目的分析2005-2012年湖南省衡阳市孕产妇死亡案例,寻找影响孕产妇死亡的相关因素,为制定降低孕产妇死亡率的有效措施提供依据。方法回顾性分析衡阳市2005-2012年孕产妇死亡的个案调查资料,采用WHO十二格表进行评审分析。结果①孕产妇死亡率:2005-2012年衡阳市孕产妇死亡率呈下降趋势,2012年孕产妇死亡率为26.71/10万。②死亡孕产妇系统管理率:190例死亡孕产妇中仅40例进行了孕期系统管理,占21.05%。③死亡原因构成比及顺位:前4位死因依次为产科出血、妊娠合并内科疾病、妊娠高血压疾病、栓塞性疾病。④评审结论 :190例死亡孕产妇可避免死亡为150例,不可避免死亡为40例。结论加强孕产妇健康教育,提高孕产妇系统管理质量,加强产科人员技术培训,严格准入制度,取缔非法接生,杜绝非专业人员跨行接生,建立孕产妇急救绿色通道、危急重症孕产妇转诊一步到位等是降低孕产妇死亡的重要措施。

【Objective】By analyzing the relevant data of maternal mortality from 2005 to 2012 in Hengyang City, we hope to identify relevant factors affecting maternal mortality, and to provide a scientific basis for the effective measures to reduce the maternal mortality.【Method】We retrospectively reviewed and analyzed the cases of maternal mortality from 2005 to 2012 of Hengyang City with the WHO twelve-table.【Results】 ① Maternal mortality: From 2005 to 2012, the maternal mortality of Hengyang City was winding down. In 2012, the maternal mortality rate was 26.71/100000. ② Systematical management rate during pregnancy:In 190 cases of maternal death, only 40 cases carried on the systematical management during pregnancy, accounting for 21.05%. ③ Main causes of deaths and sequence: the top four causes of death in turn are obstetric hemorrhage, pregnancy with internal medicine disease, pregnancy hypertension disease and embolism disease. ④ Conclusion of the review: In 190 cases of maternal deaths, 150 cases of death could have been avoided, 40 cases of death were inevitable.【Conclusion】From 2005 to 2012, the maternal mortality rate of Hengyang City has been decreasing. The followings are the most important measures we can take to reduce maternal mortality: strengthening maternal health education, improving the quality of maternal systematic management, strengthening the obstetric staff technical training, imposing strict admittance system, banning illegal delivery and non-professional midwives, and establishing first aid green channel for critically ill maternity referrals.