剖宫产率升高和指征变化的多因素分析

Analysis of the Factors Leading the Rising Cesarean Section Rate and Changes of Cesarean Section Indication

目的:探讨导致剖宫产率升高及指征变化的原因,寻求降低剖宫产率的措施。方法:回顾性分析8年间在我院住院产妇的病例资料,分为三种分娩方式:顺产、阴道助产(包括吸引产和产钳助产)和剖宫产。结果:1996年至1999年剖宫产率显著低于2000年至2003年的,分别为31.4%和42.0%,差异有极显著性(P<0.01);而前者阴道助产率(9.5%)显著高于后者(3.1%)(P<0.01)。在剖宫产指征中,难产和胎儿宫内窘迫占据第1和2位,社会因素近4年上升到第3位。结论:社会因素的增加、阴道助产的下降是导致剖宫产率升高的主要原因,因此严格掌握剖宫产指征和严密观察产程同时适当提高阴道助产的比率是降低剖宫产率有效措施。

Objective: To investigate the factors leading the rising cesarean section rate and changes of cesarean section indication and look for the means to decreasing the cesarean section rate. Method: We studied retropectively all the delivery cases in our hospital from Jan 1996 to Dec 2003, and divided them into three groups: nature delivery, aspirator or forceps delivery and cesarean section. Result: The cesarean section rate in 1996～1999 was significantly lower than that in 2000～2003(31.4% vs. 42.0%, P<0.01), and the rate of aspirator or forceps delivery was 9.5% in 1996～1999, which was significantly higher than that of 3.1% in 2000～2003 (P<0.01). The dystocia and fetal distress were the first and second indications of cesarean section, social factor was elevating to the third. Conclusion: The social factor and decreasing rate of aspirator or forceps delivery were the main causes leading to the persisting rise of cesarean section rate. In order to decrease the rate of cesarean section, we should encourage the reasonable aspirator or forceps delivery under the strict observation of labor course and strictly grasp the medical indication of cesarean section.