title: [Secular trends of cesarean delivery and cesarean delivery on maternal request among primiparous women with singleton pregnancy in Southern and Northern China during 1993-2010].
abstract: OBJECTIVE
  To explore the secular trends of cesarean delivery and cesarean delivery on maternal request (CDMR) among primiparous women with singleton pregnancy in Southern and Northern China.
  
  
  METHODS
  The Perinatal Healthcare Surveillance System was established in 26 counties/cities of 3 Chinese provinces since 1993. A total of 1 317 774 primiparous women with singleton pregnancy were monitored through the system during the 1993 - 2010 period. Chi-square tests were performed to assess the linear trends in the prevalence of cesarean delivery and CDMR.
  
  
  RESULTS
  During the 18-year period, 496 054 cesarean deliveries and 129 219 CDMRs were identified. The prevalence rates of cesarean delivery and CDMR were 37.6% and 10.0% respectively. CDMR accounted for 26.0% of all cesarean births. The prevalence of cesarean delivery increased from 29.4% during the 1993 - 1995 period to 58.7% during the 2006 - 2010 in Southern urban area, from 18.2% to 58.3% in Southern rural area and from 4.3% to 49.5% in Northern rural area. The prevalence of CDMR increased by 34 folds from 0.6% during the 1993 - 1995 period to 21.3% during the 2006 - 2010 period in Southern urban area, by 40 folds from 0.6% to 24.4% in Southern rural area and by 44 folds from 0.6% to 27.3% in Northern rural area. The proportions of CDMR in all cesarean deliveries significantly increased in all three regions. Women aged over 30 years, overweight and well-educated were more likely to experience a cesarean delivery including CDMR.
  
  
  CONCLUSIONS
  The Chinese prevalence rates of cesarean delivery and CDMR increased dramatically during the 1993 - 2010 period and ranked the highest in the world by 2010. And CDMR became a non-negligible component in all cesarean sections.
authors.affiliation: Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China.
authors.forename: Yi-bo
authors.initials: YB
authors.lastname: Zhu
authors.forename: Hong-tian
authors.initials: HT
authors.lastname: Li
authors.forename: Ya-li
authors.initials: YL
authors.lastname: Zhang
authors.forename: Zhi-wen
authors.initials: ZW
authors.lastname: Li
authors.forename: Le
authors.initials: L
authors.lastname: Zhang
authors.forename: Jian-meng
authors.initials: JM
authors.lastname: Liu
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D010298:Parity; D057240:Patient Preference; D011247:Pregnancy; D015995:Prevalence; D055815:Young Adult