Stafford R S
University of California, School of Medicine, San Francisco.
West J Med. 1990 Nov;153(5):511-4.
Cesarean section use in the United States has increased to 24.7% of deliveries in 1988 and is the most common hospital surgical procedure. California cesarean section rates were examined to measure recent trends in obstetric practices and to project future patterns of cesarean section use. Using discharge abstracts from 1983 to 1987 California hospital deliveries, total cesarean section rates were found to increase from nearly 22% in 1983 to 25% in 1987, an increase of 15%. Using a series of least-squares regression models, time trends in the distribution of indications associated with cesarean section among all deliveries and indication-specific cesarean section rates were evaluated. Increases in the number of women with previous cesarean section and fetal distress contributed to rising cesarean section rates. In addition, indication-specific cesarean section rates increased for breech presentation and dystocia. These trends were counterbalanced, in part, by declining rates of repeat cesarean sections. Trends noted for July 1985 through 1987 did not differ substantially from those observed for January 1983 to June 1985, suggesting that recent policy attempts to alter cesarean section use have not had a measurable effect on existing trends. Projections suggest that California cesarean section rates will rise to a level of 34% by the year 2000.
1988年，美国剖宫产的使用率已增至分娩总数的24.7%，成为医院里最常见的外科手术。对加利福尼亚州的剖宫产率进行了调查，以衡量产科实践的近期趋势，并预测未来剖宫产的使用模式。利用1983年至1987年加利福尼亚州医院分娩的出院摘要，发现剖宫产总率从1983年的近22%上升到1987年的25%，增长了15%。使用一系列最小二乘回归模型，评估了所有分娩中与剖宫产相关的指征分布的时间趋势以及特定指征的剖宫产率。有剖宫产史的女性数量增加以及胎儿窘迫导致了剖宫产率上升。此外，臀位和难产的特定指征剖宫产率也有所上升。这些趋势部分地被再次剖宫产率的下降所抵消。1985年7月至1987年期间观察到的趋势与1983年1月至1985年6月期间观察到的趋势没有实质性差异，这表明近期改变剖宫产使用情况的政策尝试对现有趋势没有产生可衡量的影响。预测表明，到2000年，加利福尼亚州的剖宫产率将升至34%的水平。
