二胎政策开放前后剖宫产指征的分析

Analysis on the Indications of Cesarean Section Before and After the Implementation of Two-Child Policy

目的分析二胎政策实施前后剖宫产指征的变化。方法随机选取我院2014年6月至2017年6月1 326例住院分娩孕产妇的病例资料进行回顾性分析,其中剖宫产分娩670例,根据全面二胎政策实施时间分为2014年6月至2015年12月(实施前)390例和2016年1月至2017年6月(实施后)280例。结果二胎政策实施后的剖宫产率为47.38%,显著低于实施前的53.06%(P<0.05)。实施后,剖宫产指征居于前五位的是瘢痕子宫、社会因素、胎儿窘迫、妊娠并发症和高龄孕妇。实施后,剖宫产指征为瘢痕子宫的占比为33.57%,显著高于实施前的13.59%(P<0.01);实施后,剖宫产指征为高龄孕妇的占比明显增加(P<0.05),社会因素、产程异常、巨大儿、羊水过少的占比明显下降(P<0.05)。结论二胎政策实施后剖宫产率呈下降趋势,剖宫产指征发生变化,以瘢痕子宫为指征的剖宫产率升高显著。

Objective To analyze the changes of the indications of cesarean section before and after the implementation of two-child policy. Methods 1 326 medical records of hospitalized pregnant women in our hospital from June 2014 to June 2017 were randomly selected and retrospectively analyzed. 670 cases had cesarean section included 390 cases from June 2014 to December 2015 （before implementation） and 280 cases from January 2016 to June 2017 （after implementation） according to the implementation time of universal two-child policy. Results After the implementation of two-child policy, the cesarean section rate was 47.38%, significantly lower than 53.06% before the implementation （P 〈0.05）. After implementation, the top five indicators of cesarean section were scar uterus, social factors, fetal distress, pregnancy complications and older pregnant women. After implementation, the proportion of scar uterus as the cesarean section indicator was 33.57%, significantly higher than 13.59% before implementation （P 〈0.01）. After implementation, the proportion of older pregnant women as the cesarean section indicator increased significantly （P 〈0.05）, and the proportions of social factors, labor abnormalities, macrosomia and oligohydramnios decreased significantly （P 〈0.05）. Conclusions After the implementation of the two-child policy, the cesarean section rate shows a downward trend, the cesarean section indications change, and the cesarean section rate of scar uterus as indicators increases significantly.