Department of Obstetrics and Gynecology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan people's hospital), 78# Xinguchong, Wandaolunan, Wanjiang District, Dongguan, Guangdong, 523059, China.
Dongguan Key Laboratory of Major Diseases in Obstetrics and Gynecology, Dongguan, 523059, China.
BMC Pregnancy Childbirth. 2024 Oct 3;24(1):641. doi: 10.1186/s12884-024-06784-6.
To study the possible associations between advanced maternal age and cesarean section(CS) under the two child policy.
This study used a cohort study from Dongguan People's Hospital in Guangdong Province, China from 2017 to 2020. The cohort was restricted to women aged ≥ 20 who give birth to babies with a gestational age of > 28 weeks and a weight of > 1000 g. Divide the advanced maternal age (AMA) pregnant women into two age groups: 35-39 years old and 40 years old or older age. We analyzed CS rate and CS contribution using the modified Robson classification system. Frequency of cesarean was determined for each group and compared by using χ and prevalence ratio.
Overall, 47654 women were included, of which 7924 (16.63%) were between the ages of 35 and 39, and 1529 (3.21%) were aged 40 or older. The total CS rate is 40.64%, with 36.10% for mothers aged 20 to 34, 57.90% for women aged 35 to 40, and 64.75% for women aged 40 or older age. In the AMA groups (n = 9453), Robson group 2' was the most common, followed by groups 5 and 10. Women at 40 years or older age were 3 times more likely to undergo a cesarean delivery in Robson group 1', and 1.76 times more likely in group 10. The CS rate in group 2' were statistically significantly higher in the very AMA group.
The CS rates increased noticeably with maternal age under the two child policy. Based on the modified Robson classification system, AMA women should pay more attention to primiparous women with single pregnancy, uterine scars, and premature birth in multiple pregnancies.
研究在二孩政策下，高龄产妇与剖宫产之间的可能关联。
本研究采用了中国广东省东莞市人民医院 2017 年至 2020 年的一项队列研究。该队列仅限于年龄≥20 岁、分娩孕周>28 周且体重>1000g 的产妇。将高龄产妇（AMA）分为两个年龄组：35-39 岁和 40 岁及以上。我们使用改良的 Robson 分类系统分析剖宫产率和剖宫产贡献。对每个组别的剖宫产率进行了频率分析，并通过 χ 检验和患病率比进行比较。
总体而言，共纳入 47654 名女性，其中 7924 名（16.63%）年龄在 35-39 岁之间，1529 名（3.21%）年龄在 40 岁及以上。总剖宫产率为 40.64%，20-34 岁产妇为 36.10%，35-40 岁产妇为 57.90%，40 岁及以上产妇为 64.75%。在 AMA 组（n=9453）中，Robson 组 2'最为常见，其次是组 5 和组 10。在 Robson 组 1'中，40 岁及以上女性行剖宫产的可能性是组 1 中女性的 3 倍，在组 10 中是 1.76 倍。在非常高龄产妇组中，组 2'的剖宫产率明显更高。
在二孩政策下，剖宫产率随产妇年龄显著增加。基于改良的 Robson 分类系统，高龄产妇应更加关注初产妇、单胎妊娠、子宫瘢痕和多胎早产。
