Reducing the cesarean section rate in a rural community hospital.

OBJECTIVE: To determine the success of a program designed to reduce the cesarean section rate in a rural community hospital, to identify reasons for any reduction in the rate and to identify any accompanying increases in the maternal and neonatal morbidity and mortality rates. DESIGN: Longitudinal study of modes of delivery. SETTING: A 44-bed community hospital with a medical staff of nine family physicians serving a population of 9000. PATIENTS: All 1161 women who gave birth at the hospital from Jan. 1, 1985, to Dec. 31, 1989. Routinely recorded data were manually extracted from medical charts and entered into a computer database. INTERVENTION: The guidelines of the National Consensus Conference on Aspects of Cesarean Birth (NCCACB) for vaginal birth after cesarean section (VBAC), management of breech presentation and the diagnosis of dystocia requiring cesarean section were introduced at the hospital in 1985. OUTCOME MEASURES: The annual overall cesarean section rates and the rates among nulliparous women, multiparous women eligible for VBAC and multiparous women ineligible for VBAC. RESULTS: The overall cesarean section rate decreased from 23% in 1985 to 13% in 1989 (p = 0.001). Among the nulliparous women the rate decreased from 23% to 12%, but the difference was insignificant (p = 0.069); this decrease was due to a drop in the number of dystocia-related cesarean sections. The rate among VBAC-eligible multiparous women decreased from 93% to 36% (p less than 0.001) because of an increased acceptance of VBAC by the patients and the physicians. The rate among multiparous women ineligible for VBAC was virtually unchanged. There were 20 neonatal transfers to an intensive care unit, with no tendency toward an increase over the study period. None of the mothers died; one newborn, of a nulliparous woman, died from a prolapsed umbilical cord. CONCLUSIONS: The program was accompanied by a significant decrease in the cesarean section rate. Rural hospitals with facilities and personnel for emergency cesarean sections should consider the introduction of a similar program.     

降低剖宫产率对策的探讨

目的了解本院和全市接产医院剖宫产率及指征情况,为降低剖宫产率提供依据.方法对本院2000年剖宫产情况与全市抽样调查情况进行比较分析.结果2000年本院剖宫产率为60.11%,高于全市剖宫产率47.44%;主要指征构成依次为社会因素(38.9%)、胎儿窘迫(13.6%)、臀位(7.2%)及相对性头盆不称(5.9%).2000年全市剖宫产主要指征构成依次为胎儿窘迫(22.41%)、社会因素(16.93%)、相对性头盆不称(9.78%)及臀位(6.84%).结论本院剖宫产率高于全市平均水平,社会因素剖宫产显著高于全市.为降低剖宫产率,提出3方面的措施①产科医务人员应正确掌握剖宫产指征;②对孕产妇及其家属进行深入宣教,使他们正确认识剖宫产的利弊,改变对剖宫产的盲目追求而减少社会因素剖宫产;③转变产时服务模式,推广导乐陪伴分娩及分娩镇痛法,为自然分娩提供有利条件.     

上海市剖宫产现况调查情况分析

目的 为了解市接产医院剖宫产情况。方法 于１９９８年７月,对本市７５所二、三级接产医院的产科病史及医和人员进行了调查。结果 全市剖宫产率为４５．９％,其中初产妇占８７．４％;选择性剖宫产占４０．４２％。主要指征构成依次为：胎儿窘迫（２７．５４％）,相对性头盆不称（１２．８７％）,社会因素（１０．１５％）及臀位（９．０８％）。进一步对剖宫侃进行评审分析,指征掌握正确率为７３．８８％。以胎儿窘迫为指征     

Explaining variations in cesarean section rates: patients, facilities or policies?

Using overall rates of cesarean section and either rates of diagnosis or rates of cesarean section for the four main indications for this procedure, we analysed the variations among teaching and community hospitals in four of Ontario's six regions. The rates varied substantially in both 1979 and 1982, with the overall rate for cesarean section in 1982 being 17.1 to 21.0 per 100 deliveries in the teaching hospitals and 16.5 to 19.7 in the community hospitals. The rate of diagnosis of dystocia varied up to threefold in the teaching hospitals and up to twofold in the community hospitals. Fetal distress was diagnosed at even more variables rates. The rate of repeat cesarean section varied most in the teaching hospitals, whereas the rate of cesarean section for breech presentation varied significantly in the community and the teaching hospitals in 1982 but only in the community hospitals in 1979. Nearly all the rates increased between 1979 and 1982. Differences in patient characteristics and in availability of resources appeared less important in explaining these rate variations than differences in clinical policy.     

Cesarean section: trends and morbidity.

A review of 1683 cesarean sections performed at one hospital in a 3-year period (1977-79) showed that the cesarean section rate had trebled since 1967-79, the rates being 16.9% and 5.8%. The main indications for cesarean section responsible for this rise were dystocia, breech presentation and a previous cesarean section. AFter the operation 23.3% of received antibiotics. If the cesarean section rate is to fall, the biggest impact can be made by planning vaginal delivery in selected patients with a previous cesarean section and by improving the management of nonprogressive labour.     

Study on the Indications for and Factors Related to Cesarean Section at Three District Hospitals in Shanghai

In recent years, the rate of cesarean section has been increasing world widely, which cause extensive social attention. In many Chinese hospitals, the rate was between 40% and 60%[1], and significantly higher than 15%, the upper limit recommended by World…     

妊娠合并子宫肌瘤67例分析

目的 探讨子宫肌瘤与妊娠分娩之间的相互影响及剖宫产术中同时剜除了宫肌瘤的可行性；方法 分析67例子宫肌瘤患者的临床资料。结果 子宫肌瘤患者妊娠期各种并发症的发生率为91．0％，剖宫产率为86．6％，其中55例患者于剖宫产术中同时行肌瘤剜除术。结果 子宫肌瘤可使妊娠并发症和难产率增加，妊可使瘤体增大，且易发生变性，剖宫产术中同时行肌瘤剜除术是安全可行的。     

Elective repeat cesarean sections: how many could be vaginal births?

OBJECTIVE: To determine (a) the proportion of women undergoing elective repeat cesarean section without a trial of labour who were eligible for such a trial by the 1986 guidelines of the panel of the National Consensus Conference on Aspects of Cesarean Birth, (b) whether vaginal birth after cesarean section (VBAC) was discussed with these women and (c) the reasons cited for not having a trial of labour. DESIGN: Chart audit. SETTING: Level 2 perinatal care centre in a general teaching hospital. PATIENTS: All 313 women with a history of previous cesarean section who gave birth at the centre during 1989. RESULTS: Only 93 (30%) of the 313 women underwent a trial of labour. According to the 1986 guidelines 71% were eligible. A further 13% would have been eligible according to the revised 1991 guidelines. Of the 220 women who underwent elective repeat cesarean section, only 24 (11%) had a discussion of VBAC noted in their hospital charts. However, of all 117 patients whose charts indicated discussion of VBAC 93 (79%) chose to try it. Most of the women had either questionable indications or no indication noted for undergoing repeat cesarean section. CONCLUSION: Most of the women who underwent repeat cesarean section were eligible for a trial of labour. However, few charts noted a discussion of VBAC. Further physician and patient education is necessary to promote the appropriate use of VBAC and repeat cesarean section.     

Recent trends in cesarean section rates in Ontario.

After increasing steadily for 15 years the cesarean section rate in Ontario stabilized at 20.2 per 100 deliveries in the fiscal years 1986-87 and 1987-88. An important factor in the stabilization was a decrease in the rate of repeat section. The diagnosis and management of dystocia and fetal distress continue to put upward pressure on the cesarean section rate, which is higher than would be expected if recent practice guidelines had been fully implemented. There is a need for further research into the appropriate management of labour and delivery and into more targeted techniques for bringing practice into line with appropriate standards of care.     

河北保定市成年女性尿失禁的流行病学调查

目的调查保定市成年女性尿失禁(UI)的患病率及其相关影响因素。方法根据随机抽样原则,对2010年11月~2011年11月于保定市第三中心医院体检中心体检的年龄≥18岁的女性进行现场问卷调查。结果共获得有效问卷3 986份。调查结果显示,保定市成年女性UI患病率为26.39%(1 052/3 986),其中,以压力性尿失禁为主,其患病率为21.70%(865/3 986)。各类型尿失禁的患病率均随着年龄的增加而增加,绝经期后趋于稳定。χ2检验表明,成年女性尿失禁的影响因素是年龄、体重指数、重体力劳动、慢性盆腹痛、便秘、绝经、慢性咳嗽、慢性高血压病和生育史(P<0.05),2型糖尿病与成年女性尿失禁无关(P>0.05)。经阴道分娩与计划性剖宫产,以及梗阻性难产剖宫产与计划性剖宫产对压力性尿失禁的影响比较差异均有统计学意义(P<0.05),而经阴道分娩与梗阻性难产剖宫产对压力性尿失禁的影响差异无统计学意义(P>0.05)。结论保定市成年女性尿失禁患病率较高,且以压力性尿失禁为主。年龄、体重指数、重体力劳动、慢性盆腹痛、便秘、绝经、慢性咳嗽、慢性高血压病、生育史是保定市成年女性尿失禁发生的影响因素,而计划性剖宫产是压力性尿失禁的保护性因素。     

以相对头盆不称为指征的剖宫产100例分析

对我院１９９３年６月至１９９５年６月间，诊断为相对头盆不称而施行剖宫产手术者１００例进行回顾性分析，结果：６６例处理正确，诊断正确率为６６％；另外３４例中，过早诊断相对头盆不称者１４例；在产程中因观察处理不当诊断相对头盆不称者２０例。提示：在产程中及时正确地诊断相对头盆不称，并允许其进行充分的试产，在观察产程中予以正确的处理，是降低剖宫产率，提高产科质量的关键。     

深圳市龙岗区各级医院剖宫产指征分析

目的：探讨深圳市龙岗区各级医院剖宫产指征的掌握情况。方法：对2010年度深圳市龙岗区各级医院收治的13764例剖宫产患者的临床资料进行回顾性分析。结果：本区总的剖宫产率为37．27％、疤痕子宫（19．5l％）、胎儿窘迫（15．77％）、社会因素（15．71％）是本区剖宫产指征的前三位．二级医院中疤痕子宫（20．42％）居剖腹产指征的第一位,民营医院中社会因素（23．16％）居剖宫产指征的第一位．二级医院中因子痫前期、妊娠期糖尿病、妊娠合并内外科疾病、妊娠期肝内胆汁淤积症、胎盘脐带异常等高危因素而行剖宫产手术的比例以明显高于一级公立医院和民营医院;一级医院和民营医院中以相对头盆不称、产程异常等明确的产科因素为剖宫产指征的比例明显高于二级医院。结论：应加强孕期宣教．增强医惠沟通,避免过度诊断,加强医疗市场监管,减少无医学指征剖宫产。     

新产程标准实施后产程中剖宫产指征的变化及妊娠结局观察

目的：分析新产程标准实施后产程中剖宫产指征的变化及妊娠结局。方法：选取我院待产的产妇120例,将所有产妇随机分为两组,各60例。对照组为原产程中自然分娩转剖宫产产妇,观察组为新产程实施后自然分娩转剖宫产产妇,分析比较两组剖宫产指征变化及妊娠结局。结果观察组潜伏期延长、活跃期停滞指征低于对照组,相对头盆不称指征高于对照组,差异显著（P＜0．05）。结论：新产程标准实施可最大限度的给予产妇时间试产,有利于进行阴道分娩,降低剖宫产发生率,但由于试产时间较长,容易引发产后出血,在临床试产过程中需注意观察产妇情况。     

8年剖宫产率及剖宫产指征分析

目的:分析近8年剖宫产率及剖宫产指征的变化,探讨降低剖宫产率的临床措施。方法:对2000~2007年来10 377例分娩孕妇的临床资料进行回顾性分析,比较剖宫产率和剖宫产手术指征变化。结果:剖宫产率逐年升高,2000年为29.4%,2007年升至60.1%。剖宫产主要指征为社会因素、胎儿窘迫、难产、妊娠并发症,其中社会因素上升最快。结论:降低剖宫产率的关键是严格掌握剖宫产指征,积极处理难产,减少因社会因素而行的剖宫产。     

540例腹膜外剖宫产术的探讨

１９９１年１月～１９９３年１２月我院分娩胎儿数为６１２３例，其中行剖宫产术者８８５例，剖宫产率１４．４５％，其中腹膜外组５４０例，腹膜外剖宫产率６１．０２％（５４０／８８５），结果表明，腹膜外剖宫产适应征范围有所扩大，和子宫下段剖宫产３４５例指征比较，前５位头盆不称，宫内窘迫、臀位、过期妊娠、妊娠高血压综合征基本相同，同时表明腹膜外组受术者侵袭少、出血少、术后恢复快，尤其对有感染或可疑感染病例更为适用，但腹膜外剖宫产仍不能完全取代子宫下段剖宫产，如前置胎盘，第２次剖宫产，需剖腹检查者．     

剖宫产率增高的原因及其对策

目的: 分析我院产科剖宫产率上升的原因,探讨降低剖宫产率的对策。方法: 统计1991~2004年我院产科住院分娩的孕妇总数、剖宫产数及剖宫产指征、产钳及胎吸分娩数,对14年来剖宫产率及手术指征进行回顾性分析。结果: 14年来剖宫产率逐年上升,难产包括子宫收缩乏力、相对性头盆不称、巨大胎儿、持续性枕后位和持续性枕横位等,是剖宫产的主要原因,但以胎儿窘迫、社会因素为指征上升最为明显,差异均有显著性(P<0.05~P<0.01),而产钳、胎吸助产率则逐年减少。结论: 胎儿窘迫、社会因素是剖宫产率增加的主要原因;正确诊断胎儿窘迫,处理难产,严格掌握剖宫产指征,提倡责任制助产,进行心理调控是降低剖宫产率、提高产科质量的关键。     

剖宫产指征对剖宫产率的影响研究

目的 探讨剖宫产指征对剖宫产率的影响.方法 回顾性分析2002 年-2011 年10 年间我院剖宫产率变动趋势及发生剖宫产的指征顺位变化.结果 我院剖宫产率呈缓慢上升趋势,平均22%.导致剖宫产率上升的主要指征是难产、胎儿窘迫、妊娠合并症及并发症.近3 年来,随着临床质控力度的提高,难产及胎儿窘迫明显下降,瘢痕子宫及社会因素呈上升趋势.结论 降低剖宫产率的关键是严格掌握剖宫产指征,尽量减少人为因素的剖宫产.     

A five year appraisal of caesarean section in a northern Nigeria university teaching hospital

A retrospective analysis of cases of caesarean section performed in Jos University Teaching Hospital between January 1994 and December 1998 was undertaken to determine the incidence, indications, perinatal and maternal outcome. There were 11,571 deliveries with 2083 caesarean sections done giving an incidence of 18%. 62.2% of the patients who had caesarean section were booked for antenatal care and delivered in the hospital, while 37.8% were unbooked seen as emergency. 90% of the operations were done as an emergency while only 10% was electively performed. There was a high caesarean section rate in all the age groups as well as the various parity distributions. The main indications for the elective section were repeat caesarean section, placenta praevia, precious baby, severe pregnancy induced hypertension and bad obstetric history while those for emergency section were cephalo-pelvic disproportion foetal distress, repeat caesarean section, antepartum haemorrhage, severe pregnancy induced hypertension/eclampsia, obstructed labour and breech presentation. The maternal mortality rate was 624.1/100,000 due mainly to haemorrhage, eclampsia and sepsis and there was one anaesthetic death amongst the booked patients. The perinatal mortality rate was 81.6/1000. The clinical causes of deaths were birth asphyxia, ante-partum haemorrhage, obstructed labour and prematurity.     

某二级医院的剖宫产原因分析及对策

目的对比分析某县级医院2005年和2012年剖宫产率及剖宫产原因,探讨降低剖宫产率的干预对策。方法调取2005年和2012年3 660例产科住院分娩孕妇资料,采用回顾性调查研究,分年度统计剖宫产率,对剖宫产原因进行分类统计。结果 2012年某县级医院剖宫产率为40.83%,比2005年的46.83%下降了6个百分点,剖宫产原因分类2012年与2005年相比瘢痕子宫、头盆不称、要求剖宫产的比例明显上升;臀位、重度妊高症、羊水少、引产失败的构成比明显下降。结论 2012年剖宫产率较2005年下降,与医院对促自然分娩的重视、产科技术的提高、产前检查得到重视及规范有关。     

我院580例剖宫产手术指征的回顾性分析

目的分析我院580例剖宫产手术指征。方法对我院2002年1月至2008年12月在我院行剖宫产术孕妇580例临床资料进行回顾性分析。结果剖宫产指征前3名为头盆不称（38.97%）、社会因素（20.86%）、胎膜早破（11.89%）。产后出血17例,新生儿窒息16例,新生儿肺炎10例。结论为降低剖宫产率,应采取多渠道多种形式对孕妇及家属进行有关正确认识剖宫产的健康教育,为产妇创造良好的分娩环境,以消除恐惧,增强信心。同时医务人员要严格剖宫产指征,合理使用产科技术,重视产程的观察、产程处理,提高质量服务,以降低剖宫产率。