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目的:调查不同年代产妇分娩方式的变化情况,分析非医学指征剖宫产的影响因素,并提出相应对策。方法:回顾1989、1994、1999、2004和2009年8 496例住院分娩产妇的临床资料,从分娩方式、人口学特征、剖宫产原因等方面进行分析。结果:本组阴道助产率从1989年的14.56%降至2009年的8.78%;阴道自然分娩率从1989年的63.40%降至2004年的50.47%;非医学指征剖宫产率从1989年的9.36%升至2004年的26.96%和2009年的27.71%,自1994年后超过医学指征剖宫产率;不同年代分娩方式构成比较差异有统计学意义(χ2=155.552,P=0.000);非医学指征剖宫产1 720例,其中产妇或家属要求剖宫产1 259例(73.20%),医生建议剖宫产461例(26.80%);多因素Logistic回归进入非医学指征剖宫产的变量是生活环境、职业和学历。结论:医患双方“共需”是非医学指征剖宫产率居高不下的直接原因,孕妇生活环境、职业及学历对分娩方式选择有重要影响。降低剖宫产率需孕产妇、医护人员及全社会的共同参与。
OBJECTIVE: To investigate the changes of maternal delivery modes in different years, analyze the influencing factors of non-medical indications of cesarean section, and propose corresponding countermeasures. Methods: The clinical data of 8 496 hospitalized women in delivery in 1989, 1994, 1999, 2004 and 2009 were retrospectively analyzed from the aspects of mode of delivery, demographic characteristics and causes of cesarean section. Results: The vaginal delivery rate decreased from 14.56% in 1989 to 8.78% in 2009; the vaginal natural delivery rate dropped from 63.40% in 1989 to 50.47% in 2004; the non-medical indication cesarean section rate increased from 1989 The incidence of cesarean section surpassed that of medical indications after 9.36% in 2004, up 26.96% in 2004 and 27.71% in 2009. There was significant difference in the mode of delivery between different years (χ2 = 155.552, P = 0.000 ); Non-medical indications 1 720 cases of cesarean section, maternal or family members require cesarean section 1 259 cases (73.20%), the doctor recommended cesarean section 461 cases (26.80%); multivariate Logistic regression into non-medical indications Cesarean section variables are the living environment, occupation and education. Conclusion: Both doctors and patients are the direct cause of cesarean section rate which is not medical indication. The living environment, occupation and education of pregnant women have an important influence on the choice of mode of delivery. Reduce the rate of cesarean section required pregnant women, health care workers and the community as a whole participate.