Bihler Julia, Tunn Ralf, Reisenauer Christl, Pauluschke-Fröhlich Jan, Wagner Philipp, Abele Harald, Rall Katharina K, Naumann Gert, Wallwiener Markus, Brucker Sara Y, Hübner Markus
Department of Women's Health, University Hospital of Tübingen, Tübingen, Germany.
Department of Urogynaecology, German Pelvic Floor Centre, St. Hedwig Hospital, Berlin, Germany.
Geburtshilfe Frauenheilkd. 2017 Nov;77(11):1182-1188. doi: 10.1055/s-0043-120919. Epub 2017 Nov 27.
Currently, almost every third child in Germany is delivered by caesarean section. Apart from straightforward and clear indications for caesarean section which account for approx. 10%, the large proportion of relative indications in particular needs to be critically reviewed if the current C-section rate is to be effectively lowered. It is more than doubtful, however, whether this can be a realistic goal in Germany, especially in the context of international developments. All studies on this topic demonstrate that the personal attitude of the obstetric team has a considerable influence on the pregnant woman's personally preferred mode of delivery. Therefore, in the first part of the DECISION study, the personal preferences of urogynaecologists were evaluated regarding the best suitable mode of delivery.
All 432 delegates at the 9th German Urogynaecology Congress in Stuttgart in April 2017 were invited to participate in an online questionnaire study. The questionnaire was developed especially for this study.
Of the 432 registered delegates, 189 (43.8%) participated in the survey. 84.7% (n = 160) of the study participants would prefer a vaginal delivery, in an otherwise uncomplicated pregnancy. Only 12.2% (n = 23) opted for an elective caesarean section. The main reasons stated for this decision were concerns about incontinence (87.5%) and pelvic floor trauma (79.2%). Amongst the study participants, 83.6% would like to be part of a risk stratification system presented in the questionnaire which, with the aid of specific parameters, is intended to allow early identification of a population with a high risk of developing pelvic floor disorders. There was also great interest in postpartum pelvic floor recovery (97.8%) and an associated optional pessary therapy (64.4%). The type of delivery already experienced (vaginal delivery vs. primary caesarean section) and parity also reveals to have a significant influence on the personal preferred mode of delivery as well.
Urogynaecologists prefer vaginal delivery for themselves. There is a great interest to participate in a risk stratification process in order to approach childbirth in an individualized and risk-adapted manner.
目前，德国几乎每三个孩子中就有一个是通过剖宫产出生的。除了约占10%的明确剖宫产指征外，如果要有效降低当前的剖宫产率，尤其需要对占比很大的相对指征进行严格审查。然而，这在德国是否能成为一个现实目标，特别是在国际形势下，很值得怀疑。所有关于这个话题的研究都表明，产科团队的个人态度对孕妇个人偏好的分娩方式有相当大的影响。因此，在“决策”研究的第一部分，评估了泌尿妇科医生对于最合适分娩方式的个人偏好。
邀请了2017年4月在斯图加特举行的第9届德国泌尿妇科大会的所有432名代表参与一项在线问卷调查研究。该问卷是专门为这项研究设计的。
在432名注册代表中，189名（43.8%）参与了调查。在其他方面无并发症的妊娠中，84.7%（n = 160）的研究参与者更倾向于阴道分娩。只有12.2%（n = 23）选择择期剖宫产。做出这一决定的主要原因是担心尿失禁（87.5%）和盆底创伤（79.2%）。在研究参与者中，83.6%希望参与问卷中提出的风险分层系统，该系统借助特定参数旨在早期识别出有发生盆底功能障碍高风险的人群。对产后盆底恢复（97.8%）及相关的可选子宫托治疗（64.4%）也有很大兴趣。既往经历的分娩类型（阴道分娩与初次剖宫产）和产次对个人偏好的分娩方式也有显著影响。
泌尿妇科医生自己更倾向于阴道分娩。他们非常有兴趣参与风险分层过程，以便以个体化和适应风险的方式对待分娩。
