上海危重孕产妇会诊抢救中心近10年内剖宫产手术指征的变化趋势分析

Analysis the trend of cesarean section indication in Shanghai serious gravida consultation and rescue center in the past 10 years

目的:通过分析上海危重孕产妇会诊抢救中心近10年来剖宫产手术指征构成比的变化趋势,为合理控制剖宫产率提供依据。方法:回顾分析2002年、2005年、2008年及2011年在我中心分娩的8720例产妇的临床资料,观察剖宫产率及剖宫产指征的变化趋势。结果:(1)近10年,剖宫产率有明显上升趋势(从2002年的53.59%升至63.82%,P<0.0001)。(2)各剖宫产指征的构成比有显著差异(P<0.0001)。其中,胎儿宫内窘迫、头位难产所占比例明显下降;疤痕子宫、妊娠各种并发症或合并症所占比例显著上升;2002年高龄初产、珍贵儿等社会因素所占比例为14.39%,2005年最高达28.03%,2008年有下降趋势,2011年降为18.74%。(3)妊娠合并症或并发症为剖宫产指征时,多数合并内科疾病,10年来其比例有显著上升趋势(2002年为64.66%,2011年为86.44%);妊娠期高血压疾病所占比例显著下降,而合并心脏病、免疫系统疾病、内分泌系统疾病所占比例显著升高。结论:上海危重孕产妇会诊抢救中心10年间剖宫产指征的构成比有显著变化,其中产科因素指征逐年下降,而外科因素显著上升。本中心具有诊治产科疑难危重,尤其严重内外科合并症的综合抢救优势。需继续控制无高危因素的社会因素剖宫产术。

Objective：Analysis of constituent ratio trend about cesarean section indication in Shanghai serious gravida consultation and rescue center in the past 10 years, for provi- ding the basis for the reasonable control of the rate of cesarean section. Methods：Took a retrospective analysis of 8720 deliveries in our center in 2002/2005/2008/2011, to get the constitu- ent ratio trend about cesarean section indication and ratio. Results： （ 1 ） A significant upward trend in the ratio of cesarean section in the past 10 years （53.59% in 2002 and 63.82% in 2011. P〈0. 0001 ）. （2）There were significant differences in different cesarean section indica- tion （P〈0. 0001 ）. The ratio of fetal distress and abnormal labor decreased,while that of scar u- terus and complication with pregnancy increased. The ratio of social factors as elderly primipara and precious fetal was 14.39 % in 2002,28.03 % in 2005 and 18.74% in 2011. （3）Analyzing the ratio of cesarean section with pregnancy complication, we noticed a clear increase from 64.66% to 86.44% in the past 10 years. The ratio of cesarean section in hypertensive disorders complieating pregnancy deereased and that in immune, endocrine and heart disorders increased. Conclusions：There are significant differences in different cesarean section indication in Shanghai serious gravida consultation and rescue center in the past 10 years. Obstetrics factors decrease and surgical factors increase. That show reflect critical maternal in Shanghai serious grayida eonsuhation and rescue eenter in rescuing, especially the advantage of diagnosis and treatment in serious internal and surgical complications. The ratio of cesarean section about social factor should be controlled more strictly.