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目的:探讨剖宫产率及指征变化、阴道助产率与围生儿死亡率的关系。方法:将1990～2012年剖宫产率、阴道助产率及围生儿死亡率进行比较,截取1990、2001、2012年3年剖宫产指征进行回顾性分析。结果:1990、2001、2012年剖宫产率分别为21.87%、66.60%、43.68%,其中1990与2001、2012年及2001与2012年剖宫产率、阴道助产率比较差异均有统计学意义(P<0.05)。1990、2001、2012年剖宫产指征中社会因素、妊娠合并症并发症、瘢痕子宫、巨大儿、羊水少、胎位异常方面比较差异均有统计学意义(P<0.05)。1990、2001、2012年围生儿死亡率分别为14.32‰、10.61‰、2.06‰,差异有统计学意义(P<0.01)。高剖宫产率并不能使围产儿死亡率下降,剖宫产率与围产儿死亡率不相关。结论:社会因素、巨大儿、瘢痕子宫在一定程度上导致了剖宫产率的上升,但围生儿死亡率的下降主要依靠加强围产保健和危重孕产妇管理及提高助产技术。
Objective: To investigate the relationship between changes of cesarean section rate and indications, vaginal delivery rate and perinatal mortality. Methods: The rates of cesarean section, vaginal delivery and perinatal mortality from 1990 to 2012 were compared, and the indications of cesarean section for 3 years in 1990, 2001 and 2012 were intercepted and analyzed retrospectively. Results: The rates of cesarean section in 1990, 2001 and 2012 were 21.87%, 66.60% and 43.68% respectively. Among them, the difference of cesarean section rate and vaginal delivery between 1990 and 2001, 2012 and 2001 and 2012 were statistically significant Significance (P <0.05). There were significant differences in social factors, complications of pregnancy complications, scar uterus, macrosomia, oligohydramnios and fetal position abnormalities in cesarean section indications in 1990, 2001 and 2012 (P <0.05). Perinatal mortality rates in 1990, 2001 and 2012 were 14.32 ‰, 10.61 ‰ and 2.06 ‰, respectively, with significant differences (P <0.01). High rates of cesarean section did not reduce perinatal mortality, and cesarean section rates did not correlate with perinatal mortality. CONCLUSIONS: Social factors, macrosomia, and scarring of the uterus have led to a rise in cesarean section to some extent, but the reduction in perinatal mortality has mainly been attributed to the enhancement of perinatal care and critical maternal management and the enhancement of midwifery techniques.