Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China.
BACKGROUND
Cesarean delivery (CD) rates have risen globally with nearly 50% of the non-indicated CDs worldwide in China and Brazil. In China's One Child Policy era (1979-2015) most deliveries were women having their only child. Family size is a major determinant of the safety of medically non-indicated CD or CD on maternal request. The goal of this study is to document CD rates, indications, and analyze the relative safety of non-indicated CD compared to SVD and intrapartum CD.


METHODS
Univariate and multivariate logistic regression analyses of the association between mode of delivery and short-term maternal and perinatal outcomes were performed on a cross-section of all deliveries at 39 hospitals in 14 provinces of China in 2011, presented as adjusted odds ratio (aOR), 99% confidence intervals (CI).


RESULTS
Among 108,847 deliveries, 59,415 were CD (54.6%) with 20.8% of deliveries or 38.2% of all cesareans were non-indicated CD. Compared to SVD, antepartum non-indicated CD was associated with a decreased likelihood of post-partum hemorrhage (PPH) (aOR = 0.80, CI = 0.69-0.92) and was not associated with maternal death or combined severe outcomes (maternal death, transfusion, or hysterectomy). Intrapartum indicated CD was associated with an increased risk of PPH (aOR = 1.68, CI = 1.50-1.89) compared to SVD. Compared to SVD, antepartum non-indicated CD was associated with lower likelihood of neonatal death (aOR = 0.14, CI = 0.06-0.34), neonatal ICU admission (aOR = 0.50, CI = 0.36-0.69), 5-minute Apgar<4 (aOR = 0.06, CI = 0.10-0.36), and respiratory distress syndrome (RDS) (aOR = 0.31, CI = 0.16-0.58), but not significantly associated with changes in rates of infection, hypoxic ischemic encephalopathy (HIEE), birth trauma or meconium aspiration rates.


CONCLUSIONS
In 2011 when 81% of deliveries were women having their first child antepartum non-indicated CD had short-term maternal and perinatal outcomes as safe as SVD. Now that all Chinese women can have a second child the safety profile may change.
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Lei
L
Hou
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, United States of America.
Susan
http://orcid.org/0000-0002-9749-8428
S
Hellerstein
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, United States of America.
Allison
A
Vitonis
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Liying
L
Zou
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Yan
Y
Ruan
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Xin
X
Wang
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Weiyuan
W
Zhang
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*