以胎儿窘迫为指征的剖宫产416例分析

Analysis of 416 cases with indication of fetal distress undergoing cesarean section

目的分析探讨以胎儿窘迫为指征而行剖宫产术诊断的准确性及手术的合理性,降低以胎儿窘迫为指征的剖宫产率。方法对1993年10月至2003年10月间416例以胎儿窘迫为指征的剖宫产病例资料进行回顾性分析。结果以胎儿窘迫为指征者占剖宫产总数的20.90%,居首位。术前术后胎儿窘迫诊断符合率较低,表明对胎儿窘迫存在有诊断过度的问题,提示有一部分不合理的操之过急的剖宫产存在,缺乏合理性,诊断标准欠妥当。单纯根据胎心率或羊水情况诊断胎儿窘迫欠妥当,而胎心监护仪准确度亦有一定局限性。结论诊断胎儿窘迫尚需多方面其他因素综合判断,采用产前多项指标联合监测及产时全程监护方法,探索医学规范的评判标准,结合孕妇的具体情况进行全面分析,提高胎儿窘迫的诊断符合率。正确掌握剖宫产指征,降低剖宫产率。

Objective To analyse the correctness of diagnosis and rationality of cesarean section which indication of fetal distress ,to decrease the ratio of the operation. Methods We analysed retrospectively 416 cases with indication of fetal distress undergoing cesarean section from Oct. 1993 to Oct. 2003. Results Fetal distress was the first indicatio of cesarean section （20.90%）. Diagnose accordance rate of fetal distress was comparatively low before and after operation. It indicated that there had immoderate diagnosis of fetal distress. It indicated that there had immoderate cesarean section without appropriate diagnostic criteria. It was unconscionable to have the diagnosis of fetal distress only with fetal heart rate or amniotic fluid condition. And fetal heart monitor had limitations in degree of accuracy. Conclusion It need judgement of multiple factors to have diagnosis of fetal distress. The diagnose accordance rate of fetal distress can be increased with united - monitoring of multiple indications in an- tepartum and whole range monitoring in intrapartum, normative diagnosis standard, multi -analysis of gravida＇s state. We should grasp the indicatio of cesarean section to decrease the ratio of cesarean section.