Cesarean Delivery in China: Analysis of Cesarean Deliveries Without Indication [34]

INTRODUCTION: Since the 1990s, China's cesarean delivery rate has risen from less than 10% to one of the highest cesarean delivery rates in the world, estimated at around 50%. The rate of cesarean delivery without medical indication has increased from 0.6% to 21–27%. The objective of this study was to analyze the cesarean deliveries without indication. METHODS: A large retrospective review of discharge summaries and chart review of all deliveries in 39 hospitals in three geographic regions of Mainland China from January 1 to December 31, 2011, was evaluated for cesarean delivery rates and indications for delivery. RESULTS: A survey of a total of 112,138 women at delivery with gestation ages greater than 24 weeks was analyzed. The cesarean delivery rate was 54.5% (61,084), with regional variation from 51.1% to 65.6%. Only 7.8% of cesarean deliveries were repeat. Sixty-five percent of the cesarean deliveries were scheduled and performed before labor. Overall, 20.9% of deliveries or 38.4% of cesarean deliveries were performed without internationally recognized medical indications, with the highest rate (52% of cesarean deliveries) in central China. Of the cesarean deliveries without indication, 85% were performed before labor. Maternal request accounted for 57% of cesarean deliveries without indication. Other physician diagnoses accounted for the remainder of nonindicated cesarean deliveries, including antepartum determination of cephalopelvic disproportion (20.2%), age older than 35 years (11.2%), “precious baby” (3.2%), nuchal cord without fetal distress (1.45%), and myopia (1%). CONCLUSION: Efforts to reduce cesarean delivery rates in China may focus on scheduled cesarean deliveries without indication, but relative safety of delivery choices needs further analysis.