以Robson十分类法为基础的剖宫产术分娩率分析

目的探讨基于Robson十分类法，对不同类别产妇剖宫产术分娩率进行分析的临床应用价值。 方法选择2019年1月1日至12月31日，于江苏省苏北人民医院分娩的孕龄≥28孕周的3 595例产妇为研究对象。应用Robson十分类法，将3 595例产妇分为10类：第1类(n＝685，孕龄≥37孕周、单胎头位、自然临产初产妇)，第2a类(n＝962，孕龄≥37孕周、单胎头位、引产临产初产妇)或第2b类(n＝258，孕龄≥37孕周、单胎头位、临产前剖宫产术分娩初产妇)，第3类(n＝325，孕龄≥37孕周、单胎头位、无剖宫产术分娩史、自然临产经产妇)，第4类(n＝237，孕龄≥37孕周、单胎头位、无剖宫产术分娩史、引产临产或临产前剖宫产术分娩经产妇)，第5类(n＝575，孕龄≥37孕周、单胎头位、≥1次剖宫产术分娩史产妇)，第6类(n＝102，单胎臀位初产妇)，第7类(n＝52，有剖宫产术分娩史、单胎臀位经产妇)，第8类(n＝113，有剖宫产术分娩史、多胎妊娠产妇)，第9类(n＝28，有剖宫产术分娩史、斜位或横位单胎妊娠产妇)，第10类(n＝258，孕龄<37孕周、有剖宫产术分娩史、单胎头位产妇)。采用回顾性分析方法，收集所有受试者相关临床病例资料，包括剖宫产术分娩史、剖宫产术类型与剖宫产术分娩指征等。对这10类产妇剖宫产术分娩率及其剖宫产术分娩指征分布情况进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。 结果①本研究3 595例产妇的总体剖宫产术分娩率为41.75%(1 501/3 595)，择期剖宫产术分娩者占44.84%(673/1 501)，剖宫产术分娩指征中，41.77%(627/1 501)为瘢痕子宫，10.26%(154/1 501)为胎位不正，9.26%(139/1 501)为产程异常。②应用Robson十分类法对本研究3 595例产妇进行分类分析的结果显示，第2类产妇所占比例最高，为33.94%(1 220/3 595)，其次为第1类和第5类产妇，分别占19.05%(685/3 595)与15.99%(575/3 595)。第5、2、10类剖宫产术分娩产妇数排名前3，占所有剖宫产术分娩产妇的76.95%(1 155/1 501)，占所有产妇的32.13%(1 155/3 595)；第5～9类产妇剖宫产术率均>90%。③第1、2a类剖宫产术分娩产妇首要剖宫产术分娩指征均为产程异常，所占比例分别为73.91%(17/23)与67.44%(116/172)；第5、10类为瘢痕子宫，所占比例分别为98.59%(559/567)与34.81%(55/158)；第6、7、9类为胎位不正，所占比例分别为93.94%(93/99)、66.00%(33/50)与100.00%(28/28)；第8类为多胎妊娠，所占比例为91.51%(97/106)。86例无剖宫产术分娩指征的剖宫产术分娩产妇中，第2b类产妇所占比最高，为90.70%(78/86)。 结论以Robson十分类法为基础，对不同类别产妇剖宫产术分娩率及其剖宫产术分娩指征进行分析，有助于临床医师快速识别需要降低剖宫产术分娩率的目标人群，并分析目标人群具体剖宫产术分娩情况，从而制定更有效、更具针对性的干预措施，控制总体剖宫产术分娩率。

Analysis of cesarean section rate based on Robson Ten-Group Classification

Objective To investigate clinical application values on cesarean section rate in different groups of parturients based on Robson Ten-Group Classification method.Methods A total of 3595 parturients with gestational age≥28 gestational weeks in Northern Jiangsu People′s Hospital from January 1 to December 31,2019 were selected as research subjects.The 3595 parturients were classified into 10 groups based on Robson Ten-Group Classification method:group 1(n=685,primipara with gestational age≥37 gestational weeks,single cephalic and spontaneous labour);group 2a(n=962,primipara with gestational age≥37 gestational weeks,single cephalic and induced labour)or group 2b(n=258,primipara with gestational age≥37 gestational weeks,single cephalic and cesarean section before labour);group 3(n=325,multipara with gestational age≥37 gestational weeks,single cephalic and spontaneous labour,excluding previous cesarean section);group 4(n=237,multipara with gestational age≥37 gestational weeks,single cephalic and induced labour or cesarean section before labour,excluding previous cesarean section);group 5(n=575,multipara with gestational age≥37 gestational weeks,single cephalic and previous cesarean section);group 6(n=102,all nulliparous breeches);group 7(n=52,all multiparous breeches,including previous cesarean section);group 8(n=113,all multiple pregnancies,including previous cesarean section);group 9(n=28,parturients with oblique or horizontal position pregnancy,including previous cesarean section);group 10(n=258,parturients with gestational age<37 gestational weeks and single cephalic,including previous cesarean section).Retrospective analysis was used to collect clinical case data of all subjects,including cesarean section delivery history,cesarean section types,and indications for cesarean section and so on.The cesarean section rate of these 10 groups of parturients and distribution of cesarean section delivery indications were analyzed.The procedures followed in this study were in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.Results①Among 3595 parturients,the cesarean section rate was 41.75%(1501/3595),and 44.84%(673/1501)of them were delivered by elective cesarean section.Among indications of cesarean section,scarred uterus accounted for 41.77%(627/1501),malposition of fetus accounted for 10.26%(154/1501),and abnormal labor process accounted for 9.26%(139/1501),respectively.②Analysis of 3595 parturients using Robson Ten-Group Classification method showed that parturients in group 2 accounted for the largest proportion,33.94%(1220/3595),and followed by parturients in group 1 and group 5,which were 19.05%(685/3595)and 15.99%(575/3595),respectively.The number of parturients with cesarean section in group 5,2 and 10 ranked the top 3,accounting for 76.95%(1155/1501)of all parturients with cesarean section,and accounting for 32.13%(1155/3595)of all parturients.The cesarean section rates in group 5 to group 9 all were above 90%.③The primary indication of cesarean section was abnormal labor process in group 1 and group 2a,accounting for 73.91%(17/23)and 67.44%(116/172),respectively.The primary indication of cesarean section in group 5 and group 10 was scar uterus,accounting for 98.59%(559/567)and 34.81%(55/158),respectively.In group 6,7 and 9,the primary indication of cesarean section was malposition,accounting for 93.94%(93/99),66.00%(33/50)and 100.00%(28/28),respectively.The primary indication of cesarean section in group 8 was multiple pregnancy,which accounted for 91.51%(97/106).Among the 86 parturients who received cesarean section without cesarean section indication,the proportion of parturients in group 2b was the highest,which was 90.70%(78/86).Conclusions Based on Robson Ten-Group Classification method,analysis of cesarean section rate and cesarean section delivery indications of different groups of parturients will help clinicians quickly identify the target population who needs to reduce cesarean section rate,and analyze the specific cesarean section delivery conditions of target population,so as to develop more effective and targeted interventions to control cesarean section rate.