What is an appropriate caesarean delivery rate for China: a multicentre survey

作者：Yao Zhang, Ana Pilar Betrán, Xiaotian Li, Dandan Liu, Ningxia Yuan, Li Shang, Wan‐Ni Lin, Songjun Tu, Lijing Wang, Xiaoshu Wu, T. J. Zhu, Yao Zhang, Zequn Lu, Zheng Li, Cong Gu, Jin Fang, Zongwen Liu, Liya Ma, Zhen Cai, Xiangyu Yang, Haitao Li, H Zhang, Xing‐Ming Zhao, L Yan, Lijing Wang, Xiangrong Sun, Qi Luo, L Liu, Jun Zhu, Wen Qin, Qiang Yao, Siyan Dong, Yulu Yang, Ziyu Cui, Yao He, Xiaoxia Feng, Li He, H Zhang, Li Zhang, Xiaosheng Wang, João Paulo Souza, Hongbo Qi, Ting Duan, Junfeng Zhang · 发表于：BJOG An International Journal of Obstetrics & Gynaecology · 年份：2021 · DOI：10.1111/1471-0528.16951 · 被引用次数：33 · 研究领域：Maternal and Perinatal Health Interventions、Pelvic floor disorders treatments、Enhanced Recovery After Surgery

OBJECTIVE: To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction. DESIGN: A multicentre cross-sectional study. SETTING: A total of 94 hospitals across 23 provinces in China. POPULATION: A total of 73 977 randomly selected deliveries. METHODS: We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C-Model to calculate reference CD rates. MAIN OUTCOME MEASURES: CD rates in China. RESULTS: In 2015-2016, the overall CD rate in China was 38.9% (95% CI 38.6-39.3%). Considering the obstetric characteristics of the population, the multivariable model-based reference CD rate was estimated at 28.5% (95% CI 28.3-28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs. CONCLUSIONS: Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one-third of the total CDs. Given the large vari...