Abstract
BackgroundAntenatal ultrasound scan is a widely accepted component of antenatal care. Studies have looked at the relationship between ultrasound scanning and caesarean section (CS) in certain groups of women in China. However, there are limited data on the utilization of antenatal ultrasound scanning in the general population, including its association with CS. The purpose of this study is to describe the utilization of antenatal ultrasound screening in rural Eastern China and to explore the association between antenatal ultrasound scan and uptake of CS.MethodsBased on a cluster randomized sample, a total of 2326 women with childbirth participated in the study. A household survey was conducted to collect socio-economic information, obstetric history and utilization of maternal health services.ResultsCoverage of antenatal care was 96.8% (2251/2326). During antenatal care, 96.1% (2164/2251) women received ultrasound screening and the reported average number was 2.55. 46.8% women received at least 3 ultrasound scans and the maximum number reached 11. The CS rate was found to be 54.8% (1275/2326). After adjusting for socio-demographic and clinical variables, it showed a statistically significant association between antenatal ultrasound scans and uptake of CS by multivariate logistic regression model. High husband education level, high maternal age, having previous adverse pregnant outcome and pregnancy complications during the index pregnancy were also found to be risk factors of choosing a CS.ConclusionsA high use of antenatal ultrasound scan in rural Eastern China is found and is influenced by socio-demographic and clinical factors. Evidence-based guidelines for antenatal ultrasound scans need to be developed and disseminated to clinicians including physicians, nurses and sonographers. Guidance about the appropriate use of ultrasound scans should also be shared with women in order to discourage unreasonable expectations and demands. It is important to monitor the use of antenatal ultrasound scan as well as the indications for caesarean section in rural China.
Highlights
Antenatal ultrasound scan is a widely accepted component of antenatal care
This paper reports a study in rural Eastern China where the use of antenatal ultrasound scans is frequent with 96.1% women reporting having received at least one scan during pregnancy
In another study in China, it is found that women who give birth at home have an average of 2.3 ultrasound scans, whilst women delivering in hospital tend to have more antenatal visits and more ultrasound scans [39]
Summary
Antenatal ultrasound scan is a widely accepted component of antenatal care. Studies have looked at the relationship between ultrasound scanning and caesarean section (CS) in certain groups of women in China. Countries with high coverage of skilled maternal care often face problems related to frequent utilization of instrumental intervention, the commonest two are high rate of Caesarean Section (CS) and overuse of antenatal ultrasound scans [1]. There are great discrepancies in the availability and use of CS with inability to meet these minimum coverage levels in many low to middle income countries and increasing concern about rising CS rates in other areas. This was recently highlighted in surveys from Asia and Latin America [3,4,5]. In China rates are reported to be increasing twice as much in rural areas compared to urban areas [7,8]
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