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目的探讨近年来剖宫产率增高的原因,分析剖宫产各项指征的合理性以及剖宫产率增高与围产儿死亡率的关系,寻找降低剖宫产率的对策。方法回顾性分析2000年1月～2006年12月桐庐县妇幼保健院4582例剖宫产及159例围产儿死亡的临床资料。结果(1)剖宫产率逐年上升,从2000年的14.58%上升到2006年的46.36%,差异有显著性(P(0.01)。(2)剖宫产指征变化:前4年胎儿窘迫、头位难产位居第1、2位,从2004年开始胎儿窘迫位次有所下降,但仍占有较高的比例,头位难产所占比例逐年下降;社会因素所占比例逐年攀升,并于2004年起持续位居第1;脐带绕颈、羊水过少所占比例逐年上升。(3)围产儿死亡率并未下降,死亡率在8.34～11.85‰之间,平均为10.15‰,差异无显著性(P(0.01)。结论(1)剖宫产率逐年升高而围产儿死亡率并未下降。(2)剖宫产率升高的原因与医患双方有关。提高孕妇对剖宫产的认识、鼓励阴道分娩;提高围产保健质量、纠正妊娠期异常;加强医患沟通、正确掌握剖宫产指征是降低剖宫产率的关键。
Objective To explore the reasons for the increased cesarean section rate in recent years, to analyze the rationality of cesarean section indications and the relationship between increased cesarean section rate and perinatal mortality and to find ways to reduce the cesarean section rate. Methods The clinical data of 4582 cases of cesarean section and 159 cases of perinatal death in Tonglu MCH from January 2000 to December 2006 were retrospectively analyzed. Results (1) The rate of cesarean section increased year by year, from 14.58% in 2000 to 46.36% in 2006, the difference was significant (P <0.01). (2) The change of cesarean section indications: , The first bit of dystocia ranked No. 1 and No. 2, fetal distress rankings declined from 2004, but still occupy a higher proportion of head dystocia proportion declined year by year; the proportion of social factors increased year by year, and The proportion of umbilical cord around the neck and oligohydramnios increased year by year. (3) The perinatal mortality rate did not decrease, the mortality rate was between 8.34 ~ 11.85 ‰, with an average of 10.15 ‰, the difference was (P <0.01) .Conclusion (1) The rate of cesarean section increased year by year and the perinatal mortality rate did not decline. (2) The reason of the increase of cesarean section rate was related to both the doctor and the patient. Palace of awareness, to encourage vaginal delivery; improve the quality of perinatal care to correct abnormal pregnancy; strengthen communication between doctors and patients, to correctly grasp the indications of cesarean section is to reduce the key to cesarean section rate.