二胎政策放开前后6年54986例剖宫产指征分析

Analysis of Cesarean Section Indications in Six Years during the Different Two-Child Policy Periods

目的分析二胎政策放开前后6年剖宫产指征分布的变化,探讨降低剖宫产率的有效措施。方法选取2013年1月1日-2018年12月31日南京某专科医院住院分娩剖宫产产妇54986例,按未放开二胎政策阶段、放开单独二孩政策阶段、全面放开二孩政策阶段分组,对其剖宫产指征构成及其变化进行回顾性分析。结果 2013年-2018年,剖宫产率平均值为43.15%(54 986/127 420),未放开二胎政策阶段组剖宫产率为44.51%(16 479/37 026),单独二孩政策阶段组剖宫产率为41.98%(17 897/42 631),全面二孩政策阶段组剖宫产率为43.15%(20 610/47 763);三组间剖宫产率存在统计学差异(χ~2=51.516,P<0.001)。剖宫产主要指征依次是:疤痕子宫、胎儿宫内窘迫、社会因素、切盼儿、臀位、巨大儿、引产失败、双胎妊娠、高龄初产、持续性枕后位。结论不同的二孩政策阶段剖宫产率间存在差异;非医学指征的社会因素剖宫产已经不占初产妇的剖宫产的最大构成;疤痕子宫剖宫产占经产妇剖宫产的最大构成比。

Objective To explore the changes on cesarean section indications in six years during the different two-child policy periods.Aimed to provide effective solution for reducing the cesarean section rate.Methods Retrospective analysis was conducted on medical record data of 54986 pregnancy women in a special hospital in Nanjing from January 1,2013 to December 31,2018,and were designed as group Non-two-child policy period,group two-child policy period and group Universal-two-child policy period.Comparison was done among three groups in the aspect of cesarean section indications.Results The average rate of cesarean section from 2013 to 2018 was 43.15%(54 986/127 420).The rate of cesarean section of group Non-two-child policy period was 44.51%(16479/37 026).The rate of cesarean section of group two-child policy period was 41.98%(17 897/42 631).The rate of cesarean section of group Universal-two-child policy period was 43.15%(20 610/47 763).The rates of cesarean section among three groups had statistical difference(χ~2=51.516,P<0.001).The main indication of cesarean section insequence were:scarred uterus,fetal distress,social factor,precious baby,breech position,fatal macrosomia,induced labor failure,twin pregnancy,elder primipara,abnormal fetal position.Conclusion Cesarean section rates were different under different two-child policies.Social factors cesarean section was not the main composition of cesarean section.Scarred uterine cesarean section had become the largest composition of cesarean section.