运用Robson分类法对“全面二孩”政策后剖宫产率控制的研究

Research on thecharacteristics of cesarean delivery after the universal two child policy using Robson classification

目的应用Robson分类法分析大连某妇幼保健专科医院“全面二孩”政策后产妇人群及剖宫产率变化特点,为降低不同特征产妇的剖宫产率提供依据。方法以大连某妇幼保健专科医院2016年1月1日—2019年12月31日住院分娩的61691例产妇为研究对象,对初产妇和经产妇分别应用Robson分类法进行分组,运用卡方趋势检验分析不同特征产妇构成比、剖宫产构成比及剖宫产率变化趋势,寻找对总剖宫产率影响较大的产妇群体。结果2016—2019年初产妇总剖宫产率为30.7%,初产妇剖宫产率呈上升趋势(P<0.05),Robson分类法下,初产妇人群剖宫产构成比占前3位依次是R2a组(初产妇单胎头位,足月,引产临产)、R2b组(初产妇单胎头位,足月,临产前剖宫产)、R6组(所有初产妇单胎臀位),其中R2a组、R9组(单胎横位或斜位的初产妇)四年间呈上升趋势,R10组(早产的初产妇)呈下降趋势(P<0.05);组内剖宫产率中R1组、R8组(双胎妊娠初产妇)呈上升趋势(P<0.05)。2016—2019年经产妇总剖宫产率为42.5%并呈下降趋势(P<0.05),Robson分类法下,经产妇人群剖宫产构成比占前3位依次是R5a组(有1次剖宫产史的经产妇)、R7组(所有经产妇、单胎臀位)、R10组(早产的经产妇),其中R5a组呈上升趋势,R10组呈下降趋势(P<0.05);组内剖宫产率中R8组(双胎妊娠经产妇)呈上升趋势,R4组(经产妇无剖宫产史,单胎头位,足月)呈下降趋势(P<0.05)。结论全面二孩政策下,对初产妇剖宫产率的控制应重点关注单胎头位足月以及所有单胎臀位的初产妇人群,对经产妇剖宫产率的控制应重点关注有1次剖宫产史、所有单胎臀位以及早产的经产妇人群。

Objective To analyze the characteristics of the maternal population and the rate of cesarean delivery after universal two child policy in a maternity and child health care hospital in Dalian using the Robson classification method,with the aim to provide a basis for reducing the rate of cesarean delivery for women with different characteristics.Methods This study included a total of 61,691 women who were hospitalized and delivered in a maternity and child health care hospital in Dalian from January 1,2016 to December 31,2019.Cesarean deliveries were categorized separately for primiparous and multiparous women according to the Robson classification method.Chi-square trend test was used to examine the trend in the rates and indications of cesarean delivery in different subgroups of women over time,and the subgroups that have greater contributions to the increasing cesarean delivery rate were explored.Results The total cesarean delivery rate of pregnant women in 2016-2019 was 30.7%,and the rate of cesarean delivery among primipara showed an upward trend(P<0.05).Based on the Robson classification,the top 3 contributing groups were R2a,R2b,R6;the proportion of R2a and R9 group showed an upward trend,and that of R10 group showed a downward trend(P<0.05);R1 and R8(Twin pregnancy primipara)group-specific cesarean delivery rate showed an upward trend(P<0.05).The cesarean delivery rate among multipara was 42.5%,and the cesarean delivery rate showed a downward trend over time(P<0.05).Under the Robson classification,the top 3 contributing groups R5a,R7,and R10;the proportion of R5a showed an upward trend,and that of R10 showed a downward trend(P<0.05);R8(multiparous twin pregnancy)group-specific cesarean delivery rate showed an upward trend,and R4(Multiparous women without a previous uterine scar,with single cephalic pregnancy,≥37weeks gestation)group-specific cesarean delivery rate showed a downward trend(P<0.05).Conclusion After implementation of the universal two-child policy,the control of cesarean delivery rate of primipara may need to focus on the groups R2a(Nulliparous women with single cephalic pregnancy≥37 weeks gestation who had labor induced),R2b(Nulliparous women with single cephalic pregnancy≥37 weeks gestation who were delivered by caesarean delivery before labor),and R6(All nulliparous women with a single breech pregnancy);the control of cesarean delivery rate among multipara may need to focus on the groups R5a(One history of cesarean section),R7(All multiparous women with a single breech pregnancy,including women with previous uterine scars),and R10(Preterm multiparous women).