“二孩”政策后产妇分娩方式及剖宫产指征的变化

Changes in maternal delivery modes and indications for cesarean section after the "two-child" policy

目的分析"二孩"政策后分娩方式及剖宫产指征的变化。方法回顾性分析2014年1月1日～2017年12月31日在沈阳市妇婴医院住院分娩的55 274例产妇的临床资料,以2016年1月1日为时间截点,将纳入研究的产妇分为"二孩"政策前组(n=24 647)及"二孩"政策后组(n=30 627),比较两组分娩方式及剖宫产指征的变化。结果采用χ2检验进行统计学分析。结果 "二孩"政策前后两组的剖宫产率、阴道分娩率及产钳助产率比较,差异均无统计学意义(P>0.05)。与"二孩"政策前组比较,"二孩"政策后组的经产妇比例明显增加,且经产妇的剖宫产率明显上升,差异均有统计学意义(P<0.05)。"二孩"政策后组中以瘢痕子宫、胎儿窘迫和妊娠期高血压疾病为剖宫产指征的构成比上升明显,以头盆不称、社会因素、产程异常、羊水过少及产前出血为剖宫产指征的构成比明显下降,与"二孩"政策前组比较,差异均有统计学意义(P<0.05)。结论 "二孩"政策后瘢痕子宫再次剖宫产者明显增多是剖宫产率不降的主要原因,减少以社会因素为手术指征的剖宫产数量、提高剖宫产术后再次妊娠阴道分娩(VBAC)成功率、应用新产程标准将进一步降低剖宫产率。

Objective To analyze the changes in delivery modes and indications for cesarean section after the"two-child"policy.Methods The clinical data of 55 274 maternal women hospitalized in our hospital from January 1,2014 to December 31,2017 were retrospectively analyzed.With a cut-off point on January 1,2016,the maternal women were divided into the before-two-child-policy group(n=24 647)and the after-two-child-policy group(n=30 627),and the changes in the delivery modes and cesarean section indications were compared between the two groups.The results were statistically analyzed using theχ^2 test.Results There was no significant difference in cesarean section rate,vaginal delivery rate and forceps-assisted delivery rate between the two groups before and after the"two-child"policy(P>0.05).Compared with the before-two-child-policy group,the proportion of multiparous women in the after-two-child-policy group increased significantly,and the cesarean section rate also increased significantly,with statistically significant differences(P<0.05).The composition ratio of cesarean section indications including scar uterus,fetal distress,and gestational hypertension evidently increased after the two-child policy,and the composition ratio of indications including cephalopelvic disproportion,social factors,abnormal labor stage,oligohydramnios and antepartum hemorrhage significantly decreased after the"two-child"policy,compared with the before-two-child-policy group,the differences were statistically significant(P<0.05).Conclusion After the"two-child"policy,the increase of cesarean section in scar uterus is the main reason for the non-decreasing cesarean section rate.Reducing the number of cesarean sections indicated by social factors,improving the success rate of vaginal birth after cesarean(VBAC),and applying new labor stage standards will further reduce the cesarean section rate.