二胎政策开放前后5706例剖宫产指征分析

目的 分析二胎政策开放前后剖宫产指征分布的变化,探讨降低剖宫产率的有效措施。方法 选取2013年1月至2016年12月同济大学附属第十人民医院住院分娩剖宫产患者5706例,对其剖宫产指征构成及变化进行回顾性分析。结果 2013—2016年,剖宫产率平均为51.26%(5706/11131),新生儿窒息率为1.93%(215/11131),2016年剖宫产率明显低于2013—2015年(P<0.01),但新生儿窒息和围产儿死亡率无明显改变(P>0.05)。剖宫产主要指征依次为: 社会因素、瘢痕子宫、胎儿窘迫、产程异常、引产失败；2015、2016年瘢痕子宫的构成比明显高于2013、2014年(P<0.01),呈递增趋势；2016年,产程异常剖宫产率明显低于2013—2015年(P<0.01)。2015、2016年,经产妇、高龄产妇数量明显上升(P<0.01)。结论 二胎政策开放后,以瘢痕子宫为指征的剖宫产构成比升高,但总体剖宫产率并未增高；高龄产妇、经产妇数量增多。

Indications for cesarean section in 5706 cases since implementation of two-child policy

ObjectiveTo investigate the changes of indications for cesarean section since the implementation of two-child policy. Methods The indications for cesarean section of 5706 cases performed in Shanghai Tenth People''s Hospital from January 2013 to December 2016 were analyzed retrospectively. Results From 2013 to 2016, the average rate of cesarean section delivery was 51.26% (5706/11131), neonatal asphyxia rate was 1.93% (215/11131). Cesarean section rate in 2016 was significantly lower than that from 2013 to 2015 (P<0.01), and the neonatal asphyxia and perinatal mortality rate did not increase (P>0.05). The main indications of cesarean section were social factors, uterine scar, fetal distress, abnormal labor and induction failure. The constituent ratio of uterine scar in 2015 and 2016 was significantly higher than that of the previous 2 years (P<0.01) with an increasing trend. Abnormal labor cesarean section rate was significantly lower than that of the previous 3 years (P<0.01). In 2015 and 2016, the number of multiparae and older mothers significantly increased (P<0.01). Conclusion After the implementation of two-child policy, the constituent ratio of uterine scar for cesarean section, the number of multiparae and older mothers are significantly increased, but the overall cesarean section rate is not increased.