北京地区剖宫产率变化及指征分析  

Cesarean Section Rates and Cesarean Section Indications Survey in Beijing

作　　者：钱睿亚[1] 陈政弘[2] 张为远[1] 汤丽荣[1] 

机构地区：[1]首都医科大学附属北京妇产医院,100026 [2]首都医科大学北京神经外科研究所流行病学室,100069

出　　处：《医学研究杂志》2016年第12期112-116,共5页Journal of Medical Research

摘　　要：目的研究北京地区近30年剖宫产率变化情况及剖宫产指征分析。方法选择2013年6月-2014年7月在北京城区6所医院妇科／妇检门诊要求常规体检的20～65岁已生育女性。采用自制北京地区产后女性生殖健康状况调查表对研究女性进行面对面调查，调查内容包括研究对象的一般情况、分娩情况及剖宫产指征。结果2649例生育女性，按照末次妊娠的分娩方式，分为阴道分娩组1521例，剖宫产组女性1128例。调查人群总剖宫产率为42．6％，剖宫产率自1999年后进行性大幅上升，2009-2013年间剖宫产率达到57％。初次剖宫产的主要指征为社会因素，占总剖宫产率的26．33％，其次为难产，占总剖宫产率的12．5％。剖宫产和阴道分娩比率与受教育程度密切相关，受教育水平大专及大学组剖宫产比率最高（X^2=24．585，P=0．000）。社会因素剖宫产比率在2004-2008年间达到高峰（36．8％），2009年后出现下降。高龄初产的比率逐年上升。结论北京地区剖宫产率逐年升高（截至2013年底），1999年后剖宫产率增长明显，剖宫产率升高的主要原因是社会因素导致的无指征剖宫产率增多。剖宫产和阴道分娩比率与受教育程度及家庭收入显著相关。无指征剖宫产比率2009年后出现下降。高龄初产的比率逐年上升。过期妊娠为指征的剖宫产比率逐年下降。Objective To investigate cesarean section ratio change in Beijing city and analyze the reasons of high cesarean section rate. Methods A questionnaire based observational study was conducted from June 30, 2013 to July 1, 2014 in 6 hospitals in Beijing city. Inclusion criteria of the study was 20 -65 years old women who asked for routine physical examinations in these 6 hospitals, based on the delivery method of their last pregnancy, they were divided into two groups： the vaginal delivery group and the cesarean delivery group. The questionnaire included general information such as age, residence, occupation, education level, marital status, economic sta- tus, delivery mode, cesarean section indications. Results 2649 women finished this investigation. The total cesarean section rate was 42.6%. Cesarean section rate increased quickly since year 1999 and reached 57% in year 2009 - 2013. The main cesarean indication was CDMR （ cesarean delivery on maternal request, CDMR） （26.33%）, next was dystocia（ 12.50% ）. Women with very low （ primary and below） and very high education level （master and above） preferred vaginal delivery（X2 = 24. 585,P = 0. 000）. CDMR reached sum- mit in year 2004 -2008 （36.8%）. Elderly primipara women increased yearly and the rate of overdue pregnancy was declining. Conclu- sion Cesarean section rate increased yearly in Beijing city （ data ended in December 2013 ） , the main reason was CDMR. Cesarean sec- tion ratio was associated with education level and household income. CDMR ratio declined since vear 2009 - 2013.

关 键 词：剖宫产 阴道分娩 剖宫产指征 

分 类 号：R71[医药卫生—妇产科学]