Analysis Of Related Factors And Clinical Pathway Management Of Cesarean Section In A Hospital

Objective:(1)To describe the changes of cesarean section in a hospital in 2002-2006,to analyze the maternal and child complications of cesarean section.(2)To describe the changes of cesarean section in 15 years and the relationship between cesarean section indication and cesarean section rate change,to find the main factors affecting cesarean section.(3)The clinical data of the planned cesarean section were analyzed by the data of the clinical cesarean section of the hospital from 2013 to 2016.(4)Through the control of cesarean section indications and the standard of clinical path,the paper expounds the achievements and existing problems of obstetrical cesarean section,and puts forward corresponding countermeasures to improve the quality of obstetric medical treatment.Methods:.Collating the relevant information of a hospital 2002-2016 annual cesarean section,using the retrospective analysis of the hospital 15 years of cesarean section rate of change,cesarean section maternal and child complications,cesarean section indications and changes since 2013 clinical study of cesarean section clinical pathways.Chi square test and two groups of independent samples were used to compare the rank sum test.The collected data were input to the EXCEL form,and SPSS17.0 analysis software was used to analyze each index accordingly.,while the use of comparative research,literature research on cesarean section related factors were analyzed.Result:1.The rate of cesarean section was firstly increasing and then decreasing in the period from 2002 to 2016,and the peak value was 48.08% in 2009,which difference was significant(P <0.05).The average age of cesarean section was decreased,and the average hospitalization days of cesarean section showed a decreasing trend.The incidence of maternal and child complications after cesarean section was maintained at a reasonable and stable level.2.Cesarean section indications of dystocia factors,including birth canal abnormalities,abnormal labor,the proportion of fetal abnormalities were declining trend;non-dystocia factors in the proportion of scar uterus increased significantly,pregnancy complications,prenatal hemorrhage and heavy pregnancy hypertension accounted for the annual change is not very obvious;social factors without cesarean section accounted for the proportion remained at a relatively small proportion.There were significant differences(P <0.05)between all the factors.3.The planned cesarean section clinical pathway carried out since 2013,access rate,completion rate increased year by year,in 2016 reached 99.16% and 96.38%,the overall variation rate of about 86%,the rate of postpartum hemorrhage,II a healing rate is basically normal,II a healing rate of 2013,lower in 2016,failed to meet the qualified index.The corresponding path into maternal analysis group and did not enter into the path of the actual path group were compared,two groups of average hospitalization days and the average cost of a significant difference,enter the path to shorten the average hospitalization time,reduce the per capita cost;to enter the path between the groups are divided into complete paths and exit paths group,two group the average hospitalization days and the average cost has significant differences,and complete the path group the average hospitalization days and the per capita cost than the exit path was lower;select 2010-2011 years all the cesarean section as the implementation of the path before and after the implementation of the path of 2014-2015 cesarean section were compared,after applying the clinical pathway to reduce the average hospitalization days.The per capita cost increase.Conclusion:.1.The rate of cesarean section was the highest in the period of 2002-2016,and the average rate of cesarean section was higher than that of the whole province.The maternal and neonatal complications after cesarean section were reasonable and stable ratio.2.The proportion of dystocia factors in cesarean section decreased,the proportion of non dystocia increased,the proportion of fetal abnormalities decreased,and the scar uterus was gradually replaced by fetal abnormalities,which became the first operation indication,and the other surgical indications changed little.3.The planned cesarean section clinical path specification to a certain extent,diagnosis and treatment of cesarean section operation since 2013,the health index is basically normal,the implementation plan of cesarean section clinical pathway after cesarean section,the overall decline,reduce maternal average hospitalization days,but the overall cost per capita,mutation rate increased,reduce the per capita cost,the mutation rate control is an important work.4.Strengthen the management of pregnancy,improve the technology of delivery and promote natural childbirth,strictly control the indications of cesarean section,pay attention to the prevention and cure of the pregnant and parturant of "scar uterus",strengthen the management of the clinical path of the planned cesarean section,control the rate of variation,reduce the medical cost,standardize the process of diagnosis and treatment,and improve the medical quality of the Department of production.