1993至2010年中国部分地区单胎初产妇剖宫产和孕妇要求剖宫产率变化趋势

Secular trends of cesarean delivery and cesarean delivery on maternal request among primiparous women with singleton pregnancy in Southern and Northern China during 1993-2010

目的了解中国部分地区单胎初产妇女剖宫产和孕妇要求剖宫产率的长期变化趋势。方法对象为1993至2010年3省26县（市）单胎初产妇1317774名。用趋势卡方检验探讨剖宫产率的时间变化趋势。结果18年间剖宫产496054例，剖宫产率为37．6％；孕妇要求剖宫产129219例（10．0％）。南方城市剖宫产率从29．4％上升到58．7％，南方农村从18．2％到58．3％，北方农村从4．3％到49．5％。南方城市孕妇要求剖宫产率从0．6％到21．3％，上升34倍；南方农村从0．6％到24．4％，上升40倍；北方农村从0．6％到27．3％，上升44倍。孕妇要求剖宫产占剖宫产比重在3个地区均呈上升趋势。结论中国部分地区18年间剖宫产和孕妇要求剖宫产率显著上升，已居世界最高水平；孕妇要求剖宫产已成剖宫产的主要部分。

Objective To explore the secular trends of cesarean delivery and cesarean delivery on maternal request （CDMR） among primiparous women with singleton pregnancy in Southern and Northern China. Methods The Perinatal Healthcare Surveillance System was established in 26 counties/cities of 3 Chinese provinces since 1993. A total of 1 317 774 primiparous women with singleton pregnancy were monitored through the system during the 1993-2010 period. Chi-square tests were performed to assess the linear trends in the prevalence of cesarean delivery and CDMR. Results During the 18-year period, 496 054 cesarean deliveries and 129 219 CDMRs were identified. The prevalence rates of cesarean delivery and CDMR were 37.6% and 10. 0% respectively. CDMR accounted for 26. 0% of all cesarean births. The prevalence of cesarean delivery increased from 29.4% during the 1993-1995 period to 58.7% during the 2006-2010 in Southern urban area, from 18. 2% to 58. 3% in Southern rural area and from 4. 3% to 49. 5% in Northern rural area. The prevalence of CDMR increased by 34 folds from 0. 6% during the 1993-1995 period to 21.3% during the 2006-2010 period in Southern urban area, by 40 folds from 0. 6% to 24. 4% in Southern rural area and by 44 folds from 0. 6% to 27. 3% in Northern rural area The proportions of CDMR in all cesarean deliveries significantly increased in all three regions. Women aged over 30 years, overweight and well-educated were more likely to experience a cesarean delivery including CDMR. Conclusion The Chinese prevalence rates of cesarean delivery and CDMR increased dramatically during the 1993-2010 period and ranked the highest in the world by 2010. And CDMR became a non-negligible component in all cesarean sections.