摘要
目的 应用Robson分类法探讨在三孩政策下单胎头位足月初产妇的分娩方式及剖宫产指征的变化.方法 回顾性分析温州医学院附属萧山医院2020年6月至2023年5月住院分娩的3 868例单胎头位足月初产妇分娩数据,以2021年5月31日为界将产妇分为政策前组和政策后组,比较三孩政策下两组分娩方式、剖宫产率、剖宫产指征的变化;根据Robson分类法将两组初产妇各分成三亚组:R1(单胎头位足月 自然临产初产妇)、R2a(单胎头位足月引产初产妇)、R2b(单胎头位足月临产前或引产前剖宫产初产妇),分析各亚组初产妇占比、剖宫产率,以及剖宫产指征分布.结果 政策前后两组的阴道顺产率和剖宫产率比较,差异均无统计学意义(x2分别=0.24、0.02,P均＞0.05),政策后组的助产率及分娩镇痛率明显高于政策前组,差异均有统计学意义(x2分别=15.26、176.65,P均＜0.05).政策后组的胎儿宫内窘迫占比低于政策前组,羊水过少占比高于政策前组,差异均有统计学意义(x2分别=4.31、5.44,P均＜0.05).政策后组中R1初产妇的占比低于政策前组,差异有统计学意义(x2=4.47,P＜0.05),两组R1初产妇的剖宫产率和剖宫产贡献值、R2a初产妇的占比及剖宫产率和剖宫产贡献值以及R2b的占比和剖宫产贡献值比较,差异均无统计学意义(x2分别=0.01、0.19、3.55、1.44、0.06、0.12、0.31,P均＞0.05).政策前后均提示社会因素指征主要分布于R2b组,其占比例分别为68.89％,69.84％,但差异无统计学意义(x2=0.04,P＞0.05).结论 在三孩政策前后,单胎头位足月初产妇的分娩方式、剖宫产指征没有明显变化,但单胎头位足月临产前或引产前剖宫产初可能是初产妇剖宫产的关键人群,降低该组人群入组率主要在于控制社会因素指征.
Abstract
Objective To explor the changes in delivery mode and indications for cesarean section in full-term single-ton primiparous women with singleton cephalic presentation under the three-child policy using the robson classification system.Methods A retrospective analysis was conducted on the delivery data of 3,868 full-term singleton primiparous women with singleton cephalic presentation from June 2020 to May 2023 at the Xiaoshan Hospital,Wenzhou Medical University.The women were divided into pre-policy and post-policy groups based on May 31,2021.The changes in deliv-ery mode,cesarean section rate,and indications for cesarean section under the three-child policy were compared between the two groups.According to the Robson classification system,the primiparous women in both groups were further catego-rized into three subgroups:R1(spontaneous onset of labor in full-term singleton primiparous women with singleton ce-phalic presentation),R2a(induced labor in full-term singleton primiparous women with singleton ce-phalic presentation),and R2b(pre-labor or pre-in-duced cesarean section in full-term singleton primip-arous women with singleton cephalic presentation).The proportions of women in each subgroup,cesare-an section rates,and distribution of indications for cesarean section among each subgroup were analyzed.Results The comparison of the rates of vaginal delivery and ce-sarean section between the pre-policy and post-policy groups showed no statistically significant differences(x2=0.24,0.02,P＞0.05).The rates of midwifery assistance and labor analgesia in the post-policy group were significantly higher than the pre-policy group,with statistically significant differences(x2=15.26,176.65,P＜0.05).The proportion of fetal dis-tress in the post-policy group was lower,while oligohydramnios was higher in the post-policy group,with both differenc-es being statistically significant(x2=4.31,5.44,P＜0.05).The proportion of R1 subgroup in the post-policy group was lower than that in the pre-policy group,with a statistically significant difference(x2=4.47,P＜0.05).There were no statis-tically significant differences in the comparison of cesarean section rates and contribution values for R1 subgroup,cesare-an section rates,contribution values,and proportions of R2a subgroup,as well as the proportions and contribution values of R2b subgroup between the two groups(x2=0.01,0.19,3.55,1.44,0.06,0.12,0.31,P＞0.05).Social factor indications were mainly distributed in the R2b group,with proportions of 68.89％and 69.84％in the pre-policy and post-policy groups,respectively,but the difference was not statistically significant(x2=0.04,P＞0.05).Conclusion There was no significant changes in the delivery mode and indications for cesarean section before and after the three-child policy.How-ever,the group of full-term singleton primiparous women with singleton cephalic presentation undergoing pre-labor or pre-induced cesarean section may be a key population for reducing the cesarean section rate among primiparous women.The reduction in the inclusion rate of this group is mainly attributed to controlling social factors as indications.
基金项目
浙江省医药卫生科技项目创新人才支持计划(2021RC120)
维普
万方数据