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     

Attitudes of Midwives in Sweden Toward a Woman’s Refusal of an Emergency Cesarean Section or a Cesarean Section on Request

Background: A woman’s refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician’s decision making in relation to a woman’s refusal of an emergency cesarean section and to a woman’s request for a cesarean section without a medical indication. Methods: The study has a cross‐sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). Results: In the case of a woman’s refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman’s request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman’s decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman’s autonomy in this situation. If the only reason was “her own choice,” 77 percent of the midwives responded that the obstetrician should not comply. Conclusions: The main focus of midwives seems to be the baby’s health, and therefore they do not always agree with respect to a woman’s refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician. (BIRTH 38:1 March 2011)     

Central Fetal Monitoring: Effect on Perinatal Outcomes and Cesarean Section Rate

ABSTRACT: Background: In a trend similar to continuous electronic fetal monitoring, many hospitals are incorporating central fetal monitoring into labor and delivery suites. The objective of this study was to investigate whether the use of central fetal monitoring had an effect on neonatal outcomes or cesarean section rate. Methods: This retrospective study involved patient data from deliveries occurring at Women and Children’s Hospital of Buffalo, Buffalo, New York, between the years 2000 and 2003. In the period from January 1, 2000, to December 31, 2001, central fetal monitoring was available, whereas in the period from February 1, 2002, to December 31, 2003, it was unavailable. Data on deliveries at Women and Children’s Hospital of Buffalo were obtained using the Western New York Perinatal Data System, which is an electronic data set based on birth certificate information. The method of delivery, admission to the neonatal intensive care unit, and 5‐minute Apgar scores less than 7 were compared for deliveries occurring with and without the use of central fetal monitoring. These outcomes were further subdivided into full‐term and preterm deliveries. Results: Three thousand five hundred and twelve deliveries used central monitoring and 3,007 deliveries did not. For full‐term deliveries, in the years with central fetal monitoring compared with the years without it, no differences in the cesarean section rate (13.4 vs 14.5%, not significant [NS]), the admission rate in neonatal intensive care unit (3.3 vs 3.3%, NS), or the incidence of Apgar score less than 7 (0.6 vs 0.5%, NS) were observed. For preterm deliveries, comparing the years with central fetal monitoring with the years without, no differences in the cesarean section rate (21.3 vs 21.3%, NS), the admission rate in neonatal intensive care unit (17.7 vs 20.1%, NS), or the incidence of Apgar score less than 7 (7.0 vs 6.5%, NS) were observed. Analyses pooling all deliveries also failed to show any differences in any of the parameters. Conclusions: No statistically significant difference was demonstrated in the rates of cesarean section, admission to the neonatal intensive care unit, or incidence of Apgar scores of less than 7 associated with the use of central fetal monitoring. Therefore, we could not identify any benefit to the use of central fetal heart rate monitoring. (BIRTH 33:4 December 2006)     

Estimating the Rate of Cesarean Section by Maternal Request: Anonymous Survey of Obstetricians in Australia

Background: The rate of cesarean section in Australia now exceeds 30 percent, and evidence from population studies indicates that maternal requests for elective cesarean delivery might make an important contribution. The objective of this study was to explore the rate of such deliveries in Australia, in the absence of a formal investigation. Methods: An anonymous survey was sent to all 1,239 specialist obstetricians and 317 obstetric specialty trainees in Australia. Specialists were asked the number of elective cesarean deliveries they performed in 2006 that satisfied the National Institutes of Health definition of maternal request cesarean delivery. Trainees were asked whether they intended to agree to maternal requests for cesarean section in their future specialist practice. Results: The response rate from specialists was 98.6 percent, and from trainees was 81 percent. To account for possibility of multiple submissions, we performed two analyses: one using all responses, the other after removing 297 surveys in the second mail‐out that were identical to surveys received from the first mail‐out (n = 735). Proportions were similar in both groups. We estimated that between 8,553 and 12,434 maternal request cesarean sections were performed in Australia in 2006, representing at least 17 percent of all elective cesarean sections, and slightly more than 3 percent of all births. Conclusion: Maternal request is an important contributor to cesarean section rates in Australia.     

The Rise of the Caesarean Section: A Review

Summary: Caesarean section is of recent development as a credible procedure. A rapidly increasing incidence in many countries has led to far-ranging concern. Proposed causes for the increase include insistence on repeat operations and a resultant cumulative effect, more frequent diagnoses of disproportion and ineffective labour, the use of fetal heart monitoring, and a steady trend away from vaginal breech delivery. Increased perinatal morbidity is seen in Caesarean section, together with a qualified increase in perinatal mortality. Maternal morbidity is greater and maternal death rates are reportedly 2–4 times greater in Caesarean section births. More work is needed on the psychosocial sequelae of abdominal delivery.     

Difficult Deliveries in Cesarean Section

Cesarean section rate has been on the rise. It is commonly perceived as a simple and safe alternative to difficult vaginal birth. However, there are situations during C section where delivery of fetus may be difficult. This can cause maternal and fetal complications. To avoid such mishaps, anticipation of potential difficulties and planning in advance can be fruitful. This amounts to mobilization of a good team of anesthetist, assistant and skilled neonatologist. Proper technical skills are needed not only to use the equipment but to deal with such situations for safe delivery of the fetus. The training in technical skills can be imparted through drill protocols under C section skills. This way, one should try and accomplish safe atraumatic fetal delivery.     

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...     

Trends in Cesarean Delivery: Rate and Indications

Objectives

To compare the cesarean delivery rates over the last decade and to examine the indications contributing to changed trends, if any.

Methods

To compare the rate and indications of cesarean delivery over the last decade, the data were collected in a retrospective manner from all the deliveries that occurred between January 1 and December 31 in 2001, 2006, and 2011, in the department of obstetrics and gynecology, Seth G.S. Medical College and K.E.M. Hospital, a large tertiary care municipal hospital in Western India. A cohort of 20853 delivered women was studied. The rates and indications of primary and repeat cesarean sections were analyzed among the live births to estimate the relative contribution of each indication to the overall increase in rate.

Results

The cesarean delivery rate increased from 171.70 to 289.30 per 1,000 live births, with an increase in primary cesarean delivery rate from 118.53 (69.03 %) in 2001 to 210.09 (72.62 %) in 2011 per 1,000 live births. Fetal distress, arrest of descent, multiple gestations, and fetal indications contributed to this increase.

Conclusions

There is a significant increase in the total cesarean rate with primary cesarean accounting for most of the increase.     

止血带在前置胎盘剖宫产术中的应用

目的:评估止血带在前置胎盘剖宫产术中的应用效果。方法:选择2004年1月至2010年12月在我院入院的前置胎盘患者共142例,胎盘均位于子宫下段前壁。采用常规方法行子宫下段横切口70例为对照组,研究组72例,在切开子宫之前,用橡胶止血带扎住子宫下段,结扎点在胎先露下方,在止血带上方切开子宫,迅速娩出胎儿。结果:研究组平均术中出血量、产后出血发生率均显著低于对照组,两组比较差异有高度统计学意义(P<0.01),研究组无一例子宫切除。两组新生儿出生体重、Apgar评分、脐动脉血pH值比较差异无统计学意义(P>0.05)。两组均无围生儿死亡。结论:对位于子宫前壁的前置胎盘,在切开子宫之前使用止血带,能显著降低术中出血量,是一种安全、有效的处理前置胎盘术中出血的新措施,对新生儿结局无不良影响。     

改良式剖宫产术132例分析

探讨改良式剖宫产术的临床价值。方法于下胜利部两髂前上棘连线下２－３ｃｍ处做横行直切口,钝性分离脂肪层及腹直肌,横向撕开腹膜,肠线单层连续缝合子宫肌层,不缝合腹膜,肠线连缝合膜及间断全层缝合皮肤及下组织。     

1989 U.S. Cesarean Section Rate Steadies—VBAC Rate Rises to Nearly One in Five

ABSTRACT: The 25 years of rising cesarean delivery rates in the United States may have finally run their course. In 1989 the rate of 23.8 cesareans per 100 deliveries was not significantly different from 24.7 in 1988, 24.4 in 1987, or 24.1 in 1986. The 1989 primary rate of 17.1 first cesareans per 100 women with no previous cesarean was also not significantly different from 17.5 for 1988, or 17.4 for 1987 and 1986. The percentage of vaginal births after cesarean section per 100 deliveries showed a remarkable rise between 1988 and 1989—from 12.6 percent in 1988 to 18.5 percent in 1989. Data are from the National Hospital Discharge Survey conducted by the National Center for Health Statistics, Centers for Disease Control.     

剖宫产术中回收式自体输血研究进展

迄今为止,产后出血仍然是全世界范围内孕产妇死亡的首要原因,输血在治疗产后出血中起着非常重要的作用,尤其是产后大出血及难治性产后出血,临床多以异体血的输注为主,自体输血很少见。由于术中回收式自体输血（IOCS）可能导致医源性羊水栓塞、同种异体免疫性溶血等,在一定程度上阻碍了其在剖宫产术中的开展。但近年随着我国高危、瘢痕子宫等孕妇增多及自体输血相关技术的提高,IOCS在剖宫产术中的临床应用逐渐增多,其有效性及安全性得到证实,不仅可以减少异体输血,防止异体输血的并发症与不良反应发生,某种程度上也解决了血液资源稀缺问题,同时减轻了产妇及社会经济负担,降低妊娠不良结局发生率,甚至挽救产妇生命。现对剖宫产术中血液回收和回输有关问题及临床应用进行综述。     

Maternal–Fetal Conflict: Court-Ordered Cesarean Section

Advances in prenatal care have created areas of conflict between the pregnant woman and her fetus. Court orders mandating cesarean section have denied to pregnant women rights that are accorded to all other competent adults in the United States. The caregiver–patient relationship can become adversarial in such situations. Nurses participating in the decision-making process when judicial involvement is being considered must be informed about the issues.     

Updating Care of Cesarean Section Patients

At a time when prepared childbirth and the participation of both parents in labor and delivery is being stressed, nurses need to reexamine the impact of a cesarean section on the family. Nurses need to he active in modifying those experiences of a cesarean section family that may he in direct conflict with their expectations: loss of participation in delivery, separation of the couple during delivery, diminution of the father's role, and prolonged isolation of the infant front the parents after delivery. Nursing cure of these patients should be maternity-oriented rather than surgery-oriented.