临产后剖宫产率及适应证变化对总剖宫产率影响的分析

目的探讨临产后剖宫产率及适应证变化对总剖宫产率的影响。方法总结1990、1996及2002年各年1～6月所有完整在案的临产后剖宫产病历458例，各分为有适应证组及无适应证组，分析其剖宫产率变化及适应证变化。结果临产后剖宫产率占临产后总分娩人数的比例呈上升趋势。1990年及1996年各为22．O％及20．8％，2002年为39．4％。在有无适应证两组对比中，2002年无产科适应证而手术者的比例与前两年相比明显增加，1990年及1996年无适应证组的剖宫产数占临产后总剖宫产数的比例分别为33．84％及32．58％，而2002年无适应证组的剖宫产数占临产后总剖宫产数的比例为63．37％。在有产科剖宫产适应证者中，“试产失败”的比例2002年与1990年及1996年比较明显增加，1990、1996及2002年各为11．45％、16．67％及25．81％。胎儿窘迫的比例则下降，1990、1996及2002年各为25．19％、21．67％及12．90％。结论临产后剖宫产率的增加是近年来剖宫产率逐年增高的重要原因之一。重视社会因素，加强孕产期宣教及保健，重视潜伏期及第一产程的管理监护及心理护理问题，是降低临产后剖宫产率的重要措施之一。

The effect of the variation of cesarean sections during labor and their indications on total cesarean section rate

Objective To investigate the effect of variation of cesarean sections during labour and their indications on the total cesarean section rate. Methods A total of 458 cases of cesarean section was selected from January to June of 1990,1996,2002. They were divided as indication group and no indication group. The change of the indication and cesarean section rate was compared. Results The ratio of cesarean section during labour in total cesarean sections rised. The ratio was 22.0%, 20.8% and 39.4% in 1990, 1996 and 2002 respectively. The proportion of no indication surgery in 2002(63.37%) showed significant growth as compared with that of 1990 (33.84) and 1996 (32.58). Of all cases of cesarean section having indications, the rate of trial produce failure increased in 2002 (25.81%) while it was 11.45% and 16.67% in 1990 and 1996 respectively. The rate of fetal distress decreased from 25.19% (1990), 21.67% (1996) to 12.90% (2002). Conclusion Ascen ding of cesarean section rates during labour was an important factor that increased cesarean section rate in recent years. To decrease the total rates of cesarean section, many important measures should be done such as paying more attention to social factors, reinforcing propaganda and maternal health care , encouraging spontaneous vaginal delivery, emphasizing company during labour and analgesia or pain free delivery, laying stress on the management and monitoring during first stage of labour as well as psychological care.