立陶宛在降低初产妇剖宫产率方面的经验。
Lithuania's experience in reducing caesarean sections among nulliparas.
机构信息
Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania.
Victoria Hospital, Kirkcaldy, Fife, KY2 5AH, Scotland, UK.
出版信息
BMC Pregnancy Childbirth. 2018 Oct 25;18(1):419. doi: 10.1186/s12884-018-2052-2.
BACKGROUND
To evaluate the role of the TGCS to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate by using this tool.
METHODS
The Robson classification was introduced in Lithuanian hospitals prospectively classifying all the deliveries in 2012. The CS rate overall and in each Robson group was calculated and the results were discussed. The analysis was repeated in 2014 and the data from the selected hospitals were compared using MS EXCEL and SPSS 23.0.
RESULTS
Nulliparas accounted for 43% (3746/8718) and 44.6% (3585/8046) of all the deliveries in 2012 and 2014 years, respectively. The CS rate among nulliparas decreased from 23.9% (866/3626) in 2012 to 19.0% (665/3502) in 2014 (p < 0.001).The greatest decrease in absolute contribution to the overall CS rate was recorded in groups 1 (p = 0.005) and 2B (p < 0.001). Perinatal mortality was 3.5 in 2012 and 3.1 in 2014 per 1000 deliveries (p = 0.764).
CONCLUSION
The TGCS can work as an audit intervention that could help to reduce the CS rate without a negative impact on perinatal mortality.
背景
评估 TGCS 在降低初产妇（罗伯逊分组 1 和 2）剖宫产率中的作用，并找出使用该工具降低剖宫产率的妇女群体。
方法
在立陶宛医院前瞻性地引入罗伯逊分类法，对 2012 年所有分娩进行分类。计算了总体剖宫产率和每个罗伯逊分组的剖宫产率，并讨论了结果。2014 年重复了该分析，并使用 MS EXCEL 和 SPSS 23.0 比较了选定医院的数据。
结果
初产妇占 2012 年和 2014 年所有分娩的 43%（3746/8718）和 44.6%（3585/8046）。初产妇剖宫产率从 2012 年的 23.9%（866/3626）降至 2014 年的 19.0%（665/3502）（p<0.001）。对总体剖宫产率的绝对贡献下降最大的是分组 1（p=0.005）和 2B（p<0.001）。2012 年和 2014 年每 1000 例分娩的围产儿死亡率分别为 3.5 和 3.1（p=0.764）。
结论
TGCS 可以作为一种审计干预措施，有助于降低剖宫产率，而不会对围产儿死亡率产生负面影响。
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