537例经产妇分娩方式及难产因素分析

目的:分析经产妇分娩方式及难产因素,探讨经产妇各项剖宫产指征的合理性,寻求降低经产妇剖宫产率的对策,提高经产妇母儿安全水平。方法:将1999年3月～2009年2月无妊娠合并症的537例经产妇按分娩时间分为前5年组和后5年组,对其基本特征、分娩方式、难产主要因素进行分析比较。结果:后5年组与前5年组比较,经产妇年龄呈明显增加趋势;自然分娩率、阴道助产率、臀位助产率降低,剖宫产率增高;臀位妊娠发生率无变化,瘢痕子宫比例明显增加,其剖宫产率均明显增高。结论:应加强经产妇的围产期保健及高危妊娠管理,重视有阴道助产史和胎儿体重较前次分娩新生儿体重有较大增加的孕妇的产程,避免发生母儿并发症;通过降低臀位妊娠和瘢痕子宫经产妇的剖宫产率,可以合理降低经产妇的剖宫产率。

Analysis on delivery modes and dystocia factors of 537 multiparous women

Objective:To analyze delivery modes and dystocia factors of multiparous women,explore the rationality of various indications of cesarean section in multiparous women,find countermeasures to reduce the rate of cesarean section,and improve safety levels of multiparous women and their infants. Methods:A total of 537 multiparous women without pregnant complications from March 1999 to February 2009 were divided into former five-year group and latter five-year group according to delivery time,then the basic characteristics,delivery modes,and main dystocia factors were analyzed and compared. Results:Compared with former five-year group,the age of multiparous women in latter five-year group showed a significant increasing trend;the rates of spontaneous abortion,vaginal midwifery,and breech presentation midwifery decreased,the rate of cesarean section increased;but the incidence of breech presentation pregnancy didn't change,the proportion of multiparous women with scar uterus increased significantly,and the rate of cesarean section in multiparous women with scar uterus increased significantly. Conclusion:Perinatal care and high risk pregnancy management of multiparous women should be strengthened,more attention should be paid to the labor course of pregnant women with history of vaginal midwifery and significant increase of neonatal weight compared with the last pregnancy to avoid maternal and infantile complications;the rate of cesarean section of multiparous women can be reduced reasonably by reducing the cesarean section rates of multiparous women with breech presentation pregnancy and scar uterus.