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目的通过分析剖宫产病历,了解助产机构剖宫产指征掌握情况,以便更好地探讨降低北京市剖宫产率的有效措施。方法组织专家对北京市16家助产机构3 204份剖宫产病历进行现场查阅并填写病历调查记录表,使用统计学软件对剖宫产指征等情况进行统计学分析。结果北京市剖宫产原因中非医学指征占23.16%,位居第一;原指征与核实指征在胎心监护异常、产程延迟和停滞、引产失败等方面所占比例有统计学差异;付费方式不同的孕妇剖宫产率不同,在剖宫产病历中非医学指征与有指征者的付费方式无统计学差异。结论北京市剖宫产原因中非医学指征所占比例较大;胎心监护异常、产程延迟和停滞、引产失败等存在过度诊断进行剖宫产的问题;通过加强剖宫产病历的质量控制、健康教育及对助产人员的助产知识技能的培训,可能降低剖宫产率。
Objective To analyze the history of cesarean section and understand the indications of cesarean section in midwifery in order to better explore the effective measures to reduce cesarean section rate in Beijing. Methods The experts organized 3 204 cesarean section records of 16 midwifery institutions in Beijing on the spot and filled in the record of medical records, and used statistical software to analyze the indication of cesarean section. Results The non-medical indications of cesarean section in Beijing accounted for 23.16%, ranking the first. There was a significant difference in the proportion of original indications and verification indications in abnormal fetal heart rate monitoring, delayed and delayed labor, and induced abortion ; Cesarean section rates of pregnant women with different payment methods were different. There was no significant difference in the payment methods between non-medical indications and those with indications in the cesarean section medical records. Conclusions The causes of cesarean section in Beijing include a large proportion of non-medical indications; abnormal fetal heart rate monitoring, delayed and delayed labor, and induction of labor failure have the problem of over-diagnosis of cesarean section. By strengthening the quality control of cesarean section medical records , Health education and midwifery knowledge and skills training for midwives may reduce cesarean delivery rates.