Clinicians in China are deeply involved in efforts to improve maternity care throughout the country. A Women's Health section has been established in the Chinese Society of Obstetrics and Gynecology. Staff of tertiary hospitals participate in perinatal surveillance of cities, including regular maternal and perinatal mortality meetings and comparative inter-hospital evaluations of service and clinical statistics. Clinicians from larger urban centers visit rural hospitals to provide guidance in management of high risk patients.
PIP: China is a developing country with 1/5 of the world's population. Recently, systematic maternal health care has come to many cities. Lately, too, with the introduction of perinatal surveillance, maternity care has entered a period of integrated perinatal health care. In cities, maternal mortality has dropped to 20/1000,000. In rural areas, it can be 10 times that. The distribution of qualified personnel is uneven. Hospital clinicians are involved in the Chinese Society of Obstetrics and Gynecology. They attend the Society's National Congress. In Beijing, maternal health service is regionalized. Senior staff responsibilities include consultation and teaching rounds, committee meetings, and quality evaluation. Rural China lags behind the rest of the nation in health care. In 1990, risk approach strategy was begun. A pilot study was conducted at Beijing Medical University, 4 army hospitals, and Beijing Women's Health Institute. Physicians from Beijing worked at the pilot site, Shunyi county once every 2 weeks. 7 of 29 townships were randomly selected to cover a population of 100,000, The Maternal-Child Health (MCH) structure was used. This is 3-tiered--village, township, and county. During the 1st year, MCH workers sought pregnant mothers and brought them to the township center for antenatal care early in their pregnancies. These women had 2212 babies; the perinatal mortality rate was 26.7/1000. The causes of death were identified. Risk scoring was attempted during the 2nd year. Most of those women at risk were attended in the county hospital. However, 60% of the perinatal deaths occurred there. A neonatal ward was established in the county hospital. Workers were taught such skills as rotation of labor presentations, and monitoring of hypertensive diseases of pregnancy. Neonatal mortality then dropped from 14/1000 to 8/1000; death from low birth weight decreased sharply. In 1986, there were 2335 births; the perinatal mortality was 17.6/1000. Risk approach is feasible and effective in lowering perinatal mortality and morbidity in rural Beijing. The county MCH Institute is teaching workers in 29 townships to practice risk approach.