剖宫产指征10年回顾

目的:分析剖宫产指征变化,探讨剖宫产率居高不下的原因及降低剖宫产率的可行性措施。方法:对松江分院2000年1月1日～2009年12月31日住院剖宫产分娩的8 888例患者的病历资料进行回顾性分析。结果:①在剖宫产指征构成比中,社会因素位居第一,其次依次为胎儿窘迫、头盆不称、疤痕子宫、臀位等。②10年来社会因素剖宫产指征呈快速上升趋势,在3个阶段的剖宫产指征构成比中分别为8.2%、54.4%和37.6%。第三阶段社会因素剖宫产指征构成比较前明显下降,P<0.01,是总剖宫产率明显下降的主要原因,P<0.01,但仍维持在一个较高水平。10年来以疤痕子宫为指征在剖宫产指征构成比中有逐年上升趋势,P<0.05或<0.01。③围产儿死亡率无统计学差异(P>0.05)。结论:①降低剖宫产率的关键在于严格掌握剖宫产指征,提高产科质量,提高阴道助产技术水平;加强孕产期保健及其健康教育,提高人们对剖宫产并发症的认识,降低以社会因素为指征的剖宫产率。②剖宫产率在一定范围内降低了围产儿死亡率,但剖宫产率的进一步升高,围产儿死亡率并未随之下降。因此,应合理掌握剖宫产指征,降低剖宫产率。

Retrospective analysis on the indications of cesarean section from 2000 to 2009

Objective:To analyze the change of indications of cesarean section,explore the causes of high cesarean section rate and the feasible measures to reduce cesarean section rate.Methods:The medical data of 8 888 hospitalized cases who underwent cesarean section in the hospital from January first,2000 to December 31st,2009 were analyzed retrospectively.Results:Among the proportions of indications of cesarean section,social factor ranked the first,followed by fetal distress,cephalopelvic disproportion,scar uterus,and breech presentation,and so on.From 2000 to 2009,cesarean section rate induced by social factor increased rapidly,the proportions among three stages of indications of cesarean section were 8.2%,54.37%,and 37.6%,respectively.During the third stage,the proportion of cesarean section induced by social factor decreased significantly(P<0.01),which was the main reason of decrease of cesarean section rate(P<0.01),but it still maintained at a relatively high level.From 2000 to 2009,the proportion of scar uterus among the indications of cesarean section showed an increasing trend year by year(P<0.05 or P<0.01).There was no significant difference in perinatal mortality(P>0.05).Conclusion:The key points to reduce cesarean section rate are grasping the indications of cesarean section,improving the quality of obstetric department and technical level of vaginal midwifery,enhancing gestational health care and health education,improving the cognition of persons about complications of cesarean section,reducing the cesarean section rate induced by social factor.Cesarean section rate reduces perinatal mortality in a certain range,but perinatal mortality doesn’t decrease with the increase of cesarean section rate.Thus,the indications of cesarean section should be mastered reasonably and the rate of cesarean section should be reduced.