剖宫产率及剖宫产指征20年回顾

目的:探讨近20年剖宫产率与剖宫产指征的变化及与围产儿死亡率的关系。方法:对1990～1999年(前10年组)与2000～2009年(后10年组)的剖宫产患者的相关资料进行回顾性分析。结果:前、后10年剖宫产率分别为16.31%、32.92%,差异有统计学意义(χ2=1 058.94,P=0.000);围产儿死亡率分别为54.52‰、23.08‰,差异有统计学意义(χ2=221.97,P=0.000)。剖宫产率与围产儿死亡率呈负相关,前10年相关系数-0.738,P=0.015;后10年相关系数-0.638,P=0.047。前10年剖宫产指征前5位依次为难产、臀位、胎儿窘迫、剖宫产史、子痫前期;后10年剖宫产指征前5位依次为难产、剖宫产史、臀位、社会因素、胎儿窘迫。结论:1990～2009年剖宫产率升高,围产儿死亡率下降,剖宫产率升高在一定程度上降低了围产儿死亡率。剖宫产指征明显变化,超出单纯医学指征范围。

Contrast analysis of rate and indications for cesarean section from 1990 to 2009

Objective:To analyze the changes of the rate and indications of cesarean section,and analyze the correlation between them and perinatal death over the past decade.Methods:To retrospectively analyze the cases of cesarean section from 1990 to 1999 and 2000 to 2009 respectively.Results:The rates of cesarean section in the earlier 10 years and later 10 years were 16.31% and 32.93% respectively and demonstrated a significant difference(P=0.000).The perinatal death rates were 54.52‰ and 23.08‰ respectively and also demonstrated a significant difference(P=0.000).The rates of cesarean section and perinatal mortality were negatively correlated both in the earlier and later 10 years.The indicators for cesarean section in the earlier 10 years were dystocia,breech presentation,fetal distress,history of cesarean section and preeclampsia in sequence,while in the later 10 years were dystocia,history of cesarean section,breech presentation,social factors and fetal distress in sequence.Conclusion:The cesarean section rate increased and perinatal mortality decreased from 1990 to 2009 and the increase of cesarean section rate reduced the perinatal mortality to some extent.The indications of cesarean section changed remarkably and exceeded medical ranges.