Trujillo Hernández B, Tene Pérez C E, Ríos Silva M
Hospital General de Zona y Medicina Familiar No. 1 del IMSS Colima.
Ginecol Obstet Mex. 2000 Jul;68:306-11.
The increase in frequency of cesareans that has been noted through 70's, not diminished--like it was expected--perinatal morbidity and mortality. The most important indications to cesarean are distocias, previous cesarean and fetal stress. In 1998 frequency of cesarean deliveries in our hospital was 35% of the pregnancy attended. The claim of this study was to determine risks factors to cesarean in our hospital. A case-control study was performed, selecting 165 cases (cesareans) and 328 controls (via vaginal). It was determined OR of the risks factors and atribuible fraction. Data were analyzed by X2. The most important indications to cesarean delivery were: distocias (39%, n = 64); previous cesarean (23%, n = 41) and fetal stress (11%, n = 21). There was not significative differences in age, height and rupture membrane time in both groups. History of cesarean delivery gave major risk to another surgical intervention (OR = 12.7, p = < 0.0001, atribuible fraction 92%). Nuliparous (OR = 6.6, p < 0.00000, atribuible fraction 85%), second gestation (OR = 1.8, p = 0.002) or history of abortion (OR = 1.8, p = 0.04) were factors mainly associated to cesarean delivery. We concluded that the precise 'medications of this surgical intervention specially in nuliparous or previous cesarean delivery cases must be replanteated to diminish its elevated frequency.
整个70年代剖宫产率持续上升，围产期发病率和死亡率并未如预期那样下降。剖宫产最重要的指征是难产、既往剖宫产史和胎儿窘迫。1998年我院剖宫产率占分娩总数的35%。本研究旨在确定我院剖宫产的危险因素。采用病例对照研究，选取165例剖宫产病例和328例经阴道分娩的对照。确定危险因素的比值比（OR）和归因分数。数据采用卡方检验分析。剖宫产最重要的指征为：难产（39%，n = 64）；既往剖宫产史（23%，n = 41）和胎儿窘迫（11%，n = 21）。两组在年龄、身高和胎膜破裂时间方面无显著差异。既往剖宫产史会增加再次手术干预的风险（OR = 12.7，p = < 0.0001，归因分数92%）。初产妇（OR = 6.6，p < 0.00000，归因分数85%）、第二次妊娠（OR = 1.8，p = 0.002）或流产史（OR = 1.8，p = 0.04）是与剖宫产相关的主要因素。我们得出结论，必须重新审视这种手术干预的精确“用药”，特别是在初产妇或有既往剖宫产史的病例中，以降低其高发生率。
