Wax Joseph R, Cartin Angelina, Pinette Michael G, Blackstone Jacquelyn
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine, United States.
Birth. 2005 Sep;32(3):203-6. doi: 10.1111/j.0730-7659.2005.00370.x.
Patient choice cesarean refers to elective primary cesarean in the absence of a medical or obstetrical indication. The purpose of this study was to determine obstetricians' attitudes and practices with respect to patient choice cesarean in Maine, United States.
A questionnaire was sent to all Maine Fellows of the American College of Obstetricians and Gynecologists actively practicing obstetrics, after receiving institutional review exemption. Data were analyzed using descriptive statistics, Fisher exact, or chi-square tests.
Seventy-eight of 110 (70.9%) obstetricians responded. Of these, 60 of 71 (84.5%) respondents performed or were willing to perform patient choice cesarean. However, 15 of 71 (21.1%) preferred a cesarean delivery for themselves (women) or partners (men). Indications included urinary continence (53.3%), adverse previous birth experience (41.7%), anal continence (35.0%), concern for fetal death or injury (33.3%), and fear of childbirth, preservation of sexual function, or pelvic organ prolapse (26.7% each). Less frequent were pain (11.7%), convenience (8.3%), and provider availability (10.0%). In addition, 82.1 percent believed medical evidence and 85.9 percent believed ethical issues sometimes or always supported patient choice cesarean. Responses were similar by gender, age, and time interval from training completion with two exceptions. Women under age 35 years were more likely to opt for a cesarean delivery themselves (p = 0.04), and 42.9 percent of respondents under age 35 years interpreted the medical literature as supporting cesarean in all cases versus 4.2 percent of older colleagues (p = 0.008). Sixty-four of 78 (82.1%) respondents would find a randomized trial of planned vaginal versus planned cesarean delivery helpful in addressing the issue of patient choice cesarean.
Although Maine obstetricians were willing to perform patient choice cesarean, few preferred this delivery mode for themselves or their partners. A randomized trial of planned vaginal versus planned cesarean delivery is highly desired.
患者选择剖宫产是指在没有医学或产科指征的情况下进行的选择性初次剖宫产。本研究的目的是确定美国缅因州产科医生对患者选择剖宫产的态度和做法。
在获得机构审查豁免后，向缅因州所有积极从事产科工作的美国妇产科医师学会会员发送了一份问卷。使用描述性统计、Fisher精确检验或卡方检验对数据进行分析。
110名产科医生中有78名（70.9%）回复。其中，71名受访者中有60名（84.5%）进行过或愿意进行患者选择剖宫产。然而，71名中有15名（21.1%）为自己（女性）或伴侣（男性）选择剖宫产。指征包括尿失禁（53.3%）、既往不良分娩经历（41.7%）、肛门失禁（35.0%）、担心胎儿死亡或受伤（33.3%）以及害怕分娩、保留性功能或盆腔器官脱垂（各26.7%）。疼痛（11.7%）、便利性（8.3%）和提供者可及性（10.0%）则较少见。此外，82.1%的人认为医学证据，85.9%的人认为伦理问题有时或总是支持患者选择剖宫产。按性别、年龄和完成培训后的时间间隔分类的回复相似，但有两个例外。35岁以下的女性更有可能自己选择剖宫产（p = 0.04），35岁以下的受访者中有42.9%将医学文献解释为在所有情况下都支持剖宫产，而年长同事中这一比例为4.2%（p = 0.008）。78名受访者中有64名（82.1%）认为计划阴道分娩与计划剖宫产的随机试验有助于解决患者选择剖宫产的问题。
尽管缅因州的产科医生愿意进行患者选择剖宫产，但很少有人为自己或伴侣选择这种分娩方式。非常需要进行计划阴道分娩与计划剖宫产的随机试验。
