Ji Honglei, Jiang Hong, Yang Limin, Qian Xu, Tang Shenglan
Department of Epidemiology and Social Science, Shanghai Institute of Planned Parenthood Research/WHO Collaborating Center for Research in Human Reproduction, Shanghai, China Department of Maternal, Child and Adolescent Health, School of Public Health and Global Health Institute, Fudan University, Shanghai, China.
Department of Maternal, Child and Adolescent Health, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Health), Fudan University, Shanghai, China.
BMJ Open. 2015 Nov 13;5(11):e008994. doi: 10.1136/bmjopen-2015-008994.
To identify factors contributing to the rapid rise of caesarean section in Shanghai through the prospective observation of changes in the preferred mode of delivery in pregnancy among primiparous Chinese women.
Prospective study.
Two general hospitals in Shanghai.
A cohort of 832 low-risk primiparous women participated in the investigation from 2010-2012 three consecutive times, from their second to third trimester and, finally, 1-2 days post partum.
Participants were interviewed, using standard questionnaires, for information on demographic characteristics, maternal childbirth self-efficacy, their preference of delivery mode before childbirth and on the people most influential to them when making decisions on delivery mode. Caesarean section indications in the medical records were extracted by the investigators and assessed against clinical guidelines. Caesarean sections were categorised into three groups: guideline-defined indications, doctor-defined indications and maternal request.
Preferred mode of delivery; indications for caesarean section; actual mode of delivery; determinants of caesarean section.
Of 832 pregnant women enrolled, 13.2% preferred caesarean section in the second trimester. This figure rose to 17.0% in the third trimester among 599 followed women. Of 523 women completing all three interviews, 58.1% underwent caesarean section. However, 34.9% of women undergoing caesarean section did not have any indications listed in the clinical guidelines nor based on maternal request. Multinomial regression analysis showed that doctors' influence was one of the significant risk factors of undergoing caesarean section, with doctor-defined indications. Participants with low maternal childbirth self-efficacy were more likely to request caesarean sections themselves.
When deciding to deliver via caesarean section without justified clinical indications in the guideline, Chinese doctors played an important role in decision-making. Among primiparous Chinese women, decisions to use caesarean sections were often made during the third trimester or during the process of labour.
通过前瞻性观察中国初产妇孕期分娩方式偏好的变化，确定导致上海剖宫产率迅速上升的因素。
前瞻性研究。
上海的两家综合医院。
832名低风险初产妇组成的队列在2010年至2012年期间连续三次参与调查，从孕中期到孕晚期，最后在产后1至2天。
使用标准问卷对参与者进行访谈，以获取有关人口统计学特征、产妇分娩自我效能感、分娩前对分娩方式的偏好以及在决定分娩方式时对其影响最大的人员的信息。研究人员从病历中提取剖宫产指征，并根据临床指南进行评估。剖宫产分为三组：指南定义的指征、医生定义的指征和产妇要求。
偏好的分娩方式；剖宫产指征；实际分娩方式；剖宫产的决定因素。
在832名登记孕妇中，13.2%在孕中期偏好剖宫产。在599名跟踪的孕妇中，这一数字在孕晚期升至17.0%。在完成所有三次访谈的523名妇女中，58.1%接受了剖宫产。然而，34.9%接受剖宫产的妇女没有临床指南中列出的任何指征，也不是基于产妇要求。多项回归分析表明，医生的影响是剖宫产的重要危险因素之一，即医生定义的指征。产妇分娩自我效能感低的参与者更有可能自己要求剖宫产。
在中国，当在没有指南中合理临床指征的情况下决定剖宫产时，医生在决策中发挥了重要作用。在中国初产妇中，剖宫产的决定通常在孕晚期或分娩过程中做出。
