摘要
目的了解不同级别医院剖宫产产妇特征与指征构成情况。方法调查对象为单独二孩政策效应显现之前(2013年8月至2014年7月)在河北省两所二级医院和内蒙古自治区一所三级医院分娩的1 608名剖宫产产妇,剔除剖宫产指征缺失者和指征未按重要程度进行排序者,最终纳入分析者1 400名(二级医院1 146名,三级医院254名)。经统一培训的医院产科项目人员在产妇出院前收集人口学特征和剖宫产指征等相关信息。采用t检验、χ~2检验比较不同级别医院的产妇特征及指征构成差异。结果在二级医院分娩者绝大多数为农村人口(91.8%),在三级医院分娩者均为城市居民(100%)。二级医院初产妇和35岁以上高龄产妇占比(37.4%、2.8%)均显著低于三级医院(79.1%、9.1%),差异均有统计学意义。在剖宫产指征构成方面,两类医院有共同特点,即就初产妇而言,前五位指征中偏主观性的指征(胎儿窘迫、社会因素、相对头盆不称/脐带绕颈)占比在40%以上;就经产妇而言,两类医院均有超过60%的产妇因瘢痕子宫而行剖宫产。两类医院也有不同点,即虽然瘢痕子宫位列经产妇剖宫产指征的首位,但二级医院占比(82.0%)显著高于三级医院(64.2%),差异有统计学意义;再者,二级医院因单一指征行剖宫产的比例也高于三级医院,经产妇尤为显著(二级医院74.4%,三级医院47.2%,P<0.05),差异有统计学意义。结论在单独二孩政策效应显现之前,即便在三级医院,高龄产妇占比也不足10%;两类医院初产妇因偏主观性的指征而行剖宫产的比例均超40%,提示需继续控制非临床必要剖宫产。尤其在二级医院,82.0%的经产妇因瘢痕子宫而行剖宫产,提示亟待加强基层助产机构服务能力,鼓励产妇阴道试产。
Objective To compare the differences in characteristics of women with cesarean delivery and cesarean indications between secondary and tertiary hospitals.Methods From August 2013 to July 2014,a survey was conducted among pregnant women who underwent cesarean section in two secondary hospitals in Hebei province and one tertiary hospital in Inner Mongolia.To collect information on maternal characteristics and indications for cesarean section,questionnaires were administered by trained obstetricians or nurses before women were discharged from hospitals.T tests and Chi-square tests were performed to compare the differences in maternal characteristics and indications for cesarean section between hospitals.Results 1 608 women were surveyed,and 1 400 remained in the analysis,including 1 146 from the secondary hospitals and 254 from the tertiary hospital.A majority of women who delivered in the secondary hospitals were farmers,while almost all women who delivered in the tertiary hospital were non-farmers.Both the proportions of nulliparous women and women aged≥35 years in the secondary hospitals(37.4%,2.8%)were significantly lower than those in the tertiary hospital(79.1%,9.1%)(P<0.001).There were similarities regarding cesarean indications between hospitals.Subjective indications for nulliparous women in both secondary and tertiary hospitals,including fetal distress,relative cephalopelvic disproportion/cord entanglement,and non-medical factors,accounted for>40%;moreover,for multiparous women,repeated cesarean accounted for>60%.There were also dissimilarities.Both the proportions of women undergoing a repeated cesarean and those undergoing a cesarean for a single indication were significantly higher in the secondary hospitals than those in the tertiary hospital.Conclusion Before the selective two-child policy took effect,the proportion of women aged≥35 years had been<10%among those undergoing a cesarean delivery,even in tertiary hospital.More than two fifths of nulliparous pregnant women in both hospitals underwent c
作者
廖紫珺
周玉博
周燕
李宏田
司可艺
刘建蒙
LIAO Zijun;ZHOU Yubo;ZHOU Yan;LI Hongtian;SI Keyi;LIU Jianmeng(Institute of Reproductive&Child Health,Ministry of Health Key Laboratory of Reproductive Health,Beijing 100191,China)
出处
《中国生育健康杂志》
2018年第2期106-109,141,共5页
Chinese Journal of Reproductive Health
基金
国家自然科学基金(81571517)
国家卫生计生委妇幼司-联合国儿童基金会驻华办事处联合资助项目(2016-2017年度)
优博培育计划建设项目(BMU20160571)
关键词
高龄产妇
剖宫产指征
主观指征
瘢痕子宫
pregnant women with advanced age
cesarean indications
subjective indications
repeat cesarean
