title: A descriptive analysis of the indications for caesarean section in mainland China.
abstract: BACKGROUND
  In recent decades we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. However, the real reasons for this phenomenon are uncertain. Notably, the number of women requesting elective CS without accepted valid medical indication has also increased, generating a nationwide debate because several studies have shown that this may be the underlying cause of the increase in CS rates observed recently. Therefore, we carried out a multicentre, large-sample, cross-sectional study to describe the CS rate and indications for CS in mainland China during 2011.
  
  
  METHODS
  This was a multicentre, large-sample, cross-sectional study of women who delivered infants in 39 hospitals in 14 provinces in China during 2011. We selected 111, 315 deliveries that occurred during 2011, excluding miscarriages or termination of pregnancy before 28 gestational weeks.
  
  
  RESULTS
  The overall rate of CS in mainland China was 54.90%. The most common indication for CS was caesarean delivery on maternal request (CDMR; 28.43%), followed by cephalo-pelvic disproportion (14.08%), fetal distress (12.46%), previous CS (10.25%), malpresentation and breech presentation (6.56%), macrosomia (6.10%) and other indications (22.12%). CDMR accounted for 15.53% of all the deliveries and 28.43% of all CS deliveries in mainland China.
  
  
  CONCLUSIONS
  CDMR appears to be a considerable driver behind the increasing CS rate in mainland China. The relaxation of China's "one-child policy" may translate into a greater number of CS because of previous CS delivery. To decrease the CS rate, we should first decrease the rate of CS on maternal request. Appropriate policies and guidelines should be considered to accomplish the goal.
authors.forename: Yajun
authors.initials: Y
authors.lastname: Liu
authors.forename: Guanghui
authors.initials: G
authors.lastname: Li
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Yan
authors.initials: Y
authors.lastname: Ruan
authors.forename: Liying
authors.initials: L
authors.lastname: Zou
authors.affiliation: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China. zhangwy9921@hotmail.com.
authors.forename: Weiyuan
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D001946:Breech Presentation / Q000000981:diagnostic imaging / Q000601:surgery*; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D002681:China; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D057240:Patient Preference / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014463:Ultrasonography; D055815:Young Adult