Dissecting the current caesarean section rate in Shanghai, China

Yanhong Ming,Meng Li,Jinwen Zhang,Rong Huang,Lin Zhang,Ming Qin,Fei Dai,Jun Zhang,Liping Zhu,Hongping Yu

doi:10.1038/s41598-019-38606-7

Abstract

The high caesarean section (CS) rate has been of great public concern around the world. Yet, large-scale studies of dissecting such a high CS rate are few in the Chinese population. We carried out a cross-sectional survey randomly selecting 10,855 births from 20 hospitals in Shanghai from January to June, 2016. Labor and delivery information was extracted from medical records. The Robson classification system for CS was used to classify all women into ten groups. The overall CS rate was 41.5%. Prelabor CS in nulliparous, term singleton vertex women was the predominant contributor (37.4%) to the total CS and accounted for the second highest proportion of total births (15.5%) in all hospital types. The vast majority of women with a previous CS had a repeat CS (96.6%). CS rate was still high in Shanghai. Nulliparous women in low risk and having CS before labour, often without any medical indication, was a major contributor to the high CS rate.

Highlights

The cesarean section (CS) rate has been rising worldwide over the last two to three decades[1]
Due to the important role of birth weight in mode of delivery[5], we analyzed the mode of delivery according to birth-weight category by Robson Ten-Group Classification System (RTGCS)
Among the 20 hospitals, were located in the city proper (Fig. 1). hospitals delivered fewer than 5,000 births; 4 delivered between 5,000 and 10,000 births; and 4 had more than 10,000 deliveries in 2016

Summary

Introduction

The cesarean section (CS) rate has been rising worldwide over the last two to three decades[1]. The Robson Ten-Group Classification System (RTGCS) offers a useful tool to dissect the overall CS rate and facilitate the understanding of the components. It classifies all deliveries into one of ten groups based on five basic parameters[3]: obstetric history, onset of labor, fetal lie, number of fetuses, and gestational age. The RTGCS is a simple and reliable delivery classification system that has gained wide acceptance by the international obstetric and midwifery community[4]. It enables comparisons between different districts and institutions. Findings of this study may help develop strategies to reduce CS rate in China

Methods

Results

Conclusion