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.

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.

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.

Vaginal Caesarean Section: A Review of Indications in Mali

Introduction: The vaginal caesarean described since the 19th century remains unknown to many practitioners. The publications available on the subject are rare. The objective of this review is to report the experience of our team in Mali on vaginal cesarean section. Materials and Methods: This is a documentary review of a series of 5 cases on the practice of vaginal caesarean section at the Sominé Dolo Hospital and Reference Health Center of the Sanitary District of Bla in Mali between 2005 and 2022. Results: We performed a vaginal caesarean section on 5 patients in this series. The indications were retroplacental hematoma in 2/5 cases including 1 with a live fetus, eclampsia crisis in 1/5 cases, dystocia on uterine prolapse in 1/5 cases and beating cord prolapse in 1/5 cases. In the 5 cases, the pregnancy was not at term. In 3/5 cases, cesarean section was indicated to save the non-term fetus with a very low possibility of success by classic cesarean section and in 2/5 cases for maternal rescue with fetal death in utero. 2 live newborns were released in satisfactory condition, 1 died after 6 hours of life. Antibiotic therapy was not necessary in the majority of cases. The average length of hospitalization was 3 days. Conclusion: The circumstances of the realization of the vaginal cesarean section in our series of studies remain frequent in the practice of modern obstetrics. The short duration of hospitalization and the low use of antibiotics can contribute to the reduction of the medical cost of caesarean section in low-income countries, such as Mali.

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.

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.

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。

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。

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。

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。

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。

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.

孕期心理状况与无医学指征剖宫产的关联研究

目的:探讨孕期抑郁、焦虑和压力等心理因素对无医学指征剖宫产的影响。方法:采用前瞻性队列研究方法,以2016年10月—2019年1月在南京医科大学附属妇产医院纳入的1453例孕妇作为研究对象。采用焦虑自评量表、抑郁流行病学研究中心量表和压力知觉量表分别评估孕妇孕早、中、晚期的心理状况。根据产科病例获取分娩方式并判断是否具有剖宫产医学指征,在无剖宫产医学指征的孕妇人群中,采用广义估计方程分析孕期心理因素与剖宫产的关联。结果:本研究最终纳入1453例孕妇作为研究对象,其中516例孕妇有剖宫产医学指征。余937例无剖宫产医学指征的孕妇中,139例孕妇选择剖宫产。调整母亲分娩年龄、孕前体重指数、产次、妊娠合并糖尿病和分娩孕周后,发现孕妇孕晚期伴有任一不良心理症状(高压力、抑郁或焦虑)可增加无医学指征剖宫产发生的风险(OR=1.69,95%CI:1.04~2.73,P=0.034),孕晚期抑郁与无医学指征剖宫产呈正相关(OR=1.32,95%CI:1.03~1.69,P=0.028),焦虑和压力与无医学指征剖宫产的关联无统计学意义。结论:孕晚期抑郁与无医学指征剖宫产发生的风险增加有关。建议在未来产检护理中,应重视孕产妇的心理疏导,尤其是孕晚期的心理健康。

手术室护理干预对剖宫产手术患者切口愈合效果及并发症的影响

目的探讨剖宫产手术患者配合手术室护理干预对提高切口愈合质量,减少并发症的作用。方法选择2022年1~12月在我院接受剖宫产手术的产妇100例作为研究对象,按照计算机病案随机编号抽取结果进行分组,对照组(50例)产妇配合常规护理干预;观察组(50例)产妇实施手术室护理干预,对比两组产妇护理前后心理状态、舒适程度予以评估,分析结果组间统计学差异。监测两组产妇护理前后手术应激指标变化。观察两组产妇术后切口愈合效果,记录两组产妇术后出现并发症的具体症状表现,统计总发生概率。结果护理干预前,两组产妇心态评分、舒适性评分组间对比无统计学差异(P>0.05),干预后观察组产妇抑郁、焦虑评分均低于对照组,舒适度评分均高于对照组(P<0.05)。同时观察组患者护理干预后心率、血压监测结果均高于对照组(P<0.05)。另外,观察组患者切口愈合甲级占比高于对照组,并发症总发生概率低于对照组(P<0.05)。结论针对剖宫产手术患者通过开展手术室护理干预能够有效调节产妇不良心态,提高切口愈合效果,减少并发症问题,值得运用推广。

剖宫产指征相关因素分析及降低剖宫产率对策探讨

目的探讨剖宫产指征相关因素及降低剖宫产率对策。方法回顾性分析2018年1—12月于海淀区妇幼保健院规律产检并分娩的9712例孕妇的临床资料,分析孕妇剖宫产指征构成。结果2018年1—12月分娩孕妇9712例,其中剖宫产分娩孕妇3774例,剖宫产率为38.86%。指征明确的剖宫产占42.8%,指征相对不明确的剖宫产占比30.2%,可阴道试产的剖宫产占比25.5%,无指征剖宫产占比1.5%。指征明确孕妇中,产程异常、头盆不称最多见;指征相对不明确孕妇中,胎儿窘迫、羊水过少及相对头盆不称最多见;可阴道试产孕妇中,高龄初产、高度近视及瘢痕子宫最多见。结论可合理降低相对不确定的指征和可阴道试产者的剖宫产率,需要医务人员、孕妇及医疗机构的共同努力。

大连市初产妇及经产妇剖宫产率及剖宫产指征分析

目的:探讨大连市初产妇及经产妇剖宫产率现状及剖宫产手术指征构成,为大连市剖宫产率控制提供循证学依据。方法:收集大连市8家综合和妇幼专科医院2021年全年分娩资料,计算总剖宫产率,并比较不同级别、不同性质和不同城区医院剖宫产率的差异。分析二级医院及三级医院初产妇与经产妇剖宫产率及剖宫产手术指征构成。结果:8家医院的总剖宫产率为42.16%(7219/17123)。近郊和远郊医院的剖宫产率明显高于中心城区医院(45.13%、47.78%vs 38.87%,P<0.01),二级医院的剖宫产率高于三级医院(44.20%vs 41.37%,P<0.01),综合医院的剖宫产率高于专科医院(47.10%vs 40.42%,P<0.01)。三级医院的初产妇剖宫产率高于二级医院(40.63%vs 38.29%,P<0.05),经产妇剖宫产率明显低于二级医院(43.12%vs 52.55%,P<0.01)。三级医院初产妇剖宫产指征占比首位为高龄初产(12.50%),二级医院为无医学指征(23.44%)。二级医院及三级医院经产妇剖宫产指征占比首位均为瘢痕子宫(87.13%和79.60%)。结论:大连市剖宫产率处于较高水平,不同特征医院之间剖宫产率均存在明显差异;不同级别医院之间初产妇与经产妇剖宫产率及剖宫产指征占比均存在差异。高龄初产及无医学指征占初产妇剖宫产指征比重高;瘢痕子宫占经产妇剖宫产指征比重高。

无医学指征剖宫产的影响因素及对策

无医学指征剖宫产是造成高剖宫产率的一个重要原因,也是公共卫生和全世界医疗机构关注的问题。事实上,许多潜在因素包括社会人口学、传统文化、家庭、法理及医源因素在无医学指征剖宫产形成中发挥了重要作用,并加剧了无医学指征剖宫产这一现象出现。更重要的是,通过构建和谐医疗环境、提高无痛分娩率、加强妊娠期健康宣教、规范产科管理、优化分娩环境和增加人文关怀等合理干预可有效降低无医学指征剖宫产。期望为卫生政策制定、临床指南和促进该领域未来的临床实践提供有意义的参考。

无痛分娩对产妇剖宫产率以及指征变化的影响研究

目的分析无痛分娩对剖宫产率以及指征变化的影响。方法随机选取2019年3月—2022年3月期间武夷山市中医院收治的70例孕产妇作为研究对象,将35例接受无痛分娩的产妇设为观察组,另外35例未接受无痛分娩的产妇设为对照组。对两组孕产妇剖宫产率、各项剖宫产指征所占比率以及两组产妇的宫口开全时间、总产程时间、新生儿Apgar评分、新生儿脐动脉血血气指标进行对比分析。结果观察组剖宫产率(11.43%)低于对照组(31.43%),差异有统计学意义(χ^(2)=11.878,P=0.001)。两组产程阻滞、相对头盆不称相比,差异无统计学意义(P>0.05)。观察组新生儿Apgar评分与对照组相比,差异无统计学意义(P>0.05)。观察组乳酸浓度明显低于对照组,动脉血气pH值高于对照组,差异有统计学意义(P<0.05)。观察组产妇的宫口开全时间、总产程时间均明显短于对照组,差异有统计学意义(P<0.05)。结论无痛分娩有利于促进孕产妇自然分娩,降低剖宫产率,缩短产程和宫口全开时间,且有利于降低新生儿酸浓度比,保障母婴健康。