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

Yan-Jie Ji,Huixia Yang,Hai-Bo Wang,Jie Yan,Da-Jian Long,Kaidong Ma,Yang-Feng Wu,Yun-Xiu Li,Zhi Bai

doi:10.3389/fmed.2021.774487

Abstract

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.

Highlights

Cesarean sections (CSs) with medical indication can effectively reduce maternal and neonatal morbidity and mortality, overuse of CS is a threat to the health of the mother and the child [1, 2]
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
This was a retrospective cohort study conducted in two hospitals in Guangdong Province of China: Longhua Hospital located in Shenzhen and Dongguan Hospital located in Dongguan, which is next to Shenzhen

Summary

Introduction

Cesarean sections (CSs) with medical indication can effectively reduce maternal and neonatal morbidity and mortality, overuse of CS is a threat to the health of the mother and the child [1, 2]. In contrary to the recommendation, the worldwide CS rate has increased dramatically during the past 30 years and has led to global concerns [5, 6]. This significant increase has been driven mainly by non-medically indicated CS in many countries [7]. 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%.

Methods

Results

Conclusion