Reasons for the Rising Cesarean Delivery Rates: 1978–1984
Reasons for the Rising Cesarean Delivery Rates: 1978–1984
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剖腹产率上升的原因：1978 年至 1984 年
DOI：
10.1097/00132582-198712000-00004
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发表时间：
1987
影响因子：
7.2
通讯作者：
G. Rhoads
中科院分区：
文献类型：
--
作者：
P. Shiono;D. McNellis;G. Rhoads
这项研究的目的是估计美国医院的剖腹产率，并确定自1979年国家儿童健康和人类发展研究所关于剖腹产的共识发展会议以来，剖腹产率上升的原因是否发生了变化。剖腹产率从1974年的9.1%稳步上升到1978年的14.7%，1984年又上升到21.2%。1974-1978年剖宫产率上升的三分之一是由于重复剖宫产，9%是由于胎儿窘迫。自1978年以来，47%的剖宫产率上升归因于重复剖宫产，16%归因于胎儿窘迫。最近剖宫产率的上升较少是由于难产和臀位。有剖宫产史者剖宫产率为96%。胎儿窘迫并发症从1978年的1%增加到1984年的6%。臀先露的发生率下降了18%（2.8-2.3%），这可能表明头外倒转术的成功使用有所增加。如果未来剖宫产后阴道分娩的数量增加，那么整体剖宫产率将下降或趋于稳定。应将额外的努力集中在胎儿窘迫和难产的诊断类别上，因为这些并发症的定义可能正在改变，以包括不太严重的形式。
This study was undertaken to estimate the cesarean delivery rate in United States hospitals and to determine whether the reasons for rise in this rate have changed since the National Institute of Child Health and Human Development Consensus Development Conference on Cesarean Childbirth in 1979. The cesarean delivery rate steadily increased from 9.1% in 1974 to 14.7% in 1978, and to 21.2% in 1984. One-third of the rise in the cesarean rate from 1974–1978 was due to repeat cesareans, and 9% was due to fetal distress. Since 1978, 47% of the rise in the cesarean rate was attributed to repeat cesareans, and 16% to fetal distress. Less of the recent rise in the cesarean rate was due to dystocia and breech presentation. The rate of cesarean delivery among those with a previous cesarean was 96%. Deliveries complicated by fetal distress increased from 1% in 1978 to 6% in 1984. The incidence of breech presentation dropped by 18% (2.8–2.3%), which may indicate an increase in the successful use of external cephalic version. If the number of vaginal deliveries after cesarean increases in the future, then the overall cesarean delivery rate will decrease or stabilize. Additional efforts should be focused on the diagnostic categories of fetal distress and dystocia, because it is likely that the definitions of these complications are changing to include less severe forms.