孕妇体重与剖宫产、产程持续时间、宫颈扩张速度之间的联系

为了探求孕妇体重与引产过程中产程持续时间 ,宫颈扩张速度以及剖宫产终止妊娠的关系 ,作者选择了 5 0 9例引产孕妇 ,采用一致的待产程序和手术指征 ,观察孕妇的年龄、体重、孕周、种族、产次、引产指征等项目 ,在排除产妇年龄、宫颈起始状态及糖尿病等干扰因素后比较不同的体重水平剖宫产率、宫颈扩张速度、产程持续时间之间的差异。结果 :总的剖宫产率为 2 0 % ,剖宫产组孕妇的平均体重大于阴道分娩组 ,分别为 97± 2 9kg和 87± 2 2kg,初产妇体重每增加 10kg ,剖宫产率就上升 2 5 % (OR1.17;95 %CI1.0 4 ,1.2 8)。经阴道分娩的病例中初…     

四川省非医学指征剖宫产现状分析

目的:分析四川省非医学指征剖宫产现状及影响因素,寻求降低剖宫产率的对策。方法:随机抽取全省5个市进行调查,每个市随机抽取2个市级、2个县级、2个乡级助产服务机构进行数据收集,每个机构收集100份剖宫产病例,共对2824份有效问卷的剖宫产手术指征及影响因素进行分析。结果:非医学指征剖宫产占剖宫产总数的46.03%;不能忍受自然分娩疼痛、认为剖宫产安全、对自然分娩感到恐惧是选择剖宫产的主要原因;低龄、初产妇、无妊娠并发症、入院至分娩时间≥24小时组非医学指征剖宫产率高(P<0.01),脑力劳动组非医学指征剖宫产率高于体力劳动组(P<0.05)。结论:非医学指征剖宫产增加是近年来剖宫产率升高的主要原因。加强自然分娩的健康教育、推广应用分娩镇痛技术和处置难产技术以及政策支持是降低剖宫产率的有效措施。     

北京市延庆县医院5年孕足月剖宫产率及指征分析

目的探讨剖宫产率及剖宫产指征的变化和对围产儿死亡率的影响,寻找降低剖宫产率的方法。方法回顾性总结北京市延庆县医院2008年1月至2012年12月住院分娩的病历资料,分析剖宫产率及剖宫产指征变化的各项相关数据和围产儿死亡率的关系。结果 1剖宫产率逐年下降[2012年剖宫产率(39.03%)与2008年(53.94%)相比,P0.05];2剖宫产指征中以社会因素为指征的剖宫产率通过医护人员的努力得到了有效的控制而下降,随着剖宫产率的下降,产程异常为指征的剖宫产比例增加;3围产儿死亡率趋于稳定,并未随着剖宫产率的下降而升高,2012年围产儿死亡率(3.17‰)与2008年(2.93‰)相比,差异无统计学意义(χ2=0.04,P0.05)。结论提高助产技术及加强孕期宣教,可进一步降低剖宫产率。     

近10年剖宫产率及剖宫产指征变化的临床分析

目的 :总结近 10年剖宫产率及剖宫产指征的变化。方法 :回顾性分析我院近 10年来剖宫产孕妇的临床资料。结果 :①剖宫产率逐年升高 ,1992年为 2 1.1% ,2 0 0 1年上升至 5 7%。② 1992～ 1999年 ,剖宫产指征以难产为第 1位 ,而近 2年 ,社会因素占第 1位。结论 :剖宫产率升高主要为无医学指征行剖宫产术增多所致 ,降低剖宫产率的关键是严格掌握剖宫产指征 ,尽量减少因社会因素而行的剖宫产术     

2002—2010年剖宫产率升高的影响因素分析

目的探讨近年来剖宫产率升高的影响因素及其弊端。方法对解放军总医院妇产科2002年1月至2010年12月分娩的12522例孕妇的临床资料进行回顾性分析,比较不同时期剖宫产率和剖宫产手术指征的变化。结果从2002年至2005年剖宫产率由44.50%（514/1155）升至66.02%（746/1130）,2008年（64.97%,1059/1630）至2010年（64.06%,1251/1953）剖宫产率仍保持较高水平,剖宫产率总体呈升高趋势。阴道分娩助产率从2002年的3.29%（38/1155）下降至2010年的0.05%（1/1953）,两者比较,差异有统计学意义（P〈0.05）。2006—2010年剖宫产指征中,社会因素、妊娠合并症并发症和胎儿窘迫位于前3位。瘢痕子宫作为剖宫产指征所占比例从2006年的3.57%（26/729）升高至2010年的6.95%（87/1251）;多胎妊娠作为剖宫产指征从2006年的2.33%（17/729）升高至2010年的3.52%（44/1251）。结论剖宫产率升高原因多种,其中社会因素、妊娠期合并症并发症和胎儿窘迫是重要的影响因素,严格掌握剖宫产指征是降低剖宫产率的关键。     

科学分析管理剖宫产指征、降低剖宫产率

目的：分析江苏省扬州市妇幼保健院2009年1月—2012年12月剖宫产率及剖宫产指征构成比及其变化情况,探讨降低剖宫产率的有效方法。方法：成立高危妊娠评估专家组,每例剖宫产者均需由专家组审批、核查;坚持每周一次例会制度,回顾性分析每周的剖宫产指征;正确对待经济利益,增加分娩镇痛项目及其他服务。结果：4年间不同剖宫产指征构成比及顺位有所改变,其中社会因素从2009年的第2位降至2012年的第9位;剖宫产率逐年下降,从68.0%降至46.5%。结论：剖宫产率过高是多因素共同作用的结果,通过采取科学、综合、集体管理和行政干预等方法能有效降低剖宫产率。     

影响剖宫产率与剖宫产指征的因素分析

目的：剖析近年来剖宫产率居高不下的主要影响因素，为制定降低剖宫产率的具体措施提供资料。方法：对1989年至2001年间吉林大学第二医院产科住院产妇的足月分娩病例进行回顾性分析。结果：①剖宫产率呈逐年上升趋势，而产钳率呈逐年下降趋势；②剖宫产占难产分娩的比例逐年增高，同期产钳助产占难产分娩的比例逐年下降；③2000年以前居于前四位的剖宫产手术指征是：相对头盆不称、胎儿窘迫、臀位、胎膜早破；1999年起珍贵儿指征已出现，2000年及2001年已跃居第二位；④2000年与2001年脐带绕颈作为剖宫产指征居于第五位和第六位；⑤因单因素指征行剖宫产的比例逐年增加，而因多因素指征行剖宫产的比例逐年下降。结论：现今，剖宫产手术指征已远远超过单纯医学指征的范围，来自孕产妇及医生的主观意愿影响着对分娩方式的合理选择。     

我国部分地区剖宫产率影响因素和指征分析

目的:分析我国目前高剖宫产率的现状,以及不同地区剖宫产术的影响因素。方法:回顾性分析2005～2006年全国24家城市医院产科分娩的4281例产妇各分娩方式(顺产、助产、有指征剖宫产及无指征剖宫产)的影响因素和常见剖宫产手术指征构成比,并比较近期母婴预后。结果:①总剖宫产率为57.84%,其中无医学指征者36.23%;顺产率39.99%,阴道助产率2.17%。②各地区分娩方式构成比差异有高度统计学意义(P<0.01),以华南地区剖宫产率最高,西南地区剖宫产率最低;职业劳动量小、文化教育水平高的人群剖宫产率高(P<0.01);≥35岁的高龄产妇有医学指征剖宫产率高于<35岁者(P<0.01)。③有医学指征的剖宫产因素主要为头盆不称(11.51%)、胎儿窘迫(11.31%)、胎位异常(臀位或横位)(6.99%)、巨大儿(5.25%)、妊娠并发症(6.06%)、骨产道狭窄(3.51%)等。结论:剖宫产率的升高由多种因素导致。对手术指征的把握依地区医疗水平、群众生活背景、产妇职业、年龄、围生期发病率的不同而不同。不必要的剖宫产术并未减少产后出血率、新生儿发病率。医护人员应提高助产技术水平,合理掌握手术指征,加强医患沟...     

剖宫产手术指征把握对提高分娩质量相关性探讨

目的：探讨正确把握剖宫产手术指征对提高分娩质量的相关性。方法：本次研究选取2003年、2004年我院产科分娩资料,探讨剖宫产率及产科质量变化,并分析二者相关性。结果：对比两年产科质量,新生儿窒息率、产后出血率、剖宫产率无明显变化（P〉0．05）。对比剖宫产指征,社会因素在两年中均居第一,其次均为疤痕子宫,与2003年比较,2004年胎盘比例有所下降,胎儿窘迫比例上升,均有统计学差异（P〈0．05）,其它指征比较无明显变化（P〉0．05）。结论：我国剖宫产率居较高水平,易引发多种远期并发症,需加大健康宣教,降低因社会因素等引发的剖宫产率,并做好各项指征的把握,以全面提高产科分娩质量。     

汶川地震前后灾区的剖宫产率及剖宫产指征变化

近年来,剖宫产率逐年上升,剖宫产指征也随之发生了变化.2008年5月12日四川省汶川地区发生了8.0级强烈地震.我院所在位置为重灾区,现对我院地震前后住院分娩的7320例孕妇进行分析,对正确掌握剖宫产手术指征、合理控制剖宫产率的具体措施进行探讨.     

Cesarean section rates and indications in Greece: data from a 24-year period in a teaching hospital

OBJECTIVE: To assess the overall cesarean section rates and indications in a Greek teaching hospital over a period of 24 years. METHOD: Data from 34,575 deliveries between 1977 and 2000 were reviewed. Analysis of cesarean section rates and indications followed. RESULTS: The overall cesarean section rate increased progressively from 13.8% (1977-83) to 29.9% (1994-2000). Cesarean section rates due to previous cesarean delivery increased from 7.7% of all deliveries (1977-83) to 10.9% (1994-2000). Primary cesarean section rates increased more than three-fold from 6.1% (1977-83) to 19% (1994-2000). The main indications for primary cesarean section were: dystocia (including dysfunctional labor, cephalopelvic disproportion and malpresentations), fetal distress, breech presentation, and hypertensive disorders of pregnancy. CONCLUSIONS: The overall cesarean section rate increased more than two-fold over the study period. Previous cesarean section was the most common indication. However, the overall increase is mainly to increase of primary cesarean section rates.     

Modern indications for cesarean section.

Total cesarean section rates and rates of various indications for primary cesarean section were reviewed for four yearly periods during the past decade. The time periods studied were chosen to follow the introduction of new obstetric practices and technologic advances in monitoring fetal condition. The total cesarean section rate increased from 6.8% to 17.1% during this time. The most common indication for primary cesarean section was cephalopelvic disproportion, which represented approximately 40% of cases during each study period. Primary cesarean section for fetal distress increased to 28.2% but has decreased over the past 2 years to a present rate of 11.7%. Primary cesarean section for breech presentation increased from 12.3% to 21%. From the perspective of this review a total cesarean section rate of 15% is predicted for the future.     

1389例剖宫产术回顾分析

回顾性分析１０年剖宫产术１３８９例。结果是平均剖宫产率为２３％，无孕产妇死亡，围产几平均死亡率为１２．６３‰。剖宫产主要指征为相对性头盆不称，胎儿宫内窘迫，臀位、骨盆狭窄。提示提高剖宫产率并不一定能降低围产儿死亡率，恰当掌握剖宫产指征，加强对孕期及产程的监测、管理，既可能降低母婴死亡率，又能适当控制剖宫产率。     

A critical appraisal of cesarean section rates at teaching hospitals in India.

OBJECTIVES: To obtain an estimate of cesarean section rates and examine the indications and consequences at teaching hospitals in India. METHODS: Information was obtained on total number of normal and cesarean deliveries during 1993-1994 and 1998-1999 from 30 medical colleges/teaching hospitals. In addition, prospective data were recorded for a period of 2 months on 7017 consecutive cesarean sections on indications for cesarean delivery, associated complications and mortality. RESULTS: The overall rate of cesarean section increased from 21.8% in 1993-1994 to 25.4% in 1998-1999. Among the 7,017 cesarean section cases, 42.4% were primigravidas, 31% had come from rural areas, 20.8% were referred including 8% with history of interference, 66% were booked cases, period of gestation was less than 37 weeks in 21.7% and in 18% the surgery was elective. Major indications for cesarean section included dystocia (37.5%), fetal distress with or without meconium aspiration (33.4%), repeat section (29.0%), malpresentation (14.5%) and PIH (12.5%). Maternal and perinatal mortality was 299/100,000 and 493/1,000 deliveries, respectively, and is high in spite of the increase in the cesarean section rates. CONCLUSIONS: There is need for standardized collection of information on all aspects of childbirth to ascertain the incidence and indications of cesarean section nationally so that comparison and improvements of care can take place.     

剖宫产率增高原因的探讨

目的 分析20年剖宫产率和指征变化,探讨剖宫产率升高原因。方法 抽样选择1980年～1999年20年我院剖宫产病例1579例,比较剖宫产率和手术指征变化。结果 80年代剖宫产率平均23.79％,90年代平均达41.15％,两者差异有显著性(P<0.01)。在剖宫产指证中,头盆不称、妊娠并发症逐渐下降,而胎儿宫内窘迫、高龄初产、巨大儿、社会因素逐渐上升。结论 提高医务人员对剖宫产的认识,加强孕产期保健及管理,改变产时服务模式,正确掌握剖宫产指征,有望控制剖宫产率。     

Prevalence and causes of cesarean births among women residing at high altitude in Lhasa,Tibet: A retrospective observational study of 7365 women

ObjectiveCurrently, there is paucity of data on the rate of vaginal deliveries and cesarean section among women in Tibet. In this study, we carried out an observational study of 7365 consecutive pregnant women in Lhasa, Tibet who gave birth at our tertiary care institution between 2012 and 2015.Materials and methodsIn this retrospective study, we reviewed the hospital records for demographic data, obstetric history, and the number of vaginal and emergency cesarean section deliveries. The overall and annual rate of vaginal and cesarean section deliveries was calculated. Causes, indications or risks for cesarean section were also analyzed.ResultsDuring the review period, 7365 neonates were delivered at our hospital, including 1690 (23.0%) deliveries via cesarean section. The yearly rate of cesarean section progressively declined from 26.7% in 2012 to 18% in 2015 (P < 0.001). Furthermore, the annual rate of emergency cesarean section declined 53.9%between 2012 and 2015(P < 0.001). Fetal risk factors (39.9%) and maternal risk factors (40.3%) were the major causes of cesarean section in the women. Social factors as a cause of cesarean section fluctuated between 7.9% and 11.1%.ConclusionThis study has demonstrated a steady decline in the annual rate of cesarean section in women in Tibet between 2012 and 2015. A decrease in the rate of emergency cesarean section contributed substantially to this decline. Moreover, approximately 10% caesarian sections were performed without clear indications, highlighting the need for strengthening prenatal counseling for pregnant women in Tibet.     

Male fetuses and the risk of cesarean delivery

OBJECTIVE: To assess the reported increased rate of cesarean sections in women carrying male fetuses. STUDY DESIGN: A retrospective analysis of all deliveries in 2001 was performed. All singleton deliveries were enrolled. We compared fetal sex distribution in cesarean ased risk of cesarean sections performed for various indications. The study had 80% power to detect a explained by different parturient difference in the cesarean section rate in women carrying male and female fetuses. RESULTS: The overall cesarean section rate was similar in women with male or female fetuses, 19.7% and 19.1%, respectively. This lack of association was also found in specific subgroups of cesarean indications: non-reassuring fetal heart rate pattern, fetal distress, nonprogressive labor, elective cesarean, suspected macrosomia, abnormal lie and severe preeclampsia. CONCLUSION: In contrast with previous investigators, we did not find an increased risk of cesarean section in women carrying male fetuses.     

临产后剖宫产率及适应证变化对总剖宫产率影响的分析

目的探讨临产后剖宫产率及适应证变化对总剖宫产率的影响。方法总结1990、1996及2002年各年1～6月所有完整在案的临产后剖宫产病历458例，各分为有适应证组及无适应证组，分析其剖宫产率变化及适应证变化。结果临产后剖宫产率占临产后总分娩人数的比例呈上升趋势。1990年及1996年各为22．O％及20．8％，2002年为39．4％。在有无适应证两组对比中，2002年无产科适应证而手术者的比例与前两年相比明显增加，1990年及1996年无适应证组的剖宫产数占临产后总剖宫产数的比例分别为33．84％及32．58％，而2002年无适应证组的剖宫产数占临产后总剖宫产数的比例为63．37％。在有产科剖宫产适应证者中，“试产失败”的比例2002年与1990年及1996年比较明显增加，1990、1996及2002年各为11．45％、16．67％及25．81％。胎儿窘迫的比例则下降，1990、1996及2002年各为25．19％、21．67％及12．90％。结论临产后剖宫产率的增加是近年来剖宫产率逐年增高的重要原因之一。重视社会因素，加强孕产期宣教及保健，重视潜伏期及第一产程的管理监护及心理护理问题，是降低临产后剖宫产率的重要措施之一。     

Cesarean section rate: much room for reduction

OBJECTIVE: To examine the indications and rate of cesarean section in referral hospitals. METHODS: Between January 2003 and December 2005, a total of 11,506 women delivered at King Hussein Medical Center, of which 2,075 cesarean sections (CS) were performed. Patients who underwent cesarean section were divided into three age subgroups: < 25 yr (n = 3,118), 25-35 (n = 6,147), and > 35 yr (n = 2,241), and two parity subgroups - primiparous (n = 3,326) and multiparous (n = 8,180). Information abstracted included maternal characteristics and indications for CS. Statistical analyses were performed using the Pearson chi-square test and Fisher's exact test to evaluate differences between the various subgroups. RESULTS: From a total of 11,506 deliveries that took place, 2,075 cesarean sections were performed with an incidence of 18%. According to age, the CS rate was 11.85%, 20.5% and 19.9%, respectively, in the three age subgroups. According to parity, the CS rate was 16.3% and 18.7% in the primiparous and multiparous women, respectively. When matched to age, the indications for CS showed no significant difference among the three age subgroups. When matched to parity, the indications also showed no significant difference between the two parity subgroups except for dystocia which was significantly higher in the primiparous compared to multiparous women (p < 0.01), and for repeated CS which was significantly higher in the multiparous compared to primiparous women (p < 0.0001) CONCLUSION: Some indications for cesarean section such as dystocia and fetal distress were over-utilized resulting in a high CS rate. Proper management of labor and precise interpretation of fetal heart tracing might be effective in reducing the cesarean section rate.