“全面二孩”政策开放后剖宫产指征变化情况及现状分析

To analyze the trend of cesarean section(CS)indication and situationn among pregnant women during universal second child pregnancy

目的分析"全面二孩"政策背景下剖宫产指征变化趋势及现状,从而探讨降低剖宫产率的有效措施。方法根据我国全面实施二胎政策开放的时间为节点,选取北部战区总医院妇产科住院患者,以政策开放前(2014.1-2016.12)为对照组,政策开放后(2017.1-2019.1)为研究组,比较两组间的患者一般情况、产妇体重增长情况、新生儿体重、剖宫产率变化情况、剖宫产指征构成比等指标。结果剖宫产患者终止妊娠的孕周较后推移;新生儿体重降低;近6年剖宫产率呈逐年下降趋势;前5位剖宫产手术指征顺位发生了变化,以瘢痕子宫为指征的剖宫产率升至第1位,社会因素剖宫产比呈下降趋势,高危及双胎妊娠产妇较前增加。结论严格掌握剖宫产手术指征,尤其是控制社会因素剖宫产仍是降低剖宫产率的关键点,加强产前检查、规范的产程处理、鼓励低危瘢痕子宫阴道分娩等一系列措施可有效控制剖宫产率。

Objective To analyze the trend of cesarean section(CS)indication and situationn among pregnant women during second child pregnancy.In order to explore effective and feasible strategies to reduce the rate of CS.Methods A retrospective study of women that consented to CS between Jan 2013 and Jan 2018 in our hospital.22632 cases had CS included 12069 cases from January 2013 to January 2015(before implementation)and cases from January 2016 to January 2018(after implementation)according to the implementation time node of universal two-child policy.The age、gestational age、Maternal weight gain、the birth weight of newborns、cesarean section rate and cesarean section indication were recorded.Results After the policy′s implementation,The intrapartum gestational age of cesarean section which were significantly higher than those of control group,while the birth weight,which was significantly lower than that of control group.the overall cesarean rate decreased significantly from 50.5%in 6 years..In the composition of cesarean section indications,elective repeat CS occupied the first position,whereas the caesarean delivery on maternal request was chosen less frequently.The proportion of high risk mother and twin pregnancy increased significantly(P<0.05).Conclusion Our data suggest that reduce esmedical necessity CS is an important tool in China to the rate of caesarean section reduction.The cesarean section rate can be effectively controlled by strengthening prenatal examination,normative labor process,encouraged low-risk trial of labor after cesarean.