我国部分地区剖宫产率影响因素和指征分析

摘要

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.%Objective:To analyze the present high cesarean section (CS)rate in China and the influential factors in different areas. Methods:A retrospective analysis of 4281 women in 24 hospitals nationwide from 2005 to 2006 was done to investigate the influencing factors of the delivery modes( spontaneous vaginal delivery, operative vaginal delivery, CS with indications and CS without indications), the propotion rates of usual CS indications and the short term outcomes of mothers and children. Results :①The overall CS rate was 57. 84％, of which CS without indications accounted for 36. 23％; spontaneous vaginal delivery accounted for 39. 99％ and operative vaginal delivery was 2. 17％. ②The constitutive ratios of delivery modes in different areas were significantly different ( P＜0. 01 ). The rate of CS without indications in southeastern China was the highest, while that in southwestern China was the lowest; The CS rate was higher in well educated women whose work were lower intensity( P＜0. 01 ); Women older than 35ys had a higher rate of CS with indications than women less than 35ys( P ＜0.01 ). ③The medical indications of CS were mainly cephalopelvic disproportion(11. 51％ ), fetal distress(11.31％ ), breech or other abnormal presentation (6. 99％ ), macrosomia(5. 25％ ), pregnancy complications ( 6. 06％ ) and narrow birth canal ( 3. 51％ ). Conclusions: Many factors lead to a high CS rate in China. The judgement of CS indications differs according to the local medical levels, population life standards, women career, age and the peripartum morbility. The unnecessary CS can not reduce postpartum heamorrhage and neonatal morbility. Measures should be taken to improve obstetric skills, properly grasp the CS indications and strengthen the communication between doctors and patients, thus to decrease the high CS rate caused by human factors.