初产妇剖宫产指征1990-1999年与2000-2009年的对比研究

摘要

目的 探讨20年初产妇剖宫产指征及构成比的变化.方法 采用回顾性分析的方法,比较1990-2009年20年间初产妇剖宫产指征、构成比、孕妇年龄、孕周的差异.结果 1990-1999年前10年初产妇剖宫产指征前3位依次为:难产、臀位、胎儿窘迫,2000-2009年后10年初产妇剖宫产指征前3位依次为:难产、臀位、社会因素.与前10年比较,后10年社会因素、羊水过少、巨大胎儿的构成比升高;难产、臀位、前置胎盘、过期妊娠的构成比下降,差异有统计学意义(均P<0.05);高龄初产及孕妇年龄的差异无统计学意义.前、后10年初产妇剖宫产构成比分别是71.72%和61.10%(χ2=73.683,P<0.001),初产妇剖宫产中早产的构成比分别是1.76%和3.72%(χ2=12.906,P<0.001).结论 1990-2009年间后10年初产妇剖宫产构成比较前10年下降,剖宫产指征及构成比发生变化,难产、臀位、胎儿窘迫仍然是初产妇剖宫产的主要指征.社会因素成为近10年初产妇剖宫产的主要指征之一.%Objective To explore the changes of indicators of cesarean section for primiparas and their constituent ratios in 1990 -1999 and 2000 -2009. Methods A retrospective analysis was conducted to compare the difference of indicators of cesarean section,their constituent ratios, pregnant women' s ages and gestational weeks for primiparas from 1990 to 2009. Results From 1990 to 1999,the three leading indicators of cesarean section for primiparas were dystocia, breech position and fetal distress in order. From 2000 to 2009, the three leading indicators were dystocia, breech position and social factors in order. The constituent ratios of social factors, oligohydramnios and fetal macrosomia increased significantly in the later 10 years compared with those in the earlier 10 years ( P ＜ 0.05 ),while the constituent ratios of dystocia, breech position, placenta previa and prolonged pregnancy decreased( P ＜ 0.05 ), and the constituent ratio of elderly primiparas and primipara age were not statistically different in the later and the earlier ten years( P ＞ 0.05 ). The constituent ratios of cesarean section for primiparas in the earlier 10 years and later 10 years were 71.72％ and 61.10％ ( x2= 73. 683,P ＜ 0. 001 ) respectively, and the constituent ratios of premature birth were 1.76％ and 3.72％ , respectively( x2 = 12. 906, P ＜0.001 ). Conclusion The constituent ratio of cesarean section for primiparas decreases from 1990 to 2009. The dystocia, breech position and fetal distress are still the main indicators of cesarean section for primiparas. It' s a concern that social factors have become one of major indicators of cesarean section for primiparas in the recent 10 years.