2019—2022年淮南地区剖宫产现状及指征变化情况分析

Analysis of the status and indication changes for cesarean section in Huainan region,2019-2022

目的探讨淮南地区医疗机构剖宫产现状及指征变化情况,以期为制订科学的干预措施及管理策略提供实证依据。方法以2019年1月至2022年12月在淮南市妇幼保健院、淮南市第一人民医院、淮南东方医院住院生产的产妇作为调查对象,收集产妇一般人口学信息及孕产相关信息,剖宫产指征依据《剖宫产手术的专家共识(2014)》进行评估,采用描述性分析方法分析剖宫产情况及指征变化情况,并采用单、多因素分析方法对非医学指征剖宫产的相关因素进行分析。结果共收集10878例产妇的相关资料,其中剖宫产3750例,占比为34.47%。2019—2022年剖宫产率呈逐渐降低趋势(趋势χ^(2)=160.049,P<0.01),分别为45.63%、39.31%、31.85%、23.63%。2019—2022年剖宫产指征分布差异有统计学意义(χ^(2)=340.037,P<0.01),其中均以瘢痕子宫占比最高。2019—2022年剖宫产指征中瘢痕子宫、胎儿窘迫占比呈逐渐升高趋势,胎盘早剥、前置胎盘占比呈逐渐降低趋势。3750例剖宫产产妇中非医学指征剖宫产166例,占比为4.43%。非医学指征剖宫产主要原因为担心无法自然分娩,试产后最后还要改剖宫产(32.53%)。多因素logistic回归分析结果显示年龄30~<35、35~40岁(OR=1.093、1.097)、孕前BMI≥28.0kg/m^(2)(OR=2.933)、经产妇(OR=1.664)、不知晓孕产相关知识(OR=1.670)、有产前焦虑(OR=4.865)的产妇非医学指征剖宫产率可能更高。结论2019—2022年淮南地区医疗机构剖宫产率呈降低趋势,剖宫产指征以瘢痕子宫占比最高,仍有一定比例的无剖宫产指征剖宫产现象。

Objective To explore the status and indication changes for cesarean section in medical institutions in Huainan region,in order to provide empirical evidence for the formulation of scientific intervention measures and management strategies.Methods Women who gave birth in Huainan Maternal and Child Health Hospital,Huainan First People's Hospital,and Huainan Dongfang Hospital from January 2019 to December 2022 were selected as the survey objects.General demographic information and pregnancy-related information were collected.Indicators for cesarean section were evaluated according to Expert Consensus on Cesarean Section Operation(2014).Descriptive analysis was used to analyze the status of cesarean section and the change of indications,and univariate and multivariate analyses were used to analyze the related factors of cesarean section without medical indications.Results A total of 10878 cases of maternal data were collected,including 3750 cases of cesarean section,accounting for 34.47%.The cesarean section rates from 2019 to 2022 showed a gradually decreasing trend(trend χ^(2)=160.049,P<0.01),and were 45.63%,39.31%,31.85%,and 23.63%,respectively.There was significant difference in the distribution of indications of cesarean section from 2019 to 2022(χ^(2)=340.037,P<0.01),among which scar uterus accounted for the highest proportion.From 2019 to 2022,the proportion of scar uterus and fetal distress in the indications of cesarean section showed a gradually increasing trend,while the proportion of placental abruption and placenta previa showed a gradually decreasing trend.Among the 3750 women who gave cesarean section,166 had cesarean section without medical indications,accounting for 4.43%.The main reason for cesarean section without medical indications was the fear of not being able to deliver naturally,and after the trial delivery,a cesarean section must be changed(32.53%).The results of multivariate Logistic regression analysis showed that the rate of cesarean section without medical indications was higher in women aged 30-35(OR=1.093)and 35-40(OR=1.097),with a pre pregnancy BMI of≥28.0 kg/m^(2)(OR=2.933),multiparous women(OR=1.664),those who were unaware of pregnancy and childbirth related knowledge(OR=1.670),and those who had prenatal anxiety(OR=4.865).Conclusions From 2019 to 2022,the cesarean section rate in medical institutions in Huainan region shows a decreasing trend.The highest proportion of cesarean section indications is scar uterus,and there are still a certain proportion of cesarean section without indications.