背景:剖宫产率在全球范围内一直在增加。伊朗是世界上CS率最高的国家之一(47.9%)。这项审查是为了评估妇女的患病率和原因,家庭成员\',和卫生专业人员对伊朗CS的偏好。
结果:在此混合方法系统综述中,我们搜索了MEDLINE/PubMed,Embase,CINAHL,POPLINE,PsycINFO,全球健康图书馆,谷歌学者;以及包括SID在内的伊朗科学数据库,和Magiran从1990年1月1日至2019年10月8日。初级定量,定性,包括在伊朗使用波斯语或英语进行的混合方法研究。定量研究的荟萃分析是通过从65个横截面中提取数据进行的,纵向,和介入研究的基线测量。对于元合成,我们使用了26项定性研究,如人种学,现象学,案例研究,和扎根的理论。采用ReviewManager5.3版和综合Meta分析(CMA)软件进行Meta分析和Meta回归分析。结果显示,5.46%的未产妇女(95%CI5.38-5.50%;χ2=1117.39;df=28[p<0.00001];I2=97%)首选CS分娩方式。基于妊娠时间的亚组分析结果表明,妊娠早期和中期妇女报告的CS偏好比例为5.94%(95%CI5.86-5.99%),和3.81%(95%CI3.74-3.83%),在怀孕后期。这篇综述的异质性很高。大多数女人怀孕了,不管他们的平价,参与者的风险水平是未知的,一些波斯出版物被评价为质量低。采用归纳和演绎相结合的方法来综合定性数据,和CERQual用于评估对结果的信心。元综合产生了10个新兴主题和3个最终主题:“女性因素”,\'健康专业因素\',andex\'健康组织,设施,或系统因素。
结论:尽管女性对CS的偏好较低,CS率仍然很高。这意味着超越个人意志的因素的作用。我们确定了多个个体,卫生机构,以及影响伊朗CS偏好的卫生系统因素。近年来,人们进行了许多设计尝试,测试和实施干预措施,以减少伊朗不必要的CS,比如对母亲友好的医院,分娩和分娩的标准协议,为妇女准备的课程,助产士,妇科医生,并通过“卫生部门发展政策”为专家和助产士举办讲习班。虽然这些方案是有效的,CS的高比率持续存在,需要更多的努力来优化CS的使用。
BACKGROUND: Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS rates in the world (47.9%). This review was conducted to assess the prevalence of and reasons for women\'s, family members\', and health professionals\' preferences for CS in Iran.
RESULTS: In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well as Iranian scientific databases including SID, and Magiran from 1 January 1990 to 8th October 2019. Primary quantitative, qualitative, and mixed-methods studies that had been conducted in Iran with Persian or English languages were included. Meta-analysis of quantitative studies was conducted by extracting data from 65 cross-sectional, longitudinal, and baseline measurements of interventional studies. For meta-synthesis, we used 26 qualitative studies with designs such as ethnography, phenomenology, case studies, and grounded theory. The Review Manager Version 5.3 and the Comprehensive Meta-Analysis (CMA) software were used for meta-analysis and meta-regression analysis. Results showed that 5.46% of nulliparous women (95% CI 5.38-5.50%; χ2 = 1117.39; df = 28 [p < 0.00001]; I2 = 97%) preferred a CS mode of delivery. Results of subgroup analysis based on the time of pregnancy showed that proportions of preference for CS reported by women were 5.94% (95% CI 5.86-5.99%) in early and middle pregnancy, and 3.81% (95% CI 3.74-3.83%), in late pregnancy. The heterogeneity was high in this review. Most women were pregnant, regardless of their parity; the risk level of participants were unknown, and some Persian publications were appraised as low in quality. A combined inductive and deductive approach was used to synthesis the qualitative data, and CERQual was used to assess confidence in the findings. Meta-synthesis generated 10 emerging themes and three final themes: \'Women\'s factors\', \'Health professional factors\', andex \'Health organization, facility, or system factors\'.
CONCLUSIONS: Despite low preference for CS among women, CS rates are still so high. This implies the role of factors beyond the individual will. We identified a multiple individual, health facility, and health system factors which affected the preference for CS in Iran. Numerous attempts were made in recent years to design, test and implement interventions to decrease unnecessary CS in Iran, such as mother-friendly hospitals, standard protocols for labor and birth, preparation classes for women, midwives, and gynaecologists, and workshops for specialists and midwives through the \"health sector evolution policy\". Although these programs were effective, high rates of CS persist and more efforts are needed to optimize the use of CS.