妊娠早期初产妇分娩意愿的相关影响因素分析

Analysis of related factors of delivery intention of primiparae in early pregnancy

目的研究妊娠早期初产妇分娩意愿的相关影响因素,为进一步降低无指征剖宫产率提供依据。方法于2019年3月至2019年12月在上海市徐汇区各社区建册的孕妇中,选择没有生育史、B超证实孕7~12周、单胎妊娠、既往无严重内外科疾病史的孕妇,进行面对面问卷调查,分析孕妇分娩意愿的相关影响因素。结果发放问卷2 000份,收回有效问卷1 942份。分娩方式的选择在年龄、户籍、文化程度、是否独生子女、有无意愿生二胎方面差异均有统计学意义(χ2值分别为85.26、44.50、20.94、17.57、167.87,均P<0.05)。多因素分析结果显示:高龄(≥35岁)(OR=3.233,95%CI:1.501~6.962)、本市户籍(OR=2.524,95%CI:1.777~3.587)、大专或本科(OR=2.024,95%CI:1.306~3.137)、高中及以下(OR=4.720,95%CI:2.471~9.016)、不愿意以后生育二胎(OR=2.382,95%CI:1.628~3.486)的孕妇更倾向于选择剖宫产分娩。结论对于高龄、文化程度偏低、本市户籍、不愿意生二胎的重点人群,医生要制定合理的医疗干预,有利于降低无指征剖宫产分娩的比例。

Objective To investigate related influencing factors of parturition willingness of primiparae in early pregnancy,so as to provide basis for further reducing rate of cesarean section without indications.Methods From March 1,2019 to December 1,2019,those pregnant women who had no delivery history in 7~12 weeks of singleton pregnancy confirmed by B-ultrasound and had no past histories of serious internal and surgical diseases from the pregnant women registered in all communities in Xuhui District of Shanghai were selected and face-to-face questionnaires were conducted.The survey contents included general basic information,whether would want a second child later,choice of delivery pattern and mastery of delivery knowledg in order to analyze the factors that affected the willingness about delivery pattern of the pregnant woman.Results 2000 questionnaires were distributed and 1942 valid questionnaires were recalled.In choice of delivery pattern there were significant differences among different age groups,different registered residence places,different educational levels,whether the pregnant woman was only-son/daughter and whether she was willing to want a second child later(χ~2=85.26,44.50,20.94,17.57 and 167.87 respectively,all P<0.05).Multivariate analysis showed that those elderly pregant women(≥35 years old)(OR=3.233,95%CI:1.501~6.962),with urban registered residence(OR=2.524,95%CI:1.777~3.587),junior college and undergraduate schooling records(OR=2.024,95%CI:1.306~3.137),high school and below educational levels(OR=4.720,95%CI:2.471~9.016) and unwilling to have a second child later(OR=2.382,95%CI:1.628~3.486) were more likely to choose cesarean delivery.Conclusion Obstetricians should formulate reasonable medical intervention for those key population such as elderly pregant women with low education level,urban household registration,and unwilling to have a second child later,so as to reduce the rate of cesarean delivery without indications.