10年间剖宫产率及指征变化与围生儿死亡率的关系

目的：探讨剖宫产率及剖宫产指征变迁对围生儿死亡率的影响。方法：对10年间剖宫产病例资料进行回顾性分析。结果：1992－1996年剖宫产率为36．50％，显著低于1997－2001年的47．78％，两者比较，差异有极显著性（P＜0．01）。在剖宫产指征中，妊娠并发（合并）症始终处于第1位，社会因素上升为第2位，难产为第3位，胎儿窘迫为第4位。围生儿死亡率1992－1996年为17．88‰，1997-2001年为22．23‰，两者比较，差异无显著性（P＞0．05）。结论：剖宫产率升高在一定范围内降低了围生儿死亡率，但随着剖宫产率的进一步升高，围生儿死亡率并未随之下降。因此，应合理掌握剖宫产指征，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。     

3475例剖宫产指征分析

目的 探讨１９９７年初至１９９８年末剖宫产指征的掌握情况。方法 对３４７５例剖宫产病例进行回顾性分析。结果 剖宫产率为４５．２％。主要指征依次为：妊娠并发症（３６．６％）、胎儿窘迫（２２．６％）、妊娠合并症（１３．５％）、巨大儿（１０．２％）、珍贵儿（９．８％）、臀位（９．８％）、高龄初产（９．１％）,其中巨大儿的诊断符合率６２．３％、５６％（１３．５％）、巨大儿（１０．２％）、珍贵儿（９．８％）     

Re-laparotomy after cesarean section

OBJECTIVE: To assess the rate, indications, and outcome of re-laparotomy after cesarean section in the early postoperative period. DESIGN: A retrospective observational study during a 121-month period. SETTING: A tertiary care university center. POPULATION: A cohort of 3380 women who underwent cesarean section out of 18,609 parturients. MAIN OUTCOME MEASURES: Incidence of re-laparotomy after cesarean section in the early postoperative period. RESULTS: The incidence of re-laparotomy after cesarean section was 0.53% (18/3380). Of these 18 women, 12 (66%) were operated for hemorrhage, 3 (17%) for eventration, and 3 (17%) for formation of intra-abdominal abscess. Hysterectomy was required in one case (5.5%). We had no maternal mortalities. CONCLUSION: Although the incidence of re-laparotomy after cesarean in the early postoperative period is low and the outcome is favorable, several measures must be undertaken to reduce the need for re-laparotomy.     

Myomectomy during cesarean section.

OBJECTIVE: To evaluate the outcome of myomectomy during cesarean section and to compare it with a control group. MATERIALS AND METHODS: Using a retrospective case-control design; 40 patients who underwent myomectomy at time of cesarean delivery were compared with the control group consisted of 80 patients with myomas who underwent cesarean delivery alone. RESULTS: The mean size of fibroids removed was 8.1+/-4.7 cm (range, 3-25 cm). In control group it was 5.7+/-2.7 cm (range, 2-14 cm). The incidence of hemorrhage in the study group was 12.5% as compared with 11.3% in the control group (p>0.05). There was also no significant differences in the incidence of postoperative fewer and frequency of blood transfusion between myomectomy and control groups (p>0.05). CONCLUSION: Myomectomy during cesarean section is not always a hazardous procedure and it can be performed without significant complications by experienced obstetricians.     

三种剖宫产术式比较

目的 探讨三种剖宫产术式的优缺点,寻找安全性大、优越性强的手术方式。方法 对１９３例足月妊娠具有手术指征的产妇随机分三组,分别采用新式、腹膜外及子宫下段剖宫产术,对手术时间、术后病率及病人子宫与腹壁切口Ｂ超检查情况进行了对比观察。结果 手术时间：新式与子宫下段剖宫产相比,手术时间有明显差异（Ｐ〈０．０５）,新式与腹膜外剖宫产相比,手术时间有差异（Ｐ〈０．０５）,腹膜外与子宫下段剖宫产手术时间相比,     

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。     

剖宫产社会性因素分析

目的 分析社会性因素剖官产的相关因素及对母婴的影响。方法 采用回顾性分析的方法对1993年1月至1999年10月间517例行剖宫产的资料进行分析。结果 社会性因素行剖宫产者93例(17.99％)。其中知识分子59例(63.44％);因医务人员亲属或朋友33例(35.48％);未临产或潜伏期里剖宫产者75例(80.65％)。产后3日内乳汁分泌量少于经阴道分娩者82例(88.17％),剖宫产后并发大出血11例(11.83％),切口感染4例,术中出现呼吸骤停抢救1例,发生新生儿窒息5例(其中重度窒息2例) (5.38％);新生儿肺炎2例(2.15％)。结论 剖宫产社会性因素包括现代观念、医患方因素等。开展无痛阴道分娩,降低社会性因素剖宫产率。     

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。     

剖宫产术后预防性应用不同抗生素的疗效分析

目的　选择较理想的剖宫产术后预防性使用的抗生素。方法　回顾性分析 12 6 6例腹膜内剖宫产产妇 ,使用不同种类抗生素的临床效果及药物不良反应等。根据使用的抗生素种类分为6组 :1组用青霉素 +氨苄青霉素 ;2组用美洛西林钠 ;3组用舒巴坦 +氨苄青霉素 ;4组用环丙沙星 ;5组用盐酸克林霉素 ;6组用头孢唑啉。结果　 (1)术后体温恢复正常的时间 ,1组为 (5 4 0± 2 8 4)h、2组为 (4 8 9± 2 7 8)h、3组为 (4 9 9± 2 3 9)h、4组为 (5 8 6± 33 7)h、5组为 (5 2 5± 2 5 2 )h、6组为(6 3 1± 5 1 1)h ,其中 6组较其他组术后体温恢复时间长 ,差异有极显著性 (P <0 0 0 1)。 (2 ) 2组孕妇用药费用及产褥病率与 1组比较 ,差异均无显著性 (P >0 0 5 ) ,且药物不良反应低。结论　青霉素 +氨苄青霉素仍然是剖宫产术后预防性应用抗生素的首选方案 ,美洛西林钠值得推广使用 ,对青霉素过敏者 ,抗生素的选择有限 ,宜进一步探讨     

Obstetrician gender and the likelihood of performing a maternal request for a cesarean delivery

Objective

To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics).

Study design

Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS.

Results

After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR = 1.53) and clinics (OR = 2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals.

Conclusions

While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions.     

剖宫产术后的安全性研究

目的 比较剖宫产与自然分娩者产后两年内并发症的异常情况的发生情况,以评估剖宫产术后安全性,方法 采用历史前瞻性流行病学方法。结果 剖宫产后两年内切口痛,子宫活动度受限,慢性腹痛发生率分别为５．１％、９．６％、４．３％,贫血发生率为１１．１％,均高于自然分娩者,差异有统计学意义,结论 为了保护妇女的身心健康,必须正确掌握剖宫产指征。     

Repeat cesarean section and primary elective cesarean section: recently trained obstetrician-gynecologist practice patterns and opinions

OBJECTIVE: This study was undertaken to determine opinions of obstetrician-gynecologists regarding vaginal birth after cesarean (VBAC) section and elective cesarean section. STUDY DESIGN: A questionnaire was administered to obstetrician-gynecologists attending 2 review courses. RESULTS: Of 500 obstetrician-gynecologists, 304 completed the survey for a response rate of 61%. Most (92%) counseled VBAC candidates differently, and 84% quoted differential VBAC completion rates on the basis of the indication for prior cesarean section. Uterine rupture was virtually always discussed (99%). Pelvic floor risks were infrequently discussed with urinary incontinence, pelvic organ prolapse, and fecal incontinence discussed by less than one third of obstetricians (30%, 28%, and 25%, respectively). Fifty-nine percent of physicians would perform a primary elective cesarean section, and 67% would perform a primary elective cesarean section specifically to prevent pelvic floor disorders. CONCLUSION: Two thirds of recent graduates are willing to perform an elective cesarean section to prevent pelvic floor injury. Most offer VBAC; however, less than a third include risk of pelvic floor injury in their informed consent discussions.     

新式剖宫产术1800例临床总结分析

目的 比较以色列式剖宫产与腹壁纵切口子宫下段剖宫产。方法 对1997年7月至1999年11月间开展M.Stark教授创立的以色列式剖宫产术1800例和1993年6月至1997年6月间开展的腹壁纵切口子宫下段剖宫产术1500例的临床资料、术后并发症、新生儿Apgar评分进行比较。结果 两组开腹时间、开腹出血量、切皮至胎儿娩出时间、手术时间、排气时间、手术并发症的差异均有显著性(P<0.05),新生儿Apgar评分的差异无显著性(P>0.05)。结论 以色列式剖宫产术具有一定的优点,有临床推广应用价值。     

剖宫产围手术期抗生素的预防性应用

目的 探讨低感染风险剖宫产产妇围手术期预防性应用抗生素的必要性及最佳用药方案.方法 前瞻性随机对照研究低感染风险子宫下段剖宫产产妇围手术期抗生素应用与否以及不同用药方案与术后病率和术后感染的关系.抗生素选择头孢唑肟钠或克林霉素,均为静脉给药.共纳入2007年11月至2008年10月在南京大学医学院附属鼓楼医院妇产科分娩的产妇720例,随机分成4组:A组176例,围手术期不使用抗生素,B组190例,术前30 min一次给药,术后不再使用;C组180例,术前30 min开始给药,术后继续使用2 d;D组174例,手术结束后开始给药,共5d.比较4组产妇术后体温恢复正常的时间、术后病率、术后感染及术后住院天数.统计学分析采用方差分析、卡方检验及Fisher精确概率法. 结果 720例产妇术后感染率、术后病率分别为0.83%(6/720)和4.58%(33/720),4组产妇剖宫产术后感染发生率差异无统计学意义(P>0.05),B组和C组产妇术后体温恢复正常时间、术后病率及术后平均住院天数均分别显著低于A组和D组[B组:(41.9±31.6)h、1.05 oA(2/190)、(4.8±1.1)d;C组:(41.1±36.5)h、1.11%(2/180)、(4.7±0.9)d;A组:(67.0±40.6)h,7.39%(13/176)、(5.7±1.0)d,D组:(70.1±39.9)h、9.20%(16/174)、(5.9±1.1 d),P均<0.01].但B、C组之间和A,D组之间各项指标比较差异无统计学意义(P>0.05). 结论 低感染风险产妇剖宫产术前30 min静脉使用抗生素能显著降低术后病率的发生,且一次性用药即可,无需对低感染风险的剖宫产产妇在术后重复应用抗生素预防感染.     

Indications associated with increased cesarean section rates in a Swedish hospital.

OBJECTIVE: To analyze the indications and Robson classes associated with the rapid increase in cesarean section (CS) rates at S?der Hospital, Stockholm, Sweden, in the late 1990s. METHOD: Records of women who underwent CSs in 1994 and 1999 at S?der Hospital were retrospectively reviewed. Diagnostic frequency and Robson class, which takes into account characteristics such as parity, previous deliveries, prematurity, and fetal presentation, were compared for the 2 years. RESULTS: Suspected fetal distress (+1.6%; P = .0001), maternal request (+1.5%; P < .0001), and labor dystocia (+0.8%; P = .03) were associated with the increase in CS rates. The rate of CSs with cephalic presentation and spontaneous onset of labor at term, as well as the rate of CSs following induced labor or elective CSs, increases significantly in both nulliparas and multiparas (Robson classes 1-4) (P < .02). CONCLUSION: The increasing CS rate was due to maternal preference and lower thresholds of decision for physicians.