全国剖宫产率及剖宫产指征构成比调查的多中心研究

Cesarean delivery rate and indications in China's Mainland： a cross sectional study in 2011

目的 分析全国剖宫产率变化趋势及剖宫产指征构成比.方法 选择北京市等全国14个省份39家医院（包括20家三级医院及19家二级医院）2011年1月1日至12月31日112 138例住院分娩产妇的临床资料,其中三级医院产妇79 631例（71.012％,79 631/112 138）,二级医院产妇32 507例（28.988％,32 507/112 138）;初产妇90 971例（81.124％,90 971/112 138）,经产妇21 167例（18.876％,21 167/112 138）.对剖宫产率、产妇的分娩方式及剖宫产指征进行分析.结果 （1）112 138例产妇中,剖宫产术分娩61 084例（54.472％,61 084/112 138）,自然分娩49 734例（44.351％,49 734/112 138）,阴道助产1 320例（1.177％,1 320/112 138）.61 084例剖宫产中,无指征剖宫产为14 998例（13.375％,14 998/112 138）,有指征剖宫产46 086例（41.098％,46 086/112 138）.三级医院剖宫产44 535例,剖宫产率为55.927％（44 535/79 631）,二级医院剖宫产16 549例,剖宫产率为50.909％ （16 549/32 507）,三级医院剖宫产率显著高于二级医院（P＜0.01）.（2）无指征剖宫产14 998例,占总剖宫产数的24.553％（14 998/61 084）,其中三级医院8 793例,占三级医院剖宫产总数的19.744％（8 793/44 535）;二级医院6 205例,占其剖宫产总数的37.495％（6 205/16 549）,二级医院无指征剖宫产率显著高于三级医院（P＜0.01）.（3）无指征剖宫产居剖宫产率首位,共14 998例（24.553％,14 998/61 084）,其余指征中,母体因素23 391例（38.293％,23 391/61 084）,胎儿因素18 607例（30.461％,18 607/61 084）,其他指征4 088例（6.692％,4 088/61 084）.剖宫产指征构成比由高到低依次为无指征（24.553％,14 998/61 084）、胎儿窘迫（12.507％,7 640/61 084）、头盆不称（11.787％,7 200/61 084）、瘢痕子宫（10.374％,6 337/61 084）、臀位及横位（5.815％,3 552/61 084）、产程异常（5.710％,3 488/61 084）、巨大儿（5.594％,3 417/61 084）.结论 我国近年来的剖宫产率仍处于高水平阶段,其主要原因为无指征剖宫产数量增加.有指征剖宫产率的构成比主要为胎儿窘迫、头盆不称、瘢痕子宫、胎位异常和产程异常.三级医院剖宫产率显著高于二级医院.

Objective To estimate cesarean delivery rates and indications by region in China's Mainland.Methods A cross sectional survey of all deliveries in 39 hospitals in 14 provinces of China's Mainland from January 1 to December 31,2011 was evaluated for mode of delivery,cesarean delivery rates and indications for delivery.Results （1） A survey of a total of 112 138 women at delivery with gestations greater than 24 weeks was analyzed.79 631 and 32 507 deliveries were obtained from the tertiary and secondary hospitals respectively.90 971 were primipara,21 167 were multipara.Of these pregnancies,61 084,49 734 and 1 320 cases resulted in cesarean delivery,vaginal delivery and operative vaginal delivery respectively,the cesarean delivery rate was 54.472% （61 084/112 138）.Among 61 084 women who had cesarean delivery,14 998 cases of the cesarean deliveries were performed without medical indications,46 086 cases of the cesarean deliveries had medical indications.The cesarean delivery rate of the tertiary hospitals was 55.927% （44 535/79 631）,and was significant higher than that in the secondary hospitals （50.909%,16 549/32 507; P〈0.01）.（2）Overall 24.553 % （14 998/61 084）of cesarean deliveries were performed without medical indications.19.744% （8 793/44 535）of the cesarean deliveries without medical indications were performed in the tertiary hospitals,and was significant lower than in the secondary hospitals （37.495%,6 205/16 549; P〈0.01）.（3）Maternal request was the most common indication （24.553% of all cesarean deliveries）,followed by fetal distress （12.507%,7 640/61 084）,cephalopelvic disproportion （11.787%,7 200/61 084）,previous uterine surgery （10.374%,6 337/61 084）,malpresentation （5.815%,3 552/61 084）,failure to progress（5.710%,3 488/61 084）and suspected maerosomia（5.594%,3 417/61 084）.Conclusions The increasing caesarean section rate in China's Mainland is explained mainly by the high nonindicated caesarean section rate.The main medical indications of the cesarean deliveries included fetal distress,cephalopelvic disproportion,previous uterine surgery,malpresentation and failure to progress.