Wang Xin, Hellerstein Susan, Hou Lei, Zou Liying, Ruan Yan, Zhang Weiyuan
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 YaoJiayuan Road, Chaoyang District, Beijing, 100026, China.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 01210, USA.
BMC Pregnancy Childbirth. 2017 Feb 6;17(1):54. doi: 10.1186/s12884-017-1233-8.
The caesarean section rate has risen rapidly in China. The purpose of this retrospective study was to estimate caesarean section rates and indications by hospital facility level in Mainland China to investigate reasons contributing to the high rate.
This cross-sectional hospital-based study collected data from 39 hospitals in three geographical regions in China, covering 14 different provinces, municipalities, and autonomous regions, including 20 tertiary health hospitals and 19 secondary hospitals. Data from all women who gave birth at these hospitals during 2011 were included.
A total of 112,138 women who gave birth after 24 weeks of gestation were surveyed. Of these pregnancies, 54.5% (61,084 cases) resulted in caesarean section, non-indicated caesarean section accounted for 38.4% of caesarean sections. Overall caesarean section rates were higher at the tertiary level hospitals (55.9%) compared to the secondary level hospitals (50.9%). The secondary level hospitals had higher rates of non-indicated caesarean section (48.9% of caesarean sections) compared to tertiary level hospitals (34.5% of caesarean sections). The rate of caesarean section on maternal request was higher in the secondary hospitals (16.6%) than in the tertiary hospitals (10%) (P < 0.001), as well as the caesarean section rate for CPD prior to labour. Operative vaginal deliveries were overall rare (1.2%) with 90.9% (1200/1320 cases) performed in the tertiary hospitals.
Caesarean section on maternal request accounts for a large portion of China's high caesarean section rate, especially in the secondary hospitals. The first step to reduced caesarean section rates is to decrease the number of non-indicated caesarean sections.
中国剖宫产率迅速上升。这项回顾性研究旨在按中国大陆医院机构级别估算剖宫产率及指征，以探究导致高剖宫产率的原因。
这项基于医院的横断面研究收集了中国三个地理区域39家医院的数据，涵盖14个不同的省、直辖市和自治区，包括20家三级医院和19家二级医院。纳入了2011年在这些医院分娩的所有女性的数据。
共调查了112,138例妊娠24周后分娩的女性。在这些妊娠中，54.5%（61,084例）为剖宫产，无指征剖宫产占剖宫产的38.4%。三级医院的总体剖宫产率（55.9%）高于二级医院（50.9%）。与三级医院（剖宫产的34.5%）相比，二级医院无指征剖宫产率更高（剖宫产的48.9%）。二级医院因产妇要求的剖宫产率（16.6%）高于三级医院（10%）（P < 0.001），临产前因头盆不称的剖宫产率也是如此。总体而言，阴道助产很少见（1.2%），其中90.9%（1200/1320例）在三级医院进行。
因产妇要求的剖宫产在中国高剖宫产率中占很大比例，尤其是在二级医院。降低剖宫产率的第一步是减少无指征剖宫产的数量。
