Leitch C R, Walker J J
University Department of Obstetrics and Gynaecology, Glasgow Royal Maternity Hospital.
Br J Obstet Gynaecol. 1998 Jun;105(6):621-6. doi: 10.1111/j.1471-0528.1998.tb10176.x.
To investigate the reasons for the rise in caesarean section rate and note any change in indications.
A retrospective, descriptive study comparing the years 1962 and 1992.
A large city centre teaching hospital.
There was an overall increase in the caesarean section rate from 6-8% in 1962 to 18.1% in 1992. No single cause contributed more than 30% towards this increase. The main indications in both years were similar: failure to progress (42.2% vs 36.7%) and fetal indications (18.1% vs 18.9%). The largest relative increases were in the malpresentation group (10.8% vs 16%) and previous caesarean section (4.5% vs 15.2%).
These results suggest that there has been a lowering in the overall threshold concerning the decision to carry out a caesarean section rather than changes in obstetric management. Obstetricians and the women in their care have to decide whether the current balance between risk and benefit is acceptable or whether they wish to alter the underlying philosophy if any significant reduction is to be sustained.
调查剖宫产率上升的原因，并留意指征方面的任何变化。
一项回顾性描述性研究，比较1962年和1992年。
一家大型市中心教学医院。
剖宫产率总体从1962年的6%-8%上升至1992年的18.1%。没有任何单一原因对这一增长的贡献率超过30%。这两年的主要指征相似：产程无进展（42.2%对36.7%）和胎儿相关指征（18.1%对18.9%）。相对增幅最大的是胎位异常组（10.8%对16%）和既往剖宫产史组（4.5%对15.2%）。
这些结果表明，关于实施剖宫产的决策，总体阈值有所降低，而非产科管理发生了变化。产科医生及其护理的女性患者必须决定，当前风险与获益之间的平衡是否可接受，或者，如果要持续显著降低剖宫产率，他们是否希望改变基本理念。
