Abstract: Background　Maternal and infant safety is the premise of women and children's health. However，the number of high-risk pregnant and puerperal women has increased dramatically in recent years.How to carry out effective management of high-risk pregnant women and puerperas has become the focus and a difficult issue at present.Objective　To analyze the changes of high risk factors in pregnancy from 2015 to 2017，so as to provide basis for formulating effective hierarchical management measures.Methods　The data of pregnant women reported by information systems of all districts and counties in Hangzhou from 2015 to 2017 were collected，and the changes of high-risk factors were analyzed statistically.Results　The total number of pregnant women was 329 135 from 2015 to 2017，including 212 148  （64.46%）high-risk pregnant women and puerperas．From 2015 to 2017，the total number of high-risk pregnant women and puerperas and incidence of high risk pregnancies increased significantly （χ2trend=891.12，P<0.001）．The top 3 high-risk factors were the same from 2015 to 2017，respectively：uterine scar （history of cesarean section，uterine fibroids exenteration，etc），surgery time≥2 years，abortion （natural，artificial）≥2 times，age≥35 years，and other high-risk factors were different in different years.There was significant difference in the number of high-risk factors between 2015 and 2017（χ2=1 112.49，P<0.001）among which，the number of single high-risk factor decreased significantly，and the number of 2 and more than 2 high-risk factors increased significantly（χ2trend=712.40，P<0.001）.To compare different high-risk scores and grades between 2015 and 2017，the difference had statistical significance （χ2=26.89，P<0.001）， among which，the proportion of grade A high-risk score was higher，while the proportion of grade C high-risk score was lower（P<0.017）.Age，average numbers of pregnancies，deliveries and examinations，the number of examinations>10 and 0 follow-up visit of high-risk pregnancy was less than that in normal pregnancy（t=136.04，P<0.001；t=365.84，P<0.001；t=90.10，P<0.001；t=151.89，P<0.001；χ2=24 345.92，P<0.001；χ2=408.58，P<0.001）.Conclusion　The proportion of high-risk pregnant women and puerperas increased significantly from 2015 to 2017，and risk factors are different in different years.Therefore，early screening of high-risk pregnant women and puerperas should be emphasized，especially for those with uterine scar （history of cesarean section，uterine fibroids exenteration，etc），surgery time≥2 years，abortion（natural，artificial）≥2 times，age≥35 years.At the same time，appropriate hierarchical management measures can help improve pregnancy outcomes and ensure the safety of pregnant women and fetuses.

Key words: Pregnancy, High-risk, Pregnant women, High-risk factors, Hierarchical management, High-risk score

摘要： 背景　母婴安全是妇女儿童健康的前提和基础，但是近年来高危孕产妇数量急剧增加，如何进行有效的高危孕产妇管理成为目前所关注的重点与难点。目的　分析2015—2017年妊娠高危因素变化情况，为制定有效分级分层管理措施提供依据。方法　收集2015—2017年杭州市各区、县信息系统上报的孕产妇资料，对高危因素变化情况进行统计分析。结果　2015—2017年孕产妇总数为329 135例，其中高危孕产妇212 148例（64.46%）。2015—2017年高危孕产妇总数及发生率逐年上升（χ2趋势=891.12，P<0.001）。2015—2017年前3位危险因素相同，分别为瘢痕子宫（剖宫产史、子宫肌瘤剜除史等）手术时间≥2年、流产（自然、人工流产）≥2次、年龄≥35岁，其他因素在不同年份有所不同。2015—2017年高危因素发生数量比较，差异有统计学意义（χ2=1 112.49，P<0.001），其中单一高危因素发生率逐年降低，2种及以上高危因素发生率逐年升高（χ2趋势=712.40，P<0.001）。2015—2017年不同高危评分分级情况比较，差异有统计学意义（χ2=26.89，P<0.001），其中A级高危评分所占比例较高，而C级高危评分所占比例较低（P<0.017）。高危妊娠孕产妇年龄、平均孕次、平均产次、平均产检次数、产检次数>10次、产后随访0次所占比例均大于正常妊娠孕产妇（t=136.04，P<0.001；t=365.84，P<0.001；t=90.10，P<0.001；t=151.89，P<0.001；χ2=24 345.92，P<0.001；χ2=408.58，P<0.001）。结论　2015—2017年高危孕产妇比例明显上升，高危因素在不同年份顺位有所差异，应及早筛查高危孕产妇，尤其瘢痕子宫（剖宫产史、子宫肌瘤剜除史等）手术时间≥2年、流产（自然、人工流产）≥2次、年龄≥35岁应加以重视，同时实施适当的分级分层管理措施，改善妊娠结局，保障孕产妇及胎儿安全。

关键词: 妊娠, 高危, 孕妇, 高危因素, 分级分层管理, 高危评分