University of Colorado School of Medicine, Denver, CO, USA.
University of Colorado, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO, 80045, USA.
Reprod Health. 2020 Dec 17;17(Suppl 3):165. doi: 10.1186/s12978-020-01021-7.
The objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women's and Children's Health Research (Global Network).
This is a secondary analysis of a prospective, population-based study of home and facility births conducted in the Global Network sites.
Cesarean birth rates increased uniformly across all sites between 2010 and 2018. Across all sites in multivariable analyses, women younger than age twenty had a reduced risk of cesarean birth (RR 0.9 [0.9, 0.9]) and women over 35 had an increased risk of cesarean birth (RR 1.1 [1.1, 1.1]) compared to women aged 20 to 35. Compared to women with a parity of three or more, less parous women had an increased risk of cesarean (RR 1.2 or greater [1.2, 1.4]). Four or more antenatal visits (RR 1.2 [1.2, 1.3]), multiple pregnancy (RR 1.3 [1.3, 1.4]), abnormal progress in labor (RR 1.1 [1.0, 1.1]), antepartum hemorrhage (RR 2.3 [2.0, 2.7]), and hypertensive disease (RR 1.6 [1.5, 1.7]) were all associated with an increased risk of cesarean birth, p < 0.001. For multiparous women with a history of prior cesarean birth, rates of vaginal birth after cesarean were about 20% in the Latin American and Southeast Asian sites and about 84% at the sub-Saharan African sites. In the African sites, proportions of cesarean birth in the study were highest among women without a prior cesarean and a single, cephalic, term pregnancy. In the non-African sites, groups with the greatest proportion of cesarean births were nulliparous women with a single, cephalic, term pregnancy and all multiparous women with at least one previous uterine scar with a term, cephalic pregnancy.
Cesarean birth rates continue to rise within the Global Network. The proportions of cesarean birth are higher among women with no history of cesarean birth in the African sites and among women with primary elective cesarean, primary cesarean after induction, and repeat cesarean in the non-African sites.
本分析旨在记录参与全球妇女儿童健康研究网络（全球网络）的中低收入国家机构中剖宫产率的趋势及其相关风险因素。
这是对全球网络机构中进行的家庭和机构分娩的前瞻性、基于人群的研究进行的二次分析。
2010 年至 2018 年期间，所有地点的剖宫产率均呈均匀上升趋势。在多变量分析中，与 20 至 35 岁的女性相比，20 岁以下的女性剖宫产风险降低（RR 0.9 [0.9, 0.9]），35 岁以上的女性剖宫产风险增加（RR 1.1 [1.1, 1.1]）。与多胎产妇相比，多胎产妇的剖宫产风险增加（RR 1.2 或更高 [1.2, 1.4]）。四次或更多次产前检查（RR 1.2 [1.2, 1.3]）、多胎妊娠（RR 1.3 [1.3, 1.4]）、产程异常进展（RR 1.1 [1.0, 1.1]）、产前出血（RR 2.3 [2.0, 2.7]）和高血压疾病（RR 1.6 [1.5, 1.7]）均与剖宫产风险增加相关，p < 0.001。对于有剖宫产史的多产妇，在拉丁美洲和东南亚地区，阴道分娩后行剖宫产的比例约为 20%，而在撒哈拉以南非洲地区，该比例约为 84%。在非洲地区，无剖宫产史和单胎头位足月妊娠的女性中，剖宫产比例最高。在非非洲地区，剖宫产比例最高的人群是单胎头位足月妊娠的初产妇和至少有一次子宫瘢痕史且足月妊娠的多产妇。
全球网络内的剖宫产率继续上升。在非洲地区，无剖宫产史的女性和在非非洲地区行初次选择性剖宫产、初次引产剖宫产和再次剖宫产的女性中，剖宫产的比例更高。
