Use of the 10-Group Classification System to analyze how the population control policy change in China has affected cesarean delivery.

Abstract

To analyze the initial effect following the relaxation of China's population control policy on the cesarean delivery (CD) rate using the 10-Group Classification System (TGCS). A retrospective study included all deliveries at a center in Nanjing, China, during 2014-2015. The deliveries were classified using the TGCS. The obstetric populations and the CD rates in each group were compared between 2014 and 2015. Overall, 11006 deliveries were analyzed. The overall CD rate increased from 28.3% (1623/5737) in 2014 to 33.8% (1782/5269) in 2015 (P<0.001). The largest contributor to the overall CD rate-accounting for approximately one-third of all CDs-were nulliparous women with a single cephalic term pregnancy and induced labor or prelabor CD (group 2); the CD rate in this group increased from 27.2% to 31.4%. Moreover, the proportion of women with a single cephalic term pregnancy with previous CD (group 5) steeply increased from 6.4% to 10.4% of all deliveries; the CD rate in this group during 2014-2015 was 76.6%. With China ending its one-child policy, the characteristics of the obstetric population changed. Women with a single cephalic term pregnancy with previous CD were the largest contributor to the CD rate increase.