剖宫产指征变化及对母婴预后影响的临床分析

Changes of cesarean section indicators and their impact on maternal-fetal prognosis

目的探讨剖宫产率及剖宫产指征变化的原因及对策,以降低剖宫产率,提高产科质量。方法采用回顾性分析的方法比较2012-01-2014-12间我院住院分娩的7517例产妇剖宫产率的差异及剖宫产指征的变化和对新生儿结局的影响。结果 2012-2014我院剖宫产率居高不下,均大于50%,并呈逐年渐升趋势。3年间剖宫产指征前3位是：社会因素、妊娠合并症及并发症、胎儿宫内窘迫,其中社会因素位居第1位,且社会因素、瘢痕子宫、相对性头盆不称、胎儿窘迫的比率逐年明显增加（P〈0.05）。与经阴道分娩相比较,剖宫产产妇近远期并发症的发生率明显增加,差异有统计学意义（P〈0.05）,且其平均住院时间更长,住院费用也明显增加（P〈0.01）,新生儿发生产伤及窒息的比例增高,差异有统计学意义（P〈0.05）。结论剖宫产率持续增高是由多因素综合作用的结果,其中剖宫产指征中社会因素的构成比升高值得关注。因此,应该结合临床实际,从多角度、多方向着手降低剖宫产率,以提高产科质量,确保母婴健康。

Objective To investigate the major reasons and countermeasures of changes of cesarean section rate and indicators of cesarean section for reducing the cesarean section rate and improving obstetrics quality. Methods A retrospective analysis was conducted to compare the cesarean section rate,indicators of cesarean section and their effect on neonatal prognosis in 7 517 hospitalized parturients from January 2012 to December 2014 in Second Affiliated Hospital,Medical College of Xi＇an Jiaotong University. Results Cesarean section rate was higher（ 50%） in 2012- 2014 with a rising trend yearly. The top three leading indicators of cesarean section were social factor,pregnancy complications and fetal distress. The rates of cesarean section due to social factor,scar uterus,cephalopelvic disproportion,fetal distress increased year by year（P〈0.05）. Compared with the patients with vaginal delivery,the incidences of short-term and long-term complication increased significantly in cesarean section（P〈0.05）,the average hospital stay and hospitalization expenses also increased significantly（P〈0.01）,and the incidences of birth injuries and neonatal asphyxias increased significantly（ P〈0. 05）. Conclusion The cesarean section rate is rising from a result of the combined multiple factors and it is concerned that the constituent ratio of social factor as an indicator of cesarean section has increased. Therefore,it is necessary to combine clinical practice from all-around and multiple directions for reducing the cesarean section rate and improving obstetrics quality and securing maternal-fetal health.