Sanchez-Ramos L, Kaunitz A M, Peterson H B, Martinez-Schnell B, Thompson R J
Department of Obstetrics and Gynecology, University of Florida Health Science Center, Jacksonville 32209.
Am J Obstet Gynecol. 1990 Sep;163(3):1081-7; discussion 1087-8. doi: 10.1016/0002-9378(90)91132-v.
A department-wide effort to reduce the cesarean section rate at the University Medical Center of Jacksonville (Florida) began in 1987. University Medical Center, a teaching hospital with approximately 4500 annual deliveries, serves an almost exclusively indigent obstetric population. Overall, the cesarean section rate declined from 28 per 100 deliveries in 1986 to 11 per 100 in 1989. Decreasing the number of repeat cesarean sections played an important role in reducing total cesarean deliveries. In 1986 32% of women with prior cesarean sections underwent a trial of labor. By 1989 this proportion had increased to 84%. In 1986 65% of women undergoing a trial of labor were delivered vaginally. By 1989 this proportion had increased to 83%. For these reasons the proportion of patients who had repeat cesarean sections dropped from 8% in 1986 to 3% in 1989. Changing approaches to the evaluation and management of dystocia and fetal distress also helped to lower the overall cesarean section rate. In 1986 cesarean sections for at least one of these two indications accounted for 14% of all deliveries. By 1989 this percentage had dropped to 4%. Because selective criteria for vaginal delivery of fetuses in breech presentation were maintained, incremental increased rates of vaginal breech delivery had only a minimal impact on lower overall cesarean section rates. The reduction in the number of cesarean sections was accomplished without compromising neonatal outcomes. In fact, during this 4-year period neonatal mortality rates actually decreased; neonatal morbidity rates remained stable. Our experience suggests that cesarean section rates can be substantially reduced without compromising the newborn.
1987年，佛罗里达州杰克逊维尔大学医学中心开展了一项全院范围的降低剖宫产率的工作。该大学医学中心是一家教学医院，每年约有4500例分娩，服务对象几乎全是贫困的产科人群。总体而言，剖宫产率从1986年的每100例分娩28例降至1989年的每100例11例。减少再次剖宫产的数量在降低剖宫产总数方面发挥了重要作用。1986年，有过剖宫产史的女性中32%尝试了阴道分娩。到1989年，这一比例增至84%。1986年，尝试阴道分娩的女性中有65%通过阴道分娩。到1989年，这一比例增至83%。由于这些原因，接受再次剖宫产的患者比例从1986年的8%降至1989年的3%。改变难产和胎儿窘迫的评估及处理方法也有助于降低总体剖宫产率。1986年，因这两种指征中至少一种而行剖宫产的占所有分娩的14%。到1989年，这一比例降至4%。由于维持了臀位胎儿阴道分娩的选择标准，阴道臀位分娩率的逐步上升对降低总体剖宫产率的影响极小。剖宫产数量的减少是在不影响新生儿结局的情况下实现的。事实上，在这4年期间，新生儿死亡率实际上有所下降；新生儿发病率保持稳定。我们的经验表明，在不影响新生儿的情况下，剖宫产率可大幅降低。
