上海市剖宫产率及其影响因素

The rate of cesarean section and its effect factors in Shanghai

目的:了解上海市剖宫产率现状及其相关影响因素,为制定相应干预措施提供科学依据。方法:通过查阅分析历年报表了解剖宫产变化趋势,通过现场问卷调查,了解2009年住院分娩的孕产妇及提供孕产期服务相关的医务人员对分娩方式的认知与选择。结果:①上海市的剖宫产率呈上升趋势,近5年相对稳定波动在51%左右。②孕产妇对分娩方式的选择意向在孕期的不同时期有显著变化,越接近分娩对剖宫产的选择意向越强。③剖宫产指征前3位分别为:社会因素(34.4%)、胎儿窘迫(16.8%)、疤痕子宫(9.9%),以社会因素为首位,尤以上海市户籍者为明显(54.14%),主要是怕痛、担心胎儿安全、医务人员建议等。④上海市户籍产妇选择剖宫产主要受个人心理因素及周围环境影响,而外地户籍者选择剖宫产主要受经济、文化水平影响;医务人员对剖宫产弊端的低认知、医疗风险的规避、收益的考虑等使其更倾向于剖宫产。结论:剖宫产率居高不下,影响因素复杂。急需加强健康教育、推广产时适宜技术、提高助产质量等以降低剖宫产率。

Objective：To understand the status of cesarean section rate and its effect factors in Shanghai,provide a scientific basis for making related intervention measures.Methods：The trend of change of cesarean section rate was studied by analyzing relative report forms.The cognitions and choices of pregnant women delivering in the hospital and related medical workers who provided maternal services in 2009 were investigated by field investigation with a questionnaire.Results：The rate of cesarean section in Shanghai showed a increasing trend,fluctuating around 51% in recent 5 years.The willing to choose delivery modes among pregnant women changed during different gestational periods,and the willing to choose cesarean section became stronger when delivery approached.The top three indications for cesarean section were：social factors （34.4%）,fetal distress （16.8%） and scar uterus （9.9%）.The social factors were the more common factors,especially among Shanghai residents （54.14%）,including being afraid of pain,anxiety of fetal safety and advices from medical workers.For Shanghai residents,the choice of cesarean section was affected by personal psychological factors and environment,while for the immigrants,it was affected by economic status and educational level; the low cognition of medical workers to adverse effects of cesarean section,avoidance of medical risks and consideration of profits made the medical workers prefer cesarean section.Conclusion：The effect factors of high cesarean section rate are complicated.Health education,developing proper midwifery technology and improving maternal quality are emergently required to reduce the cesarean section rate.