MacKenzie I Z, Cooke Inez, Annan B
Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK.
J Obstet Gynaecol. 2003 May;23(3):233-8. doi: 10.1080/0144361031000098316.
In this paper, we aimed to identify changes in the indications for and timing of caesarean section over 20 years. This involved a prospective data collection by clinical record analysis throughout the 12-month periods for 1976, 1986 and 1996. The study was carried out in the maternity unit of a large district teaching hospital. We studied all women delivered by caesarean section. Main outcome measures were rates for different indications for caesarean section for the populations served during each of the 3 years. Analysis of 1819 caesarean sections showed an increasing rate, from 6.7% in 1976 to 14.2% in 1996. The proportion of planned antepartum deliveries remained constant at 54%, with previous caesarean section given as the main indication in 1976 (55%) and 1986 (49%) and maternal request in 1996 (23%). Caesarean section for intrapartum fetal distress doubled over the study period, with little evidence of improved neonatal or long-term outcome. Caesarean section for failed labour induction and failed first- and second-stage progress all increased and for failed assisted delivery increased threefold. Caesarean section with a singleton breech presentation increased from 30% to 88% and for twin pregnancies from 13% to 47%. The rate of caesarean section for women delivered previously by section remained unaltered at 56%. The proportion of pregnancies delivered by caesarean section increased for virtually all indications. Consumer expectation has encouraged a more ready use of section, with maternal choice being the most frequent indication in 1996.
在本文中，我们旨在确定20年间剖宫产指征和时机的变化。这涉及通过对1976年、1986年和1996年全年临床记录分析进行前瞻性数据收集。该研究在一家大型地区教学医院的产科进行。我们研究了所有剖宫产分娩的妇女。主要结局指标是这3年中各年份所服务人群不同剖宫产指征的发生率。对1819例剖宫产的分析显示，剖宫产率呈上升趋势，从1976年的6.7%升至1996年的14.2%。计划剖宫产分娩的比例保持在54%不变，1976年（55%）和1986年（49%）以既往剖宫产为主要指征，1996年以产妇要求为主要指征（23%）。在研究期间，因产时胎儿窘迫行剖宫产的比例翻倍，但几乎没有证据表明新生儿或远期结局得到改善。因引产失败、第一产程和第二产程进展失败行剖宫产的比例均增加，因助产失败行剖宫产的比例增加了两倍。单胎臀位剖宫产率从30%增至88%，双胎妊娠剖宫产率从13%增至47%。既往有剖宫产史的妇女再次剖宫产率保持在56%不变。几乎所有指征的剖宫产分娩比例均有所增加。消费者的期望促使剖宫产的使用更加普遍，产妇选择是1996年最常见的指征。
