农村两县县级医院剖宫产率升高的因素分析

目的:了解农村县级医院近年来剖宫产率升高的变化趋势和剖宫产手术指征构成的变化情况;分析县级医院剖宫产率升高的主要医学和社会因素,提出控制和降低剖宫产率的干预措施。方法:通过病历回顾分析和定性研究相结合的方法,对河北省某县和四川省某县县级医院剖宫产率较高的2003年和较低的1997年剖宫产的影响因素以及剖宫产率升高的原因进行深入分析。应用SPSS11.0软件对数据进行分析。结果:农村县级医院近年来剖宫产率呈逐年上升趋势,剖宫产手术指征中除常见的相对头盆不称和胎儿窘迫外,河北县级医院脐带绕颈和妊高征的比例明显上升,四川县级医院孕妇及家属要求的比例上升至第1位。患孕产期合并症/并发症的比例增加、孕妇产前BMI指数和体重的增高分别是两县县级医院剖宫产率升高的重要因素。在社会因素方面,孕妇及家属要求手术和医生避免医疗纠纷是县级医院剖宫产率升高的主要原因。结论:在农村地区应通过提高孕产期保健服务质量,加强专业人员培训,开展健康教育等措施,尽快控制和降低剖宫产率。

Analysis on effect factors of high cesarean section rate in two county level hospitals

Objective:To understand the change tendency of cesarean section rate and changes of constitution of cesarean section indications in two county level hospitals,analysc the main medical and social factors about cesarean section rate in two county level hospitals so as to provide intervention measures to control and decrease cesarean section rate.Methods:Effect factors and causes of high cesarean section rate in 2003 and 1997 were analysed in two county level hospitals,then the results were analysed by SPSS 11.0.Results:The rate of cesarean section in rural areas increased year by year.In county level hospitals of Hebei,the percentages of cord around neck and hypertensive disorder complicating pregnancy in Hebei increased,except cephalopelvic disproportion and fetal distress;the percentage of demand of pregnant women and their families in Sichuan increased to the first place.The main effect factors of high cesarean section rate in two counties were increased incidences of complications,high BMI and body weight,respectively.Demand of pregnant women and their families and avoidance of medical disputes were main social effect factors of high cesarean section rate in county level hospitals.Conclusion:Improving the quality of prenatal health care services,strengthening training of staff and developing health education may control and reduce cesarean section rate.