Krychowska Alina, Kosińska Katarzyna, Karwan-Płońska Anna
Studenckie Koło Naukowe przy I Klinice PołoZnictwa i Ginekologii, Warszawie.
Ginekol Pol. 2004 Dec;75(12):926-31.
The aim of this research was a retrospective analysis of indications for caesarean section during last fifteen years and assessing recent trends.
1106 pregnancies and deliveries by caesarean section at the Ist Clinic of Obstetrics and Gynaecology, Medical University of Warsaw in 1985-86 (547--I group) and 2000-01 (559--II group) were enrolled in the study. It was performed in order to estimate and evaluate such factors as age of women, mean duration of pregnancy, indications for caesarean section, complications, and general newborn condition.
In 1985-86 and 2000-01 fetal distress was the most frequent indication for delivery via caesarean section (14.35% and 18.57% respectively, p=ns). It was followed by cephalopelvic disproportion (13.99%) and malposition (13.99%) in I group and by pregnant women diseases (14.07%) and malposition (12.45%) in II group. Analysing pathology of the placenta, we established that index of placenta praevia decreased from 2.49% to 0.57% (p < 0.01) and index of abruption of placenta from 2.25% to 0.81% (p = 0.05). Ratio of cases of cephalopelvic disproportion decreased statistically from 13.99% in the I group to 8.76% in the II group (p = 0.006). Index of prolonged labor in the I stage increased from 8.3% to 12.34% (p = 0.027).
(1) Caesarean section is the surgical method of delivery for women with high risk pregnancy and complicated labor to protect mother and the foetus from the anticipated complications of delivery through natural passages. (2) The overall rate of caesarean section has risen because of widening of the indications. (3) Fetal distress has been the most frequent indication for caesarean section in last fifteen years. (4) Index of indications for cesarean section other than obstetric--ophthalmic, cardiological, neurological and orthopaedic, increased as a result of better health care of pregnant women. (5) Decision to perform caesarean section should be taken in consideration of present clinical situation and future consequences of abdominal delivery.
本研究旨在回顾性分析过去十五年剖宫产的指征并评估近期趋势。
选取华沙医科大学第一妇产科诊所1985 - 1986年（547例——I组）和2000 - 2001年（559例——II组）的1106例剖宫产妊娠及分娩病例纳入研究。进行该研究是为了估计和评估诸如产妇年龄、平均孕期、剖宫产指征、并发症以及新生儿总体状况等因素。
1985 - 1986年和2000 - 2001年，胎儿窘迫是剖宫产分娩最常见的指征（分别为14.35%和18.57%，p = 无显著差异）。I组其次是头盆不称（13.99%）和胎位异常（13.99%），II组其次是孕妇疾病（14.07%）和胎位异常（12.45%）。分析胎盘病理情况，我们发现前置胎盘指数从2.49%降至0.57%（p < 0.01），胎盘早剥指数从2.25%降至0.81%（p = 0.05）。头盆不称病例的比例从I组的13.99%统计学上降至II组的8.76%（p = 0.006）。第一产程延长指数从8.3%增至12.34%（p = 0.027）。
（1）剖宫产是高危妊娠和难产妇女的手术分娩方式，可保护母亲和胎儿免受经自然产道分娩预期并发症的影响。（2）由于指征范围扩大，剖宫产的总体比率有所上升。（3）胎儿窘迫是过去十五年剖宫产最常见的指征。（4）由于孕妇医疗保健水平提高，非产科——眼科、心脏病科、神经科和骨科的剖宫产指征指数有所增加。（5）决定实施剖宫产应考虑当前临床情况及腹部分娩的未来后果。
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