Cesarean delivery on maternal request in Southeast China
Cesarean delivery on maternal request in Southeast China
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DOI：
10.1097/aog.0b013e31816e349e
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发表时间：
2008-05-01
影响因子：
7.2
通讯作者：
Li, Zhu
中科院分区：
文献类型：
--
作者：
Zhang, Jun;Liu, Yinghui;Li, Zhu
目的：了解近十年来中国东南地区剖宫产率及产妇要求剖宫产率。方法：我们使用了一个基于人群的妇幼健康监测系统的数据，该系统覆盖了中国东南部两个省的21个市县。我们调查了1994年至2006年初110万例单胎分娩的剖宫产率和产妇要求剖宫产率。应产妇要求剖宫产被定义为妊娠38周或更晚无阴道分娩禁忌的单胎妊娠的产前剖宫产。结果：在13年的研究期间，受过高中或更高教育的女性比例从13%增加到46%。总体剖宫产率从1994年的22%上升到2003年的60%，2006年下降到56%。应产妇要求剖宫产的相应比率（每100例分娩）分别为0.8%、22%和20%。城市和县之间的比率差别很大。在一些地区，应产妇要求进行剖宫产占所有剖宫产的一半。1994 - 2006年期间，发病率变化模式多样且不均匀，风险因素格局发生了较大变化。以前，未生育、受过高等教育、产妇年龄较大、是否在省或县医院分娩以及妇女的职业与产妇要求的剖宫产率有关。产妇要求的剖宫产率不再因年龄、医院级别或职业而异。结论：近十年来，中国东南地区剖宫产率急剧上升。应产妇要求剖宫产是增加的主要原因。
OBJECTIVE: To estimate the incidence of overall cesarean delivery and cesarean delivery on maternal request in southeast China in the past decade.METHODS: We used data from a population-based maternal and child health surveillance system, which covers 21 cities and counties in two provinces in southeast China. We examined the rate of cesarean delivery and cesarean delivery on maternal request in 1.1 million singleton births from 1994 to early 2006. Cesarean delivery on maternal request was defined as a prelabor cesarean delivery for a singleton gestation without contraindications for vaginal delivery at 38 weeks of gestation or later.RESULTS: During the 13-year study period, the percentage of women who had high school or higher education increased from 13% to 46%. The overall cesarean rate increased from 22% in 1994 to 60% in 2003 and moderated to 56% in 2006. The corresponding rates of cesarean delivery on maternal request (per 100 all deliveries) were 0.8%, 22%, and 20%, respectively. The rates varied enormously among cities and counties. In some areas, cesarean delivery on maternal request accounted for half of all cesarean births. The patterns of rate change were diverse and uneven, and the pattern of risk factors changed substantially between 1994 and 2006. Nulliparity, higher education, older maternal age, having been delivered at provincial or county hospitals, and women's occupations were previously associated with rate of cesarean delivery on maternal request. The rate of cesarean delivery on maternal request no longer varies by age, hospital level, or occupation.CONCLUSION: The rate of cesarean delivery increased dramatically in southeast China in the past decade. Cesarean delivery on maternal request was the predominant contributor to the increase.