剖宫产率升高的原因分析及对策

目的:探讨剖宫产率升高的相关因素及与产科质量指标的相关性,针对剖宫产率升高的原因寻找对策。方法:对柳州市人民医院产科19872004年剖宫产率、剖宫产指征及产科质量相关指标进行分析。结果:19871990年、19911993年、19941996年、19972000年及20012004年剖宫产率分别为8.85%、13.51%、15.72%、38.50%、44.97%;新生儿窒息率分别为6.41%、5.34%、4.80%、3.53%、2.62%,有显著性差异(P<0.05);围生儿死亡率分别为19.36‰、10.94‰、7.75‰、11.32‰、10.50‰。前3个阶段围生儿死亡率随剖宫产率的上升有所下降,差异有显著性(P<0.01),后2个阶段围生儿死亡率随剖宫产率的上升,围生儿死亡率无明显下降,差异无显著性(P>0.05)。社会因素和脐带绕颈是近年来剖宫产率上升的主要原因,1995年、2000年、2004年因社会因素和脐带绕颈要求剖宫产分别占当年剖宫产的0.75%及3.74%、5.10%及14.89%、12.22%及14.85%。结论:近阶段剖宫产率升高的原因主要是脐带因素和社会因素所致。加强全民健康教育,加大围产期保健知识的宣传;合理掌握剖宫产指征,提高产时监护技术及助产技术,创造宽松的医疗环境,进一步完善法律制度,建立监督机制,将剖宫产率列为产科质量考核的一项指标。这些措施的施行有助于降低剖宫产率。

Cause of increasing cesarean section rate and countermeasures

Objective:To analyze the cause of increasing cesarean section rate in the last few years and to find some countermeasures against it.Methods:The rate and indication of cesarean section in 31221 women who delivered at Liuzhou People's Hospital in the past eighteen years(from 1987 to 2004) were analyzed retrospectively.Results:The average rate of cesarean section,neonatal asphyxia and perinatal mortality was respectively followed: 8.85%,6.41%,19.36‰ during 1987~1990,13.51‰,5.34%,10.94‰ during 1991-1993,15.72%,4.80%,7.75‰ during 1994~1996,38.50%,3.53%,11.32‰ during 1997~2000,44.97%,2.62%,10.50‰ during 2001-2004,the different among them was significant(P<0.01) except perinatal mortality in the last two stages(P>0.05).Social factors and abnormal cord were the main reasons of increasing cesarean section rate.Social factors section went up year by year from 0.75% in 1995 up to 5.10% in 2000 and 12.22% in 2004,abnormal cord section also went up from 3.74% in 1995 up to 14.89% in 2000 and 14.85% in 2004.Conclusion:Social factors and abnormal cord were the main reasons of increasing cesarean section rate in the last few years,neonatal asphyxia rate decreased as the cesarean section rate increasing,cesarean section was an important solution to detract perinatal mortality,but excess cesarean section could not let it down any more.we should take some comprehensive countermesures to keep the cesarean section under control and gradually reduce it,such as dealing with the indication of cesarean section reasonably and carefully,elevating the technology of deliver.