- 學位論文
探討安胎對產生不確定胎心音而行緊急剖腹生產的相關性
Discussion the Relationship between Cesarean Section for the Nonreassuring Fetal Status and Tocolysis for Premature Uterine Contraction
摘要
剖腹產率的持續增加， 一直以來都是各國衛生單位所困擾的議題。 而在台灣孕婦施行剖腹產的比例，也已經高達35%， 遠比世界衛生組 織所提出的10~15%的標準還高。 在諸多剖腹產的適應症中， 不確定胎心音一直高居緊急剖腹生產的 最主要原因之一，但到目前為止,除了相對的危險因子外，真正的原因 尚未被探索出來。 目前臺灣因不孕症而接受人工生殖科技治療的人數也相對增加， 這 也意味著在孕程中， 因過多的人為介入， 隨之而來需要安胎的比率也 越來越高。因此在本研究特別進一步探討因子宮早期收縮而住院安胎 的案例， 在待產時是否與發生不確定胎心音而行剖腹產有著某種程度 iii 的 關聯？ 而經過以台灣健保資料來做進一步的探討發現， 曾經因子宮 早期收縮而住院安胎的案例， 在待產時發生不確定胎心音而行緊急剖 腹生產的粗勝算比，約為不曾經因子宮早期收縮而住院安胎的1.25 倍 （ 在95%的信賴區間內）。若再作相關因子的調整之後， 勝算比成為 1.26（ 在95%的信賴區間內）。若再將年齡分成不同的級距，特別在25 歲至34 歲， 其粗勝算比為1.43（ 在95%的信賴區間內）， 調整之後勝 算比成為1.44（ 在95%的信賴區間內）， 兩者均有顯著的差異。 而子宮早期收縮而安胎住院，與一般婦產科住院的最大不同在於必 需絕對臥床與使用安胎的藥物治療， 這也可能是造成不確性胎心音而 行緊急剖腹生產的所在。不過真正的機轉為何？ 還有待後續的研究來 進一步的探討。但在原本的醫療準則上仍可作部份的更動， 諸如絕對 臥床改採相對臥床， 減少安胎用藥使用的時間。此外在待產時， 有此 情行的產婦更應該視為高危險妊娠， 預先作萬全的準備， 在一旦緊急 狀況時， 可從容應付， 降低DDI所須耗損的時間。如此一來， 對於降 低剖腹產率一定會有相當的助益， 而且對於新生兒與產婦的安全也能 夠進一步的提升。
並列摘要
Just as other countr ies, the increasing cesarean rate is always a problem for the Taiwanese's author it ies. According to the repor t , the cesarean rate is as high as 35% in Taiwan recent ly, and is signif icant ly higher than the opt imal 10–15% recommended by Wor ld Health Organizat ion. Nonreassur ing fetal status is always a major indicat ion for emergency cesarean sect ion. However there was no research about the relat ionship between nonreassur ing fetal status and tocolysis for uter ine cont ract ion. Therefore we make use of the Longitudinal Health Insurance Database in Taiwan to obtained the data about women whom had been received the emergency cesarean sect ion under the indicat ion of nonreassur ing fetal v status, and divided them into tocolysis group and non-tocolysis group. After we compared the difference between tocolysis group and non-tocolysis group, the odds rat io1.25 (95% CI) was noted. After we adjudged the relat ive r isk factor , the odds rat io became to 1.26( 95% CI). When we focused on the specif ic ages ( range between 25 and 34), the rude odds rat io was up to 1.44(95% CI) , and even up to 1.45 ( 95% CI) after adjudged the relat ive r isk factor . Therefore we can conclude that there was difference between these 2 groups. From our research, we can conclude the tocolysis for premature uter ine contract ion is also a r isk factor for the nonreassur ing fetal status. Even though the mechanism is not clear , we st il l could try to reduce the dose of tocolysis regimen or change the protocol of complete bed rest to relat ive bed rest under the guarding of medical staff. Besides, we should not ify the anesthesia staff at once if this kind of pat ient was admit ted for labor, in order to save the DDI .Therefore the safety of mothers and newborns would be conf irmed.