2016年上海市3538例经产妇二次分娩方式及影响因素研究

目的 探讨上海市经产妇二次分娩方式的选择及影响因素。方法 2016年7 - 10月份，调取上海市20家接产医院2016年1 - 6月份产次为2的孕产妇（包括本次分娩）的分娩病史，摘抄与本次研究相关的病史资料作为调查数据并进行分析。结果 上海市经产妇二次分娩时剖宫产率为47.60%，其剖宫产指征主要为疤痕子宫（74.28%）；既往剖宫产者二次分娩剖宫产率高于既往阴道分娩者（OR = 122.315，95%CI: 91.705～163.142），差异有统计学意义（P＜0.05）；大专及以上学历者二次分娩时剖宫产率高于初中及以下学历者（OR = 0.545,95%CI:0.315～0.945），差异有统计学意义（P＜0.05）；随着年龄（OR = 0.385，95%CI: 0.227～0.651；OR = 0.627，95%CI: 0.489～0.804）、流产次数（OR = 0.493，95%CI: 0.328～0.739；OR = 0.648，95%CI: 0.438～0.960）的增加，二次分娩时剖宫产率也随之升高，差异均有统计学意义（P＜0.05）。结论 经统计学检验，既往剖宫产、流产次数、年龄以及文化程度与经产妇二次分娩剖宫产风险呈正相关。

Study on the methods and influencing factors of 3538 multiparas in Shanghai in 2016

Objective To investigate the way and related factors of multiparas secondary delivery in Shanghai. Methods 20 hospitals which had obstetrics were selected from July to October of 2016, the history of maternal delivery from January to June in 2016 were copied in these 20 hospitals and took the delivery history of maternal (including this birth) was 2 as the data of this study. Results The rate of cesarean section was 47.60% and the indications for cesarean delivery was scar uterus (74.28%) in the secondary delivery of maternal. The rate of cesarean section in previous cesarean is higher than the previous natural delivery (OR=122.315, 95%CI: 91.705-163.142),the difference was statistically significant(P<0.05). The rate of cesarean section in the secondary education and above is higher than those of junior high school and below (OR=0.545, 95%CI:0.315-0.945), the difference was statistically significant(P<0.05). With the increase of age(OR=0.385, 95%CI: 0.227-0.651; OR=0.627, 95%CI: 0.489-0.804) and the number of abortion(OR=0.493， 95%CI: 0.328-0.739；OR=0.648, 95%CI: 0.438-0.960), the rate of cesarean section increases in the secondary delivery of maternal, the difference was statistically significant(P<0.05). Conclusion It is necessary to take appropriate measures to reduce the rate of second childbirth on the factors such as past mode of delivery, the number of abortion, age and educational level.