Wanyonyi S, Sequeira E, Obura T
Department of Obstetrics and Gynaecology, The Aga Khan University Hospital, P.O. Box 30270-00100, Nairobi, Kenya.
East Afr Med J. 2006 Dec;83(12):651-8. doi: 10.4314/eamj.v83i12.9495.
There has been a persistent rise in the rate of Caesarean sections over the years. Whether this rise is the cause of the decline in infant mortality and improved neonatal outcome still remains debatable.
To compare the Caesarian section rate and the perinatal outcome at the Aga Khan University Hospital for the years 2001 and 2004.
Retrospective study.
The Aga Khan University Hospital, Nairobi.
The total Caesarian section rates, their indication and the perinatal outcome.
The overall Caesarian section rate was 20.4% in 1996, 25.9% in 2001 and 38.1% in 2004. The rate among patients managed by their private obstetricians was 27.1% in 1996, 30.8% in 2001 and 41.7% in 2004. Whilst among general patients, it was 14.7%, 21.5% and 34.5% over the same period. The main indication for emergency Caesarian section was foetal distress, while that for elective Caesarian section was a previous uterine scar. The overall perinatal mortality rate improved from 25.2 per 1,000 births in 2001 to 14.0 per 1,000 births in 2004 (P< 0.001, 95%CL 8.58-30.62). The early neonatal mortality rate was 12.8 per 1,000 live births in 2001 compared to 10.8 per 1,000 live births in 2004 (p=0.08, 95%CI 9.84-13.76).
There has been a significant increase in Caesarian section rate over the years. Being a referral unit dealing with many high-risk patients some of whom are supervised elsewhere and with a significant ratio of private patients, the high rate of Caesarean section at the Aga Khan University Hospital is expected. The rise could also be due to early detection of foetal compromise and improved diagnostic facilities leading to timely intervention. However, there has been a significant improvement in the neonatal outcome over the same period of time. Whether this is an effect of the high Caesarean section rate is debatable and calls for further research to correlate the two.
多年来剖宫产率持续上升。这种上升是否是婴儿死亡率下降和新生儿结局改善的原因仍存在争议。
比较2001年和2004年阿迦汗大学医院的剖宫产率及围产期结局。
回顾性研究。
内罗毕阿迦汗大学医院。
剖宫产总率、其指征及围产期结局。
1996年总体剖宫产率为20.4%，2001年为25.9%，2004年为38.1%。由私立产科医生管理的患者中，1996年的剖宫产率为27.1%，2001年为30.8%，2004年为41.7%。而同期普通患者中的剖宫产率分别为14.7%、21.5%和34.5%。急诊剖宫产的主要指征是胎儿窘迫，择期剖宫产的主要指征是既往子宫瘢痕。总体围产期死亡率从2001年的每1000例出生25.2例降至2004年的每1000例出生14.0例（P<0.001，95%可信区间8.58 - 30.62）。2001年早期新生儿死亡率为每1000例活产12.8例，2004年为每1000例活产10.8例（p = 0.08，95%可信区间9.84 - 13.76）。
多年来剖宫产率显著上升。作为一个接收许多高危患者的转诊单位，其中一些患者在其他地方接受监护，且有相当比例的私立患者，阿迦汗大学医院剖宫产率高是可以预期的。这种上升也可能是由于胎儿窘迫的早期发现以及诊断设施的改善导致及时干预。然而，同期新生儿结局有显著改善。这是否是高剖宫产率的结果存在争议，需要进一步研究以关联两者。
