医院近七年剖宫产率及剖宫产指征的变化

目的探讨剖宫产率的变化，分析剖宫产各项指征的合理性。 方法对2006年1月至2012年12月山西医科大学第一医院产科6 402例行剖宫产手术分娩产妇的病历资料进行回顾性分析，计算每年剖宫产率及各项剖宫产指征所占比例。结果2006—2008年剖宫产率从71.7%（703/980）下降到61.1%（860/1407），2009年剖宫产率略上升为63.6%（963/1514），2010—2012年剖宫产率从58.3%（1047/1797）下降到45.9%（999/2176）。2006、2007、2009、2010年剖宫产指征构成情况居前3位的为社会因素、妊娠合并症及并发症、胎儿窘迫，2008年居前3位的为社会因素、妊娠合并症及并发症、难产，2011、2012年居前3位的为社会因素、妊娠合并症及并发症、瘢痕子宫。在妊娠合并症及并发症的疾病构成中，构成比由高到低依次为妊娠期高血压疾病、妊娠合并内外科疾病、前置胎盘及胎盘早剥、糖尿病、妊娠期肝内胆汁淤积症。结论妊娠合并症及并发症、社会因素、胎儿窘迫成为剖宫产指征的主要原因。加强产前检查及保健意识可降低妊娠合并症及并发症的发生，严格掌握剖宫产指征可降低因社会因素而行剖宫率。

Changes of cesarean section rate and indications in recent seven years

Objective To study the changes of cesarean section rate, to evaluate the indications for cesarean section and to discuss how to reduce cesarean section rate. MethodsMedical records of 6 402 cases of cesarean section were retrospectively analyzed. The rate of cesarean section and the percentage of various indications of cesarean section were observed. ResultsCesarean section rate had been decreasing. The rate decreased from 71.7%（703/980） in 2006 to 61.1%（860/1407） in 2008. Cesarean rate increased slightly to 63.6% （963/1514） in 2009; cesarean section rate dropped from 58.3%（1047/1797） in 2010 to 45.9%（999/2176） in 2012. Social factors, pregnancy associated complications and fetal distress were the 3 main cesarean section indications in 2006, 2007, 2009, 2010. Social factors, pregnancy associated complications and dystocia were the 3 main cesarean section indications in 2008. Social factors, pregnancy associated complications and uterus scar were presented in the first 3 of cesarean section indications in 2011, 2012. Pregnancy associated complications consisted of hypertensive disorders complicating pregnancy,pregnancy combined with external and internal diseases, placenta previa and placental abruption, diabetes mellitus, gestational,intrahepatic cholestasis of pregnancy. ConclusionsPregnancy associated complications, social factors and fetal distress are the key reasons of cesarean section indications. It is important to strengthen prenatal checks and health awareness, reduce the occurrence of pregnancy associated complications, grasp the medical indication strictly, as well as to decrease the cesarean of social factors.