Minkoff H L, Schwarz R H
Obstet Gynecol. 1980 Aug;56(2):135-43.
Reports from the United States and around the world have marked a steadily rising cesarean section rate. Although the indications that account for the increase are generally agreed upon (previous cesarean section, dystocia, fetal distress, and malpresentation), the benefits derived from the liberalized use of cesarean section to deal with these diagnoses have not been carefully documented. In an attempt to determine if the cesarean section rate could be lowered with no adverse effect on neonatal outcome, 105,848 deliveries at Downstate-Kings County Hospital from 1961 through 1977 were reviewed. The 9727 cesarean sections performed were evaluated to determine the reasons for the increasing rates and the effect on perinatal outcome. It was concluded that by the use of fetal scalp blood sampling in cases of fetal distress, the use of internal pressure transducers in patients who fail to progress in labor, and allowing selected patients with previous sections to labor, the cesarean section rate might be substantially lowered. The maternal morbidity and mortality were also analyzed.
来自美国及世界各地的报告显示剖宫产率在稳步上升。尽管导致剖宫产率上升的指征已基本达成共识（既往剖宫产史、难产、胎儿窘迫及胎位异常），但放宽剖宫产用于处理这些诊断所带来的益处尚未得到详细记录。为了确定剖宫产率能否降低而又不对新生儿结局产生不利影响，对1961年至1977年在纽约州立大学下州医学中心国王郡医院的105,848例分娩进行了回顾。对所实施的9727例剖宫产进行评估，以确定剖宫产率上升的原因及其对围产期结局的影响。得出的结论是，通过在胎儿窘迫病例中使用胎儿头皮血采样、对产程无进展的患者使用宫内压力传感器以及允许有剖宫产史的特定患者试产，剖宫产率可能会大幅降低。同时还分析了孕产妇的发病率和死亡率。
