中文摘要：

目的了解恩施州1991-2015年孕产妇死亡的变化趋势,分析综合干预的效果和面临的挑战。方法采用回顾性对比分析法,比较3个县（市）1999年前后孕产妇死亡率（MMR）和死因构成的变化情况。结果 1991-2015年,3个县（市）的孕产妇死亡率（MMR）为71.3/10万,从1991-1998年的122.3/10万降至1999-2015年的47.0/10万,下降了61.6%。25年来的前两位死因均为产科出血和内科合并症;直接产科死亡原因的构成比呈下降趋势,产科出血的死亡率从1991-1998年的82.0/10万降至2009-2015年的6.0/10万。结论恩施州MMR的显著下降和可预防孕产妇死亡明显减少显示了综合干预的有效性,但在控制内科合并症和产科出血等方面仍面临挑战。需要提高孕产期保健有效干预的覆盖率,并改善孕产期保健和产科质量。

英文摘要：

Objective To understand the change trend of maternal mortality rate（MMR） in Enshi Tujia and Miao Autonomous Prefecture from 1991 to 2015,analyze the effect and challenges of comprehensive intervention.Methods A retrospective and comparative analytic method was used to compare the changes of MMR and composition of death causes in three counties（cities） around 1999.Results The average MMR in three counties（cities） from 1991 to 2015 was 71.3 per 100 000 people,which decreased from 122.3 per 100 000 people during 1991-1998 to 47.0 per 100 000 people during 1999-2015,the decreasing amplitude was 61.6%.The top two causes of maternal death from 1991 to 2015 were obstetric hemorrhage and medical complications.The proportion of direct obstetric factors showed a decreasing trend.The specific death rate of obstetric hemorrhage decreased from 82.0 per 100 000 people during 1991-1998 to 6.0 per 100 000 people during1999-2015.Conclusion Comprehensive intervention is effective in Enshi prefecture by reducing MMR significantly and preventable maternal death,but challenges remain in the control of medical complications and obstetric hemorrhage.The coverage rate of effective intervention for maternal health care should be increased,and maternal health care and obstetric quality should be improved.