江苏省昆山市2001-2009年剖腹产发生率及影响因素分析

  本文关键词：江苏省昆山市2001-2009年剖腹产发生率及影响因素分析，，由笔耕文化传播整理发布。

        目的1、探讨江苏省昆山市临产前剖腹产（UCS，Unlabored Cesarean Section）、临产后剖腹产（LCS，Labored Cesarean Section）及产妇选择性剖腹产（CDMR，Cesarean Delivery on Maternal Request）发生率，并预测未来5年内剖腹产发生率；2、分析产妇特征及胎儿特征对临产前与临产后剖腹产的影响；3、孕期体重变化（kg/周）（GWG，Gestational Weight Gain）对临产前与临产后剖腹产的影响；4、产妇及胎儿特征对CDMR的影响。方法这项基于人群的研究来源于2001-2009年昆山市《围产保健监测系统》。排除有剖腹产史、多胎、死产等之后，研究对象由33039对产妇与胎儿组成。GWG被定义为末次与初次产检体重之差除以相应孕周之差。特别地，依据是否出现产力（子宫收缩，宫颈口扩张）将剖腹产分为UCS与LCS，依据产妇及家属是否明确要求剖腹产而分为CDMR与非CDMR。依据世界卫生组织推荐的亚洲BMI标准，将孕前BMI（kg/m2）划分为偏瘦（<18.5）、正常（18.5~22.9）、超重（23.0~24.9）与肥胖(>25)。使用单因素与多因素无序多分类/二分类Logistic回归分析来估计各因素（产妇特征、胎儿特征、GWG）对胎儿分娩方式的影响，并且计算单因素与调整后的现患比值比（Prevalence Odds Ratio，POR）及其95%可信区间（95%CI）。统计分析软件为SAS-PC Version9.2（SAS Institute Inc., Cary, NC, USA），所有检验采用双侧检验，统计学显著性水平=0.05。结果1、58.3%为阴道顺产，36.0%为UCS（其中包含CDMR），5.7%为LCS。2001-2009年昆山市剖腹产发生率总体呈现下降趋势。2001-2009年CDMR总发生率为8.7%，从2001年的5.8%上升到2009年的10.9%，呈现上升趋势（趋势检验，P<0.0001）。2、对未来五年（2011-2015）该地区总剖腹产发生率进行预测，2011-2015年剖腹产总发生率分别为32.50%、31.46%、30.46%、29.49%、28.54%，呈缓慢下降趋势。3、在相互调整相关的混杂因素（产妇年龄、教育程度、孕期保健医疗机构、分娩次数、初次产检时BMI、出生体重、出生孕周、胎儿出生年份）后，母亲分娩时年龄≤24岁、职业为手工操作工人、受教育年限≥13年、初次产检时BMI<18.5kg/m2、轻度妊高症、低出生体重可减小发生LCS风险；产妇分娩时年龄≥30岁、孕期保健机构为妇幼保健机构及乡镇医院、初次产检时体重为超重及肥胖、中重度妊高症、初产妇、男性胎儿、巨大胎儿及过期妊娠可增加发生LCS风险。4、母亲分娩时年龄≤24岁、初次产检时BMI<18.5kg/m~2可减少发生UCS风险；而产妇生产年龄≥30岁、产妇孕期保健机构为妇幼保健机构及乡镇医院、初次产检时体重为超重及肥胖、中度及重度妊高症、初产妇、有习惯性流产史、人工流产史、男性胎儿、出生体重异常、早产及过期妊娠均可增加发生UCS风险。5、调整潜在的混杂因素之后，第四分位GWG可增加偏瘦人群中50%LCS发生风险（POR=1.51，95%CI：1.07~2.14）、正常体重人群48%LCS发生风险（POR=1.48，95%CI：1.23~1.77），然而，我们没有发现超重与肥胖人群中GWG对LCS有影响。相对于UCS，我们发现第四分位GWG可增加偏瘦人群中55%发生LCS风险（POR=1.55，95%CI：1.31~1.85）、可增加体重正常人群67%发生LCS风险（POR=1.67，95%CI：1.52~1.83）、可增加超重与肥胖人群25%发生LCS风险（POR=1.25，95%CI：1.06~1.46）。6、调整潜在混杂因素之后，产妇年龄偏大（POR=1.34，95%CI：1.16~1.55），职业为商业-服务业（POR=1.20，95%CI：1.03~1.40），受教育年限为10-12年（POR=1.11，95%CI：1.00~1.23），孕期保健机构乡镇医院（POR=1.43，95%CI：1.30~1.56），初次产前检查时体重超重和肥胖（POR=1.36，95%CI：1.17~1.58），初产妇（POR=2.49，95%CI：2.04~3.05），习惯性流产史（POR=1.46，95%CI：1.27~1.68），人工流产史（POR=1.22，95%CI：1.13~1.33），男性胎儿（POR=1.10，95%CI：1.01~1.19）可增加发生CDMR风险。结论1、江苏省昆山市2001-2009年总剖腹产发生率为41.7%，处于下降趋势，但以LCS下降为著。未来5年内（2011-2015）剖腹产发生率继续处于下降趋势。2、产妇分娩时年龄偏大（≥30岁）、孕期保健机构为乡镇医院、初次产检时体重为超重及肥胖、中重度妊高症、初产妇、男性胎儿、巨大胎儿及过期妊娠可增加UCS和LCS发生风险。3、不论UCS还是LCS，高水平的GWG均可增加剖腹产发生风险。4、产妇与胎儿特征综合影响了CDMR发生。

    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.

江苏省昆山市2001-2009年剖腹产发生率及影响因素分析

中文摘要4-7Abstract7-9引言11-13材料与方法13-17    1 数据来源13    2 纳入与排除标准13-14    3 诊断依据及相关定义14-15    4 统计学分析15-16    5 研究流程图16-17结果17-31    1 昆山市 2001 -2009 年剖腹产发生率分析17-19        1.1 临产前与临产后剖腹产发生率分析17        1.2 选择性剖腹产发生率分析17-18        1.3 灰色模型预测昆山市未来五年剖腹产总发生率18-19    2 产妇与胎儿特征在分娩方式之间比较19-21    3 孕期体重变化对分娩方式的影响21-23        3.1 孕期体重变化概念定义21        3.2 孕期体重变化特征参数在分娩方式之间比较21        3.3 孕期体重变化在分娩方式之间的比较21-23    4 产妇与胎儿特征对剖腹产的影响23-26    5 GWG 对临产后剖腹产（LCS）与临产前剖腹产（UCS）影响分析26-27    6 产妇与胎儿特征对 CDMR 影响27-31        6.1 母亲与胎儿特征在 CDMR 之间的分布比较27-28        6.2 CDMR 影响因素分析28-31讨论31-40结论40-41参考文献41-49综述49-63    参考文献57-63研究生期间发表论文63-64中英文缩略词对照表64-65致谢65-68

  本文关键词：江苏省昆山市2001-2009年剖腹产发生率及影响因素分析，由笔耕文化传播整理发布。