78438例产妇分娩方式及剖宫产指征的调查分析

Delivery methods and indications for cesarean section in 78?438 pregnant women

目的通过对西北妇女儿童医院5年间78 438例产妇分娩方式及剖宫产指征的调查,探索降低剖宫产率的手段和措施。方法收集2013至2017年在西北妇女儿童医院产科分娩的产妇78 438例,统计分析年度分娩方式的变化情况,以及不同因素下剖宫产指征的比例。结果总剖宫产率为42.35%,去除前次剖宫产后的剖宫产率为28.45%。阴道助娩率为3.89%,剖宫产后再次妊娠阴道分娩(VBAC)率为10.62%。从2014年开始,去除前次剖宫产后的剖宫产率逐年降低(χ~2=607.94,P<0.05)。剖宫产率、阴道助娩率和VBAC率年度间差异均有统计学意义(χ~2值分别为270.13、100.38、29.49,均P<0.05),但变化无规律。在剖宫产因素中,胎儿因素占43.39%,其后依次为子宫疤痕因素(33.18%)、妊娠并发症(9.46%)和产程异常(9.15%),其他因素占4.90%。手术指征比例最高的是前次剖宫产(32.82%),其后依次为臀位/横位(9.97%)、双胎/三胎(6.56%)、胎儿监护异常(6.10%)、胎儿窘迫(5.95%)、羊水过少/偏少(5.44%)、子痫前期/妊娠期高血压(5.20%)、头盆不称/巨大儿(4.71%)、先露下降/宫口扩张阻滞(3.28%)、引产失败(3.17%)、脐带因素(2.54%)、前置胎盘(2.18%)、体外受精-胚胎移植(IVF-ET)(2.12%)、妊娠期肝内胆汁淤积症(1.53%)、持续性枕横/枕后位(1.20%)、前不均倾/高直位(0.88%)、宫缩乏力(0.61%)、胎盘早剥(0.55%)。结论剖宫产后再次妊娠的剖宫产几乎占所有剖宫产的1/3。多种措施并举包括实施VBAC可促进阴道分娩;通过把控'初次剖宫产'手术指征,减少'前次剖宫产'为指征的手术,是降低剖宫产率的重要手段。

Objective To explore effective measures to reduce cesarean section rate by investigating delivery methods and indications of cesarean section in 78?438 pregnant women in the past 5 years.Method From 2013 to 2017,78?438 pregnant women with more than 28-weeks gestation admitted in Northwest Women and Children Hospital were investigated.The change of annual delivery modes and the proportion of various indications for cesarean section under different factors were analyzed.Results the rate of general cesarean section was 42.35%.After subtracting the previous cesarean section,the cesarean section rate was 28.45%.The vaginal assisted delivery rate was 3.89%and the successful rate of vaginal birth after cesarean(VBAC)was 10.62%.Starting from 2014,the cesarean section rate after removing the previous cesarean section has decreased year by year(χ~2=607.94,P<0.05).The cesarean section rate,vaginal delivery rate and VBAC success rate have annual differences(χ~2=270.13,100.38 and 29.49 respectively,P<0.05 for all),but the changes were irregular.Fetal factors among cesarean section factors had the highest proportion(43.39%),and the remaining proportions include,respectively,uterine scar factors(33.18%),pregnancy complication factors(9.46%),abnormal labor factors(9.15%)and other factors(4.9%).The most common indications for cesarean section is that they had a previous cesarean section history(32.82%);then they were walking with hip/cross position(9.97%),polyembryony(6.56%),fetal monitoring abnormality(6.1%),fetal distress(5.95%),hydramnion/hypamnion(5.44%),preeclampsia/gestational hypertension(5.2%),fetal macrosomia(4.71%),first dew drop/cervical dilatation block(3.2%),unsuccessful induced delivery(3.17%),umbilical cord factor(2.54%),Placenta previa(2.18%),IVF-ET(2.12%),intrahepatic cholestasis of pregnancy(1.53%),persistent occipital transverse/occipital posterior position(1.2%),anterior asymmetry/high straightness(0.88%),uterine inertia(0.61%)and placental abruption(0.55%).Conclusion The previous cesarean section made up almost one-third of the total.A variety of measures were taken,including the implementation of VBAC,to promote vaginal delivery;an important means to reduce the rate of cesarean section is to control the indications of first cesarean section so as to reduce previous cesarean section.