Dumont A, De Bernis L, Bouvier-Colle M H, Bréart G
INSERM Unité 149, Recherches Epidémiologiques en Santé Périnatale et Santé des Femmes, 123, boulevard Port-Royal, 75014 Paris, France.
J Gynecol Obstet Biol Reprod (Paris). 2002 Feb;31(1):107-12.
There is still some debate about the optimal rate of cesarean section (CS) needed to achieve better outcome for both mothers and infants in developing countries. We examine here two aspects of the question: i) a simple method to estimate the expected rate of CS according to obstetrical risk; ii) a test of the method to estimate the appropriate rate for maternal indications in a general population of pregnant women in West Africa.
This population-based study was conducted in a cohort of pregnant women in six West African countries (MOMA survey): Abidjan (Ivory Coast), Bamako (Mali), Niamey (Niger), Nouakchott (Islamic Republic of Mauritania), Ouagadougou (Burkina Faso), and in three areas of Senegal, two small towns (Fatick and Kafrine, Kaolack region), and one major city (Saint-Louis). 19,459 women with singleton pregnancies with expected breech presentation were followed to delivery and puerperium. Maternal indications for CS were defined as dystocia (prolonged labor over 12 hours), malpresentation, previous cesarean section, abruptio placentae, placenta paevia and eclampsia. A standardized method was used to calculate the number of expected CS in the MOMA population, according to the level of the obstetrical risk.
The minimal needs for Cs for maternal indications were estimated between 3.6 and 6.5 per 100 deliveries. However, we observed a rate of 1.3 CS per 100 deliveries.
These findings underline the lack of CS for maternal indications in urban West Africa. The method of standardization we propose could help policy makers, health planners and obstetricians to design programs to reach the appropriate level of CS and to monitor and follow-up these programs.
在发展中国家，关于剖宫产（CS）的最佳实施率以实现母婴更好结局仍存在一些争议。我们在此研究该问题的两个方面：i）一种根据产科风险估计预期剖宫产率的简单方法；ii）对该方法进行测试，以估计西非一般孕妇群体中因母体指征而进行剖宫产的合适比率。
这项基于人群的研究在六个西非国家的一组孕妇中进行（MOMA调查）：阿比让（科特迪瓦）、巴马科（马里）、尼亚美（尼日尔）、努瓦克肖特（毛里塔尼亚伊斯兰共和国）、瓦加杜古（布基纳法索），以及塞内加尔的三个地区，两个小镇（法蒂克和卡夫林，考拉克地区）和一个主要城市（圣路易）。对19459名单胎妊娠且预期为臀位的妇女进行跟踪直至分娩和产褥期。剖宫产的母体指征定义为难产（产程延长超过12小时）、胎位异常、既往剖宫产史、胎盘早剥、前置胎盘和子痫。根据产科风险水平，使用标准化方法计算MOMA人群中预期剖宫产的数量。
每100例分娩中因母体指征进行剖宫产的最低需求估计在3.6至6.5例之间。然而，我们观察到每100例分娩中有1.3例剖宫产。
这些发现凸显了西非城市地区因母体指征进行剖宫产的不足。我们提出的标准化方法可帮助政策制定者、卫生规划者和产科医生设计方案，以达到适当的剖宫产水平，并对这些方案进行监测和跟踪。
