2013至2017年丹凤县剖宫产率及剖宫产指征构成分析

Cesarean section rate and cesarean section indications in Danfeng County from 2013 to 2017

目的探讨2013至2017年丹凤县剖宫产率和剖宫产指征的变化情况,为降低剖宫产率提供有效可行的措施。方法对2013年1月至2017年12月在丹凤县医院、丹凤县中医院及丹凤县妇幼保健院住院分娩的15 771例孕妇的临床资料进行回顾性分析,比较五年间剖宫产率的变化、剖宫产指征构成比的变化,以及剖宫产率变化对新生儿窒息发生率的影响。结果 2013至2017年剖宫产率总体呈下降趋势,分别为35.40%、35.33%、31.70%、30.90%、29.25%;2017年与2013年相比,剖宫产率的下降差异有统计学意义(χ~2=29.627,P=0.000)。在剖宫产指征构成比中,瘢痕子宫居首位,并且呈逐年增加趋势(28.29%～39.91%),因头盆不称(13.72%～10.09%)、产程异常(16.67%～10.09%)、引产失败(4.57%～3.36%)及社会因素(9.53%～4.37%)导致的剖宫产占比明显下降,因胎儿窘迫(14.4%～15.02%)、胎盘因素(2.33%～3.7%)、双胎妊娠(1.09%～1.35%)、妊娠并发症(1.88%～4.04%)原因手术的占比略有升高,并且剖宫产率的下降与新生儿窒息的发生率无关联(P>0.05)。结论丹凤县五年间剖宫产率呈下降趋势,瘢痕子宫为剖宫产指征构成比中的首要因素,并且在逐年增加,控制剖宫产率并不会增加围产儿的不良结局。

Objective To investigate the rate of cesarean section and the changing ratio of cesarean section indications in Danfeng County in 2013-2017,aiming to seek a feasible and effective measure to reduce cesarean section rate.Methods We retrospectively reviewed the clinical data of 15 771 cases of delivery from 2013 to 2017 in Danfeng County Hospital,Danfeng County Traditional Chinese Medicine Hospital and Danfeng County MCH Hospital.The rate of cesarean section and the changing ratio of cesarean section indications in each year were compared,and the relationship between cesarean section rate and neonatal asphyxia was estimated.Results From 2013 to 2017,the rate of cesarean section showed a downward trend,which was 35.40%,35.33%, 31.70%,30.90% and 29.25%,respectively.The rate of cesarean section was significantly decreased in 2017 compared with that in 2013 (χ^2=29.627, P =0.000).The scar uterus took the first place in the composition of cesarean section indications,and it increased year by year (28.29%-39.91%).The proportion of cesarean section caused by cephalopelvic disproportion (13.72%-10.09%),abnormal labor process (16.67%-10.09%),induction failure of labor (4.57%-3.36%) and social factors (9.53%- 4.37%) decreased significantly.The proportion of cesarean section caused by fetal distress (14.4%-15.02%),placental factors (2.33%-3.7%),twin pregnancy (1.09%-1.35%) and pregnancy complications (1.88%-4.04%) indicated a slight increase.Decline in cesarean section rate was not correlated with incidence of neonatal asphyxia ( P >0.05).Conclusion The cesarean section rate in Danfeng County is decreasing during the last 5 years.The scar uterus is the foremost indication of cesarean section,and increases annually.Controlling cesarean section rate does not increase the adverse outcomes of perinatal infants.