基于Robson分类系统的医院剖宫产率变化及其产妇特征分析

目的 分析医院剖宫产率变化和收治产妇的人群特征,为妇幼卫生政策和临床实践提供参考。方法 选择安徽医科大学附属巢湖医院2010年10月1日至2016年9月30日住院分娩的12 041名产妇作为研究对象,应用Robson分类系统分析各组产妇的剖宫产率变化,以及其与二孩政策、出生婴儿性别比之间的关系。结果 近6年医院总剖宫产率从66.9%降低至44.2%,其中单胎头位足月妊娠初产妇（R1+R2）降低至32.1%,经产妇无子宫疤痕者（R3+R4）降低至14.2%,早产者降低至22.9%,组内差异有统计学意义（P<0.01）;自然分娩组（R1、R3）、疤痕子宫再妊娠组（R5）、双胎妊娠组（R8）产妇构成比呈上升趋势,组内差异有统计学意义（P<0.01）;医院年度总出生婴儿男女性别比是110~128：100,R1组女婴多且比例稳定,R10组（早产）和经产妇组（R4、R5）男婴比例高,但R4组2015、2016年度男婴下降明显。结论 单胎头位初产妇、无子宫疤痕经产妇和早产者是医院降低剖宫产率的重点监测人群,疤痕子宫再妊娠、臀位、双胎妊娠者的剖宫产率及构成比变化存在不确定性,应用Robson分类法可提高剖宫产率监测数据的可比性。     

Long term maternal health effects of caesarean section.

OBJECTIVE--The aim was to study whether women having had caesarean sections (index women) have more subsequent health problems, measured by hospital admissions, than women having had vaginal deliveries (control women). DESIGN--The study involved comparison of hospital admissions before (2-5 years) and after (7-10 years) the first caesarean section (exposure) among two cohorts of index and control women. SETTING--National data from the Swedish birth and hospital discharge registries were used. PARTICIPANTS--About 75% of all Swedish primiparas who had a caesarean section in 1973 (n = 2578) and in 1976 (n = 3822), and their age-matched controls, were studied; non-Swedish women and women with certain specific problems at their first birth were excluded. MEASUREMENTS AND MAIN RESULTS--Numbers of discharges from general and mental hospitals excluding discharges relating to birth, and in some analyses to pregnancy, were determined. Total numbers of discharges from general and mental hospitals, and the numbers of discharges with operations, were higher among index than control women both before and after exposure. In analyses by diagnosis, a caesarean section was a risk factor for ectopic pregnancies and sterilisations. CONCLUSIONS--The analyses suggest that the higher rate of hospital admission after caesarean section than after vaginal delivery is not due to the section itself, but to a continuation of a previous pattern of health service use. However, because this was not so for all diagnoses and alternative interpretations are possible, further studies on long term maternal morbidity are needed.     

Delivery method and self-reported postpartum general health status among primiparous women

Despite nearly four million deliveries in the United States each year, minimal information exists on unintended health consequences following childbirth, particularly in relation to delivery method. The purpose of this study was to assess the association between method of delivery and the general health status, sexual, bowel and urinary functioning of primiparous women as measured at 7 weeks postpartum. Data from the Statewide Obstetrical Review of Quality System (StORQS) Survey of Maternity Care in Washington State were analysed. Participants included all primiparous women with a delivery of a singleton infant discharged alive between August and December 1991 from 10 non-federal short-stay hospitals who responded to the StORQS Survey of Maternity Care (n = 971). The main outcome measures included the modified Medical Outcomes Study 36-Item Short-Form Health Survey and self-reported sexual, bowel and urinary functioning. At 7 weeks postpartum, women who had caesarean or assisted vaginal deliveries reported significantly lower postpartum general health status scores than women with unassisted vaginal delivery. Additionally, women with assisted vaginal delivery reported significantly worse sexual, bowel and urinary functioning. Our results suggest that more careful attention to the postpartum general health and sexual functioning of women with caesarean and assisted vaginal delivery may be merited.     

Determinants of caesarean section in Egypt: evidence from the demographic and health survey

This paper examines the impact of near birth complications and socio-demographic, healthcare and spatial characteristics of caesarean section in Egypt, using data on 4032 births from the 2000 Egypt Demographic and Health Survey. The hospital caesarean section rate was 22% in Egypt. Fever/vaginal discharge around delivery, birth weight, mother's age and education, birth order, residence and antenatal visits were important determinants of caesarean section. Variations by place of delivery were evident, although complications were more significant determinants of caesarean section in public settings and demographic characteristics were more important in private facilities. Unexpectedly, long labour and bleeding around delivery were not associated with caesarean section, particularly, in private hospitals. In view of the high and rising caesarean section rate in Egypt, monitoring the quality of maternity services in Egypt is imperative. An investigation of the forces sustaining the differential in determinants by place of delivery is needed.     

Review of Twin Pregnancies in a Tertiary Hospital in Abuja,Nigeria

Studies on twin pregnancy are uniquely important to Africa and particularly Nigeria where the highest incidence in the world exists. This study was designed to determine the trend, rate, and obstetric outcomes of twin deliveries in the University of Abuja Teaching Hospital, Gwagwalada. This was a retrospective study of twin deliveries in the hospital over a period of 10 years. During the study period, there were 349 twin births out of 10,739 deliveries, giving an overall twining rate of 32.5 per 1,000 deliveries. Preterm delivery occurred in 39.7% cases and was, therefore, the most common complication. Mode of delivery was vaginal in 72.7% while 27.3% were delivered by caesarean section. Emergency caesarean section for delivery of both the babies was carried out in 22.3% while elective caesarean section for both the babies accounted for 1.0 %. Combined vaginal and abdominal delivery occurred in 4.0% of deliveries. The stillbirth rate was 102 per 1,000 births. There were 24 (8.0%) and 37 (12.3%) stillbirths among the first and the second baby respectively. The mean foetal weight was 2.395±0.63 kg while the female-to-male ratio was 1:1.1. The rate of twin deliveries in our centre is high. Successful vaginal delivery of twins is high when the mothers are booked and the presentations of the twins are favourable. The use of antenatal care services and good intrapartum management will help improve outcome in twin pregnancies.Key words: Delivery, obstetric; Pregnancy, twin; Nigeria     

妊娠期糖代谢异常孕妇分娩时机和方式的探讨

目的:探讨妊娠期糖代谢异常孕妇的分娩时机和方式,以降低孕产妇和围产儿并发症。方法:对2006年8月至2008年7月中山大学附属第三医院产科住院分娩的302例糖代谢异常患者的临床资料进行回顾性分析。结果:孕周<37周组和>40周组孕妇的胎儿窘迫、剖宫产、新生儿窒息、新生儿高胆红素血症的发生率均高于37～40孕周组(P<0.05);剖宫产与阴道分娩组产后出血、新生儿窒息、新生儿黄疸的发生率均无统计学意义(P>0.05),但剖宫产组中孕妇血糖未控制、子痫前期、胎儿窘迫、巨大儿所占的比例高于阴道分娩组(P<0.05)。结论:妊娠期糖代谢异常孕妇分娩孕周以37～40周为宜;妊娠期糖代谢异常孕妇可阴道试产,但血糖未控制、并发子痫前期、巨大儿及出现胎儿窘迫时宜剖宫产终止妊娠。     

产妇产后对分娩方式的再认识

目的:探讨产妇产后近期对分娩方式的再认识。方法:采用前瞻性研究设计,在产后健康检查时开展面对面问卷调查和小组访谈。结果:有598例产妇(其中剖宫产、阴道分娩组各299例)回答了再次选择分娩方式时的选择意愿。共有63.7%的对象愿意选择阴道分娩,其中剖宫产组产妇接近一半将重新选择阴道分娩,而78.6%的阴道分娩产妇坚持原来的分娩方式。两组选择阴道分娩的最主要原因都是“阴道分娩产后恢复快”和“阴道分娩对母儿有利”。阴道分娩产妇选择剖宫产的主要原因是惧怕所经历的阴道分娩痛,而剖宫产组选择剖宫产的主要原因是剖宫产痛苦少、安全并且快捷方便,避免阴道分娩痛。小组访谈结果表明多数产妇当初分娩方式的选择受身边年轻母亲分娩方式的影响。两种不同分娩方式的产妇都比较满意自己所经历的分娩方式,只是阴道分娩组产妇对于都要进行会阴侧切感到不满意。结论:多数产妇满意自己所经历的分娩方式,再次选择时多数倾向选择阴道分娩。改进围产期服务模式和实施产科适宜技术,将更能体现两种分娩方式中阴道分娩的比较优势。     

Opinions about postpartum care: expectations of the population

INTRODUCTION: During the last few years family centred obstetric practice became more widespread in Hungary as well. The opinion of the population, however, is hardly known. OBJECTIVES: The authors attempted to acquire a better knowledge of the expectations of the various population segments towards postpartum care. METHODS: The opinion of 485 person was analyzed with a questionnaire survey. The questions asked about ideal visiting time at the postpartum ward, postpartum organisational structures and appropriate time for discharge. RESULTS: The average age of the examined sample was 25.2 years; 32.4% were still students, 52.6% were state employees. A very early discharge (within 6-8 hours) was suggested only by 1.2% of the sample. The ratio of those who wanted to leave the hospital at less than 24 hours postpartum was only 7.8% as well. At the same time, only one third (35.9%) of the participants would like to be discharged after 4 days after delivery. 57.7% of the whole sample would prefer discharge between day 2 and 4 after delivery. The opinions about the time of discharge are independent from the size of the family, martial status, sex, education and monthly income of the interviewees. The patients' preferences concerning the appropriate time for discharge following an uncomplicated pregnancy and normal vaginal delivery is mainly influenced by the number of children (chi 2 = 62.260; df = 20; p = 0.000) and previous deliveries (chi 2 = 57.803; df = 20; p = 0.000). Early discharge was most commonly voted for by those who had no children or by those who had many. CONCLUSIONS: When organising postpartum care, the opinion and expectations of the population should be taken into account as well. Almost 62% of the sample had no children at the time of the interview. They will be in need of obstetric care in the future as well. Because of this, their opinion is especially important.     

非异常妊娠两种分娩途径产后情况比较

目的 比较非异常妊娠初产时剖宫产和阴道产后的母婴情况，评估剖宫产术的近期安全性。方法 采用历史性队列研究方法，对武汉市4所医院2002年10月至12月间非异常妊娠分娩初产妇产后以及新生儿情况进行比较分析。结果 剖宫产后感染的发生率是阴道分娩的1．93倍(8．70％／4．51％)，其他并发症和异常情况的发生率是阴道分娩的9．55倍(2．77％／0．28％)；除新生儿窒息以外的新生儿疾病和异常情况发生率是阴道分娩的1．73倍(14．62％／8．45％)，其差异都具有统计学意义。结论 排除产前异常影响因素之后，初产妇剖宫产术后感染等并发症以及除新生儿窒息以外的新生儿疾病和异常清况剖宫产组高于阴道分娩组。为保障母婴健康，必须严格掌握剖宫产指征．     

巨大儿的分娩方式及其对妊娠结局的影响

目的:比较足月巨大儿与正常体重儿的分娩方式、母婴并发症,探讨巨大儿的不同分娩方式与妊娠结局的关系。方法:回顾性调查哈尔滨市16所医院在2000年1月1日~2005年12月31日分娩的单胎、无出生缺陷、足月(非早产、过期产)活产的巨大儿和正常体重儿的产妇病案(其中包含新生儿病案),比较2138例巨大儿和18233例正常体重儿的分娩方式与妊娠结局。结果:巨大儿组的剖宫产率、产妇住院天数、产妇产后出血比例、新生儿窒息比例高于正常体重儿组。巨大儿组的阴道助产率(7.51%)高于正常体重儿组(5.60%),但无统计学意义。分娩巨大儿的产妇产后出血比例、巨大儿窒息比例均与分娩方式无关。结论:足月巨大儿也具有较高的母婴并发症,故应探索并使用正确的产前预测巨大儿的方法,产时给于充分重视,适时正确处理,适当放宽剖宫产指征,降低母婴并发症。     

Preference for Institutional Delivery and Caesarean Sections in Bangladesh

In Bangladesh, preference for place of delivery and socioeconomic factors associated with caesarean section are not well-understood. This paper examines the socioeconomic correlates of preference for institutional delivery and caesarean sections in Bangladesh. The study used data from the nationally-representative 2007 Bangladesh Demographic and Health Survey. Both bivariate and multivariate binary logistic regression models were constructed to assess the effect of sociodemographic factors on the use of medical facilities and caesarean section for childbirth. Overall, 15% of women underwent institutional delivery, and 8% deliveries were performed by caesarean sections. Both institutional deliveries and caesarean sections have increased in recent years. The bivariate and multivariate analyses both confirmed that place of residence, religion, birth order, frequent pregnancy, antenatal care-seeking, and wealth index were important predictors of the use of medical facilities and caesarean sections for childbirth. Women''s education appeared as the most single significant determinant for the use of both services. The findings underlie the importance of monitoring caesarean section as well as professional attendance for safe motherhood. Programmes should aim to inform women highlighting the benefits of the use of skilled maternal healthcare services and demerits of home-delivery practices.Key words: Caesarean sections, Delivery settings, Logistic regression, Pregnancy, Bangladesh     

湖南省产妇分娩方式及其影响因素分析

目的 了解湖南省产妇生产方式及其影响因素,为制订促进自然分娩的干预措施提供依据。方法 采用分层整群随机抽样方法,对2011年5月1日—2012年5月1日在湖南省6所不同等级医院分娩的603名产妇进行问卷调查。结果 所调查产妇平均年龄为（27.55±4.179）岁,文化程度本科及以上者占28.17%,32.48%有流产史,24.38%为经产妇,剖宫产率为53.89%,自然分娩率为46.11%;每次都能按时接受产前检查者占51.01%,28.88%的产妇产前检查结果异常,17.42%被医生建议剖宫产,12.86%参加孕妇学校;多变量logistic回归结果显示,影响剖宫产的主要因素为产妇期望剖宫产（OR=33.118,90%CI=11.274~95.514）、丈夫期望剖宫产（OR=6.055,90%CI=2.919~13.297）、选择市级医院分娩（OR=1.708,90%CI=1.078~2.932）、医生建议剖宫产（OR=19.851,90%CI=4.666~81.460）。结论 目前湖南省的剖宫产率较高,产妇参加孕妇学校、按时接受产前检查的比例也较低,孕妇及其家属的自然分娩相关健康教育工作有待加强。     

Factors associated with preterm births in southeast Brazil: a comparison of two birth cohorts born 15 years apart

An increase in preterm deliveries in Ribeirão Preto stimulated an analysis of possible explanatory factors. Two cohorts of singleton livebirths were studied, the first based on 6746 births in 1978–9 and the second based on 2846 births in 1994. A logistic regression was carried out to assess the association of preterm birth with several socio‐demographic, behavioural and clinical variables, including year of survey. Delivery in private settings compared with a public setting, maternal age of 17 compared with any other age group, and mothers who had had previous abortions and previous stillbirths were associated with greater rates of preterm birth. Although there was an increase in preterm birth rates regardless of mode of delivery, the increase was greater in the caesarean section group than in the vaginal delivery group. Over the study period, deliveries in private hospitals and caesarean section operations increased markedly (from 4% to 36% and from 30% to 51% respectively). Caesarean section may be the main contributor to the increase of preterm birth rate in this study. It is essential to ensure that health‐care staff, especially those in private facilities, are properly educated and audited.     

武汉市剖宫产流行特征及其影响因素研究

目的 :初步掌握目前武汉市剖宫产在部分医院的流行特征 ,分析高剖宫产比的影响因素。方法 :对 2 0 0 2年 10月 6日～ 12月 10日在武汉市 4家医院分娩的 85 5例产妇进行回顾性分析。结果 :(1)剖宫产占 47 60 % ,阴道产占 5 0 88% ,阴道助产占 1 5 2 %。 (2 )剖宫产指征构成比居首位的是社会因素 (2 5 83 % )。 (3 )非必须剖宫产 165例 ,占分娩例数的 19 3 0 %。(4 )产妇选择剖宫产分娩考虑的首要因素是为了孩子健康 ,占 5 9 95 % ,其次是考虑只生一胎 ,占 45 45 %。假设无任何剖宫产指征、有无痛分娩或由信任的人陪伴 ,绝大部分产妇愿意选择阴道分娩。结论 :此次所调查医院的总体剖宫产率较高 ,其中非必须剖宫产比例较高是其重要原因。产妇及其丈夫不正确的分娩知识、态度和行为与产科医生不正确的态度和行为是非必须剖宫产的重要危险因素。     

剖宫产术后再次妊娠的分娩方式分析

目的探讨剖宫产术后再次妊娠的最佳分娩方式。方法笔者所在医院自2005年1月～2008年12月收治剖宫产术后再次妊娠孕妇132例,对其分娩方式、分娩结局、母婴并发症及医疗费用进行回顾性分析。将其中再次剖宫产（RCS）96例与随机抽取同期首次剖宫产（PCS）96例进行对照;将其中剖宫产术后阴道分娩（VBAC）36例与随机抽取同期非瘢痕子宫阴道分娩（VBNC）36例进行对照。结果132例中60例行阴道试产,36例试产成功,成功率60％;RCS96例,手术产率72．2％。VBAC组新生儿窒息、产后出血量、先兆子宫破裂发生率与对照组比较差异均无统计学意义（P〉0．05）;RCS组产后出血量比VBAC组高,平均住院天数比VBAC组长,医疗费用高,产后出血、严重粘连发生率均较PCS组高,差异有统计学意义（P〈0．05）。结论剖宫产术后再次妊娠分娩并非是剖宫产绝对指征。如无剖宫产指征,应给予试产,因为阴道分娩可以减少再次开腹手术给患者带来的各种危险和并发症,减少患者痛苦和经济负担。符合试产条件者,严密监护下阴道试产是安全的。     

A Comparison of Sexual Outcomes in Primiparous Women Experiencing Vaginal and Caesarean Births

Background and Objective:

We conducted this study to evaluate and compare postpartum sexual functioning after vaginal and caesarean births.

Materials and Methods:

This was a cross-sectional study that was carried out in postnatal health care in a hospital. A total of 50 primiprous women who had given birth 6-12 months ago and came to the hospital for postnatal care were asked to join the study. Forty of the women completed the entire questionnaire. Among these women, 20 delivered spontaneously with mediolateral episiotomy and 20 had elective caesarean section. Sexual function was evaluated by a validated, self-created questionnaire. A statistical evaluation was carried out by SPSS v.11. A two-part self-created validated questionnaire for data collection was administered regarding sexual function prior to pregnancy and 6-12 months postpartum.

Results:

The median time to restart intercourse in the normal vaginal delivery with episiotomy (NVD/epi) group was 40 days and in the caesarean section (C/S) group was 10 days postpartum. The most common problems in the NVD/epi group was decreased libido (80%), sexual dissatisfaction (65%), and vaginal looseness (55%). In the C/S group, the most common problems were vaginal dryness (85%), sexual dissatisfaction (60%), and decreased libido (35%). There were clinically significant differences between the two groups regarding sexual outcomes, but these differences were not statically significant.

Conclusion:

Postnatal sexual problems were very common after both NVD/epi and C/S. Because sexual problems are so prevalent during the postpartum period, clinicians should draw more attention to the women''s sexual life and try to improve their quality of life after delivery.     

Caesarean section delivery in Kerala, India: evidence from a National Family Health Survey

Ensuring safe pregnancy and motherhood occupies a pivotal role and has been considered as one of the key issues in the framework of reproductive and child health programmes. Evidence from research studies indicate that there is a growing tendency for caesarean section deliveries especially during complications confronted at the time of pregnancy and delivery. The present study focuses on the demographic, antenatal care, spatial and socio-economic variables associated with caesarean section delivery in Kerala, India. The data from the National Family Health Survey has been utilised for this purpose. The results from logistic regression models indicate that maternal age, birth order, current age, births in health institutions and spatial differences were significantly associated with caesarean section deliveries in Kerala. The older cohorts of mothers were found at higher risk to have caesarean section when compared to their younger counterparts. When controlled for demographic variables, the odds for caesarean section was about 1.7 times more likely to occur in private health institutions. The inclusion of spatial and socio-economic variables has neither influenced the demographic and antenatal care variables nor showed any significant association with caesarean section delivery in the state. The present study calls for that a detailed investigation on behavioural aspects of both the physician and the patient with regard to type of delivery in the state. Information related to pregnancy and health related aspects needs to be monitored more accurately, both in the public and private hospitals, to understand the determinants associated with caesarean section.     

1998-2003年中国妇女住院分娩费用分析

目的 描述1998-2003年间我国妇女住院分娩费用的变化趋势及在地区与机构间的分布.方法 利用第3次国家卫生服务调查资料,计算不同年份组、城市农村、不同分娩机构的顺产和剖宫产的费用,并用秩和检验进行组间比较.结果 近年来我国住院分娩费用普遍上涨,顺产费用城乡分别从1998-1999年的1646元和597元上涨到2002-2003年的1 884元和657元,剖宫产费用城乡分别从1998-1999年的3 155元和2 327元上涨到2002-2003年的3 633元和2 392元.城市住院分娩的平均费用明显高于农村,大城市分娩费用最高,四类农村最低.结论 1998-2003年我国城乡的住院分娩费用无论顺产还是剖宫产都在上升,与其他服务费用相比,住院分娩费用的上升幅度是否合理,有待进一步研究.     

Trial of scar

It is becoming increasingly common to attempt vaginal delivery in women whose previous delivery or deliveries have been by caesarean section. The outcome in these "trials of scar" is generally good, with reported vaginal delivery rates ranging from 60% to 94% and few complications.     

Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records

While the impact of maternal morbidities and intrapartum procedures is a common topic in perinatal outcomes research, the accuracy of the reporting of these variables in the large administrative databases (birth certificates, hospital discharges) often utilised for such research is largely unknown. We conducted this study to compare maternal diagnoses and procedures listed on birth certificates, hospital discharge data, and birth certificate and hospital discharge data combined, with those documented in a stratified random sample of hospital medical records of 4541 women delivering liveborn infants in Washington State in 2000. We found that birth certificate and hospital discharge data combined had substantially higher true positive fractions (TPF, proportion of women with a positive medical record assessment who were positive using the administrative databases) than did birth certificate data alone for labour induction (86% vs. 52%), cephalopelvic disproportion (83% vs. 35%), abruptio placentae (85% vs. 68%), and forceps-assisted delivery (89% vs. 55%). For procedures available only in hospital discharge data, TPFs were generally high: episiotomy (85%) and third and fourth degree vaginal lacerations (91%). Except for repeat caesarean section without labour (TPF, 81%), delivery procedures available only in birth certificate data had low TPFs, including augmentation (34%), repeat caesarean section with labour (61%), and vaginal birth after caesarean section (62%). Our data suggest that researchers conducting perinatal epidemiological studies should not rely solely on birth certificate data to detect maternal diagnoses and intrapartum procedures accurately.