Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy.
Int J Environ Res Public Health. 2020 Jun 29;17(13):4665. doi: 10.3390/ijerph17134665.
In recent years, the rate of caesarean sections has risen all over the world. Accordingly, efforts are being made worldwide to understand this trend and to counteract it effectively. Several factors have been identified as contributing to the selection of caesarean section (CS), especially an obstetricians' beliefs, attitudes and clinical practices. However, relatively few studies have been conducted to understand the mechanisms involved, to explore influencing factors and to clearly define the risks associated with the caesarean section on maternal request (CSMR). This comparative study was conducted to elucidate the factors influencing the choice of CSMR, as well as to compare the associated risks of CSMR to CS for breech presentation among Italian women. From 2015 to 2018, a total of 2348 women gave birth by caesarean section, of which 8.60% (202 women) chose a CSMR. We found that high educational attainment, use of assisted reproductive technology, previous operative deliveries and miscarriages within the obstetric history could be positively correlated with the choice of CSMR in a statistically significant way. This trend was not confirmed when the population was stratified based on patients' characteristics, obstetric complications and gestational age. Finally, no major complications were found in patients that underwent CSMR. We believe that it is essential to evaluate patients on a case-by-case basis. It is essential to understand the personal experience, to explain the knowledge available on the subject and to ensure a full understanding of the risks and benefits of the medical practice to guarantee the patients not only their best scientific preparation but also human understanding.
近年来，全世界剖宫产率都有所上升。因此，全世界都在努力了解这一趋势，并有效地加以遏制。已经确定了一些因素会导致剖宫产的选择（CS），特别是产科医生的信念、态度和临床实践。然而，相对较少的研究旨在了解其中的机制，探索影响因素，并明确界定因产妇要求而进行剖宫产（CSMR）的相关风险。本项比较研究旨在阐明影响 CSMR 选择的因素，并比较意大利妇女臀位剖宫产时 CSMR 与 CS 的相关风险。2015 年至 2018 年，共有 2348 名妇女通过剖宫产分娩，其中 8.60%（202 名）选择了 CSMR。我们发现，高学历、使用辅助生殖技术、以前的剖宫产分娩和产科病史中的流产可以与 CSMR 的选择呈正相关，这在统计学上是显著的。当根据患者特征、产科并发症和胎龄对人群进行分层时，这一趋势并未得到证实。最后，在接受 CSMR 的患者中未发现重大并发症。我们认为，有必要对每位患者进行评估。了解个人经历、解释有关该主题的知识，并确保充分了解医疗实践的风险和益处，这一点至关重要，以保证患者不仅得到最好的科学准备，还能得到人性化的理解。
