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为了解上海市接产医院剖宫产情况及其对母婴健康的影响 ,探讨降低剖宫产率的对策 ,分别于 1998年、2 0 0 0年及 2 0 0 1年对全市各级接产医院的产科剖宫产病史进行了检查并抽取部分病史进行指征评审。结果 :1全市剖宫产率从 1980年的 10 .0 0 %上升到 2 0 0 0年的 4 7.4 4 % ,增加了 3 .74倍 ;2剖宫产前 4位指征构成依次为 :胎儿窘迫、相对性头盆不称、社会因素及胎位不正 ,占全部指征的 60 %左右 ,其中主要为胎儿窘迫和相对性头盆不称 (约 4 0 % ) ,社会因素剖宫产比例在上升 ;3进一步对剖宫产指征进行评审分析 ,指征掌握正确率较低 ,以胎儿窘迫为指征而行剖宫产者中 ,指征依据不足或完全没有依据者在 1998年占 3 9.83 % ,2 0 0 1年占 4 2 .14 % ,以头盆不称为指征者中依据不足或完全没有依据者在 1998年占 1/3 ,2 0 0 1年为 5 4 .76% ;4比较不同分娩方式的费用及近期并发症 ,剖宫产组住院费用为 4 2 2 6.12± 60 0 .74元 ,显著高于阴道产的 2 2 0 4 .2 1± 648元 ,剖宫产产妇分娩时平均出血量为 3 77.3 8± 114 .3 5 ml,显著高于阴道产的 2 84 .16± 110 .4 4 ml,剖宫产组产后出血的发生率为 15 .2 6% ,显著高于阴道产组的 7.5 0 % ,剖宫产组的产褥病率为 11.2 1% ,显著高于阴道产组的 3 .2 1%。此外
In order to understand the cesarean section and its impact on the maternal and infant health in Shanghai Dispensing Hospital, and to explore the strategies to reduce the rate of cesarean section, in 1998, 2000 and 2001 separately, Hospital obstetrics and gynecology history of cesarean section was checked and drawn part of the history of indications review. Results: 1 The rate of cesarean section in the city rose from 10.0% in 1980 to 4 7.44% in 2004, an increase of 3.74 times. 2 The top 4 indications of cesarean section were as follows: Fetal distress, relative head basin is not known, social factors and fetal position is not correct, accounting for about 60% of all indications, of which the main fetal distress and relative lack of head basin (about 40%), the proportion of social factors cesarean section Is on the rise; 3 further cesarean indications for review and analysis, indicating that the lower the correct rate of indications, fetal distress as an indication of cesarean section indications, based on the lack of evidence or no basis in 1998 accounted for 3 9.83% in 2001 and 42.14% in 2001, accounting for one third of that in 1998, or less than one third in 2001, based on inadequate or totally unsupported indications. 76%; 4 compared the cost of different modes of delivery and recent complications, cesarean section hospitalization costs of 4 2 2 6.12 ± 60 0.74 yuan, significantly higher than the vaginal delivery of 2 2 0 4 .2 1 ± 648 yuan, The average amount of bleeding during cesarean delivery was 3 77.3 8 ± 114.35 ml, significantly higher than vaginal delivery 2 84.16 ± 110.44 ml. The incidence of postpartum hemorrhage in the cesarean section was 15.2 6%, significant Greater than 0% 7.5 vaginal delivery group, puerperal caesarean section rate of 11.2 1%, significantly higher than 3.2 1% of vaginal delivery group. In addition