title: Cesarean delivery on maternal request in China: what are the risks and benefits?
abstract: OBJECTIVE
  The purpose of this study was to describe the risks and benefits of cesarean delivery on maternal request (CDMR) in a Chinese population.
  
  
  METHODS
  A retrospective cohort study of mode of delivery was conducted at the largest obstetric center in Shanghai, China, from 2007-2013. Eligibility criteria included singleton term nulliparous women with vertex presentation; women with major fetal anomalies or stillbirth before labor were excluded.
  
  
  RESULTS
  A total of 66,226 women were included in the analysis: 40,560 women (61.2%) had planned vaginal birth, with 32,833 spontaneous vaginal deliveries (80.9%), 4990 intrapartum CDs (12.3%), and 2737 assisted vaginal deliveries (6.7%). A total of 16,333 women (24.7%) underwent CDMR. We observed no significant difference between the CDMR and planned vaginal delivery groups in the frequencies of maternal intensive care unit admission (0.2% vs 0.2%), severe postpartum hemorrhage (0.5% vs 0.5%), maternal infection (1.3% vs 1.3%), organ injuries (0.4‰ vs 0.5‰), and thromboembolic disorders (0.1‰ vs 0.1‰). The perinatal mortality rate was similar in the 2 groups (0.4‰ vs 0.6‰; adjusted odds ratio, 0.51; 95% confidence interval, 0.20-1.30; P = .159). The frequencies of birth trauma (0.2‰ vs 1.1‰), neonatal infection (0.4% vs 0.7%), hypoxic ischemic encephalopathy (0.4‰ vs 1.8‰), and meconium aspiration syndrome (0.2‰ vs 0.6‰) were lower; the frequency of respiratory-distress syndrome (0.6% vs 0.4%) was higher in the CDMR group.
  
  
  CONCLUSIONS
  Compared with nulliparous women who tried vaginal delivery, women who underwent CDMR had similar short-term maternal outcomes with some neonatal benefit.
authors: Department of Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University. Shanghai, China. Electronic address: Annaabcd114@hotmail.com.
authors: Xiaohua
authors: X
authors: Liu
authors: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
authors: Mark B
authors: MB
authors: Landon
authors: Department of Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University. Shanghai, China.
authors: Weiwei
authors: W
authors: Cheng
authors: Department of Obstetrics, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University. Shanghai, China.
authors: Yan
authors: Y
authors: Chen
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002681:China; D015331:Cohort Studies; D005260:Female; D006801:Humans; D057240:Patient Preference / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: China; cesarean delivery; maternal morbidity; perinatal death