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.

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.

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.

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.

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。

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。

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。

妊娠糖尿病患者血糖异常与剖宫产指征的相关性分析

目的:分析妊娠糖尿病患者血糖异常与剖宫产指征的相关性。方法:选择2018年6月—2020年6月天津市滨海新区塘沽妇产医院收治的120例妊娠期糖尿病患者作为观察组,另外选择同期在医院进行产检的80例健康产妇作为对照组,比较两组产妇剖宫产率、巨大儿、胎儿窘迫、胎位异常、胎膜早破发生情况。另外根据妊娠期糖尿病患者血糖指标异常情况进行分组,分为A组38例,单纯空腹血糖(FPG)异常、B组47例,单纯餐后2 h血糖(2 hPG)异常、C组35例,FPG、2 hPG均异常,比较三组妊娠糖尿病产妇间妊娠结局,包括宫产率、巨大儿、胎儿窘迫、胎位异常、胎膜早破发生情况;分析血糖异常与剖宫产指征的相关性。结果:观察组剖宫产率、巨大儿、胎儿窘迫、胎位异常、胎膜早破发生率分别为41.47%、34.17%、31.67%、23.33%、35.83%,均高于对照组的7.50%、2.50%、5.00%、2.50%、3.75%,差异有统计学意义(χ^(2)=27.794、28.519、20.575、16.340、27.899,P<0.001);三组间剖宫产率、巨大儿、胎儿窘迫、胎位异常、胎膜早破发生率相比,C组>B组>A组,差异有统计学意义(χ^(2)=13.125、13.839、9.749、18.572、10.837,P<0.05);血糖异常与巨大儿、胎儿窘迫、胎位异常、胎膜早破均呈正相关(r=0.757、0.673、0.758、0.802,P<0.05)。结论:妊娠糖尿病患者血糖异常与巨大儿、胎儿窘迫、胎位异常、胎膜早破均呈正相关,为改善妊娠结局,临床应及时采取干预措施,以降低不良妊娠结局发生率。

围产期炎症因子及氧化应激指标对剖宫产产后抑郁的预测

目的:分析围产期脑脊液与静脉血的炎症因子及氧化应激指标对剖宫产后抑郁症的预测效能。方法:回顾性分析2021年1月至2022年6月焦作市妇幼保健院行剖宫产术治疗的121例患者的临床资料,根据爱丁堡产后抑郁评分(EPDS)结果,将患者分为产后抑郁组70例和对照组51例。比较两组患者围产期脑脊液及静脉血中炎症因子、氧化应激指标的水平,分析上述指标对剖宫产后抑郁症的预测效能。结果:产后抑郁组脑脊液及外周静脉血的肿瘤坏死因子⁃α(TNF⁃α)、白介素⁃6(IL⁃6)、超敏C⁃反应蛋白(hs⁃CRP)和丙二醇(MDA)的水平均高于对照组,而超氧化物歧化酶(SOD)与氧化氢酶(CAT)的水平均低于对照组,以上差异均具有统计学意义(P<0.05)。产后抑郁与炎症因子、促氧化应激因子水平呈正相关,与抗氧化应激因子呈负相关,差异均具有统计学意义(P<0.05)。结论:围产期炎症因子、氧化应激因子变化对剖宫产后抑郁症具有较高预测效能。

基于Robson十分类法分析大连市部分医院剖宫产指征的分布

目的 基于Robson十分类法分析大连市部分医院剖宫产指征的分布。方法 选取2021年1月至12月大连市8家助产医疗机构收治的17 270例孕产妇(约占大连市2021年全市分娩量的52%),根据Robson十分类进行分类,并分析剖宫产指征。结果 孕产妇总体剖宫产率为42.29%(7304/17 270),基于Robson十分类法分析占比较高者为1组(单胎头位、自然临产、29.35%,5069/17 270)、2A组(单胎头位、初产妇引产临产、16.83%,2908/17 270)、2B组(单胎头位、初产妇临产前剖宫产、16.55%,2858/17270)。剖宫产指征中占比较高者为:瘢痕子宫(29.57%,2160/7304)、臀位(9.06%,662/7304)、无指征剖宫产(8.41%,614/7304)。剖宫产总数较高组为2B组(39.13%,2858/7304),前3名剖宫产指征:无指征剖宫产(17.98%,514/2858)、高龄初产(15.61%,446/2858)、巨大儿(14.59%,417/2858)。5A组(1次剖宫产史组)占剖宫产总数27.60%(2016/7304),首位剖宫产指征:瘢痕子宫(99.12%,1999/2016)。2A组占剖宫产总数的7.86%(574/7304),首位剖宫产指征:产程异常(21.77%,125/574)。结论 基于Robson十分类法,对不同组别产妇剖宫产率及剖宫产指征进行分析,有助于识别降低剖宫产率的目标人群,并做出针对性干预措施。

腰-硬联合麻醉用于剖宫产术对妊娠结局和产妇血流动力学指标的影响

目的探讨腰-硬联合麻醉应用于剖宫产术对妊娠结局和产妇血流动力学指标的影响。方法选取医院2021年3月至2022年9月收治的行剖宫产手术产妇48例,并按麻醉方式的不同分为对照组和观察组,各24例。对照组开展连续性硬膜外麻醉,观察组开展腰-硬联合麻醉,比较两组的麻醉效果及对妊娠结局的影响。结果观察组产妇的不良妊娠结局发生情况、血流动力学指标、麻醉效果(起效时间与维持时间)、产妇的不良反应发生情况、生活质量评分等均显著优于对照组(P<0.05);新生儿的血气指标及产妇术后12 h的生活质量评分与对照组无显著差异(P>0.05)。结论腰-硬联合麻醉应用于剖宫产术麻醉效果良好,可改善妊娠结局和产妇的血流动力学指标。

2019—2022年安徽省产科哨点医院剖宫产率及指征变化分析

目的分析2019—2022年安徽省产科哨点医院剖宫产率、非医学指征剖宫产率、初产妇剖宫产率及剖宫产指征变化情况,并比较不同类型医院间的差异。方法利用安徽省产科哨点医院监测网络,收集2019—2022年23家哨点医院产妇相关质控指标,采用χ^(2)检验对不同类型医院的剖宫产率、非医学指征剖宫产率、初产妇剖宫产率、剖宫产指征等数据进行统计学分析。结果2019—2022年安徽省23家哨点医院的剖宫产率均在2020年增长至峰值后出现下降,平均剖宫产率为45.54%;非医学指征剖宫产率呈缓慢上升,平均非医学指征剖宫产率为3.54%;2019年初产妇剖宫产率为33.71%,2020年快速增长至36.81%,2021年后逐渐下降。综合医院剖宫产率、非医学指征剖宫产率、初产妇剖宫产率均高于专科医院,差异均有统计学意义(均P<0.05)。综合医院的多胎妊娠、凶险性前置胎盘、妊娠合并症与并发症、重度胎盘早剥等指征的比例也均高于专科医院,差异均有统计学意义(均P<0.05)。结论安徽省哨点医院剖宫产率有待进一步控制,非医学指征剖宫产率和初产妇剖宫产率是剖宫产率增长的主要原因。综合医院的剖宫产率、非医学指征剖宫产率、初产妇剖宫产率均高于专科医院,应予以特别关注和重视;综合医院和专科医院的剖宫产指征构成有一定区别。