guangzhou Medical University),Bijie Maternity and Child Health Care Hospital,in conjunction with the Health and Family Planning Commission of Bijie City,after consultation and discussion,plans to select 19 obstetricians in Bijie City as "backbone teachers" to go to the Third Affiliated Hospital of Guangzhou Medical University for intensive training and compare the effects before and after training.1.2.Clinical data of parturient women In June 2020,relying on the Third Affiliated Hospital of Guangzhou Medical University,a stepped subspecialty training model for the treatment of severe pregnant and lying-in women was carried out in Bijie City,Guizhou Province to cultivate the backbone of severe obstetric treatment at the municipal level and continue to go deep into all midwifery institutions in all counties and townships.To observe the effect of this training model on clinically relevant quality control indicators of pregnant and lying-in women,analyze the data of pregnant women who deliver in this region throughout 2020,and understand the changes of various obstetric quality control indicators and the analysis of maternal and fetal outcomes.2.The research methods 2.1 Establish provincial subspecialty training for the treatment of critically ill pregnant and lying-in women(Dawan District Maternal-fetal Physician Training College-Obstetric Critical Care Modular Training).2.2 Establish a training base for the treatment of severe pregnant and lying-in women at the municipal level(Bijie City).2.3 Establish technical training stations for the treatment of severe pregnant and lying-in women in all counties and districts of Bijie City,and continuously carry out grassroots training on the treatment of pregnant and lying-in women.3.Analysis Indicators 3.1 Use cross-sectional comparative analysis method to explore the effect of training model,the basic data,theoretical assessment and skill assessment results of "backbone teachers" for statistical analysis;this paper uses SPSS 20.0 software for statistical analysis.Measurement data were expressed as mean ± standard error(x ± SEM),and independent sample t-test was used for those who met the normal distribution,and the above tests were judged to be statistically significant at P < 0.05.3.2 The obstetrical quality report data of the two groups of pregnant women: the number of critically ill pregnant women,the number of postpartum hemorrhage,the number of severe postpartum hemorrhage,the number of amniotic fluid embolism,the number of eclampsia,the number of vaginal delivery forceps delivery,the number of full-term neonatal asphyxia,and the maternal mortality rate were processed using Excel2010 software,the enumeration data were expressed as relative numbers,and the statistical table was used for descriptive analysis to explore the effect of maternal and fetal outcomes in the stepped-oriented training model.4.Results 4.1 Data of primary training physicians The average theoretical score of trainees before training was 62.947 ± 3.270 points,and the average score of trainees after training was 81.7737 ± 4.057 points,and the written examination score after training was higher than before,and the difference was statistically significant(p < 0.05);compared with that before training,the skill score after training was also improved,and the difference was statistically significant(p < 0.05).4.2 Clinical data of pregnant women 4.2.1 The vaginal delivery forceps delivery rate and the success rate of neonatal asphyxia resuscitation in Bijie City increased as a whole from January to December 2020,and the vaginal delivery forceps delivery rate and the success rate of neonatal asphyxia resuscitation in the second half of the city were significantly higher than those in the first half of the year.4.2.2 From January to December 2020,the postpartum hemorrhage rate,severe postpartum hemorrhage rate,incidence of eclampsia,amniotic fluid embolism rate and cesarean section rate of social factors in Bijie City showed a downward trend as a whole,and the postpartum hemorrhage rate,severe postpartum hemorrhage rate,incidence of eclampsia,amniotic fluid embolism rate and cesarean section rate of social factors in the second half of Bijie City were significantly less than those in the first half of the year.4.2.3 From January to December 2020,the incidence of critically ill pregnant women and the overall trend of neonatal asphyxia rate tended to be stable,and the incidence of critically ill pregnant women and the rate of neonatal asphyxia in the second half of the year were not significantly lower than those in the first half of the year.4.2.4 Maternal mortality The maternal mortality rate in Bijie City in 2020 was 12.62/100,000,a decrease of 19.48 percentage points compared with Bijie City in 20105.Conclusion 5.1 Adopting the stepped subspecialty training model for the treatment of critically ill pregnant women can significantly improve the professional knowledge skills of primary obstetrical medical staff,and improve the pregnancy outcomes of critically ill pregnant women(success rate of postpartum hemorrhage rescue,incidence of severe postpartum hemorrhage,incidence of preeclampsia complications,incidence of amniotic fluid embolism,maternal mortality,success rate of neonatal resuscitation treatment,etc.).5.2 The maternal mortality rate has decreased significantly compared with previous years.5.3 The overall incidence of critically ill pregnant women and the incidence of neonatal asphyxia did not change significantly.