武汉市某医院2001～2010年产妇分娩方式变化趋势研究

Variation Tendency of Delivery Mode in a Hospital of Wuhan from 2001～2010

目的分析近10年来产妇分娩方式的变化趋势,并确定选择性剖宫产(亦称社会因素剖宫产)与产后并发证的关系。方法采用回顾性研究方法,对武汉市某医院2001～2010年10年内住院分娩产妇的病史资料进行调查分析。结果共查阅分析了11 350例住院分娩产妇的病史资料,48.56%的产妇采用阴道自然分娩,医学指征剖宫产、试产后剖宫产以及选择性剖宫产分别占13.42%、19.91%和18.11%,总的剖宫产率为51.44%。10年内选择性剖宫产率由13.77%升高到22.63%,总的剖宫产率由45.63%升高到54.82%。相对于选择自然分娩的产妇来说,选择性剖宫产的产妇更可能会发生产后子宫切除(OR=1.42;95%CI:1.13～1.86)、产中休克(OR=2.37;95%CI:1.44～4.25)和麻醉相关并发证(OR=2.68;95%CI:1.51～4.72)。结论 10年内剖宫产率逐渐升高,选择性剖宫产增多是其主要原因。选择性剖宫产会增加一些严重产后并发证的危险性,我国急需针对选择性剖宫产制定相应的干预政策和措施。

Objectives To analyze the variation tendency of delivery mode in recent 10 years, and identify the relation between elective cesarean sections and postpartum maternal complications. Methods A retrospective cohort study was conducted. We investigated the medical records of hospital delivery women in a hospital of Wuhan from 2001 to 2010. The association between elective cesarean sections and maternal outcome was estimated for women by odds ratios （ORs）, adjusted for potential confounders. Results 1 1350 women/deliveries were surveyed. Of them, 48.56% were in vaginal delivery group, 13.42- in medical indicator group, 19.91% had a cesarean section in labor, and 18. 11% had elective cesarean section. The total cesarean section rate was 51. 44% and increased from 45.63%to 54.82% from 2001 to 2010. The elective cesarean section rate increased from 13.77% to 22.6% in recent 10 years. Taking into account potential confounders such as age, education level, elective cesarean section was associated with higher risk of hysterectomy （OR= 1.42; 95%CI：1.13-1.86）, obstetric shock （OR= 2.37; 95% CI：1.44-4.25） and anesthetic complications （OR 2.68; 95%CI：1.51-4.72） compared to women in the vaginal delivery group. Conclusions Cesarean section rate gradually rose, and selective cesarean section may be the main reason. Elective cesarean section was associated with a higher risk of postpartum maternal complications. This suggests there a need for a program to reduce unnecessary elective cesarean sections.