Analysis of the Caesarean Section Rate in Armenia for the Period 2016-2021 Based on the Results of a Single Center Study

Background: The caesarean section rate is an important factor that characterizes the effectiveness of the obstetric service. The large variability of the initial state of women in labor and the variety of indications for surgery does not allow us to identify the main determinants. We attempted to determine and analyzed the first data on the structure and frequency of caesarean section in Armenia in the hospital of the Erebоuni multidisciplinary clinic before the introduction of the M. Robson scale. Methodology: We conducted a retrospective study of the history of childbirth in 38,111 patients registered at the Erebouni Medical Center for the period 2016-2021. The materials of the study were case histories, hospitalization materials and annual reports. Results: According to the obtained data, 80.5% of caesarean section operations were performed as planned. Only 14% of pregnant women were delivered by caesarean section according to absolute indications, the frequency of that in this maternity hospital increased from 36.77% to 44.95% over the analyzed period Conclusion: Thorough psychoprophylactic preparation of pregnant women for childbirth, including those with a scar on the uterus after a previous cesarean section, can ensure a steady desire of women in labor for vaginal delivery, full mobilization of their own capabilities, and more trusting cooperation with medical staff.

Evaluation and Relevance of Indications for Primary Caesarean Section: A Five-Year Experience Report from Nevers Hospital Center

Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for primary caesarean sections and to find ways to reduce the increasing rates. Patients and Method: This is a longitudinal and retrospective study carried out from June 1, 2018 to July 31, 2022. The study included all patients who had a cesarean-section for the first time (primary caesarean). An anterior uterine scar was a non-inclusion criterion. Data were collected prospectively using Synfonievre and Agopra software via patients’ files and information collection sheet. Data were analyzed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentages for qualitative data. The statistical tests used were the Pearson Chi2 test. The observed differences were considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by the other indications (including preterm delivery, umbilical cord dystocia, malpresentation of fetus, foetal abnormalities, elective CS, triple gestation, mother abnormalities);dystocia or prolonged labor (18.7%), breech presentation in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation during of a twin birth and a singleton. Induction of labor can be an effective alternative in certain indications. An obstetrical audit is needed to reverse the caesarean section rate.

A Six-Year Review of Caesarean Sections at the Federal Teaching Hospital Abakaliki, Ebonyi State, South East Nigeria

Background: Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). Subjects and Methods: This was a six-year retrospective study covering January 1st 2012 to December 31st 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed by means of Epi Info version 7. Results are presented in tables, means and simple percentages. Results: During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. The most common indication for an emergency caesarean section was failure to progress in labour with 20.0% contribution and the most common indication for elective caesarean section was previous caesarean section with 13.5%. Majority of the babies were delivered at term (77.0%) with an average gestational age of 38 ± 2.6 weeks. Almost two-thirds of the subjects (62.5%) had emergency caesarean section. The average birthweight was 3.03 ± 0.71 kg. Maternal anaemia was the most common complication recorded 38.0%. There was direct maternal death in 2.0% of the study population. Severe birth asphyxia was recorded in 12.3% of the babies while there was 3.2% perinatal death. Conclusion: There is a high rate of caesarean section from this study. The World Health Organization has stated that there is no additional maternal or fetal benefit with caesarean section rate of greater than 10% - 15%. Stakeholders and policy makers need to do more to mitigate this rising trend.

How to Avoid Primary Caesarean Section? A Five-Year Experience Report from a Level 2 Facility in Dakar Senegal

Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospective study carried out from 1 January 2012 to 31 December 2016. The study included all patients in whom a primary CS was performed. A previous uterine scar was a non-inclusion criterion. We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit. Data were collected retrospectively from 2012 to 2015, then prospectively in 2016 using a Filemaker database. Data were analysed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentage for qualitative ones. The statistical tests used were the Pearson Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean sections (29.5%). Primary CS concerned 72.5% of overall CS. The main indications were suspicious of fetal distress (29.1%), obstructed or prolonged labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We registered more vaginal deliveries with induction of labour: 81.4% versus 75.2%. An obstetrical audit allowed better management of labour and decrease of CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation in twin delivery and singleton. The induction of labour can be an effective alternative in some indications. An obstetrical audit is necessary to reverse caesarean section rate.

中国妇女剖宫产率及其影响因素

目的探讨近10年来我国妇女剖宫产率的变化趋势及影响因素。方法利用3次国家卫生服务调查资料进行单因素和多因素Logistic回归分析。结果1990～2003年我国剖宫产率快速上升，从1993年的6．73％（95％CI=5．99～7．47）上升到2003年20．55％（95％CI=19．50～21．60）。剖宫产率城乡差异大，2003年我国城乡剖宫产率分别是39．51％（95％CI=37．19～41．83）和12．77％（95％CI=11．75～13．79）；剖宫产率的上升速度农村明显高于城市，农村的上升速度是城市的2倍；影响剖宫产的非医学原因最主要的是城乡类别。结论我国城乡社会经济的快速发展是剖宫产率急剧上升的最重要间接原因。直接原因有待进一步探讨。

产钳助产对降低剖宫产率的意义

目的探讨产钳助产技术对降低剖宫产率的意义。方法 2014年北京市海淀区妇幼保健院为降低剖宫产率进行产钳助产规范化培训,将2014年分娩的13 952例孕妇作为研究组,2013年分娩的11 588例孕妇作为对照组,对两组孕产妇并发症、分娩方式及母儿结局进行回顾性分析。结果 (1)2014年剖宫产率由2013年的38.8%下降至29.3%,两者比较差异有统计学意义(P<0.01);(2)与2013年比较,2014年产钳助产率显著升高(9.40%vs 5.85%),差异有统计学意义(P<0.01);(3)2014年的产后出血率、会阴Ⅲ度以上裂伤、新生儿窒息率与2013年比较,差异无统计学意义。结论加强产钳助产培训,提高产钳助产技术,在阴道助产指征明确和条件具备的情况下选择产钳助产术,可有效地降低剖宫产率,减少母婴并发症,促进自然分娩。

产前认知辅导对初产妇分娩方式影响的临床观察和探讨

目的观察产前认知辅导对于初产妇分娩方式的影响。方法随机选择2008年9月～2009年7月在杭州市第一人民医院接受定期产前检查并住院分娩的初产妇,随机两组,每组各100例,均从孕31周开始入组,随访到产后7天。干预组本着自愿参加的原则,接受"产前认知辅导训练",对照组仅接受常规产前检查。观察记录两组初产妇的分娩方式和自然分娩的产程进展情况。结果 (1)分娩方式比较:干预组剖宫产率显著低于对照组,差异有统计学意义(χ2=8.62,P<0.01);其中干预组社会因素剖宫产率也显著低于对照组,差异有统计学意义(χ2=13.28,P<0.01)。(2)自然分娩产妇的产程持续时间比较:两组第1产程、第3产程以及总产程的持续时间两两比较无明显差异(第1产程t=1.004,P>0.05,第3产程t=1.325,P>0.05,总产程t=0.283,P>0.05);干预组的第2产程持续时间显著短于对照组,两组比较差异有统计学意义(t=4.905,P<0.01)。结论对初产妇进行产前认知辅导可以有效降低剖宫产率,尤其是社会因素所致的剖宫产率,并有助于缩短第2产程。

对855例急诊剖宫产的分析

目的探讨急诊剖宫产的手术指征分布,以寻求降低剖宫产率的方法。方法回顾性分析北京大学第一医院妇产科2002年1月至2003年12月两年间855例急诊剖宫产的手术指征。结果同期剖宫产率48.8%,其中急诊剖宫产占总剖宫产的37.3%,占总分娩数的18.2%。急诊剖宫产以胎儿窘迫为主,居首位,占急诊剖宫产的62.9%,占同期剖宫产的23.5%。新生儿窒息率在胎儿窘迫组为1.86%,与同期非胎儿窘迫组的1.26%,无显著差异(P>0.05)。术前诊断宫内感染168例,经胎盘病理和宫腔培养确诊83例,术前、后诊断一致率43%。急诊剖宫产发生在宫口开大3cm时最多,占26.6%。结论应严格掌握胎儿窘迫和宫内感染诊断标准,产程中积极处理减少活跃期停滞的发生,有助于降低剖宫产率。

大、小鼠剖宫取胎的适宜条件

目的 :探讨大、小鼠剖宫取胎的适应条件 ,促使大、小鼠剖宫产净化的顺利进行。方法 :采用统计学方法分析大、小鼠剖宫取胎净化过程中的大量数据。结果 :( 1)按规律准确判断妊娠天数 ,可使娩出的仔鼠成活率达到72 .5 % ;( 2 )按规律选择代乳母所养育的仔鼠断乳成活率是按随机选择代乳母所养育的仔鼠断乳成活率的 1.5 1倍。结论

无痛分娩30例临床分析

目的:探讨无痛分娩与产程进展、产程中胎心率变化、新生儿出生后Apgar评分、产后出血及分娩方式的关系。方法:选择我院产科2004年11月～2005年12月实施无痛分娩的30例孕产妇(试验组)及未采用镇痛而自然分娩的30例孕产妇(对照组),比较两组的分娩情况。结果:无痛分娩镇痛效果好,孕产妇的活跃期时间较未采用镇痛而自然分娩的产妇明显缩短,剖宫产率明显降低;而第二产程、第三产程时间、产后出血量、新生儿出生后Apgar评分及产程中胎心率变化,两组间无显著性差异(P>0.05)。结论:无痛分娩镇痛效果确切,可促进第一产程活跃期进展,降低剖宫产率。

剖宫产率现状分析

随着围生医学的发展,手术、麻醉技术、感染控制及药物治疗等条件的改进,剖宫产的安全性大大提高,已经成为产科常用的手术之一,是当前产科领域中既重要又常见的手术,也是处理高危妊娠分娩的重要手段之一。但其惊人的使用率值得深思,所以有效降低剖宫产率不单纯是一个医疗问题,更是一个社会问题,应引起重视。现就有关剖宫产率的现状予以综述。

300例社会因素剖宫产术分析

目的：剖析近年来社会因素剖宫产术急剧上升的主要影响因素，为制定降低社会因素剖宫产术的具体措施提供参考资料。方法：对300例于2004年1-12月在我院因社会因素行剖宫产术的产妇进行问卷式调查。所有病例均为初产妇，单胎头位．无妊娠合并症或并发症。结果：选择社会因素剖宫产术以26—35岁、高学历者、高收入者为主。该人群对剖宫产相关知识的认知率普遍不高。选择社会因素剖宫产术的主要原因为疼痛因素（31．7％）、母儿安全（22．8％）、没信心（13．9％）、家属意愿（12．7％）、医生因素（11．2％）。结论：社会因素剖宫产是复杂的社会问题，受孕产妇和医生的主观意愿影响，降低社会因素所致剖宫产率需要全社会的关注和不懈努力。

1431例剖宫产指征分析

目的:分析2004年剖宫产指征构成及医生对剖宫产指征的掌握情况。方法:对1431例剖宫产病例进行回顾性分析。结果:剖宫产率为47.7%。,主要指征依此为:胎儿窘迫(12.3%)、羊水过少(10.4%)、臀位(9.9%)、巨大儿(9.4%)、头盆不称(9.2%)、脐带绕颈(9.1%)、疤痕子宫(7.7%)、产程异常(5.7%)、胎膜早破(5.2%)、要求手术(3.2%)。其中臀位的剖宫产率为97.9%,疤痕子宫的剖宫产率为97.3%,巨大儿的剖宫产率为74.0%,多胎妊娠的剖宫产率为73.9%。新生儿窒息率为1.3%。结论:应正确掌握剖宫产指征,避免剖宫产指征扩大化,降低剖宫产率,保障母儿身心健康。

剖宫产术后十二点式母乳喂养姿势的临床效果评价

目的探讨十二点式母乳喂养姿势在剖宫产产妇母乳喂养中的应用效果。方法选取某三级甲等医院剖宫产产妇96例,随机分为干预组和对照组各48例,对照组实施常规护理,干预组在常规护理的基础上实施十二点式母乳喂养姿势指导,比较两组首次母乳喂养成功率、住院期间纯母乳喂养率及出院时产妇母乳喂养自我效能。结果干预后干预组首次母乳喂养成功率、住院期间纯母乳喂养率及出院时产妇母乳喂养自我效能均显著高于对照组(P<0.01或P<0.05)。结论十二点式母乳喂养姿势有效提高了剖宫产产妇首次母乳喂养成功率、住院期间纯母乳喂养率及母乳喂养自我效能水平,可在临床推广使用。

近14年我院剖宫产率及其指征变化的探讨

目的:探讨剖宫产率增高的原因及降低剖宫产率的关键。方法:回顾性分析我院近14年剖宫产率及其指征变化。结果:1992～1996年剖宫产率基本稳定,平均26.013%,1997年剖宫产率超过30%,2002年达57.12%,2004年后控制"社会因素",剖宫产率有所下降为54.71%,2006年降为49.74%。结论:"社会因素"和"过度诊断"是导致剖宫产率升高的重要因素;加强孕期宣传和严格掌握剖宫产指征,是降低剖宫产率的关键。

“二孩”政策后产妇分娩方式及剖宫产指征的变化

目的分析"二孩"政策后分娩方式及剖宫产指征的变化。方法回顾性分析2014年1月1日～2017年12月31日在沈阳市妇婴医院住院分娩的55 274例产妇的临床资料,以2016年1月1日为时间截点,将纳入研究的产妇分为"二孩"政策前组(n=24 647)及"二孩"政策后组(n=30 627),比较两组分娩方式及剖宫产指征的变化。结果采用χ2检验进行统计学分析。结果 "二孩"政策前后两组的剖宫产率、阴道分娩率及产钳助产率比较,差异均无统计学意义(P>0.05)。与"二孩"政策前组比较,"二孩"政策后组的经产妇比例明显增加,且经产妇的剖宫产率明显上升,差异均有统计学意义(P<0.05)。"二孩"政策后组中以瘢痕子宫、胎儿窘迫和妊娠期高血压疾病为剖宫产指征的构成比上升明显,以头盆不称、社会因素、产程异常、羊水过少及产前出血为剖宫产指征的构成比明显下降,与"二孩"政策前组比较,差异均有统计学意义(P<0.05)。结论 "二孩"政策后瘢痕子宫再次剖宫产者明显增多是剖宫产率不降的主要原因,减少以社会因素为手术指征的剖宫产数量、提高剖宫产术后再次妊娠阴道分娩(VBAC)成功率、应用新产程标准将进一步降低剖宫产率。

剖宫产率上升的原因及对策

近年来,剖宫产率日益上升,严重影响母婴利益,作为教学医院,也影响产科的临床教学质量。为提高产科质量,确保母婴安全,我们通过回顾性分析发现,胎儿窘迫,胎位异常,巨大儿,社会因素是剖宫产率上升的主要原因。相应对策可以通过加强孕产期宣教,实行镇痛分娩,建立待产、分娩、恢复及产后为一体(labor-delivery-recovery,LDR)分娩模式,提高医护人员助产技术水平,健全法制建设等措施,旨在降低剖宫产率。

浅谈剖宫产率增高的原因及对策

20世纪80年代之前剖宫产是解决难产及解决某些高危妊娠的有效方法.随着麻醉,削宫产及新生儿抢救技术的提高,剖宫产率逐年增高.原因很多,主要原因有社会因素,其次是诊疗技术的提高以及阴道助产技术的减少等,削官产术后的并发症较多,产妇死亡率较阴道分娩高,希望临床产科医生正确掌握削宫产的手术指征,提高阴道助产技术,降低剖宫产率,提高产科质量.

经皮穴位电刺激对剖宫产产妇心率变异性的影响以及麻醉后低血压防治效果的研究

目的:观察经皮穴位电刺激(Transcutaneous Electrical Acupoint Stimulation,TEAS)对剖宫产产妇心率变异性(Heart Rate Variability,HRV)的影响以及麻醉后低血压的防治效果。方法:将择期剖宫产产妇120名,随机分为T组和C组,每组各60例。T组于麻醉前10 mins开始接受经皮内关穴电刺激,持续30 mins;C组仅在同样部位连接电极但不予电刺激。两组均采用腰硬联合麻醉,麻醉过程及药物剂量均保持一致。结果:与T0相比,两组T1、T2、T3的低频段(LF)、低频段/高频段(LF/HF)均有所下降(P<0.05);与C组相比,T组T1、T2、T3的LF、LF/HF较高,低血压、恶心呕吐、头晕、胸闷、呼吸困难的发生率及去氧肾上腺素使用率降低,患者满意度提高,P<0.05。结论:经皮穴位电刺激能明显提高剖宫产产妇心率变异性,降低麻醉后低血压和不良反应的发生率。

待产孕妇分娩方式的选择分析

了解医院剖宫产及其特征.方法:回顾性分析2000年1月至2005年12月衡阳市某医院1850例剖宫产产妇的临床资料.结果:6年间剖宫产率分别为:10.78%、12.53%、13.80%、17.38%、19.53%、20.32%,6年间剖宫产特征中,一直以难产为第一位,巨大儿、产妇要求有上升趋势.结论:应对孕妇加强健康教育,减少巨大儿的发生率,同时,应加强围生期保健宣传力度,使家属及产妇正确地认识剖宫产,降低剖宫产率.