Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
Department of Gynecology and Oncology, Maternal and Child Health Hospital of Hubei Province, Affiliated Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
Curr Med Sci. 2020 Apr;40(2):348-353. doi: 10.1007/s11596-020-2190-4. Epub 2020 Apr 26.
China's universal two-child policy was released in October of 2015. How would this new policy influence the rate of overall cesarean delivery (CD) in China? The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China (a tertiary hospital) in 2016. In this study, 22 530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were enrolled as research objects. Electronic health records of these selected objects were retrieved. According to the history of childbirth, the selected cases were divided into primiparous group containing 16 340 cases and multiparous group containing 6190 cases. Chi-square test was carried out to compare the rate of CD, neuraxial labor analgesia, maternity insurance between the two groups; t-test was performed to compare the in-hospital days and gestational age at birth between the two groups. Pearson correlation coefficient was used to evaluate the relationship among observed monthly rate of multiparas, overall CD rate, and Elective Repeat Cesarean Delivery (ERCD) rate. The results showed that the CD rate in multiparous group was 55.46%, which was higher than that in primiparous group (34.66%, P<0.05). The rate of neuraxial labor analgesia in multiparas group was 9.29%, which was lower than that in primiparas group (35.94%, P<0.05). However, the rate of maternity insurance was higher in multiparas group (57.00%) than that in primiparas group (41.08%, P<0.05). The hospital cost and in-hospital days in multiparas group were higher, and the gestational age at birth in multiparas group was lower than in primiparas group (P<0.05). The overall CD rate slightly dropped in the first 4 months of the year (P<0.05), then increased from 36.27% (April) to 43.21% (December) (P<0.05). The rate of multiparas women and ERCD had the same trend (P<0.05). There were linear correlations among the rate of overall CD, the rate of multiparas women and the rate of ERCD rate (P<0.05). With the opening of China's two-child policy, the increasing rate of overall CD is directly related with the high rate of ERCD. Trials of Labor After Cesarean Section (TOLAC) in safe mode to reduce overall CD rate are warranted in the future.
中国的普遍二孩政策于 2015 年 10 月发布。这项新政策将如何影响中国的总体剖宫产率（CD）？本文旨在研究基于中国一家大型分娩中心（一家三级医院）2016 年多胎产妇数量增加的情况下，总体 CD 率的趋势。本研究共纳入 2016 年 1 月 1 日至 12 月 31 日中国一家大型分娩中心医疗记录部门的 22530 例病例作为研究对象。检索这些选定对象的电子健康记录。根据分娩史，将所选病例分为初产妇组（16340 例）和多产妇组（6190 例）。采用卡方检验比较两组间 CD 率、椎管内分娩镇痛、生育保险的差异；采用 t 检验比较两组间住院天数和出生时的胎龄。采用 Pearson 相关系数评估观察到的每月多胎数、总体 CD 率和选择性重复剖宫产（ERCD）率之间的关系。结果显示，多产妇组 CD 率为 55.46%，高于初产妇组（34.66%，P<0.05）。多产妇组椎管内分娩镇痛率为 9.29%，低于初产妇组（35.94%，P<0.05）。然而，多产妇组的生育保险率（57.00%）高于初产妇组（41.08%，P<0.05）。多产妇组的住院费用和住院天数较高，胎龄较低（P<0.05）。总体 CD 率在年初的前 4 个月略有下降（P<0.05），然后从 36.27%（4 月）增加到 43.21%（12 月）（P<0.05）。多产妇人数和 ERCD 率呈相同趋势（P<0.05）。总体 CD 率、多产妇人数和 ERCD 率之间存在线性相关性（P<0.05）。随着中国二孩政策的开放，总体 CD 率的上升率与 ERCD 率的高上升率直接相关。未来有必要以安全模式开展剖宫产术后试产（TOLAC）以降低总体 CD 率。
