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。

Causes for the rise of cesarean section rate and its countermeasures

Objective:To study the causes for the increase of cesarean section rate(CSR) and the countermeasures.Methods:The number of gravitas delivered in our hospital during 1991-2004,the number of cesarean section and the number of forceps delivery and fetal aspiration were recorded.The change of CSR and the indication of cesarean section(CS) during the last 14 years were analyzed retrospectively.Results:The CSR increased year by year during the last 14 years.Dystocia(including uterine inertia,relative cephalopelvic disproportion,fetal macrosomia,persistent occiput posterior position and persistent occiput transverse position etc. were the first indication of CS, but fetal distress and social factors played an important role in the rise of CSR.The differences were significant(P<0.05-P<0.01).Meanwhile, the rate of obstetrical forceps and fetal aspiration decreased gradually.Conclusions:Fetal distress and social factors are the main causes for the rise of CSR.Correct diagnosis of fetal distress,proper management of dystocia,strict mastery of the indication of CS,psychological control and reliable delivery can help reduce the CSR.