title: Obstetrical disease spectrum in China: an epidemiological study of 111,767 cases in 2011.
abstract: BACKGROUND
  No national research on maternal and fetal complications and outcomes has been carried out in the mainland of China in recent years. This study was to provide a scientific basis for better control of obstetrical and neonatal diseases and better allocation of medical resources by analyzing the epidemiological characteristics of obstetrical diseases in the mainland of China.
  
  
  METHODS
  Hospitalized obstetrical cases from 19 tertiary and 20 secondary hospitals in 14 provinces (nationally representative) during the period January 1, 2011 to December 31, 2011 were randomly selected. The general condition, pregnancy complications, and perinatal outcomes of the patients were studied.
  
  
  RESULTS
  The top five medical and surgical complications of pregnant women in the mainland of China were anemia (6.34%), uterine fibroids (2.69%), thyroid disease (1.11%), thrombocytopenia (0.59%), and heart disease (0.59%). The incidences of premature rupture of membranes (PROM), preterm birth, prolonged pregnancy, hypertensive disorders complicating pregnancy (HDCP), multiple pregnancy, intrahepatic cholestasis of pregnancy (ICP), placenta previa, placental abruption, postpartum hemorrhage, and amniotic fluid embolism were 15.27%, 7.04%, 6.71%, 5.35%, 1.57%, 1.22%, 1.14%, 0.54%, 3.26% and 0.06%, respectively. The incidences of anemia and prolonged pregnancy were significantly lower in tertiary than secondary hospitals (P < 0.001), whereas the incidence of uterine fibroids, thyroid diseases, thrombocytopenia, heart disease, PROM, preterm birth, HDCP, multiple pregnancy, ICP, placenta previa, and placental abruption were significantly higher in tertiary than secondary hospitals (P < 0.001). The cesarean section (CS) rate was 54.77%. The newborn sex ratio was 119:100, and 1.03% of the neonates were malformed. The percentages of low birth weight and fetal macrosomia in full-term babies were 2.10% and 7.09%, respectively.
  
  
  CONCLUSIONS
  The incidence of some obstetrical diseases is still high in the mainland of China. The CS rate is much higher than World Health Organization recommendations, in which CS delivery by maternal request (CDMR) accounted for a large proportion. The government should propose solutions to reduce CS rate, especially the rate of CDMR. Most obstetrical complications have higher incidence in tertiary hospitals compared with secondary hospitals. It is important to manage the health of pregnant women systematically, especially those with high-risk factors.
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Luo
authors.affiliation: Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
authors.forename: Wei-Yuan
authors.initials: WY
authors.lastname: Zhang
mesh_terms: D002681:China / Q000453:epidemiology; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*