二孩政策后剖宫产率及剖宫产指征的变化

Changes in rate and indication of cesarean delivery after two-child policy

目的探讨二孩政策后产科患者构成比、剖宫产率及剖宫产指征的变化情况。方法回顾性分析2014年1月至2017年12月在川北医学院附属医院产科住院分娩的7081例产妇病例资料,了解患者的基本信息、分娩方式及剖宫产指征,计算年度剖宫产率及各剖宫产指征构成比。结果①二孩政策后剖宫产率呈上升趋势,从2014年的70.56%上升到2017年的74.01%(χ^2=13.31,P=0.00),高龄产妇及经产妇的比例逐年升高,分别从2014年的12.57%、16.04%升高到2017年的18.21%、21.43%(χ^2值分别为28.18、21.90,均P<0.05),顺产费用及剖宫产费用逐年增加(F值分别为32.62、57.09,均P<0.05);2017年的剖宫产率与2014年、2015年、2016年比较差异均有统计学意义(χ^2值分别为11.06、4.00、2.24,均P<0.05);2017年的顺产费用及剖宫产费用与2015年比较差异均有统计学意义(LSD-t值分别为12.18、19.13,均P<0.05)。②剖宫产指征中社会因素剖宫产率下降最为显著,从2014年的19.98%下降到2017的8.75%(χ^2=109.40,P<0.05),其中2016年、2017年社会因素剖宫产率分别与2014年及2015年比较差异均有统计学意义(2016年与2014年、2015年比较:χ^2值分别为73.34、32.23,均P<0.05;2017年与2014年、2015年比较:χ^2值分别为71.22、28.43,均P<0.05);其次为引产失败、产程异常、巨大儿及头盆不称(χ^2值分别为191.20、49.09、59.14、31.24,均P<0.05);而瘢痕子宫及妊娠期并发症的比例逐年升高,分别从2014年的15.65%、11.12%升高到2017年的28.77%、27.19%(χ^2值分别为77.80、139.34,均P<0.05),其中2016年、2017年妊娠期并发症比例分别与2014年及2015年比较差异均有统计学意义(2016年与2014年、2015年比较:χ^2值分别为88.65、41.06,均P<0.05;2017年与2014年、2015年比较:χ^2值分别为98.37、47.03,均P<0.05);2016年、2017年瘢痕子宫的比例分别与2014年及2015年比较差异均有统计学意义(2016年与2014年、2015年比较:χ^2值分别为46.27、17.59;2017年与2014年、2015年比较:χ^2值分别为60.31、25.90,均P<0.05)。结论二孩政策后社会因素剖宫产率下降明显,而瘢痕子宫及妊娠期并发症的比例上升较快,导致剖宫产率居高不下。

Objective To investigate changes in constituent ratio of obstetric patients,rate and indication of cesarean delivery after two-child policy.Methods The clinical data including general information,way of delivery and reason for cesarean delivery of 7081 women who gave birth in the Department of Obstetrics of the First Affiliated Hospital of North Sichuan Medical College from January 2014 to December 2017 were retrospectively analyzed.The annual rate of cesarean delivery and the constituent ratio of every indication for cesarean delivery were calculated.Results①The rate of cesarean delivery gradually increased from 70.6%in 2014 to 74.0%in 2017(χ^2=13.31,P<0.05);the proportions of elderly puerpera and multipara also increased gradually from 12.57%and 16.04%in 2014 to 18.21%and 21.43%in 2017 respectively(χ^2=28.18 and 21.90 respectively,both P<0.05);also,the fees of vaginal delivery and cesarean delivery both increased(F=32.62 and 57.09 respectively,both P<0.05).The rate of cesarean delivery in2017 was significantly higher than all that in 2014,2015 and 2016(χ^2=11.06,4.00 and 2.24 respectively,all P<0.05).The fees of vaginal delivery and cesarean delivery in 2017 were both significantly higher than those in 2015(LSD-t=12.18 and 19.13 respectively,both P<0.05).②Among the indications of cesarean delivery,the rate of cesarean delivery due to social factor was decreased mostly:from 19.98%in 2014 to 8.75%in 2017(χ^2=109.40,P<0.05),of which the rate of cesarean delivery due to social factor in each 2016 and 2017 were decreased significantly than that in each 2014 and 2015(as compared between that in 2016 and that in each 2014 and 2015:χ^2=73.34 and 32.23 respectively,both P<0.05;as compared between that in 2017 and that in each 2014 and2015:χ^2=71.22 and 28.43 respectively,both P<0.05).The next indications of cesarean delivery were failure in induced labor,abnormal prolonged labor,fetal macrosomia and cephalopelvic disproportion(χ^2=191.20,49.09,59.14 and 31.24 respectively,all P<0.05).However,the rates of uterine scar and pregnant complications increased year by year fast:from 15.65%and 11.12%in 2014 to 28.77%and 27.19%in 2017 respectively(χ^2=77.80 and 139.34 respectively,both P<0.05),of which the proportion of pregnancy complications in each 2016 and 2017 were significantly higher than that in each 2014 and 2015(as compared between that in2016 and that in each 2014 and 2015:χ^2=88.65 and 41.06 respectively,both P<0.05;as compared between that in 2017 and that in each 2014 and 2015:χ^2=98.37 and 47.03 respectively,both P<0.05).And the proportion of uterine scar in each 2016 and 2017 were significantly higher than that in each 2014 and 2015(as compared between that in 2016 and that in each 2014 and 2015:χ^2=46.27 and 17.59 respectively,both P<0.05;as compared between that in 2017 and that in each 2014 and 2015:χ^2=60.31 and 25.90 respectively,both P<0.05).Conclusion Among the indications of cesarean delivery,the rate of of cesarean delivery due to social factor has decreased fast,while the rates of uterine scar and pregnant complications both increased significantly after two-child policy,which causes the rate of cesarean delivery remains higher proportion.