以Robson十分类法研究“二孩政策”对剖宫产率的影响  

Effects of two-child policy on cesarean section rate in China： analysis under Robson Ten-Group Classification

作　　者：王佳 黄沁[1] 蒋琳[1] 向丽洁 Wang dia;Huang Qin;diang Lin;Xiang Lijie(Department of Obstetrics and Gynecology,First Affiliated Hospital of Sooehow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院妇产科,215006

出　　处：《中华围产医学杂志》2018年第10期691-696,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的以Robson十分类法探讨＂二孩政策＂对剖宫产率的影响。方法根据单独和全面＂二孩政策＂实施时间将2013年1月至2016年8月苏州大学附属第一医院9 734例产妇分为单独二孩前期（2013年1月至2013年11月）、单独二孩期（2013年12月至2015年9月）和全面二孩期（2015年10月至2016年8月），采用χ2检验和Logistic回归分析Robson十分类各组剖宫产率变化。结果第2b组（单胎头位初产妇，≥37周，临产前剖宫产）及第5组（单胎头位经产妇至少有一次剖宫产史，≥37周）剖宫产人数占总体剖宫产人数的52.78%（2 062/3 907）。全面二孩期较单独二孩前期总剖宫产率下降[34.29%（654/1 907）与43.71%（1 112/2 544），χ2=40.376，P=0.000]；第2b组下降最为明显[全面二孩期与单独二孩前期分别为5.35%（102/1 907）与14.27%（363/2 544），χ2=92.700，P=0.000]。全面二孩期与单独二孩前期比较，第1组＋第2组（单胎头位初产妇，≥37周）产妇人数构成比下降[50.24%（958/1 907）与60.34%（1 535/2 544），χ2=45.145，P=0.000]，第3组＋第4组（单胎头位经产妇无剖宫产史，≥37周）[21.66%（413/1 907）与16.71%（425/2 544），χ2=17.483，P=0.000]及第5组[14.47%（276/1 907）与9.28%（236/2 544），χ2=28.910，P=0.000]产妇人数构成比上升；第5组剖宫产后阴道分娩率上升[17.39%（48/276）与2.54%（6/236），χ2=29.732，P=0.000]。结论＂二孩政策＂后经产妇构成比上升，总剖宫产率下降，第2b组（单胎头位初产妇，≥37周，临产前剖宫产）及第5组产妇（单胎头位经产妇至少有一次剖宫产史，≥37周）是降低剖宫产率的重点监测人群。ObjectiveTo investigate the changes in cesarean section rate（CSR） after the announcement of universal two-child policy using the Robson Ten-Group Classification.MethodsA retrospective study was conducted to analyze 9 734 deliveries in the First Affiliated Hospital of Soochow University from January 2013 to August 2016. All deliveries were classified by the Robson Ten-Group Classification System and divided into three subgroups including phase 1（delivered between January 2013 and November 2013, the period before the selective two-child policy was implemented）, phase 3（ delivered between October 2015 and August 2016, the period after the universal two-child policy was implemented） and phase 2 （delivered between December 2013 and September 2015, the transition period from selective two-child policy to the universal two-child policy）. Changes in CSR were analyzed by Chi-square test and Logistic regression.ResultsThe cesarean section deliveries in Group 2b （singleton, cephalic presentation, primipara, ≥37 gestational weeks, cesarean section before labor） and group 5 （singleton, cephalic presentation, multipara with at least one cesarean section history, ≥37 gestational weeks） accounted for 52.78% （2 062/3 907） of the total cesarean section deliveries. The overall CSR decreased in phase 3 than in phase 1 [34.29% （654/1 907） vs 43.71% （1 112/2 544）, χ2=40.376, P=0.000], and the most remarkable decline was found in group 2b [5.35% （102/1 907） vs 14.27% （363/2 544）, χ2=92.700, P=0.000]. Compared with phase 1, in all deliveries, the constituent ratio of deliveries of groups 1 and 2 （singleton, cephalic presentation, primipara, ≥37 gestational weeks） was decreased in phase 3 [50.24% （958/1 907） vs 60.34% （1 535/2 544）, χ2=45.145, P=0.000], while that in groups 3 and 4 （singleton, cephalic presentation, multipara, ≥37 gestational weeks, no cesarean section history） [21.66% （413/1 907） vs 16.71% （425/2 544）, χ2=17.483, P=0.000] as well as in group

关 键 词：剖宫产术 LOGISTIC模型 人群监测 

分 类 号：R719.8[医药卫生—妇产科学]