某三级综合医院2014年-2022年产妇分娩方式及剖宫产指征的调查分析

Investigation and Analysis of Maternal Delivery Methods and Indications for Cesarean Section in a Tertiary General Hospital from 2014 to 2022

目的了解某院孕产妇住院分娩情况,探讨剖宫产的影响因素,为降低剖宫产率提供科学依据。方法回顾性选取2014年1月1日-2022年12月31日某院产科住院分娩的19553例产妇住院病案首页相关资料,分析不同年度分娩量、分娩方式和剖宫产指征的变化。结果收治住院分娩产妇19553例,其中2019年的产妇数最高达2863例,其后逐年下降至2022年1623例;高龄产妇(年龄≥35周岁)3114例,占比15.94%,且高龄产妇占比呈逐渐增长趋势(χ^(2)=58.352,P<0.05);剖宫产率总体有所上升,由66.30%升至72.03%(χ^(2)值=278.125,P<0.05),高龄组的剖宫产率高于适龄组(χ^(2)值=390.113,P<0.05);初产妇剖宫产率由2014年的61.04%上升到2022年的77.26%,经产妇剖宫产率由2014年的73.34%下降到2022年的69.38%,其中高龄初产妇的剖宫产率明显高于适龄初产妇,高龄经产妇的剖宫产率也高于适龄经产妇。剖宫产的指征前5位分别为瘢痕子宫、妊娠合并症及并发症、产程异常、胎儿窘迫和前置胎盘/胎盘早剥。结论二孩政策带来了生育高峰,剖宫产率随之呈现先下降后上升,但总体仍属较高水平,应加强产前健康宣教和推广自然分娩方式,加强高龄孕妇的全程管理,针对剖宫产相关影响因素采取针对性干预措施,降低剖宫产率,保障母婴安全。

Objectives This study aims to understand the delivery situation of pregnant women in a certain hospital,explore the influencing factors of cesarean section,and provide a scientific basis for reducing the cesarean section rate.Methods Relevant data on the front page of the medical record of 19,553 maternal hospitalizations in the obstetrics department of a hospital from January 1,2014 to December 31,2022 were retrospectively selected.Changes in delivery volume,mode of delivery,and indications for cesarean section in different years were analyzed.Results A total of 19,553 pregnant women were admitted to the hospital for delivery,with the highest number of pregnant women in 2019 being 2,863,and then decreasing year by year to 1,623 in 2022.There were 3114 cases of advanced maternal age(≥35 years old),accounting for 15.94%,and the proportion of advanced maternal age showed a gradually increasing trend(χ^(2)=58.352,P<0.05).The overall cesarean section rate increased from 66.30%to 72.03%(χ^(2) value=278.125,P<0.05).The cesarean section rate in the elderly group was higher than that in the appropriate age group(χ^(2) value=390.113,P<0.05).The cesarean section rate among primiparous women increased from 61.04%in 2014 to 77.26%in 2022.The cesarean section rate among multiparous women dropped from 73.34%in 2014 to 69.38%in 2022.The cesarean section rate among older primiparous women was significantly higher than that among primiparous women of appropriate age,and the cesarean section rate among older multiparous women was also higher than that among primiparous women of appropriate age.The top five indications for cesarean section were scarred uterus,pregnancy complications and complications,abnormal labor,fetal distress,and placenta previa/placental abruption.Conclusions The two-child policy has brought a birth peak.The cesarean section rate first declined and then increased,but overall,it is still at a relatively high level.Hospitals should strengthen prenatal health education and promote natural delivery methods,strengthen the full-process management of older pregnant women,and adopt targeted intervention measures for factors related to cesarean section to continuously reduce the cesarean section rate and ensure the safety of mothers and infants.