5年间剖宫产率下降的相关因素浅析

Related factors for decline in rate of cesarean section in last 5 years

目的探讨近5年来剖宫产率下降和剖宫产指征变化的相关影响因素,为降低剖宫产率提供有效可行的措施。方法对2008—2012年住院分娩的23 144例产妇的临床资料进行回顾性分析,比较不同年份剖宫产率和剖宫产主要指征的构成比及顺位的变化,以及阴道助产率、无痛分娩率、导乐率等。结果从2008—2012年剖宫产率由53.88%下降至36.94%,剖宫产率呈下降趋势,但平均剖宫产率44.22%;阴道助产率从2008年0.54%上升至2012年2.50%,导乐率从2008年1.36%上升至2012年12.57%;无痛分娩率从2008年2.45%上升至2012年16.19%;会阴侧切率从2008年79.04%下降至2012年55.95%。但剖宫产主要手术指征排序顺位有了变化,社会因素、疤痕子宫始终在前2位,疤痕子宫在后2年上升位居第一,分别是31.54%和32.32%,胎儿窘迫、难产及羊水过少排序顺位逐渐下降,巨大儿、妊娠合并症和并发症呈上升趋势。结论剖宫产率呈下降趋势,但平均剖宫产率仍高,社会因素及疤痕子宫仍占一半以上比例,降低剖宫产率,仍需产科医护人员、麻醉医生、行政领导和孕妇等共同努力。

Objective To investigate the related factors for decline of the rate of cesarean section and the changes of ce- sarean section indication in last 5 years, and provide a feasible and effective measures for reducing the rate of cesarean section. Methods The clinical data of 23 144 delivery in hospital from 2008 to 2012 were analyzed retrospectively. The rate of cesarean section, constituent ratio in the indications and sorting orders for caesarean section, rate of vaginal delivery, rate of painless childbirth and rate of doula accompany delivery in different years were compared. Results From 2008 to 2012,the rate of cesarean section decreased from 53.88% to 36.94% with a mean percent of 44.22% ,the rate of vaginal delivery increased from 0.54% to 2.50% ,the rate of doula accompany delivery increased from 1.36% to 12.57%, painless childbirth rate rose from 2.45% to 16.19%, while the rate of episiotomy declined from 79.04% to 55.95%. The position of scar uterine（32.32% ） in the sorted array moved ahead the social factor（31.54% ） ,followed by fetal distress, dystocia and oligohydramnios. The incidence of macrosomia and pregnancy complication increased. Conclusion The rate of cesarean section is decreasing in recent years, but the average rate is still high. The social factors and scar uterine still accounted for more than half of the reasons of cesarean section. In order to reduce the rate of cesarean section, the obstetric medical personnel, anesthesiologist, administrative leadership and pregnant women have more work to do together.