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目的:调查北京市朝阳区剖宫产现状,分析剖宫产指征,探讨北京市朝阳区剖宫产率的下降空间及控制的合理水平,旨在进一步分析影响因素,减少不必要的剖宫产。方法:选取2006~2010年北京市朝阳区产科质量报表进行剖宫产率趋势分析。调查2012年2~7月在北京市朝阳区助产机构分娩的病例,进行原始信息的现场采集和剖宫产指征的甄别。结果:2006~2010年北京市朝阳区剖宫产率呈上升趋势。助产机构剖宫产率仍较高,为48.05%;民营助产机构剖宫产率为53.53%,高于全区平均水平。经剖宫产指征审核后,社会因素占14.79%,剖宫产指征掌握不准确占6.32%。主要原因依次为胎儿窘迫不存在或诊断依据不足、羊水过少诊断不准确、头盆不称诊断依据不足、初产头浮不是剖宫产指征以及试产时间不够或未试产。结论:通过组织外院专家对剖宫产指征进行严格审核和仔细甄别,发现通过压缩社会因素及剖宫产指征掌握不准确的原因,此次调查中剖宫产下降的比例为10%左右。在此研究的基础上,有必要进一步分析北京市朝阳区剖宫产的其他影响因素;依靠全社会共同参与,促进自然分娩、强化技术培训,正确判断剖宫产医学指征;对民营助产机构加强监管,降低其剖宫产比例。
Objective: To investigate the status of cesarean section in Chaoyang District of Beijing, analyze the indications of cesarean section, explore the decreasing space of cesarean section rate and the reasonable level of control in Chaoyang District of Beijing, aiming to further analyze the influencing factors and reduce unnecessary cesarean section Production. Methods: The 2006-2010 Chaoyang District, Beijing obstetrics quality reports for cesarean section rate trend analysis. Investigate the cases of childbirth in midwifery in Chaoyang District, Beijing from February to July in 2012, and collect the original information and identify the indication of cesarean section. Results: From 2006 to 2010, the cesarean section rate in Chaoyang District of Beijing increased. The rate of cesarean section in the midwifery was still high, 48.05%. The cesarean section rate in the midwifery was 53.53%, higher than the average of the whole district. After cesarean section indication examination, social factors accounted for 14.79%, cesarean section indications inaccurate accounting for 6.32%. The main reason followed by fetal distress does not exist or the diagnosis is based on insufficient diagnosis of oligohydramnios inaccurate diagnosis of headache is not based on the lack of diagnosis of early floating head is not an indication of cesarean section and trial production time is not enough or not trial production. Conclusion: Through the organization of hospital experts on cesarean section indications rigorous examination and careful screening, found that by compressing social factors and cesarean indications to grasp the inaccurate reasons, the survey cesarean section decreased by about 10% . On the basis of this study, it is necessary to further analyze other factors affecting cesarean section in Chaoyang District, Beijing; relying on the whole society to participate in, to promote natural childbirth and strengthen technical training, to correctly judge the cesarean section of medical indications; Institutions to strengthen supervision and reduce the proportion of cesarean section.