全面二孩政策前后上海城区剖宫产率变化分析

Analysis on the change of cesarean section rate in a central district of Shanghai before and after the universal two-child policy

目的比较全面二孩政策出台前后上海城区剖宫产率的变化情况。方法回顾收集2015年1月1日至12月31日和2017年1月1日至12月31日在上海市城区6家助产机构分娩的记录,将所有分娩结局为活产(分娩孕周≥28周或胎儿出生体重>1000g)的产妇分娩记录纳入研究。依据罗布森分类系统进行分类、汇总信息,并加以分析。结果2017年总分娩数较2015年增加1729人,且产妇年龄和受教育程度增加,初产妇占比减少8.52%;2017年剖宫产率较2015年降低0.28%,初产妇剖宫产率降低1.45%,经产妇剖宫产率与2015年接近。2017年自然临产初产妇剖宫产率高于2015年,其中25~29岁年龄段剖宫产率升高最明显,差异有统计学意义(χ^2=35.497,P<0.05);具有瘢痕子宫的经产妇对总剖宫产率的贡献增加;有剖宫产史孕妇再次妊娠时选择阴道分娩的增加,在一定程度上降低了瘢痕子宫经产妇对总剖宫产率的贡献。结论二孩政策实施后,初产妇的剖宫产率较二孩政策出台前有所下降;前次剖宫产遗留的瘢痕子宫是二孩政策实施后剖宫产率上升的主要原因;尽可能鼓励初产妇顺产,同时提高产科质量[剖宫产后阴道分娩(VBAC)成功],有望在二孩政策时代进一步降低剖宫产率。

Objective To compare the changes of cesarean section rate in a central district of Shanghai before and after the implementation of the universal two-child policy.Methods The childbirth records from January 1to December 31in 2015and from January 1 to December 31in 2017in 6midwifery institutions of Shanghai were retrospectively collected,and all records of live births(gestational week≥28weeks,or birth weight>1000g)were included in this study.The cesarean section rate was classified and summarized according to the Robson Classification System,and then analyzed further.Results The total number of births in 2017increased by 1,729compared with that in 2015,the maternal age and education level also increased,but the proportion of primiparas decreased by 8.52%.The cesarean section rate in 2017was decreased by 0.28%compared with that in 2015,and the cesarean section rate of primiparas decreased by 1.45%,but the cesarean section rate of multiparas was close to that in 2015.In 2017,the rate of cesarean section in natural pregnant women was significantly higher than that in 2015(χ^2=35.50,P<0.05),with the most significant increase of cesarean section rate in 25-29years old.The contribution of multiparas with scar uterus to the total cesarean section rate had increased.And the number of pregnant women with a history of cesarean section who chose vaginal delivery during their second pregnancy increased,which to some extent reduced the contribution of multiparas with scar uterus to the total cesarean section rate.Conclusion After the implementation of the universal two-child policy,the cesarean section rate of primipara decreased.Scar uterus caused by previous cesarean section become the main reason for the increasing of cesarean section rate.So,it is expected to further reduce cesarean section rate in the era of two-child policy by encouraging natural labor of nulliparous and improving the quality of obstetrics(successful vaginal birth after cesarean).