Maternal and Child Health Journal

, Volume 16, Issue 7, pp 1484–1490 | Cite as

Clinical Indications and Determinants of the Rise of Cesarean Section in Three Hospitals in Rural China

  • Cheng Qin
  • Min Zhou
  • William M. Callaghan
  • Samuel F. Posner
  • Jun Zhang
  • Cynthia J. Berg
  • Gengli Zhao
Article

Abstract

This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

Keywords

Cesarean delivery rate Cesarean indication Rural China 

Notes

Acknowledgments

Dr. Jun Zhang is supported by the Intramural Program of the Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health.

References

  1. 1.
    Betrán, A. P., Merialdi, M., Lauer, J. A., Bing-Shun, W., Thomas, J., Van Look, P., et al. (2007). Rates of caesarean section: analysis of global, regional and national estimates. Paediatric and Perinatal Epidemiology, 21(2), 98–113.PubMedCrossRefGoogle Scholar
  2. 2.
    Zhang, J., Liu, Y., Meikle, S., Zheng, J., Sun, W., & Li, Z. (2008). Cesarean delivery on maternal request in southeast China. Obstetetrics and Gynecology, 111(5), 1077–1082.CrossRefGoogle Scholar
  3. 3.
    Tang, S., Li, X., & Wu, Z. (2006). Rising cesarean delivery rate in primiparous women in urban China: Evidence from three nationwide household health surveys. American Journal of Obstetetrics Gynecology, 195(6), 1527–1532.CrossRefGoogle Scholar
  4. 4.
    Klemetti, R., Che, X., Gao, Y., et al. (2010). Cesarean section delivery among primiparous women in rural China: An emerging epidemic. American Journal of Obstetetrics Gynecology, 202(1), 65.e1–65.e6.CrossRefGoogle Scholar
  5. 5.
    Huang, X. H. (2000). Cesarean delivery in China—today and tomorrow. Zhong Guo Shi Yong Fu Chan Ke Za Zhi. Chinese Journal of Practical Obstetrics and Gynecology, 16(5), 259–261.Google Scholar
  6. 6.
    Wang, L. H., Zhao, G. L., Bao, Y. Q., et al. (1998). An analysis on changing trend of primiparaous cesarean section rates and indications in 25 years. China Journal of Perinatal Medicine, 1(1), 9–12.Google Scholar
  7. 7.
    Feng, X. F., & Sun, J. (2007). Investigation of the social factors influencing cesarean section rate. China Journal of Misdiagnostics, 7(18), 4438–4439.Google Scholar
  8. 8.
    Ma, J., Yan, W. H., Chen, K. X., et al. (2009). Changes of rate and operation indicators of cesarean section during 1997 and 2006. Modern Medicine and Health, 25(5), 671–672.Google Scholar
  9. 9.
    Le, J. (2000). Obstetrics and gynecology (5th ed.). Beijing, China: People’s Health Publishing House.Google Scholar
  10. 10.
    National Institutes of Health. (2006). NIH state-of-the-science conference statement on cesarean delivery on maternal request. NIH Consensus and State-of-the-Science Statement, 23(1), 1–29.Google Scholar
  11. 11.
    Lumbiganon, P., Laopaiboon, M., Gülmezoglu, A. M., et al. (2010). Method of delivery and pregnancy outcomes in Asia: The WHO global survey on maternal and perinatal health 2007–08. Lancet, 375(9713), 490–499.PubMedCrossRefGoogle Scholar
  12. 12.
    Grobman, W. A., Gersnoviez, R., Landon, M. B., Spong, C. Y., Leveno, K. J., Rouse, D. J., et al. (2007). Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstetrics and Gynecology, 110(6), 1249–1255.PubMedCrossRefGoogle Scholar
  13. 13.
    Spong, C. Y., Landon, M. B., Gilbert, S., Rouse, D. J., Leveno, K. J., Varner, M. W., et al. (2007). Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. Obstetrics and Gynecology, 110(4), 801–807.PubMedCrossRefGoogle Scholar
  14. 14.
    Mozurkewich, E. L., & Hutton, E. K. (2000). Elective repeat cesarean delivery versus trial of labor: A meta-analysis of the literature from 1989 to 1999. Am Journal of Obstetetrics and Gynecology, 183(5), 1187–1197.CrossRefGoogle Scholar
  15. 15.
    Zhang, X. S., Zhou, M., & Zhao, G. L. (2006). Analysis of obstetric services of county hospitals in two county hospital in northern and southern areas of China. China Maternal and Child Health, 21(20), 2771–2773.Google Scholar
  16. 16.
    Lu, X. J., & Huang, X. H. (1994). Cesarean delivery rate and perinatal mortality. China Journal of Obstetrics and Gynecology, 29(8), 453–455.Google Scholar
  17. 17.
    Xia, Y. L., Zheng, W. H., & Wang, W. S. (2006). Changes in cesarean delivery rates over 20 years and perinatal mortality. China Journal of Eugenics Genetics, 14(12), 76–77.Google Scholar
  18. 18.
    Liu, L., Tao, F. B., & Huang, K. (2010). Cesarean section rate and its influencing factors in two counties of rural Anhui. China Journal of Public Health, 26(5), 520–521.Google Scholar
  19. 19.
    Han, W., Song, J., & Liu, A. (2011). Trends in live births in the past 20 years in Zhengzhou, China. Acta Obstetricia et Gynecologica Scandinavica, 90(4), 332–337.PubMedCrossRefGoogle Scholar
  20. 20.
    Bogg, L., Huang, K., Long, Q., et al. (2010). Dramatic increase of cesarean deliveries in the midst of health reforms in rural China. Social Science and Medicine, 70(10), 1544–1549.PubMedCrossRefGoogle Scholar
  21. 21.
    Li, N., Wang, Y., & Wang, B. (2007). The partial survey of cesarean section in hospitals and health care unit in China. China Maternal and Child Health, 22(23), 3305–3307.Google Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  • Cheng Qin
    • 1
  • Min Zhou
    • 2
  • William M. Callaghan
    • 1
  • Samuel F. Posner
    • 3
  • Jun Zhang
    • 4
  • Cynthia J. Berg
    • 1
  • Gengli Zhao
    • 2
  1. 1.Division of Reproductive HealthNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Women’s and Children’s Health CenterPeking UniversityBeijingPeople’s Republic of China
  3. 3.National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaUSA
  4. 4.National Institute of Child Health and Human Development, National Institute of HealthRockvilleUSA

Personalised recommendations