Langer B, Schlaeder G
Service de Gynéco-Obstétrique II, Hôpital de Hautepierre, Strasbourg.
J Gynecol Obstet Biol Reprod (Paris). 1998 Jan;27(1):62-70.
For more than twenty-five years, the cesarean rate in France, as in other developed countries, has continued to increase, and in 1995 was 15.9%. Cesareans are now taken for granted by the general public, who are usually unaware of their consequences for maternal mortality and morbidity and continue to consider this form of delivery as the safest for the new born child. Yet it has been clearly demonstrated that cesarean deliveries are associated with higher rates of maternal and perinatal morbidity than vaginal deliveries and that they increase maternal mortality by a factor of from 5 to 7. From an economic standpoint, cesareans are between two and three times more expensive than vaginal deliveries. The two main indicators which account for the increase in cesareans are cicatricial uterus and dystocia. These are indicators in which individual practitioners' normal practice and the fear of medical malpractice suits play a clear role. There appears to be a particular correlation between the proportion of cesareans and obstetricians' insurance premiums, obstetricians' own assessment of the risk of malpractice suits and the number of complaints lodged against hospitals or individual doctors. Cesareans performed on grounds of fetal suffering or breech deliveries represent a diminishing proportion of the total. The use of scalp pH and radiopelvimetry have made it possible to restrict the number of cesareans based on these indicators. Other factors play a role in this increase, such as parity, education level, type of maternity insurance, whether the hospital is private or public, whether or not there is a neonatal resuscitation unit, the size of the city and the obstetrician's experience and type of training. The time and day or delivery have also been shown to be relevant factors. For obstetricians themselves, the higher fees earned from cesareans do not appear to be important. Of more relevance is the opportunity they offer doctors to organise their schedule and save time. Among the various methods proposed for reducing the cesarean rate, a strict definition of and respect for the indications for a cesarean, involving comparisons between establishments and between practitioners, have been shown to be effective. To allow such figures to be compiled, France should therefore produce for each confinement a standard record containing the different perinatal data, as is already the case in numerous other countries.
二十多年来，法国的剖宫产率和其他发达国家一样持续上升，1995年达到了15.9%。如今，剖宫产已被公众视为理所当然，他们通常没有意识到其对产妇死亡率和发病率的影响，仍然认为这种分娩方式对新生儿来说是最安全的。然而，已有明确证据表明，剖宫产与阴道分娩相比，产妇和围产期发病率更高，且会使产妇死亡率增加5至7倍。从经济角度看，剖宫产的费用比阴道分娩贵两到三倍。导致剖宫产率上升的两个主要指标是瘢痕子宫和难产。在这些指标方面，个体从业者的常规做法以及对医疗事故诉讼的担忧起到了明显作用。剖宫产比例与产科医生的保险费、产科医生自身对医疗事故诉讼风险的评估以及针对医院或个体医生的投诉数量之间似乎存在特定关联。因胎儿窘迫或臀位分娩而进行的剖宫产在总数中所占比例越来越小。头皮酸碱度测定和骨盆X线测量的应用使得基于这些指标进行剖宫产的数量得以限制。其他因素也在这一增长中发挥作用，比如产次、教育水平、生育保险类型、医院是私立还是公立、是否设有新生儿复苏单元、城市规模以及产科医生的经验和培训类型。分娩的时间和日期也已被证明是相关因素。对产科医生自身而言，剖宫产带来的较高费用似乎并不重要。更相关的是剖宫产为医生提供了安排日程和节省时间的机会。在为降低剖宫产率而提出的各种方法中，对剖宫产指征进行严格定义并予以遵循，包括机构之间和从业者之间的比较，已被证明是有效的。因此，为了能够汇编这些数据，法国应为每次分娩编制一份包含不同围产期数据的标准记录，许多其他国家已经这样做了。
