我院近十年剖宫产率及剖宫产指征变化趋势分析

近年来，剖宫产率的迅速升高已成为产科医生十分关注的问题，适当放宽剖宫产指征可降低围产儿发病率及死亡率，但剖宫产率的无限增高，并不能进一步降低围产儿发病率和死亡率，反而增加了产妇并发症的发生。为正确掌握剖宫产指征，保证母婴安全，作者对我院近10年剖宫产率及剖宫产手术指征进行回顾性分析。     

1O年问剖宫产率及剖官产指征变化研究

通过对我院10年间剖宫产病例进行回顾性分析,探讨剖宫产率及剖宫产指征变化对围产儿死亡率的影响.统计显示剖宫产率逐年上升,剖宫产指征中,难产因素、胎儿宫内窘迫始终处于第1、2位,社会因素上升为第3位,其他为第4位,妊娠合并并发症为第5位,围产儿死亡率趋于稳定.结果表明尽管剖官产手术技术不断提高可在一定程度上降低围产儿死亡率,但逐年升高的剖官产率并未导致围产儿死亡率随之下降.     

剖宫产率及指征变化对围产儿死亡率的影响

目的探讨剖宫产率及剖宫产指征变化对围产儿死亡率的影响。方法对1994年1月至2003年12月间我院2434例剖宫产病例资料进行回顾性分析。结果(1)剖宫产率呈逐年上升趋势;(2)在剖宫产指征中,难产因素和胎儿窘迫持续在1、2位,社会因素逐年上升;(3)围产儿死亡率无显著性差异(P>0.05)。结论剖宫产率升高在一定范围内降低了围产儿死亡率,但剖宫产率的进一步升高,围产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。     

剖宫产率及剖宫产指征12年变化研究

目的：探讨剖宫产率及剖宫产指征变化对围产儿死亡率的影响。方法：对12年间剖产病例资料进行回顾性分析：结果：(1)剖宫产率逐年上升；(2)在剖宫产指征中，妊娠并发症、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；(3)围产儿死亡率逐年趋于稳定。结论：剖宫产率升高在一定范围内降低了围产儿死亡率，但随着剖宫率的进一步升高，围生儿死亡率并未随之下降。     

10年剖宫产率,指征及围产儿死亡率分析

目的：探讨剖宫产率、指征及围产儿死亡率的变化。方法：对１０年剖宫产病例进行回顾性分析。结果：剖宫产率逐年增高，而围产儿死亡率未相应下降。剖宫产指征变化以社会因素所占比例逐年增高为主。结论：围产儿死亡率进一步降低不能依靠剖宫产率的提高，而有待于围产保健水平的全面提高。     

剖宫产术指征的研讨

本文通过对我院1984年129例剖宫产术指征的分析,说明剖宫产率逐年上升的原因是臀位及非难产的因素。而非难产因素高于难产因素的原因在于对心脏病,妊娠高血压综合症,过期妊娠手术指征放宽,从而降低了围产儿的并发症及死亡率。至于产妇手术并发症,只要处理得当是能够加以减少或避免的。因此,我们认为,只要指征明确,在有准备的情况下进行剖宫产术是合适的。     

剖宫产指征探讨——附1453例分析

我院１９９１年～１９９４年共行１４５３例剖宫产。本文对剖宫产的主要指征进行分析，认为应在不能阴道分娩和不宜阴道分娩的条件下行剖宫产才是最根本的，消除剖宫产最安全，剖宫产的孩子最聪明的错误观点。充分认识盲目提高剖宫产率并不能进一步降低围产儿死亡率，反之可使手术并发症的发生率增加。因此，严格掌握剖宫产指征，减少术后并发症是产科医师面临的主要问题。     

1996年～2000年我院剖宫产指征的变迁

目的:分析近5a来我院剖宫产率、围产儿死亡率、剖宫产指征的变化,指导临床合理掌握剖宫产.方法:统计近5a分娩总数、剖宫产率、剖宫产指征、围产儿死亡率进行分析.结果:近2a剖宫产率升高明显,围产儿死亡率呈下降趋势;5a来剖宫产指征顺位发生了明显变化,“胎儿宫内窘迫“渐占首位,“社会因素“剖宫产增多;剖宫产产后大流血行子宫切除机率明显高于阴道分娩者.结论:手术均存在着意外及风险,应合理掌握剖宫产指征,重视孕妇心理状况,尽量减少不必要的手术.     

剖宫产率及适应证变化的临床意义

目的　探讨剖宫产率及适应证的变化在临床上的意义。方法　对 1991- 0 1～ 2 0 0 0 - 12间总分娩7186例产妇中剖宫产 2 318例产妇指征进行资料统计分析。结果　剖宫产指征扩大 ,剖宫产率升高 ,但围产儿死亡率下降。结论　客观评价剖宫产率与剖宫产指征变化的围产儿死亡率下降的临床意义     

668例剖宫产指征的分析

对深圳市福田人民医院１９９１年３月至１９９４年３月６６８例剖宫产产妇进行回顾性分析。结果显示：剖宫产率为９．９５％，手术主要指征为头盆不称、胎儿窘迫和胎位异常，分别占３１．２９％、２８．８９％和８．９８％。剖宫产并发症为９．２８％，围产儿死亡率为３．０％。剖宫产率、并发症率和围产儿死亡率均低于文献报道。提示，正确掌握剖宫产指征，严密观察下试产，可控制剖宫产率及降低母儿并发症。     

Caesarean section and perinatal outcomes in a sub-urban tertiary hospital in North-West Nigeria

Objectives:

This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1^st January 2010 to 31st December, 2012.

Materials and Methods:

This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit (ICU) and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1^st January 2010 to 31^st December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analysed using SPSS version 17.0 statistical software (Chicago, Il, USA). Absolute numbers and simple percentages were used to describe categorical variables. Association between caesarean section and perinatal mortality was determined using Pearson''s Coefficient of correlation and student t- test. P - value < 0.05 was considered statistically significant.

Result:

This study reported a caesarean section rate of 17.69 % and a perinatal mortality rate of 165.6 per 1000. Majority of the babies (78.2%) were within normal weight. The mean age of the women was 25.9 ± 6.2 years and mean parity was 4 ± 3. Majority of them were uneducated and unemployed. Obstructed labour was the commonest indication for emergency caesarean section accounting for 31.7% of caesarean sections and foetal distress was the least at 2.6 %. Two or more previous caesarean section was the commonest indication for elective caesarean section (17.1%) and bad obstetrics history the least indication (1.4%). There is a weak positive correlation (r = 0.35) between caesarean section rate and perinatal mortality and this association was not statistically significant (P = 0.12).

Conclusion:

Caesarean section and perinatal mortality rates in the present study are comparatively high. Absence of significant correlation means that a high caesarean section rate is not likely to improve perinatal outcomes in babies of normal weight; therefore the caesarean section rate in this centre should be reduced. Measures to reduce perinatal mortality such as skilled attendant in labour and training of medical staff in neonatal resuscitation should be adopted.     

剖宫产率上升的因素分析

目的分析剖宫产率升高的原因,寻求解决问题的办法,严格掌握剖宫产的手术指征,使诊治更为科学,确保母婴健康。方法对1996年1月1日￣2005年10月31日在我院进行剖宫产手术分娩的1570例病例进行回顾性分析,总结分析剖宫产率上升的原因及因素变迁,并提出相应的对策。结果剖宫产率呈逐年上升趋势,尤其近5￣6年来,上升明显,究其原因,胎儿窘迫、头盆不称、孕妇精神因素及部分社会因素为主要因素。结论加强围产期宣教,认真做好孕产期监护,医患之间加强沟通,减少医患纠纷,严格掌握剖宫产指征,以最大限度地降低剖宫产率和母婴死亡率。     

Perinatal mortality and morbidity in caesarean section

The study was conducted on 350 babies born by caesarean section. There were 29 perinatal deaths among 350 births giving a gross perinatal mortality rate of 8.3 per 1000 live births. Corrected perinatal mortality rate was 7.1%. The stillbirth rate was 2%. It was high for cases of abruptio placentae, transverse lie and cord prolapse. Septicaemia was the commonest cause of perinatal death followed by asphyxia and prematurity. Birth weight played an important role in the survival of babies. There was no foetal loss among babies in weight group of 3501-4000 g. Perinatal morbidity was mainly due to asphyxia, septicaemia, prematurity and cord infection.     

Impact of increased rate of caesarean section on perinatal outcome: sociolegal evaluation

Sharp rise in the caesarean section rate, over the past years has been causing lot of concerns. It is to be evaluated whether the decrease in perinatal mortality rate is due to the rising rate of caesarean section. Five hundred consecutive patients were selected on whom caesarean section had been performed. Both mother and baby were followed till they are discharged from the hospital. Foetal distress was the commonest indication in primigravidae who underwent caesarean section. The other indications of caesarean section in this study were breech, severe pre-eclampsia, eclampsia, cord prolapse, elderly primi, postdated, premature rupture of membrane, twin, compound presentation, meconium stained liquor. The occurrence of perinatal morbidity in caesarean section was 10% compared to 12% in vaginal delivery. Common causes of perinatal morbidity were asphyxia, prematurity, diarrhoea, septicaemia, jaundice, conjunctivitis and scalp injury. The occurrence of perinatal mortality in caesarean section was 3.8% compared to 3% in vaginal delivery. Causes of perinatal mortality were stillbirth, meconium aspiration syndrome, hypoxic ischaemic encephalopathy, prematurity and congenital malformation. In spite of safety of vaginal birth after caesarean section it continues to be underutilised. Good perinatal care proper screening and use of newer effective pharmacological agents improve the maternal progress as well as perinatal outcome without increasing the caesarean section rate.     

Cardiac disease in pregnancy--maternal and perinatal outcome

To assess the maternal and perinatal outcome in pregnant women with cardiac disease, a prospective study was carried out among 51 pregnant women with cardiac disease between January 2006 and August 2008 at a tertiary care centre at BJ Medical College, Ahmedabad, Gujarat. Rheumatic cardiac disease (68.62%) with mitral valve involvement (88.57%) was the commonest cardiac disease. In congenital cardiac disease (21.57%) group septal defect was found as the predominant form. Cardiac surgeries were performed in 11 women before pregnancy out of which 7 had balloon valvotomies, 3 had valve replacements and one had corrective tetrology of Fallot surgery. Two valvotomies were safely done during pregnancy. Out of 51 total patients, two women had opted for termination and two were lost to follow-up. Cardiac complications developed in 17.02% of the women, most common being congestive cardiac failure. It was found more in New York Heart Association grades III and IV (p = 0.00001). A total of 68.08% women delivered vaginally and 31.91% delivered by caesarean section. Complication rate was high (33.33%) in caesarean section group (p = 0.05). Maternal and perinatal outcome was good in general with no maternal death and three perinatal deaths. There were more preterm babies (27.7%; p = 0.03) and babies with intra-uterine growth restriction (48.9%; p = 0.65). None of the newborns of the women who had received anticoagulants had any congenital malformation. Rheumatic heart disease still constitutes the major type of heart disease in our country. Maternal and perinatal morbidity increases with increase in New York Heart Association grade. Surgically treated women tolerate pregnancy well. Vaginal delivery is safer and caesarean section should be reserved only for obstetric indications. Maternal and perinatal outcome can be improved by team approach at tertiary care centre.     

Changing trends in the management of eclampsia from a teaching hospital

Eclampsia is a major source of both maternal and perinatal mortality. In the management of eclampsia, the role of magnesium sulphate as anticonvulsant and early delivery are well established. The present study is an analysis of maternal and perinatal outcomes after the introduction of magnesium sulphate and liberalisation of caesarean section over a period from August 2002 to September 2004. The observations were compared with statistics from the same hospital from 1995-1997. The incidenceof eclampsia has remained relatively constant but postpartum cases of eclampsia have increased. The case fatality rate of eclampsia has fallen from 11.3% to 5.3%. The perinatal mortality has also fallen from 54.8% to 24.3%. The caesarean section rate for eclampsia has increased from near 10% to 49.7%. Both maternal mortality and perinatal mortality are lowest in the caesaean section group. But the improved perinatal salvage in caesarean section babies may partially reflect the tendency to avoid caesarean section in gross prematurity. The ideal anaesthesia for eclampsia remains unknown but the results with use of general anaesthesia in all cases with precautions produced favourable results.     

重度妊娠高血压综合征剖宫产有关问题的探讨

收治重度妊娠高血压综合征（简称妊高征）１１６例，其中８８例行剖宫产术，剖宫产率７６．５２％，剖宫产的第一指征前４位顺序为：重度妊高征５７例，头盆不称８例，胎儿宫内窘迫６例，宫颈扩张活跃期停滞４例。本组病例产褥病率１４例占１５．９％。产后出血７例占８％。并发ＨＥＬＬＰ综合征２例，其中１例母亲死亡。非剖宫产直接原因围产儿死亡２例。分析了重度妊高征剖宫产率上升的趋势和原因，认为重度妊高征剖宫产可降低母婴死亡率。结合病例分析了重度妊高征剖宫产指征。     

产科因素子宫切除26例临床分析

目的：分析产科因素所致子宫切除的发生率、手术指征、术式选择及其与分娩方式和母儿预后的关系。方法：对10年间因产科因素行子宫切除的26例孕产妇进行回顾性分析。结果：产科因素子宫切除发生率的高低与产前保健预防、围产期并发症的处治水平密切相关;必须严格掌握手术指征,恰当选择手术方式,适时实施手术;剖宫产子宫切除发生率高于阴道分娩子宫切除;孕产妇预后较好,围产儿死亡率仅为154‰。结论：产科因素子宫切除是抢救产科大出血及其危重并发症、挽救孕产妇生命的一项重要且有效的治疗措施。防治产科的严重并发症,降低剖宫产率可减少产科子宫切除的发生。     

Biophysical fetal assessment — The Rotunda experience

The evaluation of fetal health using ultrasound to establish a biophysical profile in the Rotunda Hospital in 1987 is reported. The corrected perinatal mortality rate fell from 10.0 in 1986 to 6.9 per 1,000 for babies over 500g and from 5.9 in 1986 to 3.4 for babies over l,000g. This was achieved without significant alteration in induction and caesarean section rates. The results indicate that this type of fetal assessment does lead to a reduction in perinatal mortality.     

Rotational delivery with Kielland's forceps

A retrospective study over 15 months showed that 10.7% of primigravid women and 1.6% of multigravid women were delivered by Kielland's forceps: a total of 145 babies. The successful vaginal delivery rate for attempted Kielland's forceps was 96.7%. The neonatal outcome was good and there were no perinatal deaths. Traumatic injuries were present in 7.6% of babies and were minor. The data show that even in the presence of fetal distress, Kielland's forceps can be safely employed for rotational delivery from the mid-pelvic cavity. This approach can avoid some caesarean sections without undue risk to the baby, the caesarean rate being 9.5%. As 10.7% of primigravid women required rotational delivery with Kielland's forceps, it is desirable that primigravid women should be cared for by obstetricians who are skilled in the use of the instrument, in order to maintain a low caesarean section rate in this group, with a good neonatal outcome.