Pollard J K, Capeless E L
Department of Obstetrics and Gynecology, University of Vermont, Burlington, USA.
Am J Perinatol. 1997 May;14(5):245-8. doi: 10.1055/s-2007-994136.
The objective of this paper is to evaluate the influence of patient risk status on the incidence of and indications for cesarean delivery. All live births > or = 23 weeks at the University of Vermont in 1995 (n = 2395) were retrospectively analyzed for delivery route, indication for cesarean, gestational age, parity, and practice group (to reflect risk status). The total cesarean rate was 14.4% (344 of 2395), and the primary rate was 11.4% (244 of 2144). Abnormal presentation was the most common indication (25.6%, 88 of 344). The "corrected" cesarean rate (maternal-fetal medicine and transported patients excluded) was 12.4% (273 of 2194), and the "corrected" primary rate was 9.6% (190 of 1975). Furthermore, when all deliveries were analyzed, regardless of risk status but limited to gestational age > or = 36 weeks, the rates did not change (12.6%, 280 of 2214; primary 9.2%, 183 of 1994). Arrest of dilation was the most common indication in both "corrected" subgroups (23.4 and 24.6%, respectively). Cesarean rates at tertiary care hospitals should be compared with rates at community hospitals only after correcting for dissimilar patient groups or gestational age.
本文的目的是评估患者风险状况对剖宫产发生率及指征的影响。对佛蒙特大学1995年孕周≥23周的所有活产儿（n = 2395）进行回顾性分析，内容包括分娩方式、剖宫产指征、孕周、产次及医疗组（以反映风险状况）。剖宫产总发生率为14.4%（2395例中的344例），初产剖宫产率为11.4%（2144例中的244例）。胎位异常是最常见的指征（25.6%，344例中的88例）。“校正后”的剖宫产率（排除母胎医学和转运患者）为12.4%（2194例中的273例），“校正后”的初产剖宫产率为9.6%（1975例中的190例）。此外，当分析所有分娩情况时，无论风险状况如何，但仅限于孕周≥36周，发生率并未改变（12.6%，2214例中的280例；初产剖宫产率9.2%，1994例中的183例）。产程停滞是两个“校正后”亚组中最常见的指征（分别为23.4%和24.6%）。只有在对不同患者组或孕周进行校正后，三级医疗机构的剖宫产率才能与社区医院的剖宫产率进行比较。
