Harrison Margo S, Scarbro Sharon, Juarez-Colunga Elizabeth, Jimenez-Zambrano Andrea, Bunge-Montes Saskia, Bolaños Guillermo A, Lamb Molly, Asturias Edwin J, Berman Stephen, Heinrichs Gretchen
Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
Center for Global Health, Colorado School of Public Health, Aurora, CO, USA.
Matern Child Health J. 2019 Apr;23(4):435-442. doi: 10.1007/s10995-018-2655-2.
Purpose To evaluate trends and factors associated with mode of delivery in the rural Southwest Trifinio region of Guatemala. Description We conducted a retrospective analysis of self-reported antepartum factors and postpartum outcomes recorded in a quality improvement database among 430 women enrolled in a home-based maternal healthcare program between June 1, 2015 and August 1, 2017. Assessment Over the study period, the rates of cesarean delivery (CD) increased (from 30 to 45%) and rates of vaginal delivery (VD) decreased (70-55%) while facility-based delivery attendance remained stable around 70%. Younger age (23.5 years for VD vs. 21.6 years for CD, p < 0.001), nulliparity (25.1% for VD vs. 45.0% for CD, p < 0.001), prolonged/obstructed labor (2.4% for VD vs. 55.6% for CD, p < 0.001), and fetal malpresentation (0% for VD vs. 16.3% CD, p < 0.001) significantly influenced mode of delivery in univariate analysis. The leading indications for CD were labor dysfunction (47.5%), malpresentation (14.5%), and prior cesarean delivery (19.8%). The CD rate among the subpopulation of term, nulliparous women with singleton pregnancies in vertex presentation also increased from 20% of all CD in 2015, to 38% in 2017. Conclusion Among low-income women from rural Guatemala, the CD rate has increased above the World Health Organization (WHO) recommendations in a period of 3 years. Additional research on the factors affecting this trend are essential to guide interventions that might improve the appropriateness of CD, and to determine if reducing or stabilizing rates is necessary.
目的 评估危地马拉西南特里菲尼奥农村地区分娩方式的趋势及相关因素。描述 我们对2015年6月1日至2017年8月1日期间参加家庭孕产妇保健项目的430名妇女在质量改进数据库中记录的自我报告产前因素和产后结局进行了回顾性分析。评估 在研究期间，剖宫产率（CD）上升（从30%升至45%），阴道分娩率（VD）下降（从70%降至55%），而在医疗机构分娩的比例保持稳定，约为70%。在单因素分析中，年龄较小（VD组为23.5岁，CD组为21.6岁，p＜0.001）、未生育（VD组为25.1%，CD组为45.0%，p＜0.001）、产程延长/梗阻（VD组为2.4%，CD组为55.6%，p＜0.001）以及胎位异常（VD组为0%，CD组为16.3%，p＜0.001）对分娩方式有显著影响。剖宫产的主要指征为产程异常（47.5%）、胎位异常（14.5%）和既往剖宫产史（19.8%）。足月、未生育、单胎头位妊娠亚组的剖宫产率也从2015年占所有剖宫产的20%升至2017年的38%。结论 在危地马拉农村低收入妇女中，剖宫产率在3年内已超过世界卫生组织（WHO）的建议水平。对影响这一趋势的因素进行更多研究对于指导可能改善剖宫产合理性的干预措施以及确定是否有必要降低或稳定剖宫产率至关重要。
