北京、上海、成都三市剖宫产的影响因素研究  

Study on the occurrence of cesarean section (CS) and factors related to CS in China

作　　者：程怡民[1] 袁伟 菜卫东 张文敏[4] 王铁燕[5] 王燕[6] 吴世仲 周利峰 罗琳[3] 高尔生 

机构地区：[1]国家计划生育委员会科学技术研究所,北京100081 [2]上海市计划生育科学技术研究所 [3]四川省计划生育科学技术研究所 [4]北京市宣武医院 [5]北京市海淀妇产医院 [6]中日友好医院

出　　处：《中华流行病学杂志》2003年第10期893-896,共4页Chinese Journal of Epidemiology

基　　金：世界卫生组织的资助

摘　　要：目的　了解剖宫产的发生率及与较高剖宫产率有关的影响因素。方法　采用面对面问卷调查 ;剖宫产者为“病例组” ,正常产者为“对照组” ,进行病例对照研究。结果　在 14 0 71名初产妇中 ,剖宫产者有 642 1人 (病例组 ) ,剖宫产发生率为 45.6% ;正常分娩有 7650人 (对照组 ) ,占 54.4% ;与正常分娩组相比 ,剖宫产组有以下 5个比例较高和 8种影响因素较多 ,两组间差异均有非常显著性(P均 <0 .0 1)。 5个比例较高的因素分别为文化程度高 ( 78.9%∶69.5% )、白领阶层多 ( 3 8.0 %∶3 2 .3 % )、城市户口多 ( 79.1%∶70 .6% )、月收入较高的多 (≥ 50 0元 ,81.0 %∶70 .6% )以及年龄大的多(≥ 2 5岁 ,73 .3 %∶63 .0 % )。此外 ,8种因素均较多的为 :婴儿体重超 40 0 0 g( 8.3 %∶2 .9% )、男性胎儿( 53 .9%∶51.4% )、母亲体重指数 >2 4( 8.8%∶ 4.8% )、头盆不称 ( 2 1.1%∶ 0 .9% )、胎儿宫内窘迫( 2 0 .3 %∶6.7% )、产力异常 ( 4 .2 %∶2 .7% )、滞产 ( 2 .9%∶1.0 % )以及前置胎盘 ( 1.4%∶0 .4% )。特别强调的是 ,在剖宫产组 ,初产妇年龄 >2 4岁的比例高达 70 %以上 ,头盆不称和胎儿宫内窘迫都高达2 0 %以上。两组间差异有非常显著性。结论　目前中国剖宫产率相当高 ,较高的剖宫产率不但与生理Objective To find out the occurrence of cesarean section (CS) and to probe the factors associated with CS. Methods Women with CS as “case group” and women witho ut CS as “control group” were chosen in a case-control study. Results Among 14 071 childbirth women, 6 421 had CS (case group) with the occurrence rate of 45.6 % and 7 650 ( 54.4 %) had normal delivery (control group). In comparison with the control group,the C S group had following several higher rates [with significant differences betwee n case group and control group ( P< 0.01 )]: well-educated ( 78.9 % vs 69.5 %), white collar jobs ( 38.0 % vs 32.3 %), urban re sident s ( 79.1 % vs 70.6 %), high monthly income (≥500 Yuan) ( 81.0 % v s 70.6 %), of older age (≥25 years) ( 73.3 % vs 63.0 %), heavie r baby weight (> 4 000 gram) ( 8.3 % vs 2.9 %), male babies ( 5 3.9 % vs 51.4 %),BMI of mother (>24)( 8.8 % vs 4.8 %), cepha lopelvic disproportion ( 21.1 % vs 0.9 %),intrauterine asphysia ( 20.3 % vs 6.7 %),abnormality of force of labor ( 4.2 % vs 2.7 %), prolonged labor ( 2.9 % vs 1.0 %) and placenta previa ( 1.4 % vs 0.4 %).Our study also indicated that the higher the educational level was,th e higher the rate of CS appeared; and the older the pregnant women was,the high er the ra te of CS was.In CS group, over 70% primipara were over 24 years,and over 20% pr imipara had cephalopelvic disproportion and over 20% had intrauterine asphysia i n CS group. Conclusions At present,the occurrence rate of cesarean se ction was rather high ( 45.6 %) in China.The high rate of CS was more likely t o associate not only with abnormal physiological/medical factors (eg.cephalopelv ic disproportion,intrauterine asphysia,abnormality of force of labor,and prolong ed labour,etc.),but also with some demographic factors as education,occupation, income and age,etc. It is necessary to take measures to reduce the unnecessary C S in China.

关 键 词：北京 上海 成都市 剖宫产 影响因素 正常分娩 

分 类 号：R719.8[医药卫生—妇产科学]