剖宫产率升高原因分析

Related-factor analysis of increasing cesarean delivery

目的探索剖宫产率升高的原因及剖宫产适应证的变化趋势。方法对2007年2月至2009年3月在满城县医院行剖宫产的496例病例进行回顾性分析。结果胎儿因素256例,其中胎位异常(臀位、枕横位或枕后位)69例(13.91%),胎儿窘迫30例(6.05%),羊水过少30例(6.05%),脐带绕颈25例(5.04%),巨大胎儿23例(4.64%),前置胎盘20例(4.03%),双胎5例(1.01%);骨盆狭窄54例(10.89%);孕妇因素95例,其中妊娠肝内胆汁淤积28例(5.65%),妊娠期高血压25例(5.04%),高龄初产19例(3.83%),疤痕子宫13例(2.62%),过期孕10例(2.02%);社会性因素36例(7.3%)。结论胎儿临产异常及孕妇合并疾病仍是剖宫产手术的主要手术指征,但来自孕产妇及医生的主观意愿也影响着对分娩方式的选择。

Objective To explore the trend of changes in the indications for caesarean section. Methods Data from 496 women delivering by cesarean section from February 2007 to March 2009 in our hospital were analyzed retrospectively. Results Cesarean section was performed due to the following factors： fetal factors of 256 fetuses, including 69 cases of malpresentations（13.91%）, 30 cases of intrapartum fetal distress（6.05%）, 30 cases of oligohydramnios （6.05%）, 25cases of fetal necks circled by umbilical cord （5.04%）, 23cases of fetal giants （4.64%）, 20 cases of placenta previa （4.03%）, and 5 cases of twins （1.01%）; 54 cases of pelvis constriction （10.89%）; factors of 95 gravidas, including 28 cases of cholestasis of pregnancy, 25 cases of pregnancy-induced hypertension syndrome （5.04%）, 19 cases of advanced age primigravidas （3.83%）, 13 cases of scarred uteruses（2.62%）, and 10 cases of pregnancies exceeding the time limit（2.02%）; and social factors in 36 cases（7.3%）. Conclusion Intrapartum abnormality and diseases in pregnancy are still the main contribution to rates of caesarean section, but the request of pregnancy women and subjective inclination of obstetricians also affect the choice of labor patterns.