降低剖宫产率临床措施的初步探讨

The discussion of clinical measurements in how to decreasing the rates of cesarean section

目的探讨近几年剖宫产率增高的主要因素,为制定降低剖宫产率的具体措施提供资料。方法回顾性分析2007年1月至2012年1月在我院产科分娩病例6538例,其中,剖宫产2842例。结果⑴五年间剖宫产率分别为31.3%、32.6%、37.9%、37.5%、47.9%。⑵剖宫产率呈逐年上升趋势,剖宫产占分娩的比例逐年增高;阴道助产率呈逐年下降趋势,同期阴道助产占分娩的比率逐年下降。⑶2007年后列入剖宫产手术指征前几位的是胎儿宫内窘迫、相对头盆不称、脐带绕颈、臀位、妊娠合并症等。⑷自2007年起社会因素已作为剖宫产指征之一,且居于剖宫产指征的第六位。⑸单因素指征行剖宫产的比例逐年增加,但多因素指征行剖宫产的比例逐年下降。⑹胎儿宫内窘迫一直被列为剖宫产指征的第一位,而社会因素目前成为剖宫产指征之一,且有逐年升高的趋势。结论社会因素是导致近年来剖宫产逐年增高的重要原因之一,重视社会因素,加强孕产期宣教及保健,加强潜伏期及第一产程的管理监护及心理护理问题,是降低临产后剖宫产率的重要措施。近年来剖宫产手术指征已大大超过单纯医学指征的范围,孕产妇及医生的主观意愿影响着分娩方式的选择,只有严格掌握剖宫产指征,剖宫产率才能降低,使围生儿死亡率控制在正常范围内。

Objective：To discuss the main factor for increasing of cesarean section rate for a few years ,To provide data for determining measures to reduce cesarean section rate. Methods： We reviewed the cases of mature delivery from January 2007 to January2012in our hospital. Results： （1） The clinical rates of cesarean section was 31.3% ,32.6% ,37.9% ,37. 5% ,47.9% in the 5 years. （2）The rate of cesarean section had increased gradually year after year, Cesarean section to dys- tocia delivery increased year after year;whereas there was a downward trend of vagina delivery. （3）Mter 2000 the major indi- cations of cesarean section before a few years were fetal distress,relative cephalopelvic disproportion,nuchal cord,breech pr- esention and so on. （4） Society factor was one of the indications of cesarea forceps delivery rate,while that of forceps delivery to dystocia delivery decreased, n section and rose to be the sixth since 2007. （5） The cases with a single indication had in- creased gradually and those with multiple indication had decreased accordingly. （6） Dystocia was the first and society factor was one of the indication of cesarean section and had increased gradually year after year. Conclusion： Social factors was an important factor that increased cesarean section rate in recent years. To decrease the total rate of cesarean section, many important measures should be done such as paying more attention to social factors, reinforcing propaganda and maternal health care, encouraging spontaneous vaginal delivery, emphasizing company during labour and analyesia or painfree deliv- ery, laying stress on the management and monitoring during first stage of labour as well as psychological care. The operation indication of cesarean section are beyond medical concerns recently, the subjective thought of gravida and doctors weakens the rational decisions about the way of delivery, the rate of cesarean section can be controlled if its indications are known ac- curately and the death rates of neonates can be controlled in a normal rang.