降低剖宫产率对策的探讨

目的了解本院和全市接产医院剖宫产率及指征情况,为降低剖宫产率提供依据.方法对本院2000年剖宫产情况与全市抽样调查情况进行比较分析.结果2000年本院剖宫产率为60.11%,高于全市剖宫产率47.44%;主要指征构成依次为社会因素(38.9%)、胎儿窘迫(13.6%)、臀位(7.2%)及相对性头盆不称(5.9%).2000年全市剖宫产主要指征构成依次为胎儿窘迫(22.41%)、社会因素(16.93%)、相对性头盆不称(9.78%)及臀位(6.84%).结论本院剖宫产率高于全市平均水平,社会因素剖宫产显著高于全市.为降低剖宫产率,提出3方面的措施①产科医务人员应正确掌握剖宫产指征;②对孕产妇及其家属进行深入宣教,使他们正确认识剖宫产的利弊,改变对剖宫产的盲目追求而减少社会因素剖宫产;③转变产时服务模式,推广导乐陪伴分娩及分娩镇痛法,为自然分娩提供有利条件.

Study on the Measures of Reducing Cesarean Section in Shanghai

Objectives: In order to learn the situation of cesarean section in Shanghai.Method: We carried out a retrospective study of obstetrics in our hospital and other 93 hospitals in Shanghai.Results: The average rates of cesarean section of our hospital and the other hospitals were 60.11% and 47.44% respectively. The rank order of indications for cesarean section was as follows in our hospial: social factor (38.9%), fetal distress (13.6%), breech presentation (7.2%), and cephalopelvic disproportion (5.9%). And the rank order of indications for cesarean section in other hospitals in Shanghai was as follows: fetal distress (22.41%),social factor (16.9%), cephalopelvic disproportion (9.78%) and breech presentation (6.84%). Conclusions: Cesarean section rate in our hospital was higher than that in other hospitals in Shanghai,and the proportion of social factor was higher than that in other hvspitals in Shanghai. We suggest that 3 corresponding measures be provided for the reduction of cesarean section: education for obstetric medical staff to control the indications of cesarean section strictly; health education for pregnant women and their family members to change their blind faith in cesarean section and popularization of the DOULA accompanied delivery.