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目的:了解深圳市宝安区剖宫产的指征构成及其影响因素。方法:采用分层整群抽样的方法,调查2009年10~12月在宝安区分娩的剖宫产及阴道产各800例产妇的相关资料,分析剖宫产指征构成及其影响因素。结果:800例剖宫产的指征中,排位前5位的指征为社会因素(占19.38%)、胎儿因素(占25.13%)、异常妊娠分娩史(占20.13%)、胎位异常(占12.75%)、胎盘羊水异常(占8.75%)。排位前5位的医学指征为疤痕子宫(占24.70%)、胎儿宫内窘迫(占19.01%)、臀位(占8.97%)、巨大儿(占5.20%)、活跃期停滞(占4.32%)。主要社会因素为产妇怕痛、不想受“二茬罪”、不想增加胎儿围产期缺氧及产伤的风险、家属不想焦急等待、经济条件许可等。经多元Logistic回归分析,5个因素对是否选择剖宫产有统计学意义,即产检总次数≥8次(OR=2.12,OR95%CI:1.74~2.50)、初产妇(OR=2.35,OR95%CI:1.77~3.29)、产时出血量≥220 m l(OR=1.72,OR95%C:I 1.31~2.13)、产妇年龄≥30岁(OR=1.56,OR95%CI:1.23~1.89)和有合并症及并发症(OR=2.31,OR95%C:I 1.75~2.87)。结论:宝安区剖宫产指征构成中,社会因素及疤痕子宫的比例大,针对性地对产妇及家属进行宣教及干预,有利于降低剖宫产率。
Objective: To understand the indications and influencing factors of cesarean section in Bao’an District of Shenzhen City. Methods: The stratified cluster sampling method was used to survey the data of cesarean section and vaginal delivery of 800 maternal women in Bao’an district from October to December in 2009, and the cesarean section indications and their influencing factors were analyzed. Results: Among the 800 cesarean indications, the top five indications were social factors (19.38%), fetal factors (25.13%), abnormal pregnancy delivery history (20.13%), abnormal fetal position Accounting for 12.75%), abnormal placental amniotic fluid (accounting for 8.75%). The top 5 medical indications were scar uterus (24.70%), fetal distress (19.01%), breech (8.97%), giant children (5.20%), active stagnation (4.32% %). The main social factors are the fear of pain in pregnant women, do not want to suffer from the crime of second crop, do not want to increase the risk of fetal perinatal hypoxia and birth trauma, families do not want to wait anxiously, the economic conditions permit. Multivariate Logistic regression analysis showed that there were significant differences between the five factors in choosing cesarean section, that is, the total number of examinations was ≥8 (OR = 2.12, OR95% CI: 1.74-2.50), primipara (OR = 2.35, OR95% (OR = 1.72, OR95% CI: 1.23-2.83), with a combined age of 30 years (OR = 1.56, OR 95% CI: 1.23-1.89) Symptoms and complications (OR = 2.31, OR95% C: I 1.75 ~ 2.87). Conclusion: Among the components of cesarean section indications in Baoan District, the social factors and the proportion of uterus in scars are large. Propagating and intervening maternal and family members in a targeted manner is helpful to reduce the rate of cesarean section.