De Mausumi, Biswas Supreeti, Ganguly Rajendra Prasad, Begum Sabnam Ara, Patel Satyabati, Haldar Swaraj, Roy Subesha Basu
Department of Pharmacology, RG Kar Medical College, Kolkata 700004.
J Indian Med Assoc. 2011 May;109(5):312-4, 329.
Sharp rise in the caesarean section rate, over the past years has been causing lot of concerns. It is to be evaluated whether the decrease in perinatal mortality rate is due to the rising rate of caesarean section. Five hundred consecutive patients were selected on whom caesarean section had been performed. Both mother and baby were followed till they are discharged from the hospital. Foetal distress was the commonest indication in primigravidae who underwent caesarean section. The other indications of caesarean section in this study were breech, severe pre-eclampsia, eclampsia, cord prolapse, elderly primi, postdated, premature rupture of membrane, twin, compound presentation, meconium stained liquor. The occurrence of perinatal morbidity in caesarean section was 10% compared to 12% in vaginal delivery. Common causes of perinatal morbidity were asphyxia, prematurity, diarrhoea, septicaemia, jaundice, conjunctivitis and scalp injury. The occurrence of perinatal mortality in caesarean section was 3.8% compared to 3% in vaginal delivery. Causes of perinatal mortality were stillbirth, meconium aspiration syndrome, hypoxic ischaemic encephalopathy, prematurity and congenital malformation. In spite of safety of vaginal birth after caesarean section it continues to be underutilised. Good perinatal care proper screening and use of newer effective pharmacological agents improve the maternal progress as well as perinatal outcome without increasing the caesarean section rate.
在过去几年中，剖宫产率的急剧上升引发了诸多关注。需要评估围产期死亡率的下降是否归因于剖宫产率的上升。选取了连续500例接受剖宫产的患者。对母婴进行随访直至他们出院。胎儿窘迫是初产妇剖宫产最常见的指征。本研究中剖宫产的其他指征包括臀位、重度子痫前期、子痫、脐带脱垂、高龄初产妇、过期妊娠、胎膜早破、双胎、复合先露、羊水粪染。剖宫产围产期发病率为10%，而阴道分娩为12%。围产期发病的常见原因有窒息、早产、腹泻、败血症、黄疸、结膜炎和头皮损伤。剖宫产围产期死亡率为3.8%，阴道分娩为3%。围产期死亡原因有死产、胎粪吸入综合征、缺氧缺血性脑病、早产和先天性畸形。尽管剖宫产术后阴道分娩安全，但仍未得到充分利用。良好的围产期护理、适当的筛查以及使用更新的有效药物可改善产妇情况以及围产期结局，而无需提高剖宫产率。
