講者：梁永昌醫生 (廣華醫院)
論文題目: 剖宮產 - 歷史，現代意義與神話

論文摘要：

Apart from normal vaginal deliveries, Caesarean section (剖宮產) (CS) is the most common operation performed to deliver babies. Delivery records are available in Kwong Wah Hospital (KWH) from 1930 onwards. It would be most interesting to explore when was the 1st CS performed in KWH & the subsequent trend in annual CS rate from a historical point of view (歷史).

There is a worldwide increase in CS rate. Psychological & social factors play a more important role than biological factor. Common myths (神話) about CS include: better outcome for baby & mother; safe & fast; less painful; convenience; able to set the date & time of delivery for Feng Shui (風水); choice for high socioeconomic class; & others.

Situation in Hong Kong was astonishing. In 1987, the CS rate was 12.8% in public vs. 31.7% in private hospitals. In 1999, the CS rate was 19.3% in public vs. 49.9% in private hospitals. In 2010, the CS rate was 25.3% in public hospitals but could be as high as 70% in private hospitals. The tremendous increase in CS rate in the recent decade could not be explained by increasing maternal request alone. It was related to the influx of Mainland Chinese mothers coming across the border to deliver their babies in Hong Kong. We attributed this to a “social obstetrics” phenomenon. The annual no. of births in Hong Kong reached a record high of 95,000 in 2011 (since 1966). Only half of them were born to local mothers.

The ever-increasing CS rate has resulted in an increasing incidence of placenta praevia & accreta (morbidly adherent low-lying placenta to uterus) associated with significant maternal ill health & even death.

In KWH, we have been trying our best to keep the principle (擇善固執) of performing CS only for real medical indications.