不同种类的剖宫产危险因素分析

Analysis on risk factors for different types of cesarean section

目的分析无指征剖宫产、有指征产前和产时剖宫产的危险因素,为有针对性地降低剖宫产率提供线索。方法采用病例对照研究,选取上海市两家三级医院2012年6月-2013年2月间的1 217例分娩,回顾性收集相关孕期与分娩信息。根据分娩方式分为阴道分娩、无指征剖宫产、有指征产前剖宫产和有指征产前剖宫产。针对3种不同的剖宫产类型,利用Logistic多因素回归分析,分别找出各自的危险因素并调整混杂因素。结果对于无指征剖宫产,初产妇的危险性是经产妇的1.85倍（OR=1.85,95%CI：1.21～2.83）。有指征产前剖宫产的危险因素有：孕前超重及肥胖者（OR=3.06,95%CI：1.62～5.77;OR=5.15,95%CI：1.99～13.32）,孕期被动吸烟者（OR=1.78,95%CI：1.08～2.93）,初产妇（OR=14.82,95%CI：8.08～27.19）,婴儿出生体重〈2.5 kg或〉4 kg者（OR=5.62,95%CI：1.19～26.56;OR=13.44,95%CI：3.37～53.64）,患妊娠期糖尿病（GDM）的产妇（OR=2.47,95%CI：1.17～5.22）。对于有指征产时剖宫产,母亲年龄偏大（OR=2.48,95%CI：1.07～5.72）及婴儿出生体重〉4 kg（OR=13.32,95%CI：3.37～52.63）者的危险性增加,初产妇（OR=0.14,95%CI：0.08～0.26）的危险性减小。结论降低无指征剖宫产率,需要加强对产妇尤其是初产妇的健康教育。应重视对孕产妇孕前孕期体重的干预与孕期血糖的控制,并且强调避免孕期被动吸烟的重要性,以降低有指征的产前与产时剖宫产率。

Objective To analyze the risk factors of cesarean section without medical indications,pre-labor cesarean section with indications,and intrapartum cesarean section with indications,respectively,provide clues for reducing cesarean section rate. Methods A casecontrol study was conducted among 1 217 women giving birth to their babies in two tertiary hospitals in Shanghai from June 2012 to February2013. Detailed information on pregnancy and delivery was collected retrospectively. The women were divided into four groups according to delivery modes： vaginal delivery,cesarean section without medical indications,pre-labor cesarean section with indications,and intrapartum cesarean section with indications. Multivariate logistic regression model was used to identify the risk factors for three different types of cesarean section and adjust the confounding factors. Results For cesarean section without medical indications,the risk of primiparous women was0. 85 times more than multiparous women（ OR = 1. 85,95%CI： 1. 21-2. 83）. The risk factors for pre-labor cesarean section with indications included pre-pregnancy overweight or obesity（ OR = 3. 06,95% CI： 1. 62- 5. 77; OR = 5. 15,95% CI： 1. 99- 13. 32,respectively）,passive smoking during pregnancy（ OR = 1. 78,95% CI： 1. 08- 2. 93）,primipara（ OR = 14. 82,95% CI： 8. 08- 27. 19）,neonatal birth weight less than 2. 5 kg or more than 4 kg（ OR = 5. 62,95% CI： 1. 19-26. 56; OR = 13. 44,95% CI： 3. 37- 53. 64,respectively）,GDM patients（ OR = 2. 47,95%CI： 1. 17-5. 22）. For intrapartum cesarean section with indications,older maternal age（ OR = 2. 48,95% CI：1. 07-5. 72） and macrosomia（ neonatal birth weight4 kg）（ OR = 13. 32,95% CI： 3. 37- 52. 63） were significant risk factors,while primipara was a protective factor（ OR = 0. 14,95%CI： 0. 08- 0. 26）. Conclusion To reduce cesarean section rate without medical indications,health education for women,especially the primiparous women,should be enhanced. More attention should be paid to intervention of pre-pregnancy and pregnancy weight and control of blood glucose during pregnancy,the importance of avoidance of passive smoking during pregnancy should be emphasized to reduce the rates of pre-labor and intrapartum cesarean section with indications.