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1、OverviewBackgroundoncesareanrateAssociatedMorbiditiesEtiologiesfortheriseHowmightwelowerthecesareanrate?Approaches/EffectsBackgroundCesareandelivery32.8%ofalldeliveries(2011)50%↑overlastdecade24%inwomenattemptingvaginal(2005)CesareanRatesHamiltonBE,MartinJA,VenturaSJ.Births:Preliminarydata
2、for2010.Nationalvitalstatisticsreports;vol60no2.NationalCenterforHealthStatistics.2011.CesareanDelivery–AroundtheGlobeDeclercqE,YoungR,CabralH,EckerJ.Birth.2011Jun;38(2):99-104Background↑maternalmorbidity/mortalityw/cesareanInfection–Surgicalsite,UterusHemorrhageBladderinjuryDeepvenousthro
3、mbosis→PEClark,S.,etal.Maternaldeathinthe21stcentury:causes,prevention,andrelationshiptocesareandelivery.AmJObstetGynecol2008;199:36.e1-36.e5.MaternalMortalityMaternalMortalitySubsequentPregnanciesCesareanDeliverySubsequentpregnancy-Increasedriskof:CesareandeliveryUnexplainedIUFDUterinerup
4、turewithVBACPlacentaprevia&accretaHysterectomyMaternalmortalityC/SandPrevia/AccretaIncidenceofaccreta(%)NumberofpriorcesareansNumberofpriorcesareansIncidenceofprevia(%)Silveretal.ObstetGynecol2006;107:1226-1232EffectsofCurrentCDTrendSolheimK,LittleSE,EsakoffT,ChengY,SparksT,CaugheyAB.JMFMN
5、M,2011EffectsofCurrentCDTrendSolheimK,LittleS,EsakoffT,ChengY,SparksT,CaugheyAB.JMFMNM,2011BaselineSteadyincreaseinCDSlowincreaseinCDStaticrateofCDDecreaseinCDYear200620102020202020202020Previas13,62814,80417,31615,70014,75212,228Accretas4,6125,5007,3326,2125,5363,792Maternaldeaths60062467
6、6640620564Cesareans1,296,0001,472,0001,868,8001,566,0001,364,400892,000C-hysts4,3205,1006,7205,7205,1283,592Transfusions4,6805,4967,2086,1205,5163,856Whyrisingcesareanrates?ChangingdemographicsIncreasingmaternalageIncreasingBMI/obesityMaternalpreferencesCesareandeliveryonmaternalrequest(CD
7、MR)Medical-legalenvironmentImproperincentivesDemographicChangesMartinJAetal.Annualsummaryofvitalstatistics:2006.Pediatrics2008HamiltonBEetal.Births:Preliminarydatafor2005.NatlVitalStatRep2006DemographicChangesMartinJAetal.Annualsummaryofvitalstatistics:2006.Pe
