Liu Yajun, Wang Xin, Zou Liying, Ruan Yan, Zhang Weiyuan
Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Medicine (Baltimore). 2017 Feb;96(7):e5509. doi: 10.1097/MD.0000000000005509.
In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications.From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons.The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011.After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014. Caesarean delivery on maternal request (CDMR) cannot improve the maternal-fetal prognosis compared with the spontaneous vaginal delivery. With the releasing of China's 2 children policy, more CS will be implemented due to previous CS. There is a need for further research that evaluates interventions for increasing VBAC rates that target clinicians.
近几十年来，我们观察到发达国家和发展中国家的剖宫产率均显著上升，尤其是在中国。根据世界卫生组织（WHO）的系统评价，如果剖宫产率上升10%至15%，孕产妇和新生儿死亡率会降低。然而，超过这个水平，剖宫产率的上升就不再与死亡率降低相关。迄今为止，对于导致剖宫产流行的主要因素尚未达成共识。为降低逐渐上升的剖宫产率，我们应找出剖宫产率上升的指征。本研究的目的是评估北京妇产医院剖宫产率的变化，并找出指征的变化情况。
对1995年1月至2014年12月北京妇产医院的剖宫产率进行分析。为进行分析，我们分别选取了2011年和2014年发生的14642例和16335例分娩，以分析指征差异，排除数据不完整以及因严重畸形、宫内死亡或其他原因在妊娠28周前流产或终止妊娠的情况。
过去20年的平均剖宫产率为51.15%。2002年剖宫产率最高，为60.69%；然而到2014年，剖宫产率降至34.53%。明显不同的指征是产妇要求剖宫产和既往剖宫产史。2014年因产妇要求剖宫产的比例与2011年相比下降了8.16%。然而，有既往剖宫产史的孕妇比例在3年内从9.61%增至20.42%。随着剖宫产率的下降，2014年的围产儿死亡率和新生儿窒息率与2011年相比有所降低。
经过一系列措施，剖宫产率确实下降了。与2011年相比，2014年围产儿死亡率和新生儿窒息率降低。与自然阴道分娩相比，产妇要求剖宫产并不能改善母胎预后。随着中国二孩政策的放开，由于既往剖宫产史，将会实施更多剖宫产。有必要针对临床医生开展进一步研究，评估提高剖宫产术后阴道分娩率的干预措施。
