Changes in cesarean delivery rate and indications against the background of two-child policy / 中华围产医学杂志

ABSTRACT

Objective To study the changes in cesarean delivery rate (CSR) and indications against the background of two-child policy. Methods Maternal information and indications for cesarean delivery were retrospectively obtained from medical records of 62007 women who delivered at the Obstetrics and Gynecology Hospital of Fudan University between January 2013 and December 2016. Indications for cesarean section were divided into 16 categories, such as maternal or fetal indication, repeat cesarean section, maternal request, labor arrest disorders, fetal distress, and so on. Changes in CSR and the proportion of cesarean delivery for each indication were evaluated. One-way analysis of variance, Chi-square or Fisher's exact test were used for statistical analysis. The average annual percent change (AAPC) in cesarean delivery rate was calculated by Joinpoint Analyses software. Relative contribution of each indication to the overall increase or decrease in CSR was analyzed using the data of the years of 2013 and 2016. Results The CSR dropped from 45.2％ (6683/14798) in 2013 to 38.3％ (6546/17104) in 2016. The rate of cesarean delivery due to maternal request and labor arrest disorders decreased significantly (χ2=49.402 and 14.617, both P<0.05) .The rate of cesarean delivery due to labor arrest disorders in all cases decreased sharply from 14.7‰ in 2013 to 0.9‰ in 2016 at an annual decrease of 48.0％ (95％CI - 67.6％- - 21.5％). It was also worth noting that the rate of cesarean delivery on maternal request in all cases decreased from 119.3 ‰ in 2013 to 40.7 ‰ in 2016 at an average annual decrease of 30.1％ (95％CI - 31.3％- - 28.9％). Despite of a limited number of cesarean delivery cases for uterine scar caused by leiomyoma resection, its rate increased from 1.4 per 1000 deliveries in 2013 to 2.9 per 1000 deliveries in 2016 with the highest average annual increase of 32.3％ (95％CI 10.1％-60.9％), followed by the rate of cesarean delivery due to maternal pyrexia, increasing from 6.6 per 1000 deliveries in 2013 to 16.4 per 1000 deliveries in 2016 at an average annual increase of 27.4％ (95％CI 11.0％-46.5％), and the rate of cesarean delivery due to repeat cesarean section, increasing from 67.6 per 1000 deliveries in 2013 to 113.9 per 1000 deliveries in 2016 at an average annual increase of 19.0％ (95％CI 5.0％-34.6％). The first two positive contributors to the total decrease of CSR were maternal request and labor arrest disorders (144.2％ and 27.7％, respectively), while the first two negative contributors were repeat cesarean section and maternal pyrexia (-102.3％ and -18.9％, respectively). Conclusions The CSR is reduced after the implementation of two-child policy through active control on maternal request and application of new partogram.