邱昌慧　刘爱莲　谢文

[摘要]目的 探究2007～2015年南昌市新建區农村妇女高危妊娠管理成效及应用效果。方法 选择2003～2006年南昌市新建区全部19个乡镇实施高危妊娠管理前的28 682例农村孕妇为A组，同时选择在该地区2007～2015年实施高危妊娠管理后的72 656例孕妇为B组，通过回顾性方法，综合两组各项孕产妇及新生儿分娩结局等相关临床数据，分析南昌市新建地区实施农村高危妊娠管理成果与相关因素。结果 两组的高危产妇率率比较，差异无统计学意义（P>0.05），A组孕产妇死亡率、低体重出生儿率、死胎死产率、围生儿死亡率均高于B组，高危管理率、产后访视率、建卡率、早检率、系统管理率、住院分娩率均低于B组，差异有统计学意义（P<0.05）。结论 通过对农村产妇高危妊娠的系统化管理，可有效减少高危孕产妇不良妊娠结局及围生儿出生缺陷率等；在基层中推广高危妊娠筛查技术，加强农村卫生机构的服务能力和医疗技能的培训，进一步加强对妊娠妇女及家庭的健康教育工作，将有助于改善农村妇女保健状况；建议政府部门持续加大对农村妇幼卫生工作的投入。

[关键词]高危妊娠管理；围生期保健；干预；风险评估

[中图分类号] R714.2 [文献标识码] A [文章编号] 1674-4721（2017）05（a）-0100-03

[Abstract]Objective To investigate the effect and application effect of high-risk pregnancy management in rural women in Xinjian district of Nanchang from 2007 to 2015.Methods Before the application of high-risk pregnancy management，28 682 rural pregnant women in Xinjian District of Nanchang City （overall 19 villages and towns） from 2003 to 2006 were selected as group A.After the application of high-risk pregnancy management，72 656 pregnant women in this district from 2007 to 2015 were selected as group B.The clinical data of pregnant women and pregnancy outcomes of neonates in two groups were retrospectively collected.The effects of rural high-risk pregnancy management in Xinjian district of Nanchang and related factors were analyzed.Results There was no statistical difference in the rate of high-risk pregnant women between two groups （P>0.05）.The mortality rate of pregnant women，rate of low birth weight infants，fetal death and stillbirth rate，perinatal mortality rate of group A were higher than those of group B，and the rate of high-risk management，rate of postpartum visit，rate of establishing card，early detection rate，system management rate，hospitalized delivery rate of group A were lower than those of group B （P<0.05）.Conclusion System management conducted in rural parturient with high-risk pregnancy can effectively reduce the adverse pregnancy outcomes of high-risk pregnant women and the defect rate of perinatal infants and so on.The generalization of high-risk pregnancy screening in rural areas can strengthen service ability of rural health institutes and training of medical skills，and further enhances health education for pregnant women and their families，so as to improve health conditions of rural women.It is suggested that government continue to increase efforts to maternal and child health in rural areas.

[Key words]High-risk pregnancy management；Perinatal health care；Intervention；Risk assessment

高危妊娠是指孕妇在妊娠期因某些致病因素或病理对孕妇、胎儿、新生儿造成危害，或导致难产，是造成围生期母婴死亡的重要因素之一[1]。高危妊娠管理在围生期保健中尤为重要。围生期保健是指孕产妇所需的生殖健康服务，通过对孕妇实施孕检及产后访视，及时发现高危因素并予以干预，能有效保障孕妇在围生期的健康，同时能确保其分娩安全，因而产前检查和产后访视具有极其重要的意义[2]。但围生期保健服务受到多种因素的影响，包括文化、经济、人口学特征、地理区域等[3]。大量研究显示，不同地区城乡妇女围生期保健服务的推广实施存在一定差异，尤其是在农村及流动人口多的地区中产前保健难度较大[4]。