Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Lancet. 2010 Feb 6;375(9713):490-9. doi: 10.1016/S0140-6736(09)61870-5. Epub 2010 Jan 11.
There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08.
Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events.
We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum with indication 14.5, 13.2-16.0). For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively).
To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.
US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research.
全世界的剖宫产率一直在上升，这引起了人们的关注。本文报道了世卫组织全球调查的第三阶段，该调查旨在评估 2004-05 年在非洲和拉丁美洲选定的医疗机构以及 2007-08 年在亚洲医疗机构中不同分娩方式的比率，并研究分娩方式与产妇和围产儿结局之间的关系。
9 个国家参加了亚洲全球调查：柬埔寨、中国、印度、日本、尼泊尔、菲律宾、斯里兰卡、泰国和越南。在每个国家，随机选择首都和另外两个地区或省份。我们研究了所有在每年预计分娩 6000 次或以下的机构中连续 3 个月，以及在预计分娩 6000 次以上的机构中连续 2 个月住院分娩的所有妇女。我们为机构收集数据，以详细描述其卫生设施及其产科护理资源。我们从妇女的病历中获取数据，以总结产科和围产儿事件。
我们从 122 个招募的医疗机构中报告的 112152 次分娩中获得了 109101 次的数据（覆盖率 97%），并分析了 107950 次分娩。剖宫产率总体为 27.3%（n=29428），阴道分娩率为 3.2%（n=3465）。阴道分娩（调整后的优势比 2.1，95%CI 1.7-2.6）和所有类型的剖宫产（无指征的剖宫产 2.7，1.4-5.5；有指征的剖宫产 10.6，9.3-12.0；无指征的产时剖宫产 14.2，9.8-20.7；有指征的产时剖宫产 14.5，13.2-16.0）产妇死亡和发病率指数（至少有一项：产妇死亡、入住重症监护病房[ICU]、输血、子宫切除术或髂内动脉结扎）风险增加。对于臀位，剖宫产，无论是产前（0.2，0.1-0.3）还是产时（0.3，0.2-0.4），均与围产儿结局改善相关，但也与新生儿 ICU 入住风险增加相关（2.0，1.1-3.6；和 2.1，1.2-3.7）。
为了改善产妇和围产儿结局，剖宫产只能在有医学指征时进行。
美国国际开发署（USAID）；开发计划署/人口基金/世卫组织/世界银行生殖健康特别方案（HRP）、世卫组织、瑞士；日本厚生劳动省；中国国家卫生和计划生育委员会；和印度医学研究理事会。
