上海市区级医院剖宫产指征及影响因素分析

Analysis on indications and influence factors related to cesarean section in three district hospitals in Shanghai city

目的了解剖宫产指征及分析高剖宫产率的相关影响因素。方法对2001年5月～2003年2月到上海市3所区级妇幼保健院做产前检查的孕妇进行问卷调查。结果在933名基线调查对象中，剖宫产率为37．6％，居于前4位的剖宫产指征分别为胎儿宫内窘迫（36．5％）、社会因素（35．9％）、相对性头盆不称（18．5％）和妊娠合并症（6．3％）。回归分析发现，孕前体重超重、对分娩没有信心及胎儿体重在4000g以上的对象剖宫产的可能性大。结论目前上海市的剖宫产率相当高，胎儿宫内窘迫和社会因素已成为最主要的剖宫产指征，较高的剖宫产率与孕妇的心理因素和某些人口学特征（孕妇及胎儿体重）密切相关。

Objective To understand the indications and factors related to cesarean section（CS）. Methods Pregnant woment who came for health examination in three selected district hospitals were investigated from May 2001 to Feb 2003. Results Among 933 puerperas, the CS rate was 37.6 % . The top four indications for CS were fetal distress（36.5 % ）, social factors（35.9 % ）, relative cephalopelvic disproportion（ 18.5 % ）and pregnancy complications（6.3 % ） respectively. The result of regression analysis showed that puerperas who were overweight before pregnancy, had no confidence in vaginal delivery and macrosomia were more likely to have CS. Conclusion At present, the CS rate in Shanghai is rather high. The main indications for CS are fetal distress and social factors. The high CS rate is associated with the psychological factor and some demographic factors such as fetal weight and puerperas＇ weight before pregnancy.