Objective: To investigate the perinatal mortality and its causes in Lishui City, Zhejiang Province, so as to provide insights into the reduction of perinatal mortality. Methods: The perinatal mortality data were collected from three designated monitoring counties (districts) in Lishui City from 2015 to 2020. The changing trend in perinatal mortality and causes of death were analyzed, and the differences of perinatal causes of death and maternal conditions in urban and rural areas were compared. Results: There were 406 perinatal deaths in three monitoring counties (districts) of Lishui City from 2015 to 2020. The perinatal mortality showed a downward trend (χ2trend=5.078, P=0.024), and the average perinatal mortality rate was 5.93‰. The top five causes of perinatal mortality were birth defects, unknown causes, umbilical cord factors, maternal factors and preterm delivery. There was significant difference in the causes of perinatal death between urban and rural areas (χ2=25.574, P<0.001); birth defects, umbilical cord factors and unknown causes were predominant in urban areas, accounting for 75.00% (138 deaths); while birth defects, unknown causes and maternal factors were predominant in rural areas, accounting for 67.57% (150 deaths). The proportion of junior high school education and below was significantly higher in rural women than in urban women with perinatal death (54.50% vs. 26.63%; χ2=32.117, P<0.001), and the proportion of more than 5 antenatal examinations was significantly lower in rural women than in urban women with perinatal death (46.85% vs. 59.24%; χ2=6.195, P=0.012). Conclusions The perinatal mortality appeared a tendency towards a decline in Lishui City from 2015 to 2020, and birth defect was the main cause. Prenatal and postnatal care and tertiary prevention should be strengthened.

Objective:To analyze the effects of mutiparity on the pelvic floor muscle and the best time of postpartum for pelvic floor rehabilitation intervention.Methods:By questionnaire survey and pelvic floor functional checking on women with 42 days postpartum clinic routine health checking,and following up pelvic floor muscles force exam in postpartum 3 months,6 months and 1 year,426 cases were included in the puerpera group,including primipara 325 cases as primiparous group,two birth multipara 101 cases as multiparous group,the damage of pelvic floor muscles(≤level Ⅱ) was compared between the two groups,the difference between multiparity and primiparity were compared.Results:①In postpartum 42 days,type Ⅰ muscle fiber damage rate was lower in multiparous group than that in primiparous group(P ＜0.05),there was no significant difference on the muscle fiber damage ratio (muscles force below Ⅲ) between the two groups (P ＞ 0.05).②)In postpartum 3 months,6 months,1 year there was no significant difference in proportion of muscle damage between the two groups (P ＞ 0.05).③Multiparous group pelvic floor muscle damage ratio decreased slowly and gradually in the four periods,there was no statistical difference between adjacent period (P ＞ 0.05),the pelvic muscle damage ratio appeared significant statistical difference between postpartum 6 months and postpartum 42 days(P ＜ 0.01).④In primiparous group,pelvic floor muscle damage ratio decreased significantly in postpartum 6 months,postpartum 42 days、3 months,6 months,the differces were statistically significant among the three times(P ＜ 0.05),there was no statistical difference between postpartum 6 months and 1 year(P＞0.05).Conclusions:Type Ⅰ muscle fibers suffer injury more in Primipara than that in multipara,multiparous pelvic floor muscle recovery process is more slowly than primipara's,we should pay attention to pelvic muscle recovery within 6 months after delivery.

Objective To measure the equity of resources allocation in obstetric healthcare in Zhejiang Province, and provide evidence for decision making by healthcare departments of the government. Methods Lorenz curve and Gini coefficient were used to measure the equity of obstetric healthcare resources. Results The investigation found such allocation as equitable as measured by the layout of the number of live births, as the Gini coefficient of the distribution of obstetric doctors, nurses and beds was 0.1697,0.1971 and 0.1497 respectively by total birth, failing within the equitable range. However, when measured by geographic distribution, such coefficient were 0.2701, 0.3216 and 0.3341 respectively in cities, which were less equitable yet still within equitable range. Conclusions The government and health bureaus are recommended to scientifically predict the number of immigrants and rationally deploy healthcare resources according to the service radius of healthcare resources;moreover, more gynecologic doctors and nurses should be trained to improve the human resource structure in gynecologic departments. These effort can cater to the growing healthcare demands of the society resulting from a growing population of immigrants.

Objective To investigate the incidence of adverse pregnancy outcomes among women with syphilis in Zhejiang province during 2013-2014,and to explore the influence of anti?syphilis treatment on pregnancy outcomes. Methods A retrospective study was carried out according to the Information Management System for preventing mother?to?child transmission(PMTCT)of syphilis in Zhejiang province during 2013-2014. The incidence of adverse pregnancy outcomes was compared between women with syphilis and general women without syphilis, between treated and untreated women with syphilis, as well as between women with syphilis receiving and not receiving standard anti?syphilis treatment. The effects of anti?syphilis treatment and standard anti?syphilis treatment on pregnancy outcomes were analyzed. Results Data were collected from 3 985 women with syphilis and their children. Of these women, 12 had a stillbirth, and 3 973 a live birth. Totally, 3 210(80.55%)women received anti?syphilis treatment, 967(30.12%, 967/3 210) women received substandard treatment, and 775(19.45%)did not receive anti?syphilis treatment. Of the 3 985 fetuses or neonates born to women with syphilis, 45(1.13%)had abnormal clinical symptoms/signs. The incidence rates of low birth weight and early neonatal death were 7.00%(279/3 985) and 1.13%(45/3 985) respectively in fetuses or neonates born to women with syphilis, both significantly higher than those in fetuses or neonates born to general women without syphilis (3.18%[26 092/819494] and 0.13%[1 029/819 494], respectively, both P < 0.01). Among 775 untreated women with syphilis, the incidence rates of premature birth, low birth weight, early neonatal death, congenital syphilis and abnormal neonatal symptoms/signs were 15.61%(121/775), 10.84%(84/775), 2.45%(19/775), 3.48%(27/775)and 2.84%(22/775)respectively, all significantly higher than those in 3 210 women receiving anti?syphilis therapy (8.26%, 6.07%, 0.81%, 0.81% and 1.03%,respectively, all P < 0.01). Besides, the 967 women receiving substandard anti?syphilis treatment showed higher incidence rates of premature birth, low birth weight, early neonatal death, congenital syphilis and abnormal neonatal symptoms/signs than the 2 243 women receiving standard treatment (10.44%vs. 7.31%, 8.17%vs. 5.17%, 1.55%vs. 0.49%, 1.65%vs. 0.45%, 1.96%vs. 0.62%, respectively, all P<0.01). Conclusions The incidence of adverse pregnancy outcomes is high among women with syphilis in Zhejiang province during 2013-2014. Untreated and inadequately treated maternal syphilis is strongly associated with adverse pregnancy outcomes.

Objective To discuss the effect of syphilis treatment during pregnancy on serological test results in infants born to syphilis mothers.Methods Data of pregnant women with syphilis and their infants in Zhejiang Province between January 2013 and December 2014 were retrospectively analyzed and the effect of syphilis treatment during pregnancy on non-treponemal antigen serological test results in infants were compared.x2 test was used for positive rate of serological tests,incidence of congenital syphilis,and neonatal mortality in infants with syphilis,and rank sum test was used to compare the titers of rapid plasma reagin (RPR) test and tolulized red unheated serum teat (TRUST).Results A total of 3 953 infants were born to 3 901 mothers with syphilis.Of which 3 262 were tested,including 2 226 by RPR and 1 036 by TRUST.The rate of infants with positive RPR was significant lower in treated mothers (45.02％)compared with untreated mothers (55.04％;x2 =12.88,P＜0.01).The significant differences of titers of RPR or TRUST were observed among mothers with or without treatment (RPR:Z=-2.45,P=0.01;TRUST:Z=-2.65,P=0.01),different course of treatment (RPR:Z=-2.33,P=0.02;TRUST:Z=-2.60,P=0.01).Fifty-seven infants were diagnosed with congenital syphilis.The rate of congenital syphilis was 3.50％(27/772) born to untreated mothers,which was dramatically higher than treated mothers (0.96 ％,30/3 129,x2 =27.72,P＜ 0.01).Forty-two infants died.Neonatal mortality was also higher in the untreated group (2.59 ％,20/772) than the treated group (0.70％,22/3 129,x2 =20.72,P＜ 0.01).Conclusion Adequate treatment for women with syphilis during pregnancy could decrease serological tests of RPR and TRUST among new infants and improve the infants their outcomes.

Objective: To estimate the early physical growth and disease in children born to HBsAg-positive mothers. Methods: This was a retrospective cohort study. Three areas as Xihu in Hangzhou, Lanxi in Jinhua, and Haiyan in Jiaxing in Zhejiang province were selected by cluster sampling. The growth outcomes of children born to HBsAg-positive mothers (exposure group) and matched 1∶1 women uninfected with HBV (control group) in 2014 were investigated and compared at birth, 6, 9, 12, and 18 months, respectively. There were totally 342 children in each group. Results: The incidences of low birth weight (LBW) for children born to exposure and control group were 1.8% (6/342), and 2.6% (9/342), respectively (P=0.433); and, rates of preterm birth were 2.3% (8/342), and 2.0% (7/342), respectively (P=0.794). The mean birth weight of children born to mothers without HBV infection (3.4±0.4) kg was dramatically higher than children in exposure group (3.3±0.4) kg (P=0.019). At 18 months, the average head circumference was significantly greater among children in control group (47.3±1.3) cm than children in exposure group (47.0±2.0) cm (P=0.038). Additional, mean birth weeks, height, weight, increases in height/weight/head circumference each month, weight/height/head circumference for age Z scores, proportion of growth retardation and low weight, disease prevalence were not observed statistically differences between two groups (P>0.05). All children born to HBsAg-positive mothers were received three-dose HBV vaccination. The rate of hepatitis B immunoglobulin for births born to HBsAg-positive was 98.8% (338/342). Mother to children transmission of HBV at 18 months was 1.0% (1/97). Conclusion No significant differences in growth development and disease prevalence were found among children born to HBsAg-positive women and women without HBV infection.

OBJECTIVETo analyze the trends of multiple births rates and their perinatal outcomes in Zhejiang province from 2008 to 2013.

METHODSData were obtained from hospital-based perinatal mortality surveillance system in Zhejiang, including all the hospitals in 30 monitoring counties (districts). All births (28 or more weeks of gestation) born in the monitoring hospitals were included in our study within 7 days after delivery from 2008 to 2013. Chi-square test was performed for statistical analyses for comparisons between regions. Trends in the incidence of multiple births and causes of perinatal death were analyzed using chi-square test for trend.

RESULTSFrom 2008 to 2013, the multiple births rate in Zhejiang province was increased and the rates were 2.32% (5 551/239 636), 2.49% (6 053/243 452), 2.61% (6 549/250 594), 2.82% (7 758/275 105), 2.91% (8 803/302 447) and 3.06% (9 051/295 709), respectively. And the perinatal mortality rates for multiple births were 4.32% (240/5 551), 3.45% (209/6 053), 3.76% (246/6 549), 2.86% (222/7 758), 2.77% (244/8 803) and 2.11% (191/9 051), respectively. A significant drop in the perinatal mortality rates for multiple births was observed between 2008 and 2013 (χ(2) trend = 66.52, P < 0.001). There was a significantly greater risk for perinatal death to multiple births when compared with single birth (OR = 3.62, 95% CI: 3.42-3.83). The three leading causes of perinatal death for multiple births were birth defect, premature and/or low birth weight, and twin-twin transfusion syndrome.

CONCLUSIONThe multiple births rates in Zhejiang province showed an increasing trend. The perinatal mortality rates for multiple births were decreased annually, however, it was still higher than those in developed countries.

China ; Congenital Abnormalities ; Female ; Fetofetal Transfusion ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Multiple Birth Offspring ; Perinatal Mortality ; Pregnancy ; Pregnancy, Multiple ; Premature Birth

Objective:To explore the impacts on birth situation associated with birth policy adaption in monitoring area of birth defect population in Zhejiang province.Methods:Data were obtained from hospital-based birth defect surveillance system in Zhejiang Province. The surveillance population was childbearing women living in Nanhu of Jiaxing and Fenghua of Ningbo no less than 1 year. We divided data into three groups as "only child" (Jan, 2012-Sep, 2013), "privileged second child" (Jan, 2015-Sep, 2016) and "universal second child" (Jan, 2017-Sep, 2018) according to birth policy adaption. The differences of maternal age distribution in different birth policy periods were compared by using Kruskal-Wallis test. The changing trend of the proportion of parturient in different birth policy periods was analyzed by using Trend χ 2 test. Unconditional logistic regression model was used to analyze the relationship between birth policy and adverse perinatal outcomes. Results:During "only child" , " privileged second child" and "universal second child" period, the number of childbearing women was 12 557, 14 097 and 15 509, respectively, with an increase of 12.3% and 10.0% over previous periods. Maternal ages [ M ( P25, P75)] were [27 (25, 30)], [28 (26, 31)] and [28 (26, 32)] years old. The proportion of multipara in each period was 19.5%, 35.7% and 45.8%, showing an increased trend ( P<0.001). The incidence of adverse perinatal outcomes was lowest in the "only child" period (8.7%) and highest in the "universal second child" period (11.1%). Unconditional logistic regression model showed that after adjusting for age, compared with the "only child" period, the risk of premature birth [ OR values (95% CI) were 1.20(1.08-1.33) and 1.08 (1.02-1.13), respectively] and birth defects [ OR values (95% CI) were 1.33(1.13-1.55) and 1.29 (1.20-1.39), respectively] increased in "privileged second child" and "universal second child" period. The risk of macro infants decreased significantly [ OR values(95% CI) were 0.87 (0.80-0.96) and 0.91 (0.87-0.95), respectively], and the risk of perinatal death changed insignificantly [ OR values (95% CI) were 0.78 (0.53-1.15) and 0.84 (0.69-1.02), respectively]. Conclusion:According to population based surveillance in two regions in Zhejiang, the proportion of women with advanced age, the proportion of multipara , the risks of birth defects increased with birth policy adaption.

Objective:To explore the impacts on birth situation associated with birth policy adaption in monitoring area of birth defect population in Zhejiang province.Methods:Data were obtained from hospital-based birth defect surveillance system in Zhejiang Province. The surveillance population was childbearing women living in Nanhu of Jiaxing and Fenghua of Ningbo no less than 1 year. We divided data into three groups as "only child" (Jan, 2012-Sep, 2013), "privileged second child" (Jan, 2015-Sep, 2016) and "universal second child" (Jan, 2017-Sep, 2018) according to birth policy adaption. The differences of maternal age distribution in different birth policy periods were compared by using Kruskal-Wallis test. The changing trend of the proportion of parturient in different birth policy periods was analyzed by using Trend χ 2 test. Unconditional logistic regression model was used to analyze the relationship between birth policy and adverse perinatal outcomes. Results:During "only child" , " privileged second child" and "universal second child" period, the number of childbearing women was 12 557, 14 097 and 15 509, respectively, with an increase of 12.3% and 10.0% over previous periods. Maternal ages [ M ( P25, P75)] were [27 (25, 30)], [28 (26, 31)] and [28 (26, 32)] years old. The proportion of multipara in each period was 19.5%, 35.7% and 45.8%, showing an increased trend ( P<0.001). The incidence of adverse perinatal outcomes was lowest in the "only child" period (8.7%) and highest in the "universal second child" period (11.1%). Unconditional logistic regression model showed that after adjusting for age, compared with the "only child" period, the risk of premature birth [ OR values (95% CI) were 1.20(1.08-1.33) and 1.08 (1.02-1.13), respectively] and birth defects [ OR values (95% CI) were 1.33(1.13-1.55) and 1.29 (1.20-1.39), respectively] increased in "privileged second child" and "universal second child" period. The risk of macro infants decreased significantly [ OR values(95% CI) were 0.87 (0.80-0.96) and 0.91 (0.87-0.95), respectively], and the risk of perinatal death changed insignificantly [ OR values (95% CI) were 0.78 (0.53-1.15) and 0.84 (0.69-1.02), respectively]. Conclusion:According to population based surveillance in two regions in Zhejiang, the proportion of women with advanced age, the proportion of multipara , the risks of birth defects increased with birth policy adaption.