van Roosmalen J, van der Does C D
Department of Obstetrics and Gynaecology, Leiden University Hospital, The Netherlands.
Trop Geogr Med. 1995;47(1):19-22.
High caesarean birth rates are an issue of international public health concern. Determinants of caesarean birth are reviewed in order to formulate strategies to reduce these high rates. A strong independent profession of highly qualified midwives, who care for women with low-risk pregnancies, may contribute to a relatively low caesarean birth rate. Different clinical policies which influence the intervention rate, are discussed for the most frequent reasons to perform caesarean section: dystocia, repeat caesarean birth, breech delivery and foetal distress. The risks and safety of caesarean birth differ from place to place in this world. As the relative safety of the procedure is an important factor contributing to the rise of caesarean birth, the fact that this has only been achieved in some parts of the world should restrict the indications to perform the operation in the best interests of pregnant women.
高剖宫产率是一个国际公共卫生关注的问题。对剖宫产的决定因素进行综述，以便制定降低这些高剖宫产率的策略。一个强大的、独立的、由高素质助产士组成的专业群体，她们照顾低风险妊娠的女性，可能有助于维持相对较低的剖宫产率。针对剖宫产最常见的原因，即难产、再次剖宫产、臀位分娩和胎儿窘迫，讨论了影响干预率的不同临床政策。在这个世界上，剖宫产的风险和安全性因地区而异。由于该手术的相对安全性是导致剖宫产率上升的一个重要因素，而这一安全性仅在世界某些地区得以实现，因此应从孕妇的最佳利益出发，限制实施该手术的指征。
