剖宫产率的影响因素分析及干预措施探讨

目的通过对影响剖宫产率相关因素的分析,探讨降低剖宫产率的有效干预措施,保障母婴健康。方法回顾分析禅城区中心医院2007～2011年23287例产妇的剖宫产率、剖宫产指征。结果总剖宫产率为40.76%。2011年剖宫产率(45.78%)较2007年(35.30%)明显上升,差异有统计学意义(P<0.05);其中,胎儿因素、母亲因素分别为46.66%、28.02%,较2007年(分别为40.41%、23.22%)明显升高且位居第一、第二位;而2011年宫内因素和社会因素分别为12.34%和1.81%,较2007年(分别为17.04%和9.32%)明显下降,差异有统计学意义(P<0.05)。剖宫产因素主要为瘢痕子宫(18.91%)、胎儿窘迫(17.69%)、脐带绕颈(16.78%)、头盆不称(8.64%)、胎膜早破(7.72%)、胎位异常(7.03%)、妊娠合并症(6.59%)、羊水过少(5.44%)、骨产道狭窄(2.23%)、巨大儿(1.92%)、高龄初产(1.69%)等。结论提高孕产期保健质量,积极治疗妊娠期合并症,提高助产技术水平,合理掌握手术指征,加强医患沟通,可有效降低剖宫产率。

Analysis of influential factors and intervention measures for cesarean section rate

Objective To approach specific intervention measures to reduce cesarean section rate by analyzing the correlated influential factors of cesarean section rate.Methods The data about cesarean section rates and indications of 23 287 lying in women were analyzed retrospectively from 2007 to 2011 in Chancheng District Central Hospital.Results The overall cesarean section rate was 40.76%.The cesarean rate which was 45.78% in 2011-year was obviously higher than that of in 2007-year which was 35.30% and the difference was significant(P<0.05).The factors about fetals and mothers which were 46.66%,28.02% and ranked the first,second rage in 2011-year were significantly higher than those in 2007 which were 40.41%,23.22% respectively and the difference was significant(P<0.05).The rates of intrauterine factors and social factors which were 12.34% and 1.8% respectively in 2011-year were lower than those which were 17.04% and 9.32% in 2007-year and the difference was significant(P<0.05).The main factors of cesarean section were scar uterine(18.91%),fetal distress(17.69%),umbilical cord around neck(16.78%),cephalopelvic disproportion(8.64%),premature rupture of membrane(7.72%),abnormal presentation(7.03%),pregnancy complications(6.59%),oligohydramnios(5.44%),pelvic contraction(2.23%),large for date infant(1.92%),primiparity with advanced age(1.69%).Conclusion Improving the quality of maternal health care and obstetric skills,treating pregnancy complications actively,properly grasping the cesarean section indications and strengthening the communication between doctors and patients can effectively reduce the rate of cesarean section.