昆明市剖宫产现况及对策研究

Current situation of cesarean section in Kunming and countermeasure research

目的分析昆明市助产机构剖宫产现况,探讨相关的解决措施。方法采用SPSS 18.0软件对昆明市2008-2014年妇幼卫生统计年报表及全市助产机构分娩登记本信息进行统计分析。结果 2008-2014年间,昆明市助产机构年度总分娩量呈上升趋势;2008年至2011年间,全市剖宫产率一直在42%-44%期间,2012年开始明显下降,为42.77%,2014年下降至32.77%;2012年至2014年剖宫产指征顺位前5位均为瘢痕子宫、社会因素、臀(横)位、头盆不称、胎儿窘迫,其中,社会因素构成比从2012年的首位(21.7%)降至2014年的第5位(6.02%),而瘢痕子宫构成比从21.2%上升至37%;全市初次剖宫产率从2012年的34.09%下降至23.60%。结论控制社会因素剖宫产和初次剖宫产率是降低剖宫产率的关键点。通过加强行政管理力度、监督指标落实、制定降低剖宫产率支持政策、强化培训,推广适宜技术、加强健康教育和提高孕产期保健服务质量等一系列措施可有效控制剖宫产率。

Objective To analyze the current situation of cesarean section in Kunming and explore relevant solving measures.Methods Maternal and child health care statistical annual reports and the information of birth registration book in obstetric institutions from2008 to 2014 in Kunming were analyzed using SPSS 18. 0 software. Results From 2008 to 2014,the annual amount of childbirth in obstetric institutions was increasing in Kunming; the cesarean section rates ranged from 42% to 44% from 2008 to 2011,and the rate decreased to42. 77% from 2012,which fell to 32. 77% in 2014; from 2012 to 2014,the top five reasons for cesarean section were： scar uterus,social factors,breech position,cephalopelvic disproportion,and fetal distress,among which the proportion of social factors dropped from the first reason（ 21. 7%） in 2012 to the fifth reason（ 6. 02%） in 2014,while the proportion of scar uterus increased from 21. 2% to 37%; the rate of primary cesarean section decreased from 34. 09% in 2012 to 23. 60% in 2014. Conclusion The key points to reduce cesarean section rate include controlling cesarean section rate because of social factors and primary cesarean section rate. A series of measures should be taken such as strengthening the power of administration,supervising the implementation of task,formulating policy,strengthening training,generalizing proper technology, strengthening health education and improving the quality of maternal health care services to effectively control the rate of cesarean section.