1990—2010年某三甲医院初产妇剖宫产率和剖宫产指征变化情况

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (777 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的了解住院分娩初产妇剖宫产率和剖宫产指征的长期变化情况。方法研究对象为1990年、1995年、2000年、2005年和2010年在内蒙古自治区某三甲医院分娩的6 978名初产妇。查阅产科分娩记录确定分娩方式及剖宫产指征。分娩方式分自然分娩和剖宫产,剖宫产指征包括脐带缠绕、胎儿窘迫、相对头盆不称、社会因素、臀位、双多胎、妊娠高血压等26项。采用卡方检验比较不同年份剖宫产率的差异,采用不同年份某指征别剖宫产率之差占总剖宫产率之差的百分比,评价该指征对总剖宫产率上升或下降的贡献。结果 20年间5个时点剖宫产共计2 494例,剖宫产率平均为35.7%。1990年(22.1%)至2000年(61.7%)剖宫产率上升了近2倍,44.0%的升幅可归因于脐带缠绕、胎儿窘迫、相对头盆不称3项指征的显著增加;2000年(61.7%)—2010年(37.0%)剖宫产率下降了近40%,79.8%的降幅也可归因于这3项指征的显著减少。此外,1990—2010年社会因素、双(多)胎、巨大儿和高龄产妇4项指征剖宫产率呈上升趋势。结论脐带缠绕、胎儿窘迫和相对头盆不称等剖宫产指征的把握情况显著影响初产妇住院分娩剖宫产率。2010年有近30%的剖宫产可归因社会因素、双胎或多胎、巨大儿或孕妇高龄,值得关注。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	曾娜
	刘桂兰
	周玉博
	杨晓彦
	李宏田
	冀小平
	刘建蒙

关键词 ：剖宫产, 剖宫产指征, 发生率, 流行病学

Abstract：Objective To explore the secular trends of cesarean delivery and medical cesarean indications among primiparous women in a tertiary-level hospital in inner Mongolia.Methods A total of 6 978 primiparous women who delivered babies in 1990, 1995, 2000, 2005 and 2010. Delivery modes (cesarean section/spontaneous birth) and cesarean indications were obtained from medical records. 26 cesarean indications, such as cord entanglement, fetal distress, relative cephalopelvic disproportion, maternal request cesarean, breech presentation, multiple pregnancy and gestational hypertension, were identified. Time trends for each indication were linearly modeled to estimate the relative contribution of each indication to the overall increase or decrease in cesarean rates.Results In the five time points during 20-year period, 2 494 cesarean deliveries were identified. The prevalence rate of cesarean delivery was 35.7%. The prevalence of cesarean delivery increased by 2 folds from 22.1% in 1990 to 61.7% in 2000; 44.0% of the increase was attributable to the rapid increase in three indications, including cord entanglement, fetal distress and relative cephalopelvic disproportion. The prevalence decreased by 40% from 61.7% in 2000 to 37.0% in 2010; 79.8% of the decrease was attributable to the rapid decrease of the three indications. Moreover, it is noticeable that the cesarean prevalence related to maternal request, macrosomia, multiple pregnancy and advanced maternal age steadily increased over time.Conclusion Subjective cesarean indications, such as cord entanglement, fetal distress and relative cephalopelvic disproportion, significantly affected cesarean prevalence rates, suggesting that strict diagnoses is likely to reduce cesareans. Cesarean delivery due to maternal request, macrosomia, multiple pregnancy or advanced maternal age increased over time, and accounted for nearly 30% of total cesarean section by 2010, among which maternal requested cesareans is likely preventable.

Key words： Cesarean delivery Cesarean indication Prevalence Epidemiology

收稿日期: 2015-05-05

通讯作者: 刘建蒙(liujm@pku.edu.cn);冀小平(xp_0902@sina.com)

引用本文:

曾娜, 刘桂兰, 周玉博, 杨晓彦, 李宏田, 冀小平, 刘建蒙. 1990—2010年某三甲医院初产妇剖宫产率和剖宫产指征变化情况[J]. 中国生育健康杂志, 2016, 27(2): 101-104.
ZENG Na, LIU Guilan, ZHOU Yubo, YANG Xiaoyan, LI Hongtian, JI Xiaoping, LIU Jianmeng. Secular trends of cesarean delivery and medical cesarean indications among primiparous women in a tertiary-level hospital in inner Mongolia during 1990-2010. Chinese Journal of Reproductive Health, 2016, 27(2): 101-104.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2016/V27/I2/101

1 郑平,黄醒华.35年剖宫产率及适应证的变化.中华妇产科杂志,1996,31:142-145.
2 朱逸博,李宏田,张亚黎,等.1993至2010年中国部分地区单胎初产妇剖宫产和孕妇要求剖宫产率变化趋势.中华医学杂志,2012,92:1734-1737.
3 Leitch CR,Walker JJ.The rise in caesarean section rate:the same indications but a lower threshold.Br J Obstet Gynaecol,1998,105:621-626.
4 郭红燕,李诗兰,周羡梅,等.剖宫产率与不合理剖宫产.北京医科大学学报,2000,6:519-522.
5 彭鹏,金志军,朱瑾.腹膜外剖宫产术.上海:第二军医大学出版社,2008:56.
6 Osterman MJ,Martin JA,Trends in low-risk cesarean delivery in the United States,1990-2013.Natl Vital Stat Rep,2014,63:1-16.
7 Wen YC.Do caesarean section rates 'catch-up'? Evidence from 14 European countries.Health Care Manag Sci,2013,16:328-340.
8 Eugene D,Robin Y,Howard C,et al.Is a rising cesarean delivery rate inevitable? Trends in industrialiazed countries,1987 to 2007.Birth,2011,38:99-104.
9 Al Rifai R.Rising cesarean deliveries among apparently low-risk mothers at university teaching hospitals in Jordan:analysis of population survey data,2002-2012.Glob Health Sci Pract,2014,2:195-209.
10 Charoenboon C,Srisupundit K,Tongsong T.Rise in cesarean section rate over a 20-year period in a public sector hospital in northern Thailand.Arch Gynecol Obstet,2013,287:47-52.
11 中华人民共和国国家和计划生育委员会.关于印发《关于进一步加强农村孕产妇住院分娩工作的指导意见》的通知[EB/OL].2009[2014-08-20].http://www.nhfpc.gov.cn/fys/s3581/201107/8d09ba60c19545e3b80fa65328183537.shtml
12 中华人民共和国国家和计划生育委员会.关于印发《母婴健康素养—基本知识与技能(试行)》的通知[EB/OL].2011[2014-08-20].http://www.nhfpc.gov.cn/fys/s3581/201107/8d09ba60c 19545e3b80fa65328183537.shtml.
13 Barber EL,Lundsberg LS,Belanger K,et al.Indicationscontributing to the increasing cesarean delivery rate.Obstet Gynecol,2011,118:29-38.
14 王梅红,霍增辉,桂平静,等.医疗纠纷人民调解机制规范化探究.中华医学杂志,2013,93:3652-3654.
(