中国湖北省和甘肃省两孩政策时代剖宫产率及医学指征。
The Rates and Medical Necessity of Cesarean Delivery in the Era of the Two-Child Policy in Hubei and Gansu Provinces, China.
机构信息
Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
出版信息
Am J Public Health. 2019 Mar;109(3):476-482. doi: 10.2105/AJPH.2018.304868. Epub 2019 Jan 24.
OBJECTIVES
To describe the cesarean rates in different child policy periods and assess the medical necessity of cesareans during the 2-child policy period.
METHODS
We collected hospital-level aggregate data on 93 745 deliveries and individual-level data on 27 977 deliveries from 6 hospitals in the Hubei and Gansu provinces of China from 2013 to 2016. Experts in gynecology and obstetrics assessed the medical necessity of 1024 randomly selected cesareans in 2016.
RESULTS
The overall cesarean rate decreased significantly from 45.1% in the 1-child policy period (January 2013-September 2014) to 40.4% in the selective 2-child policy period (October 2014-July 2016) and further to 38.9% in the universal 2-child policy period (August 2016-December 2016). The rate of cesarean delivery on maternal request decreased by 46.3%, whereas the rate of cesarean delivery indicated by a previous cesarean delivery increased by 118.8% (P < .001). The experts assessed 222 (21.6%) cesareans as lacking medical necessity.
CONCLUSIONS
The overall cesarean rate in Hubei and Gansu provinces decreased after the implementation of the 2-child policy, and one fifth of cesareans might be nonessential.
目的
描述不同生育政策时期的剖宫产率，并评估二孩政策时期剖宫产的医学必要性。
方法
我们收集了来自中国湖北省和甘肃省的 6 家医院 2013 年至 2016 年期间的 93745 例分娩的医院级汇总数据和 27977 例分娩的个体级数据。妇产科专家评估了 2016 年随机抽取的 1024 例剖宫产的医学必要性。
结果
总体剖宫产率从一孩政策时期（2013 年 1 月至 2014 年 9 月）的 45.1%显著下降至二孩政策的选择性时期（2014 年 10 月至 2016 年 7 月）的 40.4%，进一步下降至二孩政策的普遍时期（2016 年 8 月至 12 月）的 38.9%。因产妇要求的剖宫产率下降了 46.3%，而因前次剖宫产的剖宫产率上升了 118.8%（P<0.001）。专家评估 222 例（21.6%）剖宫产缺乏医学必要性。
结论
湖北省和甘肃省在实施二孩政策后，剖宫产率总体下降，五分之一的剖宫产可能是非必要的。
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