Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital

Background: To address the worldwide dramatically increased Cesarean section (CS) rate in the past decades, WHO has recommended the CS rate should not be higher than 10–15%. Whether it is achievable remains unknown.Methods: We collected the data of delivery from 2008 to 2017 in two typical regional hospitals in China: Longhua Hospital (national policies rigorously implemented) and Dongguan Hospital (national policies not rigorously implemented). We compared between the two hospitals the 10 years trend in annual rate of CS, standardized by age, education level, parity, and CS history, against the time of issuing relevant national, local, and hospital policies.Results: In 10 years, 42,441 women in Longhua and 36,935 women in Dongguan have given birth. China's first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was issued in 2015–2016. In Longhua, the standardized annual CS rate was around 35% in 2008–2009, which declined sharply since 2010 down to 13.1% in 2016 (p < 0.001) and then leveled off. In contrast, in Dongguan, the rate stayed around 25% at the beginning, increased to 36% in 2011, decreased sharply to 27% in 2012, and leveled off until 2015 (p < 0.001), and then bounced back to 35% in 2017. The proportion of women with the history of CS increased significantly in the two hospitals (both roughly from 6% before 2010 to 20% after 2015). Analyses stratified by modified Robson classification showed that CS rates reduced in all risk classes of delivery women in Longhua but only in the Robson class 2 group in Dongguan. Major complications did not differ by hospital.Conclusion: With vigorously implementing national policies at micro levels, the WHO-recommended CS rate could be achieved without increase in major complications.

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Trends in Cesarean Delivery Rate after Cessation of the One-Child Policy in China

American Journal of Perinatology ◽

10.1055/s-0040-1705176 ◽

2020 ◽

Cited By ~ 1

Author(s):

Xiaohua Liu ◽

Ding Huang ◽

Mark B. Landon ◽

Weiwei Cheng ◽

Yan Chen

Keyword(s):

Cesarean Delivery ◽

Chinese Population ◽

Contribution Rate ◽

Term Pregnancy ◽

Robson Classification ◽

One Child Policy ◽

Nulliparous Women ◽

Child Policy ◽

Scarred Uterus ◽

The One

Abstract Objective We aimed to describe changes in cesarean delivery (CD) rates after the change of the one-child policy in China by using the Robson classification in a large Chinese population. Study Design This retrospective cohort study included 91,015 women who delivered at ≥24 weeks of gestation at a large tertiary obstetric center in Shanghai, China from 2011 to 2016. We analyzed CD rate trend and CD contribution trend in each Robson group. Logistic regression was used to calculate the odds of CD while adjusting for confounding variables. Results The overall CD rate decreased from 49.0% in 2011 to 40.6% in 2016. In nulliparous women with singleton cephalic term pregnancy and planned CD, the CD contribution rate was reduced significantly from 29.3% in 2011 to 16.4% in 2016 (p < 0.001). In multiparous with a scarred uterus, the CD contribution rate began to increase from 3.8% in 2011 to 9.1% in 2016 (p < 0.001). Compared with delivery in 2011, delivery in 2016 was associated with a 37% (adjusted odds ratio [aOR]: 0.63; 95% confidence interval [CI]: 0.60–0.66) reduction in CD. This reduction was observed in both nulliparous women with singleton cephalic term pregnancy (aOR: 0.57; 95% CI: 0.54–0.60), and multiparous women with singleton cephalic term pregnancy without scar (aOR: 0.41; 95% CI: 0.30–0.55). Conclusion The rate of cesarean delivery in our Chinese population has declined significantly in the past few years.

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Relaxation of the One Child Policy and Trends in Cesarean Section Rates and Birth Outcomes in China Between 2012 and 2016

Obstetrical & Gynecological Survey ◽

10.1097/01.ogx.0000544558.91752.20 ◽

2018 ◽

Vol 73 (8) ◽

pp. 447-449 ◽

Cited By ~ 1

Author(s):

Juan Liang ◽

Yi Mu ◽

Xiaohong Li ◽

Wen Tang ◽

Yanping Wang ◽

...

Keyword(s):

Cesarean Section ◽

Birth Outcomes ◽

One Child Policy ◽

Child Policy ◽

The One

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Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity.

10.21203/rs.3.rs-56784/v1 ◽

2020 ◽

Author(s):

Simon Crequit ◽

Diane Korb ◽

Cécile Morin ◽

Thomas Schmitz ◽

Olivier Sibony

Keyword(s):

Body Mass Index ◽

Risk Factor ◽

Cesarean Section ◽

Retrospective Cohort ◽

Independent Risk Factor ◽

Maternal Obesity ◽

Normal Body Mass Index ◽

Robson Classification ◽

Increased Risk ◽

History Of

Abstract Background: The aim of this study was to identify characteristics of pregnant women with obesity that contribute to increased cesarean rate.Methods: Retrospective cohort in a single academic institution between 2012 and 2019. Women who delivered during this period were classified according to the Robson classification. Women with normal body mass index (N=11797) and with obesity (N=2991) were compared. The contribution of each Robson group to the overall caesarean rate were compared.Results: The overall cesarean rate was higher for women with (28.1%) than without (14.2%, p < 0.001) obesity. This result came mainly from Robson group 5a (history of one cesarean). After adjustment for medical factors within this group, the association between maternal obesity and cesarean during labor was significant.Conclusions: The higher cesarean rate in women with obesity is explained by Robson group 5a in which obesity is an independent risk factor of in labor cesarean delivery.

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Relaxation of the One Child Policy and Trends in Cesarean Section Rates and Birth Outcomes in China Between 2012 and 2016

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000547293.86024.f5 ◽

2018 ◽

Vol 38 (4) ◽

pp. 195

Author(s):

J. Liang ◽

Y. Mu ◽

X. Li ◽

W. Tang ◽

Y. Wang ◽

...

Keyword(s):

Cesarean Section ◽

Birth Outcomes ◽

One Child Policy ◽

Child Policy ◽

The One

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Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03410-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Simon Crequit ◽

Diane Korb ◽

Cécile Morin ◽

Thomas Schmitz ◽

Olivier Sibony

Keyword(s):

Body Mass Index ◽

Risk Factor ◽

Cesarean Section ◽

Retrospective Cohort ◽

Independent Risk Factor ◽

Maternal Obesity ◽

Normal Body Mass Index ◽

Robson Classification ◽

Increased Risk ◽

History Of

Abstract Background The aim of this study was to identify characteristics of pregnant women with obesity that contribute to increased cesarean rate. Methods Retrospective cohort in a single academic institution between 2012 and 2019. Women who delivered during this period were classified according to the Robson classification. Women with normal body mass index (N = 11,797) and with obesity (N = 2991) were compared. The contribution of each Robson group to the overall caesarean rate were compared. Results The overall cesarean rate was higher for women with (28.1%) than without (14.2%, p < 0.001) obesity. This result came mainly from Robson group 5a (history of one cesarean). After adjustment for medical factors within this group, the association between maternal obesity and cesarean during labor was significant. Conclusions The higher cesarean rate in women with obesity is explained by Robson group 5a in which obesity is an independent risk factor of in labor cesarean delivery.

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Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4)

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1731378 ◽

2021 ◽

Vol 43 (06) ◽

pp. 436-441

Author(s):

Gul Nihal Buyuk ◽

Hatice Kansu-Celik ◽

Zeynep Asli Oskovi Kaplan ◽

Burcu Kisa ◽

Sule Ozel ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Fetal Distress ◽

Vaginal Birth ◽

Low Risk ◽

Cervical Dilatation ◽

Abdominal Circumference ◽

Robson Classification ◽

Multiparous Women ◽

History Of

Abstract Objective The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. Methods The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. Results The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30–3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18–2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04—145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88–5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35–19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1–2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34–3.34; p = 0.001) were associated with the group requiring a C-section. Conclusion This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.

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Changing family and marital structure in China

Psychoanalysis and Psychotherapy in China ◽

10.33212/ppc.v3n2.2020.244 ◽

2020 ◽

Vol 3 (2) ◽

pp. 244-254

Author(s):

David E. Scharff

Keyword(s):

Adolescent Girl ◽

The Other ◽

Chinese Families ◽

National Trauma ◽

One Child Policy ◽

Modern Chinese ◽

Child Policy ◽

Changing Roles ◽

History Of ◽

The One

The author summarises factors that have played on changing roles and configurations in Chinese marriages and families in the last seventy years, including the one-child policy, periods of national trauma, and the recent stresses on families as China becomes more urban, individualistic, and entrepreneurial. He gives two family vignettes, one a couple that faces the strain of different expectations for their marriage, and the other a family with a history of trauma, alcoholism, and a school refusing adolescent girl, illustrating how couples and families experience the strains on modern Chinese families.

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