Zhang Jun, Liu Yinghui, Meikle Susan, Zheng Junchi, Sun Wenyu, Li Zhu
National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
Obstet Gynecol. 2008 May;111(5):1077-82. doi: 10.1097/AOG.0b013e31816e349e.
To estimate the incidence of overall cesarean delivery and cesarean delivery on maternal request in southeast China in the past decade.
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.
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.
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.
III.
评估中国东南部地区过去十年间剖宫产及产妇要求剖宫产的发生率。
我们使用了基于人群的妇幼健康监测系统的数据，该系统覆盖中国东南部两个省份的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及产妇要求剖宫产率。产妇要求剖宫产定义为妊娠38周及以后单胎妊娠且无阴道分娩禁忌证的临产前剖宫产。
在13年的研究期间，高中及以上学历女性的比例从13%增至46%。总体剖宫产率从1994年的22%增至2003年的60%，2006年降至56%。相应的产妇要求剖宫产率（每100例分娩）分别为0.8%、22%和20%。市县之间差异巨大。在一些地区，产妇要求剖宫产占所有剖宫产的一半。变化模式多样且不均衡，1994年至2006年间危险因素模式发生了显著变化。初产、高学历、产妇年龄较大、在省级或县级医院分娩以及女性职业以前与产妇要求剖宫产率有关。产妇要求剖宫产率不再因年龄、医院级别或职业而有所不同。
过去十年间中国东南部地区剖宫产率急剧上升。产妇要求剖宫产是上升的主要原因。
III级
