Effects of two-child policy on cesarean section rate in China: analysis under Robson Ten-Group Classification
10.3760/cma.j.issn.1007-9408.2018.10.010
- VernacularTitle:以Robson十分类法研究“二孩政策”对剖宫产率的影响
- Author:
Jia WANG
1
;
Qin HUANG
;
Lin JIANG
;
Lijie XIANG
Author Information
1. 215006,苏州大学附属第一医院妇产科
- Keywords:
Cesarean section;
Logistic models;
Population surveillance
- From:
Chinese Journal of Perinatal Medicine
2018;21(10):691-696
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the changes in cesarean section rate(CSR) after the announcement of universal two-child policy using the Robson Ten-Group Classification.Methods A retrospective study was conducted to analyze 9 734 deliveries in the First Affiliated Hospital of Soochow University from January 2013 to August 2016.All deliveries were classified by the Robson Ten-Group Classification System and divided into three subgroups including phase 1(delivered between January 2013 and November 2013,the period before the selective two-child policy was implemented),phase 3(delivered between October 2015 and August 2016,the period after the universal two-child policy was implemented) and phase 2 (delivered between December 2013 and September 2015,the transition period from selective two-child policy to the universal two-child policy).Changes in CSR were analyzed by Chi-square test and Logistic regression.Results The cesarean section deliveries in Group 2b (singleton,cephalic presentation,primipara,≥ 37 gestational weeks,cesarean section before labor) and group 5 (singleton,cephalic presentation,multipara with at least one cesarean section history,≥ 37 gestational weeks) accounted for 52.78％ (2 062/3 907) of the total cesarean section deliveries.The overall CSR decreased in phase 3 than in phase 1 [34.29％ (654/1 907) vs 43.71％ (1 112/2 544),x2=40.376,P=0.000],and the most remarkable decline was found in group 2b [5.35％ (102/1 907) vs 14.27％ (363/2 544),x2=92.700,P=0.000].Compared with phase 1,in all deliveries,the constituent ratio of deliveries of groups 1 and 2 (singleton,cephalic presentation,primipara,≥ 37 gestational weeks) was decreased in phase 3 [50.24％ (958/1 907) vs 60.34％ (1 535/2 544),x2=45.145,P=0.000],while that in groups 3 and 4 (singleton,cephalic presentation,multipara,≥ 37 gestational weeks,no cesarean section history) [21.66％ (413/1 907) vs 16.71％ (425/2 544),x2=17.483,P=0.000] as well as in group 5 [14.47％ (276/1 907) vs 9.28％ (236/2 544),x2=28.910,P=0.000] were increased.In group 5,the rate of vaginal birth after cesarean in phase 3 was higher than that in phase 1 [17.39％ (48/276) vs 2.54％ (6/236),x2=29.732,P=0.000].Conclusions The proportion of multiparae significantly increases,while the overall CSR significantly decreases after the implementation of universal two-child policy in China.Gravidas in groups 2b (singleton,cephalic presentation,primipara,≥ 37 gestational weeks,cesarean section before labor) and 5 (singelon,cephalic presentation,multipara with at least one cesarean section history,≥ 37 gestational weeks) are the most important target population in attempting to reduce CSR in China.
