1761例外来流动孕产妇剖宫产指征分析与健康教育对策

目的研究分析上海市外来流动孕产妇分娩点剖宫产率及其指征,寻找合适的健康教育干预策略。方法对2004年7月至2006年6月之间,复旦大学附属上海市第五人民医院浦江分院1 761份住院剖宫产病例的临床资料进行回顾性分析。结果浦江分院分娩产妇剖宫产率为21.26%。与阴道分娩对象比较:剖宫产产妇年龄偏大、孕周较长且以初产妇为多;产后出血、新生儿体重与妊娠终止方式均存在显著性差异,剖宫产者产后出血发生率更高,更高比例的巨大儿以剖宫产的方式终止妊娠;而新生儿Apgar评分则与妊娠终止方式无明显关系。剖宫产前4位指征为:头位难产、胎儿宫内窘迫、胎位异常、疤痕子宫。在初产妇中,剖宫产指征前3位与总体排序一致,社会因素列第4。经产妇中,剖宫产指征列第1位者仍为头位难产,而疤痕子宫列第2位。结论浦江分院外来孕产妇剖宫产率控制较好,流动人口经济条件差、医疗设置的限制等可能为主要原因。应进一步加强围产保健、优生优育,切实改善外来流动人口的母婴保健状况。

Analysis on Indication of Caesarean Section among 1761 Floating Pregnant Women and Health Education

Objective To study the rate and indication of cesarean section among the floating pregnant women,and to probe a suitable intervention strategy of health education.Methods From July 2004 to June 2006,the clinic data of 1761 caesarean section in Pujiang Branch of Shanghai Fifith Peopls's Hospital affiliated to Fudan University were reviewed and analyzed.Results The rate of caesarean section was 21.26%.Compaired with those delivered vaginally,the pregnant women with caesarean section were at old age,with long gestational ages,and mainly were nulliparas.There were significant differences in postpartum hemorrhage,macrosomia and pregnancy termination between the two methods.The rates of postpartum hemorrhage and macrosomia among women with caesarean section were higher than that among women with delivered vaginally.No statistical difference was detected between the Apgar grading and the methods of pregnancy termination.The main four indications of caesarean section were dystocia,fetal distress,abnormal fetal positions and previous uterine operation.The main three indications of caesarean section among nulliparas were same as the above,and the fourth indication was social factor.The first and second indications were dystocia and previous uterine operation among multiparas.Conclusion Rate of caesarean section is well controlled,which is connected with the poor economic status of migrants as well as the restrictive of medical settings.More efforts need to be enchanced including prenatal care services for floating population so as to improve the health condition of the floating pregnant women.