基于病案首页数据的剖宫产主要手术指征分析

Analysis of Major Surgical Indications of Cesarean Section Based on the Homepage of the Medical Records

目的回顾性调查某医院近两年剖宫产率及手术指征构成的变化。方法从某院病案首页信息管理系统中检索2015年-2016年住院期间进行剖宫产和顺产的所有产妇的病案首页数据进行分析核查。结果 2015年与2016年剖宫产率分别为46.89%和51.01%,2016年剖宫产率高于2015年;剖宫产主要手术指征顺位排序前四位为"妊娠合并子宫瘢痕"、"脐带问题"、"胎儿先露异常"和"母体骨盆或盆腔器官异常";其中2016年"妊娠合并子宫瘢痕"所占的比例高于2015年,"脐带问题"与"母体骨盆或盆腔器官异常"这两种手术指征所占的比例低于2015年,而不同年份的"胎儿先露异常"的指征所占的比例没有显著差异;在以"妊娠合并子宫瘢痕"为主要手术指征的剖宫产组和具有"妊娠合并子宫瘢痕"的顺产组的产妇中,剖宫产组的年龄高于顺产组;相较于省内产妇,省外产妇更倾向于顺产;多胎产妇剖宫产的比例高于单胎产妇,但两组产妇的妊娠伴随症、妊娠并发症以及怀有巨大儿的比例均没有差异。结论 2016年剖宫产率升高与"妊娠合并子宫瘢痕"手术指征有关,为合理选择分娩方式,降低剖宫产率,医师应对具有剖宫产史的产妇进行严格的监测,避免剖宫产手术指征的滥用。

Objective To investigate the changes of cesarean section rate and surgical indications of a hospital in the past two years. Methods Analyse the homepage of the medical records of maternal with cesarean section and natural birth from 2015 to 2016 in the hospital information management system. Results The rate of cesarean section in 2015 and 2016 were respectively 46.89% and 51.01%. The rate of cesarean section in 2016 was higher than 2015. The top four main surgical indications of cesarean section were ＂pregnancy with uterine scar＂, ＂umbilical cord problems＂, ＂fetal first exposed abnormalities＂ and ＂maternal pelvic or pelvic organ abnormalities＂; The proportion of ＂pregnancy with uterine scar＂ in 2016 was higher than 2015, and the proportion of ＂Umbilical cord problem＂ and ＂maternal pelvic or pelvic organ abnormalities＂ were lower than 2015, But there was no significant difference in the proportion of ＂prenatal abnormalities＂ in different years. In the comparison of the cesarean section group with ＂pregnancy combined with uterine scar＂ as the main surgical indication and the natural birth group with the ＂pregnancy with uterine scar＂, the age of the cesarean section group was higher than natural birth group.Compared to the province of maternal, outside were more inclined to go for the natural birth. The rate of cesarean section in multiple birth women was higher than the singleton pregnant women. But there were no differences in pregnancy symptoms, pregnancy complications, and macrosomia between the two groups. Conclusion The increase of cesarean section in 2016 was related to the indication of ＂pregnancy with uterine scar＂. For a reasonable choice of delivery mode, reducing the rate of cesarean section, doctors should have strict monitor to maternal cesarean section,avoid the abuse of cesarean section indications.