3省27个县(市)剖宫产流行趋势及影响因素研究

The study of cesarean-section trend and related factors

目的:通过描述剖宫产的流行趋势和分布特点,找出剖宫产的主要影响因素,为有关部门制定有效的干预计划提供依据,达到在保护孕产妇和胎/婴儿健康的前提下降低剖宫产率的目的.方法:对北京大学生育健康研究所的围产保健监测资料进行整理和分析.研究对象为江苏、浙江、河北3省27个县(市)1993～2000年间孕28周以上、有完整分娩记录的妇女共1093526例.结果:研究地区的剖宫产率从1993年的15.9%上升至2000年的44.4%,平均每年的环比增长速度为15.9%;南北方、城乡的剖宫产率均呈上升趋势,且南方比北方增长快;城市剖宫产率高于农村,南方高于北方;医院级别越高,剖宫产率越高;产妇年龄越高剖宫产率越高;干部和经商人员的剖宫产率比工人和农民的剖宫产率高;文化程度越高剖宫产率越高;婴儿出生体重越大剖宫产率越高.Logistic回归分析结果表明,有无剖宫产指征、分娩医院的级别、南北方、产妇的年龄、文化程度、城乡、婴儿出生体重、孕周、年度、星期几均是剖宫产影响因素.结论:研究地区剖宫产率呈上升趋势;医生放松剖宫产指征或对指征的错误诊断是造成剖宫产率上升的主要原因.

Objective: Describe the trend and distribution of the cesarean-section (CS), determine the CS's related factors. Methods: Analysis of the perinatal healthcare surveillance data collected by the Reproductive Healthcare Institute of Peking University. During the period of 1993 - 2000, the Institute collected totally 1 093 526 women's perinatal data from 27 counties (or cities) in 3 provinces of China. Results: The CS's trend is upward nearly linearly, from 15. 9% in 1993 up to 44. 4% in 2000, the annual average cycle-increase rate is 15.9%. The CS's trends of north and south and city and rural area are all increasing, the increase speed of CS's rate in south is quicker than that in north. The CS's rate of city is higher than that of rural area, and the CS's rate of south is higher than that of north. The higher the hospital's level, the higher the CS's rate. The older the women, the higher the CS's risk. The CS's rates of cadres and commercial employees are higher than those of workers and farmers. The higher the women's education, the higher her CS's risk. The longer the gestation, the higer the CS's risk. The heavier the fetus' birth weight, the higher his CS's risk. The results of Logistic regression suggest that indications, hospital level, north or south, city or rural, birth weight, gestational ages, year, weekday are the CS's related factors. Conclusion: The CS's rate of the 27 counties (cities) keeps going up; the chief causes for the increasing of CS's rate are doctors' broadening CS's indications or doctors' misdiagnose for CS's indications.