基层降低剖宫产率的干预研究  

Management intervention for lowering C-section rates in Suburban areas

作　　者：毛红芳[1] 王海琪[1] 荣荷花[1] 王海鸣[1] 曹敏[1] 张娟平[1] 肖杏琴[1] 金小珍[1] 国献丽[1] 

机构地区：[1]上海市嘉定区妇幼保健院,上海201821

出　　处：《中国妇幼保健》2015年第19期3117-3120,共4页Maternal and Child Health Care of China

摘　　要：目的：降低社区剖宫产率的研究。方法：选择上海市嘉定区内一家二级甲等妇幼保健院为研究现场，从2014年7月开始，多项举措实施干预研究，干预时间为半年，前后相关指标进行比较。干预措施有以下六种方法：一是行政干预，IXSE计委把剖宫产率纳入考核指标，每季度考核一次；二是建立产科人员奖励制度，对于平产每例给予一定的经济奖励，制定剖宫产率目标值，控制在目标范围内，按比例进行奖励；三是健康教育，增设《自然分娩的好处》、《镇痛分娩》等孕妇学校特色课程，对孕妇及家属进行教育，培训全体职工，改变医务人员理念，人人担当促进自然分娩宣传员；四是推进适宜技术，开设孕期运动指导营养门诊、助产士门诊、导乐分娩、镇痛分娩、自由体位分娩等；五是提高助产技术，如培训助产人员对难产的处理等；六是严格执行剖宫产指征，产科因素逐层上报，产科主任审核同意，社会因素剖宫产上报经分管领导审批，并每月通报。结果：2014年1～6月分娩数3777例，7～12月为4784例，干预效果明显。干预前后剖宫产率分别为48．85％、39．69％（P〈0．05），社会因素占剖宫产总数占比分别为18．37％、4．58％（P〈0．05），巨大儿发生率分别为7．71％、7．28％（P〈0．05）。围产儿死亡率为3．66‰、2．48‰（P〉0．05），产后出血发生率分别为2．36％、2．70％（P〉0．05）。结论：目前，社会因素占26．95％的前提下，采取多种方法进行干预来降低剖宫产率是有效且安全的。但应该考虑到，当社会因素降至较低水平时，剖宫产率再往下降可能存在一定的难度和安全隐患，因此从长远考虑，提高助产技术与服务质量是今后降低剖宫产率的关键。特别是二胎政策实行后，对前次剖宫产史孕妇再次妊娠采取阴道分娩技术目前还有Objective： To lower the C-section rate of Jiading district of Shanghai. Methods： A maternity hospital was selected as the research site. A six-month management intervention was applied since July 2014, and indexes were compared before and after the inter- vention. Six methods were carried out as intervention： （ 1 ） administrative intervention-C-section rate was counted as one of the general measurement indexes for medical facilities; （2） Incentive-Each vaginal delivery would be granted with incentive, further bonus would be given if the C-section rate was controlled within a certain range; （3） Patient education sessions-Educative session introducing the advantage of natural delivery and epidural treatment was provided for prenatal care program; （4） Training was also provided for medical specialists for encouragement; （5） Proper enhanced training was provided for midwives and OB clinicians, including labor progress observation, forceps delivery, etc. ; （6） Insist on indications for C-section, approval should be granted for any C-section with obstetrical reasons, and month- ly report is required. Results： 3 777 deliveried in Jan-June of 2014, and 4 784 deliveried from July-Dec 2014. Management interventions presented significant improvement. C-section rate dropped from 48. 85% to 39. 69% （ P〈0. 05 ）, social indicated C-section dropped from 18. 37% to 4. 58% （ P〈0. 05）, macrosomia dropped from 7.71% to 7.28% （P〈0. 05） . Maternal mortality remained 0, neonatal mortali- ty was 2. 36% and 2. 70% （P〉0. 05） respectively. Conclusion： Management intervention to reduce C-section rate is safe and effective, particularly with social indication C-section rate as high as 26. 95%. But when the social indication is very low, it would be risky to further reduce the C-section rate. It is kernel to focus on improvement of obstetrical skills and service quality. VBAC should also be practiced with more prior C-section pregnancies.

关 键 词：多项举措 降低 剖宫产率 干预 研究 

分 类 号：R473.71[医药卫生—护理学]