衡阳市非医学原因剖宫产对产妇剖宫产率的影响分析

目的:了解衡阳市产妇剖宫产的现状,阐明非医学原因剖宫产对剖宫产率的潜在影响和影响力大小等因素.方法:采用分层整群随机抽样法,衡阳市4家不同等级医院952名住院分娩产妇,调查其的分娩方式、产前剖宫产意愿,并访谈产妇的负责医生,了解实施剖宫产的原因;分析产前检查及住院分娩病历,判断是否有剖宫产医学指征.结果:衡阳市剖宫产率为54.52%,民营医院高达71.76%,各级医院剖宫产率差异有统计学意义.22.58%的孕妇产前有剖宫产意愿,产前有意愿者剖宫产率是无意愿产妇的2.063倍(OR 95%CI 1.882-2.262).43.55%的剖宫产是因产妇及家人的要求而实施,要求满足率为89.33%,产妇及家人要求的原因依次是怕产痛、为了选时生产、对分娩知识的缺乏、不能耐受待产疼痛;56.45%的剖宫产是医生要求做的.医学原因剖宫产比例为46.63%,非医学原因剖宫产比列为53.37%,其中9.83%既无医学指征、产妇方也无要求,使剖宫产率净增高5.36%;无医学指征剖宫产率(29.09%)高于医学指征剖宫产率(25.42%).结论:衡阳市剖宫产率较高,非医学原因剖宫产高于医学原因的剖宫产;非医学原因主要是产妇的要求,其次是医方的原因,使剖宫产率净增高了5.36%;加强孕妇分娩知识培训,推广无痛分娩可能对降低社会因素剖宫产具有重要的意义.

Contribution for non-medical reason's cesarean section to the high rate of cesarean delivery in Hengyang

Objective To understand the current situation of cesarean delivery in Hengyang and to clarify the infuence of cesarean section's for non-medical reasons to the rate of cesarean section. Methods Sing stratified random sampling method, To investigate 952 hospitalized childbirth puerpera's childbirth modus and the willingness of prenatal cesarean section in Hengyang, and the doctors who were responsible for the puerpera were interviewed to understand the reason of cesarean de-livery, and analyzed the prenatal examination and inpatient delivery records to determine whether there was a cesarean section indications of medicine. Results He cesarean delivery rate was 54.52% in Hengyang, the rate of private hospital was as high as 71.76%. There was statistical significance among different hospital's cesarean section rate. 22.58% of puerpera had prena-tal cesarean delivery willingness, the rate of cesarean section of the puerpera who were intended to cesarean section was 2.063 times the rate of who were not.43.55% of cesarean section were required by the maternal and their families, the maternal request to meet was at 89.33%. They required for cesarean section were due to afraid of labor pain, choosing the good time to deliv-ery, lack of knowledge of childbirth, couldn't stand the pain of waiting for the childbirth.56.45% of the cesarean delivery were required by the doctors. The ratio of cesarean section for medical reasons was 46.63%; The ratio of cesarean section for non-medical reasons (social factors) was 53.37%, and 9.83% of it had neither medical indications nor request of maternal, and the net increase of cesarean section rate was 5.36%. The rate (29.09%) of cesarean section for non-medical indication was higher than that of for medicine indication (25.42%). Conclusion The cesarean section rate of Hengyang was 54.52%, and the rate of cesarean section for non-medical reasons was higher than that of for medicine indication. Non-medical reasons were mainly to maternal request, the requirement to meet was at 90%. Followed by the doctors'reason, making the rate of cesarean section net increase 5.36%. Strengthening the training of childbirth knowledge and promoting childbirth without pain may have vital sig-nificance on reducing cesarean section for social factors.