本文關(guān)鍵詞：江蘇省昆山市2001-2009年剖腹產(chǎn)發(fā)生率及影響因素分析，，由筆耕文化傳播整理發(fā)布。

        目的1、探討江蘇省昆山市臨產(chǎn)前剖腹產(chǎn)（UCS，Unlabored Cesarean Section）、臨產(chǎn)后剖腹產(chǎn)（LCS，Labored Cesarean Section）及產(chǎn)婦選擇性剖腹產(chǎn)（CDMR，Cesarean Delivery on Maternal Request）發(fā)生率，并預(yù)測未來5年內(nèi)剖腹產(chǎn)發(fā)生率；2、分析產(chǎn)婦特征及胎兒特征對臨產(chǎn)前與臨產(chǎn)后剖腹產(chǎn)的影響；3、孕期體重變化（kg/周）（GWG，Gestational Weight Gain）對臨產(chǎn)前與臨產(chǎn)后剖腹產(chǎn)的影響；4、產(chǎn)婦及胎兒特征對CDMR的影響。方法這項(xiàng)基于人群的研究來源于2001-2009年昆山市《圍產(chǎn)保健監(jiān)測系統(tǒng)》。排除有剖腹產(chǎn)史、多胎、死產(chǎn)等之后，研究對象由33039對產(chǎn)婦與胎兒組成。GWG被定義為末次與初次產(chǎn)檢體重之差除以相應(yīng)孕周之差。特別地，依據(jù)是否出現(xiàn)產(chǎn)力（子宮收縮，宮頸口擴(kuò)張）將剖腹產(chǎn)分為UCS與LCS，依據(jù)產(chǎn)婦及家屬是否明確要求剖腹產(chǎn)而分為CDMR與非CDMR。依據(jù)世界衛(wèi)生組織推薦的亞洲BMI標(biāo)準(zhǔn)，將孕前BMI（kg/m2）劃分為偏瘦（<18.5）、正常（18.5~22.9）、超重（23.0~24.9）與肥胖(>25)。使用單因素與多因素?zé)o序多分類/二分類Logistic回歸分析來估計(jì)各因素（產(chǎn)婦特征、胎兒特征、GWG）對胎兒分娩方式的影響，并且計(jì)算單因素與調(diào)整后的現(xiàn)患比值比（Prevalence Odds Ratio，POR）及其95%可信區(qū)間（95%CI）。統(tǒng)計(jì)分析軟件為SAS-PC Version9.2（SAS Institute Inc., Cary, NC, USA），所有檢驗(yàn)采用雙側(cè)檢驗(yàn)，統(tǒng)計(jì)學(xué)顯著性水平=0.05。結(jié)果1、58.3%為陰道順產(chǎn)，36.0%為UCS（其中包含CDMR），5.7%為LCS。2001-2009年昆山市剖腹產(chǎn)發(fā)生率總體呈現(xiàn)下降趨勢。2001-2009年CDMR總發(fā)生率為8.7%，從2001年的5.8%上升到2009年的10.9%，呈現(xiàn)上升趨勢（趨勢檢驗(yàn)，P<0.0001）。2、對未來五年（2011-2015）該地區(qū)總剖腹產(chǎn)發(fā)生率進(jìn)行預(yù)測，2011-2015年剖腹產(chǎn)總發(fā)生率分別為32.50%、31.46%、30.46%、29.49%、28.54%，呈緩慢下降趨勢。3、在相互調(diào)整相關(guān)的混雜因素（產(chǎn)婦年齡、教育程度、孕期保健醫(yī)療機(jī)構(gòu)、分娩次數(shù)、初次產(chǎn)檢時(shí)BMI、出生體重、出生孕周、胎兒出生年份）后，母親分娩時(shí)年齡≤24歲、職業(yè)為手工操作工人、受教育年限≥13年、初次產(chǎn)檢時(shí)BMI<18.5kg/m2、輕度妊高癥、低出生體重可減小發(fā)生LCS風(fēng)險(xiǎn)；產(chǎn)婦分娩時(shí)年齡≥30歲、孕期保健機(jī)構(gòu)為婦幼保健機(jī)構(gòu)及鄉(xiāng)鎮(zhèn)醫(yī)院、初次產(chǎn)檢時(shí)體重為超重及肥胖、中重度妊高癥、初產(chǎn)婦、男性胎兒、巨大胎兒及過期妊娠可增加發(fā)生LCS風(fēng)險(xiǎn)。4、母親分娩時(shí)年齡≤24歲、初次產(chǎn)檢時(shí)BMI<18.5kg/m~2可減少發(fā)生UCS風(fēng)險(xiǎn)；而產(chǎn)婦生產(chǎn)年齡≥30歲、產(chǎn)婦孕期保健機(jī)構(gòu)為婦幼保健機(jī)構(gòu)及鄉(xiāng)鎮(zhèn)醫(yī)院、初次產(chǎn)檢時(shí)體重為超重及肥胖、中度及重度妊高癥、初產(chǎn)婦、有習(xí)慣性流產(chǎn)史、人工流產(chǎn)史、男性胎兒、出生體重異常、早產(chǎn)及過期妊娠均可增加發(fā)生UCS風(fēng)險(xiǎn)。5、調(diào)整潛在的混雜因素之后，第四分位GWG可增加偏瘦人群中50%LCS發(fā)生風(fēng)險(xiǎn)（POR=1.51，95%CI：1.07~2.14）、正常體重人群48%LCS發(fā)生風(fēng)險(xiǎn)（POR=1.48，95%CI：1.23~1.77），然而，我們沒有發(fā)現(xiàn)超重與肥胖人群中GWG對LCS有影響。相對于UCS，我們發(fā)現(xiàn)第四分位GWG可增加偏瘦人群中55%發(fā)生LCS風(fēng)險(xiǎn)（POR=1.55，95%CI：1.31~1.85）、可增加體重正常人群67%發(fā)生LCS風(fēng)險(xiǎn)（POR=1.67，95%CI：1.52~1.83）、可增加超重與肥胖人群25%發(fā)生LCS風(fēng)險(xiǎn)（POR=1.25，95%CI：1.06~1.46）。6、調(diào)整潛在混雜因素之后，產(chǎn)婦年齡偏大（POR=1.34，95%CI：1.16~1.55），職業(yè)為商業(yè)-服務(wù)業(yè)（POR=1.20，95%CI：1.03~1.40），受教育年限為10-12年（POR=1.11，95%CI：1.00~1.23），孕期保健機(jī)構(gòu)鄉(xiāng)鎮(zhèn)醫(yī)院（POR=1.43，95%CI：1.30~1.56），初次產(chǎn)前檢查時(shí)體重超重和肥胖（POR=1.36，95%CI：1.17~1.58），初產(chǎn)婦（POR=2.49，95%CI：2.04~3.05），習(xí)慣性流產(chǎn)史（POR=1.46，95%CI：1.27~1.68），人工流產(chǎn)史（POR=1.22，95%CI：1.13~1.33），男性胎兒（POR=1.10，95%CI：1.01~1.19）可增加發(fā)生CDMR風(fēng)險(xiǎn)。結(jié)論1、江蘇省昆山市2001-2009年總剖腹產(chǎn)發(fā)生率為41.7%，處于下降趨勢，但以LCS下降為著。未來5年內(nèi)（2011-2015）剖腹產(chǎn)發(fā)生率繼續(xù)處于下降趨勢。2、產(chǎn)婦分娩時(shí)年齡偏大（≥30歲）、孕期保健機(jī)構(gòu)為鄉(xiāng)鎮(zhèn)醫(yī)院、初次產(chǎn)檢時(shí)體重為超重及肥胖、中重度妊高癥、初產(chǎn)婦、男性胎兒、巨大胎兒及過期妊娠可增加UCS和LCS發(fā)生風(fēng)險(xiǎn)。3、不論UCS還是LCS，高水平的GWG均可增加剖腹產(chǎn)發(fā)生風(fēng)險(xiǎn)。4、產(chǎn)婦與胎兒特征綜合影響了CDMR發(fā)生。

    Objective1. To explore the prevalence of Cesarean Section （CS）, including Unlabored CesareanSection （LCS）, Labored Cesarean Section （UCS）, and Cesarean Delivery for MaternalRequest （CDMR）, and forecast the prevalence of CS in the following5years.2. To identify the association between maternal and fetal characteristics for UCS andLCS.3. To identify the association between Gestational Weight Gain （GWG） and UCSand LCS.4. To identify the association between maternal and fetal characteristics for CDMR.MethodsThis population-based retrospective cohort study was conducted between January2001and September2009in the Kunshan City, Jiangsu Province, China. Data wereretrieved from Perinatal Monitoring System of Maternal and Child Health Care Hospitalof Kunshan. The study population was consisted of33,039women and singleton livebirths, and excluded those who had the history of CS. GWG was defined as theTotal-GWG during the last and the first antenatal care divided by the interval weeks. CSwas categorized as UCS and LCS. And according to the reasons of CS which labelled asmaternal requested, were termed as CDMR. The World Health Organizationrecommended Asian standard for Body Mass Index （BMI, calculated as weight（kg）/[height （m）]2]） classifications were adopted: underweight, less than18.5; normalweight,18.5-22.9; overweight,23.0-24.9; and obese,25. We performed the multiplelogistic regression model to measure the independent association between maternal andfetal characteristics for mode of delivery, while adjusting for potential confounders, andthe Prevalence Odds Ratio （POR） with95%Confidence Interval （95%CI） wascalculated. All tests were two-sided, P <0.05was regarded as statistically significant.Statistical analysis was conducted using SAS-PC Version9.2（SAS Institute Inc., Cary, NC, USA）.Results1. The overall prevalence of CS was41.7%and in a downward trend year by year,LCS and UCS were36.0%and5.7%, respectively. The prevalence of CDMR was8.7%,and showed in a upward trend year by year, which goes up from5.8%in the year2001to10.9%in the year2009（trend test, P<0.0001）.2. We conducted a forecast for the prevalence of CS in the following5years usingGrey Model. The results indicated that overall prevalence of CS were showed adownward trend for the year2011-2015, it32.50%,31.46%,30.46%,29.49%, and28.54%, respectively.3. As for LCS, after adjusted potential confoundings each other （maternal age,education levels, hospitals when first antenatal care, parity, weight for first antenatalcare, BMI of first antenatal care, birth weight, birthweek and year of the birth）, maternalage less than24years, manual workers, education more than13years, BMI less than18.5kg/m2, preeclampsia and low birth weight were associated with decreased the riskof LCS.Maternal age more than30years, hospitals when first antenatal care was township,overweight and obesity, moderate and severe preeclampsia, parity, male fetus,macrosomia, and postterm were associated with the increased the risk of LCS.4. As for UCS, maternal age less than24years, BMI less than18.5kg/m2coulddecrease the risk of UCS.Maternal age more than30years, hospitals when first antenatal care was township,overweight and obesity, moderate and severe preeclampsia, parity, history of habitualabortion, history of induced abortion, male fetus, macrosomia and low birth weight, andpreterm or postterm were associated with the increased the risk of UCS.5. Subjects with GWG in4th quatantile have highest prevalence of LCS inunderweight group （POR=1.51,95%CI:1.072.14） and normal-weight group（POR=1.48,95%CI:1.231.77）, however, we did not find the association betweenGWG and LCS in overweight and obese individuals. We also found the associationbetween GWG and incident UCS in underweight group （POR=1.55,95%CI:1.311.85）for the4th interquantile, and overweight obese group （POR=1.25,95%CI:1.061.46）for the4th interval. Higher GWG was associated with increased UCS risk in normal-weight group （POR=1.67,95%CI:1.521.83） for the4th interquantile.6. As for CDMR, after adjusted potential confoundings, maternal age more than30years （POR=1.34,95%CI:1.161.55）, as a servics or sales （POR=1.20,95%CI:1.031.40）, education in10-12years （POR=1.11,95%CI:1.001.23）, hospitals whenfirst antenatal care was township （POR=1.43,95%CI:1.301.56）, overweight andobesity （POR=1.36,95%CI:1.171.58）, parity （POR=2.49,95%CI:2.043.05）, historyof habitual abortion （POR=1.46,95%CI:1.271.68）, history of induced abortion（POR=1.22,95%CI:1.131.33）, male fetus （POR=1.10,95%CI:1.011.19） wereincrease the risk of CDMR.Conclusion1. Overall prevalence of CS was41.7%among Kunshan City, Jiangsu Province.And it was in a downward trend in the study period, and the following5years were alsoin a downward trend.2. Maternal and fetal characteristcs were associated with the increased theprevalence of UCS and LCS as a whole.3. Higher level of GWG may increase the prevalence of CS, irrespective of LCS orUCS.4. Maternal and fetal characteristics were associated with increased the prevalenceof CDMR in a combined way.

江蘇省昆山市2001-2009年剖腹產(chǎn)發(fā)生率及影響因素分析

中文摘要4-7Abstract7-9引言11-13材料與方法13-17    1 數(shù)據(jù)來源13    2 納入與排除標(biāo)準(zhǔn)13-14    3 診斷依據(jù)及相關(guān)定義14-15    4 統(tǒng)計(jì)學(xué)分析15-16    5 研究流程圖16-17結(jié)果17-31    1 昆山市 2001 -2009 年剖腹產(chǎn)發(fā)生率分析17-19        1.1 臨產(chǎn)前與臨產(chǎn)后剖腹產(chǎn)發(fā)生率分析17        1.2 選擇性剖腹產(chǎn)發(fā)生率分析17-18        1.3 灰色模型預(yù)測昆山市未來五年剖腹產(chǎn)總發(fā)生率18-19    2 產(chǎn)婦與胎兒特征在分娩方式之間比較19-21    3 孕期體重變化對分娩方式的影響21-23        3.1 孕期體重變化概念定義21        3.2 孕期體重變化特征參數(shù)在分娩方式之間比較21        3.3 孕期體重變化在分娩方式之間的比較21-23    4 產(chǎn)婦與胎兒特征對剖腹產(chǎn)的影響23-26    5 GWG 對臨產(chǎn)后剖腹產(chǎn)（LCS）與臨產(chǎn)前剖腹產(chǎn)（UCS）影響分析26-27    6 產(chǎn)婦與胎兒特征對 CDMR 影響27-31        6.1 母親與胎兒特征在 CDMR 之間的分布比較27-28        6.2 CDMR 影響因素分析28-31討論31-40結(jié)論40-41參考文獻(xiàn)41-49綜述49-63    參考文獻(xiàn)57-63研究生期間發(fā)表論文63-64中英文縮略詞對照表64-65致謝65-68

  本文關(guān)鍵詞：江蘇省昆山市2001-2009年剖腹產(chǎn)發(fā)生率及影響因素分析，由筆耕文化傳播整理發(fā)布。