2002—2010年剖宫产率升高的影响因素分析

目的探讨近年来剖宫产率升高的影响因素及其弊端。方法对解放军总医院妇产科2002年1月至2010年12月分娩的12522例孕妇的临床资料进行回顾性分析,比较不同时期剖宫产率和剖宫产手术指征的变化。结果从2002年至2005年剖宫产率由44.50%（514/1155）升至66.02%（746/1130）,2008年（64.97%,1059/1630）至2010年（64.06%,1251/1953）剖宫产率仍保持较高水平,剖宫产率总体呈升高趋势。阴道分娩助产率从2002年的3.29%（38/1155）下降至2010年的0.05%（1/1953）,两者比较,差异有统计学意义（P〈0.05）。2006—2010年剖宫产指征中,社会因素、妊娠合并症并发症和胎儿窘迫位于前3位。瘢痕子宫作为剖宫产指征所占比例从2006年的3.57%（26/729）升高至2010年的6.95%（87/1251）;多胎妊娠作为剖宫产指征从2006年的2.33%（17/729）升高至2010年的3.52%（44/1251）。结论剖宫产率升高原因多种,其中社会因素、妊娠期合并症并发症和胎儿窘迫是重要的影响因素,严格掌握剖宫产指征是降低剖宫产率的关键。

Clinical analysis for increase of cesarean section rate

Objective To investigate the factors and weakness of the increasing cesarean section rate. Methods From January 2002 to December 2010, there were totally 12 522 pregnant women underwent delivery at the Department of Obstetrics and Gynecology in the General Hospital of PLA. The rate of cesarean section and its indications were retrospectively analyzed. Results The total rate of cesarean section showed an uptrend and had increased from 44.50%(514/1 155) in 2002 to 66.02%(746/1 130) in 2005. The rate of cesarean section from 2008 (64.97%,1 059/1 630)to 2010 (64.06%,1 251/1 953)still showed high. The rate of assisting vaginal delivery showed downtrend from 3.29%(38/1 155) in 2002 to 0.05%(1/1 953) in 2010. There was significant difference between them(P<0.05).From 2006 to 2010, the main indications of cesarean section were social factors, pregnancy-associated complications and fetal distress. In addition, the rate of cesarean section induced scar uterus was increasing year by year from 3.57%(26/729) in 2006 to 6.95%(87/1 251) in 2010. As an indication of cesarean section, the rate of multifetation was increasing year by year from 2.33%(17/729) in 2006 to 3.52%(44/1 251) in 2010. Conclusions The rate of cesarean section has increased rapidly in recently, which induced by various factors including social factors, pregnancy-associated complications and fetal distress.