南京某大型医院剖宫产及其影响因素的初步分析

目的:分析某医院剖宫产的现状,初步探讨其影响因素及控制策略。方法:整理分析了南京某大型医院2009年共1411名入院产妇的病历资料,按分娩方式分为自然分娩组(经阴道分娩)和剖宫产组,比较两组产妇的一般信息、身体状况、产时情况等,采用多因素Logistic回归分析了剖宫产的影响因素。结果:该医院2009年度剖宫产产妇为608人,占总产妇的43.09%。剖宫产产妇的年龄和体重明显高于自然分娩产妇(P0.01),既往身体状况相对较差。入院时多无产兆、宫口未开,且产妇宫高、腹围、胎心率明显较高(P0.05或P0.01)。B超检查也显示,羊水异常(过多或过少)、巨大儿、胎位不正(主要为臀位)以及脐带绕颈的比例也明显高于自然分娩产妇(P0.05或P0.01)。多因素Logistic回归分析显示,产妇高龄(35岁)、入院产兆、胎位不正、产妇腹围过大、胎儿窘迫及新生儿超重等皆为剖宫产的独立影响因素。此外发现19.24%的剖宫产产妇无临床指征(即社会因素)。结论:该医院剖宫产的比例不低,要根据影响因素合理选择剖宫产,尤其要有效控制无指征的剖宫产选择,降低剖宫产率。

Preliminary Investigation on Cesarean Section and Its Influencing Factors in a Large Hospital in Nanjing

Objective:To explore the influencing factors and control strategies through analyzing the present situation of cesarean section in a hospital.Methods:A total of 1,411 hospitalized maternal medical records were investigated from a large hospital in Nanjing in 2009. They were then divided into two groups of natural delivery (vaginal delivery) and cesarean section according to the delivery mode. The general information, physical condition, intrapartum status were compared between the two groups, and the influencing factors for cesarean section were analyzed using multivariate1 logistic regression.Results:During 2009, the total of 608 cesarean section parturient (43.09%) were recorded in this hospital, whose age and weight were significantly higher than those of natural delivery parturient (P<0.01), and the previous physical conditions were also relatively poorer. In addition, most of the cesarean section parturient had no production trillion and closed cervix when they were admitted to hospital, and their uterine height, abdominal circumference, fetal heart rate were obviously higher than those of natural delivery parturient (P<0.05 or P<0.01). Besides, B-ultrasound examination showed that the proportion of abnormal amniotic fluid (too much or less), macrosomia, malposition (mainly breech) and circulor of umbilical cord were also significantly higher than those of those of natural delivery parturient (P<0.05 or P<0.01). Furthermore, multivariate logistic regression analysis indicated the independent factors for cesarean section including maternal elderly (>35 yr), admitted production trillion, malposition, excessive maternal abdominal circumference, fetal distress and neonatal overweight. Additionally, 19.24% of cesarean section had no clinical indications (social factors).Conclusion:The proportion of cesarean section is not lower in this hospital. Thus, the parturient should choose suitable delivery mode according to the influencing factors, particularly controlling the cesarean section without indications, in order to finally reduce the cesarean section rate.