Abstract
BackgroundCesarean delivery (CD) rates have risen globally with nearly 50% of the non-indicated CDs worldwide in China and Brazil. In China’s One Child Policy era (1979–2015) most deliveries were women having their only child. Family size is a major determinant of the safety of medically non-indicated CD or CD on maternal request. The goal of this study is to document CD rates, indications, and analyze the relative safety of non-indicated CD compared to SVD and intrapartum CD.MethodsUnivariate and multivariate logistic regression analyses of the association between mode of delivery and short-term maternal and perinatal outcomes were performed on a cross-section of all deliveries at 39 hospitals in 14 provinces of China in 2011, presented as adjusted odds ratio (aOR), 99% confidence intervals (CI).FindingsAmong 108,847 deliveries, 59,415 were CD (54.6%) with 20.8% of deliveries or 38.2% of all cesareans were non-indicated CD. Compared to SVD, antepartum non-indicated CD was associated with a decreased likelihood of post-partum hemorrhage (PPH) (aOR = 0.80, CI = 0.69–0.92) and was not associated with maternal death or combined severe outcomes (maternal death, transfusion, or hysterectomy). Intrapartum indicated CD was associated with an increased risk of PPH (aOR = 1.68, CI = 1.50–1.89) compared to SVD. Compared to SVD, antepartum non-indicated CD was associated with lower likelihood of neonatal death (aOR = 0.14, CI = 0.06–0.34), neonatal ICU admission (aOR = 0.50, CI = 0.36–0.69), 5-minute Apgar<4 (aOR = 0.06, CI = 0.10–0.36), and respiratory distress syndrome (RDS) (aOR = 0.31, CI = 0.16–0.58), but not significantly associated with changes in rates of infection, hypoxic ischemic encephalopathy (HIEE), birth trauma or meconium aspiration rates.ConclusionsIn 2011 when 81% of deliveries were women having their first child antepartum non-indicated CD had short-term maternal and perinatal outcomes as safe as SVD. Now that all Chinese women can have a second child the safety profile may change.
Highlights
Cesarean delivery (CD) rates have risen rapidly globally [1,2] with nearly 50% of the world’s non-indicated CD [3] done in China and Brazil
This study aims to document CD rates, indications for CD, and to study the associations between mode of delivery and short-term maternal and perinatal outcomes in China with a focus on non-indicated CD
Compared with SVD, non-indicated antepartum CD was associated with lower risk of post-partum hemorrhage (PPH) while all other modes of delivery were associated with increased risk PPH risk
Summary
Cesarean delivery (CD) rates have risen rapidly globally [1,2] with nearly 50% of the world’s non-indicated CD [3] done in China and Brazil. Non-indicated CD, including cesarean delivery on maternal request (CDMR) and other indications not recognized internationally, accounts for a large portion of China’s high CD rate. In China, the definition of CDMR is less clear and studies use the terms CD on maternal request and CD for “social influence” variably for non-indicated CD. Cesarean delivery (CD) rates have risen globally with nearly 50% of the non-indicated CDs worldwide in China and Brazil. Size is a major determinant of the safety of medically non-indicated CD or CD on maternal request. The goal of this study is to document CD rates, indications, and analyze the relative safety of non-indicated CD compared to SVD and intrapartum CD
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