江苏省2012年至2014年剖宫产分娩率变化和剖宫产指征分布

Analysis of cesarean delivery rate and indications of cesarean section in Jiangsu Province from 2012 to 2014

目的 分析2012年至2014年江苏省剖宫产分娩率（cesarean delivery rate,CDR）变化和剖宫产指征分布情况,以期寻找进一步降低本省CDR的策略.方法 借助江苏省妇产科质量控制平台,从江苏省妇产科质量控制中心2012、2013和2014年所收集的信息中,选取年分娩量在2 400例以上且每月上报数据完整的40家医院的数据,按专科医院（11家妇幼保健院）和综合医院（29家）分2组,分析全省CDR变化,比较2组平均CDR及剖宫产第一指征分布.采用x2检验进行统计学分析.结果 （1）40家医院2012、201 3和2014年平均CDR分别为53.8％（96 347/178 970）、51.8％ （97 509/188 142）和48.8％（106 323/217 877）,有下降趋势（x2=1 026.2,P＜0.01）,无医学指征CDR分别为15.7％ （28 098/178 970）、15.5％ （29 162/188 142）和12.8％ （27 888/217 877）,2014年较2012年和2013年有明显下降（x2值分别为217.6和341.3,P值均＜0.01）.（2）专科医院2012、2013和2014年的CDR分别为51.2％（45 496/88 916）、50.6％ （45 853/90 607）和49.0％（55 404/113 105）,综合医院的CDR分别为56.5％ （50 851/90 054）、53.0％ （51 656/97 535）和48.6％ （50 919/104 772）,均有下降趋势（x2值分别为105.8和1 215.7,P值均＜0.01）.2012年和2013年综合医院的平均CDR均显著高于专科医院（x2值分别为505.6和104.3,P值均＜0.01）.2014年2组CDR相当（x2=3.2,P＞0.05）.（3） 2012年至2014年剖宫产第一指征构成排序中主要为妊娠并发症、妊娠合并症、无医学指征.自2012年至2014年,瘢痕子宫为指征的CDR在专科医院由5.4％上升至20.3％,综合医院由6.7％上升至21.6％,跃居首位.结论 2012、201 3和2014年江苏省40家医院平均CDR呈下降趋势,无医学指征CDR也逐年下降.剖宫产第一指征中以妊娠合并症、并发症为首位原因,但瘢痕子宫逐渐成为剖宫产的重要原因.

Objective By analyzing the cesarean delivery rate （CDR） and the indications of cesarean section in Jiangsu Province from 2012 to 2014, to find the strategy to reduce CDR.Methods Data of 40 hospitals whose number of delivery was over 2 400 per year from the database of the Quality Control Center of Gynecology and Obstetrics of Jiangsu Province from 2012 to 2014 were selected.The cohort was divided into two groups, one was specialized hospital including 11 maternal and child health hospitals and the other included 29 general hospitals.After analyzing the current status of cesarean section of the whole province, the average CDR and the distribution of the first indications of cesarean section in two groups were compared using Chi-square test.Results The average CDRs at year 2012, 2013 and 2014 were 53.8%（96 347/178 970）, 51.8% （97 509/188 142） and 48.8%（106 323/217 877）, which had a trend of decrease （x2=1 026.2, P 〈 0.01）.CDR without medical indications for each year were 15.7% （28 098/178 970）, 15.5% （29 162/188 142） and 12.8% （27 888/217 877）.The rate had decreased apparently from both 2012 and 2013 to 2014 （x2=217.6, P 〈 0.01;x2=341.3, P 〈 0.01）.The CDRs of specialized hospitals for year 2012, 2013 and 2014 were 51.2% （45 496/ 88 916）, 50.6% （45 853/90 607） and 49% （55 404/113 105）, while the CDRs of general hospitals for each year were 56.6%（50 851/90 054）, 53.0%（51 656/97 535） and 48.6%（50 919/104 772）.Both showed significant decreasing trend （x2=105.8 and 1 215.7, both P 〈 0.01）.The average CDR of general hospitals was obviously higher than that of specialized hospitals in 2012 and 2013 （x2=505.6 and 104.3, both P 〈 0.01）.However, the difference disappeared in 2014 （x2=3.2, P 〉 0.05）.The three main first indications of cesarean section were associated and postoperative pregnancy complications, and no medical indications.Interestingly, from 2012 to 2014, the CDR for scarred uterus in specialized hospitals raised from 5.4% to 20.3%, and that in general hospitals increased from 6.7% to 21.6%, which became the first.Conclusions The average CDR in Jiangsu Province tends to decrease each year, so does the CDR without medical indications.The first indication of cesarean section is associated or postoperative pregnancy complications, while scarred uterus becomes the most common in cesarean section.