目的 探讨首次剖宫产的风险因素和风险校正对首次剖宫率的影响。方法 选取医院2021年1月—2022年12月收治的705例剖宫产产妇作为研究对象,记录影响首次剖宫产的所有风险因素,采用回归分析筛选危险性及保护性因素,建立logistic方程并检验其精准性,比较实际剖宫产率和风险校正剖宫产率。结果 剖宫产风险因素主要包括分娩年龄、体重指数、孕次、孕周、多胎妊娠、妊娠合并症及产前并发症、产时并发症、受教育程度、职业和辅助生殖技术等（P<0.05）。而早产、经产妇为首次剖宫产率的保护因素。2021年1—12月、2022年1—12月的风险校正首次剖宫产率显著低于实际首次剖宫产率,差异有统计学意义（P>0.05）。首次剖宫产率回归方程的特异性检验结果显示,受试者工作特征（ROC）曲线下面积（AUC）为0.763,标准差为0.033（P<0.001）,95%CI：0.699~0.827。2021年1—8月、2021年9月—2022年4月、2022年5—12月实际首次剖宫产率均高于风险校正首次剖宫产率（P<0.05）。结论 分娩年龄、体重指数、孕次、孕周、多胎妊娠、妊娠合并症及并发症和产时并发症、受教育程度、职业、辅助生殖技术、胎儿情况以及孕妇产道及心理状态等均为首次剖宫产率的危险影响因素。风险校正首次剖宫产率,可为产科降低剖宫产率提供有利条件,是对产科质量进行评价的关键指标。

Objective To explore the risk factors of first cesarean section and the impact of risk correction on first cesarean section rate. Methods A total of 705 women with cesarean section admitted to the hospital from January 2021 to December 2022 were selected as study subjects， and all potential factors affecting first cesarean section were recorded. Regression analysis was used to screen out risk factors and protective factors， and a logistic equation was established to test its accuracy. The actual cesarean section rate and risk-adjusted cesarean section rate were compared. Results The risk factors of cesarean section mainly included age of delivery， body mass index， gravidity， gestational weeks， multiple pregnancies， pregnancy comorbidities and complications， intrapartum complications， education level， occupation， and assisted reproductive technology （P<0.05）. Preterm delivery and multipara were protective factors for the rate of first cesarean section. In addition， the risk-adjusted first cesarean section rates from January to December 2021 and from January to December 2022 were significantly lower than the actual first cesarean section rates， with statistical significance （P>0.05）. The results of specificity test of regression equation of first cesarean section rate showed that the area under the curve （AUC） of receiver operating characteristic （ROC） was 0.763， the standard deviation was 0.033 （P<0.001）， and the 95%CI was 0.699-0.827. The actual rates of first cesarean section from January to August 2021， from September 2021 to April 2022， and from May to December 2022 were higher than the risk-adjusted rates （P<0.05）. Conclusion Delivery age， body mass index， gravidity， gestational weeks， multiple pregnancies， pregnancy comorbidities and complications， intrapartum complications， education level， occupation， assisted reproductive technology， fetal condition， and maternal birth canal， and psychological status are all risk factors for first cesarean section rate. Risk-adjusted first cesarean section rate provides favorable conditions for obstetrics to reduce cesarean section rate， and is a key indicator for evaluating obstetric quality.