Study on the Indications for and Factors Related to Cesarean Section at Three District Hospitals in Shanghai

Objective To understand the indications for and factors related to cesarean section （CS）. Methods Pregnant women who attended health examination at three selected district hospitals were investigated from May 2001 to February 2003. Results Among 933 puerperas, the CS rate was 37. 62%. The top four indications for CS were fetal distress （36. 5%）, social factors （35.9%）, relative cephalopelvic disproportion （18.5%） and pregnancy complications （6.3%） respectively, The result of regression analysis showed that puerperas who were overweight before pregnancy, had no confidence in vaginal delivery and had macrosomia were more likely to have CS. Conclusion At present, the CS rate in Shanghai was rather high, The main indications for CS were fetal distress and social factors. The high CS rate was associated with the psychological factor and some demographic factors such as birth weight and puerperas＇ weight before pregnancy.

Cesarean Section Indications and Prognosis in Adolescents Girls at the Mother-Child Pool of the Teaching Hospital of Tengandogo (CHU-T) in Burkina Faso

Objective: Conduct a study on cesarean sections in adolescent girls at the mother-child pool of the CHU-T in order to reduce maternal-fetal morbidity and mortality. Patients and Methods: This was a descriptive and cross-sectional study with a retrospective data collection method from January 1st, 2018 to December 31st, 2019. Results: The frequency of caesarean sections in our series was estimated at 59.9% in adolescent girls. 68.7% of adolescent girls were married, the average age was estimated at 18.3 ± 1 years, primiparous women were the most represented group with a rate of 88%. Adolescent girls were housewives in 73.5% of cases, with 37.4% of them living in rural areas. The main indications for cesarean section were: pre-rupture syndrome (22.9%), fetal distress (19.3%), pre-eclampsia/eclampsia (18.1%) and bony dystocia (21.6%). The following results derive from the classification of the cesarean section indications into 2 groups according to one or the other member of the “mother-child” couple: maternal indications accounted for 57.8% while fetal adnexal indications were estimated at 36.1%. As for perinatal mortality, it reached 24.1%. Conclusion: Improving the maternal-fetal prognosis of cesarean section in adolescent girls necessarily requires the strengthening of pregnancies follow-ups among this population group where pregnancy is most often unplanned.

Cesarean Sections according to the Robson’s Classification in Two University Hospitals of Yaoundé: Indications and Maternofetal Outcome

Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health facility. For this reason, in 2015, the World Health Organization (WHO) recommended the use of Robson’s classification to evaluate the practice of cesarean sections in order to identify the groups of women who had abnormally high rates. The objective of our study was to evaluate cesarean sections using the Robson’s classification in CHRACERH and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a retrospective cross sectional and descriptive study in two (02) university hospitals in Yaoundé which took place from December 2017 to May 2018. We included in our study all women who gave birth over a period of two (02) years from January 2016 to December 2017 in these two health facilities. Our sampling was exhaustive over the study period. The parturients’ information was collected using an anonymous and pretested questionnaire. The Robson’s group of every parturient was determined. Descriptive parameters like mean and proportions were calculated. We compared the rates and indications of cesarean sections between the both hospitals using Chi2 test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections;hence, a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals: in CHRACERH, group 5 (31.1%), group 3 (20%) and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group and the hospital, the principal indication in group 1 was acute fetal distress (28.6%) in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%). In groups 5, CHRACERH and of YCH, a scarred uterus was the principal indication for the cesarean section at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH, this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification is an adequate tool for the evaluation and comparison of the rates of cesarean sections. The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as the groups most at risk for cesarean sections in the both hospitals.

The Caesarean Section in Dakar: Indications and Analysis Prognosis

The objective of this study was to analyze the indications of cesarean sections performed in a Level II clinic and to evaluate early maternal and neonatal outcome in the context of decentralization of obstetric and emergency newborn care. Material and Method: This was a retrospective descriptive and analytical study conducted at the maternity CSNC over a period of 12 months from 1 July 2010 to 30 June 2011. It included all women in childbirth by caesarean section and excluded patients admitted for management of complications of cesarean section performed in another structure. Results: During the study period, 595 caesarean sections were performed on a total of 4410 births, a rate of 13.5%. The average age of patients was 27 years. The mean parity was 2. The patients came from them even 55%. They were admitted with a single uterine scar in 28.40% of cases and bi-scar in 25.4% of cases. A pathology was associated with pregnancy in 31.6% of cases. These pathologies were dominated by vascular and renal syndromes (75.5%), anemia (13.8%) and the obstacles previa (10.1%). Caesarean sections were performed in 517 patients in emergency. The technique of Misgav Ladach was the most common 75.1%. The average hospital stay was 4.2 days with extremes of 0 and 15 days. Postoperative maternal mortality was 0.34%. Operative follow-up was simple in 98.3% of patients. Two patients (0.34%) died after surgery. In 92.4% of the cases, the newborns were alive. The Apgar score in the first minute was favorable (greater than or equal to 7/10) in 503 newborns (95.1%) and unfavorable (less than 7/10) in 47 cases (8.55%). At the fifth minute, he was favorable in 98.5% of the cases. Overall stillbirth was 72.26‰ with a total of 43 stillbirths including 3 macerated stillbirths. Conclusion: Cesarean section is by far the most accomplished action in gynecology and obstetrics. Its ease of implementation and low cost, and of course his results in terms of reduction of maternal-fetal morbidity and mortality make a key intervention and allowed its extension.

Prediction of Success Rates of Vaginal Birth after Cesarean Delivery According to the Previous Indication for Cesarean Delivery

Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.

Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women： The Shanxi Study

Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nulliparous pregnancies unless indicated, to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

2014-2020年东莞市某三级医院流动人口产妇剖宫产率及剖宫产指征分析

目的分析东莞市某三级医院2014-2020年流动人口产妇剖宫产率及剖宫产指征变化情况。方法收集2014-2020年东莞市某三级甲等医院住院分娩流动人口产妇的临床资料,剖宫产指征以第一指征为主,对其剖宫产指征构成及其变化进行回顾性分析。结果该组孕产妇32401例,剖宫产8721例,剖宫产率为26.9%。2014-2020年各年份的剖宫产率分别为29.8%、25.2%、26.6%、26.3%、25.1%、28.0%、27.1%。剖宫产指征以瘢痕子宫居首位,其他依次为胎位异常、胎儿宫内窘迫和社会因素。在高龄、非高龄产妇剖宫产指征中,瘢痕子宫和胎位异常均分别位居第1、2位,第3位剖宫产指征分别为产妇要求和胎儿宫内窘迫;高龄产妇的瘢痕子宫、前置胎盘、妊娠合并症、妊娠合并肿瘤构成比等均高于非高龄产妇,胎位异常、胎儿宫内窘迫、羊水过少、产程异常的比例则低于非高龄产妇(P<0.05)。结论该研究的剖宫产率仍高于WHO标准,剖宫产指征中以瘢痕子宫和胎位异常为主。

阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果

目的:分析阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗预防产褥感染效果。方法:回顾性分析2022年1月-2023年12月本院产科阴道试产失败中转剖宫产产妇400例临床资料,其中2022年1-12月术前作外阴备皮、冲洗的200例纳入对照组,2023年1-12月术前作外阴备皮、Ⅲ型安尔碘阴道灌洗、冲洗的200例产妇纳入观察组,对比两组术后体温、24h出血量、产褥感染率、切口感染率及白细胞计数(WBC)、C反应蛋白(CRP)和降钙素原(PCT)水平变化情况。结果:观察组术后24h(36.90±0.17℃)、48h(36.70±0.15℃)、72h体温(36.50±0.12℃)均低于对照组(37.00±0.21℃、36.80±0.16℃、36.60±0.13℃),术后24h出血量(287.3±21.5ml)少于对照组(296.2±23.7ml),产褥感染率(0.5%)低于对照组(3.5%)(均P<0.05),两组切口感染率(0.5%、1.0%)无差异(P>0.05)。观察组术后72h WBC(10.07±2.28×10^(9)/L)、CRP(2.23±0.39mg/L)、PCT(4.05±0.62ng/ml)水平均低于对照组[(12.77±3.59)×10^(9)/L、5.06±1.28mg/L、7.33±1.51ng/ml](均P<0.05)。结论:阴道试产中转剖宫产术前Ⅲ型安尔碘阴道灌洗可有效控制术后产妇体温和WBC、CRP、PCT水平,减少产褥感染发生。

卡前列甲酯栓联合缩宫素预防剖宫产产后出血的应用研究

目的探讨卡前列酯栓联合缩宫素在预防剖宫产产后出血中的效果。方法选择2021年5月至2022年11月于我院行剖宫产的产妇80例,随机分为两组各40例。对照组采用缩宫素,观察组采用卡前列酯栓联合缩宫素治疗。对比两组的产后出血情况、凝血指标及不良反应。结果观察组产后大出血发生率为5.00%,低于对照组的20.00%(P<0.05)。观察组产后2 h、24h出血量均少于对照组(P<0.05)。产后24 h,观察组的PT、APTT短于对照组,FIB水平高于对照组(P<0.05)。两组的不良反应发生率比较差异无统计学意义(P>0.05)。结论卡前列甲酯栓联合缩宫素预防剖宫产产后出血能够降低产后大出血发生率,减少产后出血量,改善凝血功能,安全性较高。

水中待产分娩与传统待产分娩对产后盆底功能障碍性疾病预防效果分析

目的:分析水中待产分娩与传统待产分娩对产后盆底功能障碍性疾病(PFD)预防效果。方法:回顾性分析2022年4月—2023年4月驻马店市中医院进行阴道试产的60例产妇临床资料,依据产妇意愿分为两组,32例采用传统待产分娩的为传统组,28例采用水中待产分娩的为水中组。比较两组产妇盆腔器官脱垂(POP)、压力性尿失禁(SUI)发生率、盆底电生理指标、产程时间、产后2 h出血量、新生儿1 min Apgar评分、新生儿体重和剖宫产率。结果:水中组POP及SUI发生率低于传统组,差异均有统计学意义(χ^(2)=4.115、4.391,P<0.05);水中组盆底肌肉Ⅰ类、Ⅱ类肌纤维肌力分级高于传统组,差异均有统计学意义(Z=2.781、2.401,P<0.05);水中组第一产程时间短于传统组,差异有统计学意义(t=2.227,P<0.05);两组产妇第二、第三产程时间、产后2 h出血量、新生儿1 min Apgar评分、新生儿体重比较,差异均无统计学意义(t=0.501、0.339、0.980、0.478、0.255,P>0.05);水中组剖宫产率低于传统组,差异有统计学意义(χ^(2)=4.391,P<0.05)。结论:水中待产分娩对产后PFD预防效果优于传统待产分娩,能够缩短第一产程时间,促进产妇自然分娩,降低POP及SUI发生率,减轻对盆底肌纤维的损伤,且对母婴结局无明显影响。

综合体温保护护理在剖宫产术中的应用效果

目的探究对剖宫产产妇实施术中综合体温保护护理的效果。方法选取2020年4月—2023年4月本院收治的92例剖宫产产妇为研究对象,通过随机数字表法分为常规组(n=46)和研究组(n=46)。常规组给予常规保温护理干预,研究组术中进行综合体温保护干预。比较两组围手术期不同时间点(术前、麻醉起效时、胎儿娩出时、手术结束时)体核温度和低体温、寒战发生率及热舒适度以及手术前后凝血指标。结果常规组麻醉起效时、胎儿娩出时、手术结束时的体温比研究组显著更低(P<0.05)。常规组的低体温、寒战发生率比研究组显著更高,热舒适度评分显著更低(P<0.05)。常规组的凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)水平比研究组显著更高,纤维蛋白原(FIB)水平比研究组显著更低(P<0.05)。结论在剖宫产产妇术中应用综合体温保护干预,能够保持产妇体温和凝血指标,降低低体温、寒战发生率,提高热舒适度。

缩宫素联合卡前列素氨丁三醇注射液预防剖宫产术后出血的效果观察

对缩宫素联合卡前列素氨丁三醇注射液预防剖宫术后出血的效果进行观察。选取六枝特区妇幼保健院2021年3月—2023年3月收治的40例行剖宫产术的产妇为研究对象,随机将产妇分为两组,即对照组(n=20)与观察组(n=20),对照组予以单一缩宫素注射液治疗,观察组则加用卡前列素氨丁三醇注射液治疗。观察两组产妇行剖宫产术后的住院时间、下床活动时间、排气时间等康复指标,2h、12h,24h出血量以及治疗前后的血液流变学指标、凝血功能指标,不良反应情况。结果显示,观察组产妇除了不良反应情况与对照组产妇无显著差异,其他数据均明显优于对照组,差异具有统计学意义(P<0.05)。研究发现,在产妇剖宫产术后出血预防中缩宫素联合卡前列素氨丁三醇发挥着显著作用,有助于改善产妇血液流变学指标、凝血功能指标,减少产妇产后出血量,促进产妇康复,且不良反应较少,治疗安全性高,值得临床广泛应用。

回收式自体输血对剖宫产大出血患者血流动力学及凝血功能的影响

目的 探讨回收式自体输血对剖宫产大出血患者血流动力学及凝血功能的影响。方法 回顾性分析2023年1月至12月广州医科大学附属妇女儿童医疗中心收治的28例剖宫产大出血患者,以不同输血方式分为两组,每组各14例。两组均进行基础处理,常规组采用常规异体输血,研究组采用回收式自体输血。比较两组血液学指标、凝血功能及不良事件发生率。结果 输血后,两组血液学指标、凝血功能、不良事件总发生率比较,差异无统计学意义(P>0.05)。结论 回收式自体输血在剖宫产大出血中应用,患者的血液学指标及凝血功能与常规异体输血相似,且不增加不良事件,可在剖宫产大出血中应用。

剖宫产指征变化及剖宫产率升高因素的分析

目的:分析6年间剖宫产率、剖宫产指征的变迁。方法:对河北省迁安市人民医院1999～2004年3638例剖宫产病例进行分析,比较剖宫产率和手术指征变化。结果:平均剖宫产率为41.94%,剖宫产率呈上升趋势。1999年为35.50%,最高2003年达49.49%,有显著性差异(P<0.01)。在剖宫产指征变化中,头盆不称逐渐下降,社会因素、胎儿窘迫逐渐上升。2002年后社会因素位居第1位。结论:剖宫产率的增加不是一个单纯的医疗问题,而是一个社会问题。加强孕产期监护和产程观察,提高医务人员及孕妇对剖宫产的认识,改变服务模式,严格掌握剖宫产指征,可有效降低剖宫产率。

湖北省妇幼保健院近5年剖宫产率及剖宫产指征的变化分析

目的分析湖北省妇幼保健院近5年来剖宫产率及剖宫产指征的变化,探讨进一步降低剖宫产率的措施。方法回顾性分析2009年至2013年湖北省妇幼保健院分娩的孕产妇临床资料,比较了近5年来剖宫产率及剖宫产指征的变化。结果 1剖宫产率有显著下降趋势(P<0.01),2009年为59.36%,2013年为50.08%。2自2010年开始,剖宫产指征位于前6位的是:前次剖宫产、胎儿窘迫、社会因素、臀位(横位),巨大胎儿,羊水过少。3剖宫产指征中,前次剖宫产、羊水过少、臀位(横位)、双胎妊娠呈明显上升趋势,而胎儿窘迫及社会因素出现下降趋势。结论近年来剖宫产率已呈下降趋势,加强健康教育和孕期体重管理,提高超声诊断技术和阴道助产技术,提倡剖宫产后再次妊娠阴道分娩有望进一步降低剖宫产率。

我国部分地区剖宫产率影响因素和指征分析

目的:分析我国目前高剖宫产率的现状,以及不同地区剖宫产术的影响因素。方法:回顾性分析2005～2006年全国24家城市医院产科分娩的4281例产妇各分娩方式(顺产、助产、有指征剖宫产及无指征剖宫产)的影响因素和常见剖宫产手术指征构成比,并比较近期母婴预后。结果:①总剖宫产率为57.84%,其中无医学指征者36.23%;顺产率39.99%,阴道助产率2.17%。②各地区分娩方式构成比差异有高度统计学意义(P<0.01),以华南地区剖宫产率最高,西南地区剖宫产率最低;职业劳动量小、文化教育水平高的人群剖宫产率高(P<0.01);≥35岁的高龄产妇有医学指征剖宫产率高于<35岁者(P<0.01)。③有医学指征的剖宫产因素主要为头盆不称(11.51%)、胎儿窘迫(11.31%)、胎位异常(臀位或横位)(6.99%)、巨大儿(5.25%)、妊娠并发症(6.06%)、骨产道狭窄(3.51%)等。结论:剖宫产率的升高由多种因素导致。对手术指征的把握依地区医疗水平、群众生活背景、产妇职业、年龄、围生期发病率的不同而不同。不必要的剖宫产术并未减少产后出血率、新生儿发病率。医护人员应提高助产技术水平,合理掌握手术指征,加强医患沟通以降低人为因素引起的高剖宫产率。

四川省非医学指征剖宫产现状分析

目的:分析四川省非医学指征剖宫产现状及影响因素,寻求降低剖宫产率的对策。方法:随机抽取全省5个市进行调查,每个市随机抽取2个市级、2个县级、2个乡级助产服务机构进行数据收集,每个机构收集100份剖宫产病例,共对2824份有效问卷的剖宫产手术指征及影响因素进行分析。结果:非医学指征剖宫产占剖宫产总数的46.03%;不能忍受自然分娩疼痛、认为剖宫产安全、对自然分娩感到恐惧是选择剖宫产的主要原因;低龄、初产妇、无妊娠并发症、入院至分娩时间≥24小时组非医学指征剖宫产率高(P<0.01),脑力劳动组非医学指征剖宫产率高于体力劳动组(P<0.05)。结论:非医学指征剖宫产增加是近年来剖宫产率升高的主要原因。加强自然分娩的健康教育、推广应用分娩镇痛技术和处置难产技术以及政策支持是降低剖宫产率的有效措施。

近5年剖宫产率及剖宫产指征的观察分析

目的:探讨剖宫产率及剖宫产指征的变化和对围生儿病死率的影响。方法:对该院近5年来剖宫产孕妇的临床资料进行回顾性分析。结果:①剖宫产率逐年上升;②在剖宫产指征中,难产因素始终处于第1位,胎儿宫内窘迫、妊娠合并症及并发症处在第2、3位,社会因素呈逐年上升趋势;③围生儿病死率趋于稳定。结论:剖宫产率逐年升高,围生儿病死率并未随之呈一直下降趋势,必须正确掌握剖宫产指征。

产妇分娩方式选择及其影响因素研究

[目的]探讨影响产妇分娩选择方式的相关因素及其相关程度。[方法]采用“产妇分娩方式的选择及其影响因素问卷”,对213名产妇进行调查,并对产妇选择顺产或剖宫产及主观、客观因素进行分析。[结果]观察人群总剖宫产率为81.2%。除符合剖宫产手术指征外,社会因素已成为影响剖宫产率上升的主要原因之一。[结论]来自孕妇及医生的主观意愿影响着分娩方式的合理选择,剖宫产的手术指征已远远超过单纯医学指征的范围,并导致剖宫产率的大幅度上升。因此降低剖宫产率应首先降低社会因素剖宫产,这也是当前需要解决的一大难题。

上海市区级医院剖宫产指征及影响因素分析

目的了解剖宫产指征及分析高剖宫产率的相关影响因素。方法对2001年5月～2003年2月到上海市3所区级妇幼保健院做产前检查的孕妇进行问卷调查。结果在933名基线调查对象中，剖宫产率为37．6％，居于前4位的剖宫产指征分别为胎儿宫内窘迫（36．5％）、社会因素（35．9％）、相对性头盆不称（18．5％）和妊娠合并症（6．3％）。回归分析发现，孕前体重超重、对分娩没有信心及胎儿体重在4000g以上的对象剖宫产的可能性大。结论目前上海市的剖宫产率相当高，胎儿宫内窘迫和社会因素已成为最主要的剖宫产指征，较高的剖宫产率与孕妇的心理因素和某些人口学特征（孕妇及胎儿体重）密切相关。