Determinants Of Elective Caesarean Section In Wuhu

Objectives To explore the trend of delivery modes of puerperas in Wuhu and analyze its impact factors in the past 10 years, in the purpose of providing basic information for reducing the rate of cesarean section in rural area of Wuhu in Anhui province to promote and achieve the ideal delivery expectation in women of reproductive age and guide reasonable medical conduct and improve the pregnant women of medical care resources consumption.Methods Collecting 7088 parturient's clinic records between January 2000 and December 2009, in Wuhu, we described the trend of cesarean section rate in women of childbearing age in Wuhu. By using stratified sampling method,we extracted 490 pregnant woman from Maternal and Child Health hospital and general hospitals in Wuhu , including four areas (Yijian , Shangsang , Jiujiang , Jinghu) and three county(Fanchang, Wuhu, and Nangling), who are joined to complet the questionnaires under the Voluntary basis.Investigation included general condition,Accepted services from Maternal and Child Health, medical Insurance, awareness of Maternal and child health knowledge,Spouse awareness of Maternal and child health knowledge,psychological factors before accouchement, families factors of the accouchement mode of puerpera. Firstly, we analyzed these factors with the single factor analysis, then we established Polynomial logistic regression model using the accouchement mode as dependent variable (1= spontaneous accouchement, 2=medical indication, 3=elective) to summarize the factors related to elective cesarean section.Results A total of 7088 hospital delivery cases in the retrospective study, there are 6265 primiparas (accounting for 88.39%); 823 multipara (accounting for 11.61%), and there are 4849 parturients selected CS as the style of accouchement. The mean age of women was 27.2 years (range from 19 to 41). The trend of cesarean section rate in the past 10 years: cesarean section rate was 53.24% in 2000, reaching 80.04% in 2009. The average of cesarean section rate in 2000-2004 and 2005-2009 was 62.36% and 72.47% respectively. The outcome of questionnaires study was summarized as followes: the mean age of women was 26.81 years (range from 18 to 42), the proportions of rural pregnant and urban pregnant were 59.18% (290/490) and 40.82 % (200/490), respectively. Among these women, 28.4% (137/490) chose to spontaneous delivery. The rates of two kinds of CS are 36.7% (medical indications CS) and 34.9% (social fators CS).Univariate analysis was used to demonstrate the relationship of social factors and selection of delivery style (1= spontaneous delivery, 2=medical indication CS, 3=elective CS ). Incidence of three deliverial styles were significially different in the groups of number of antenatal cares, hospital types, results of prenatal diagnosis, history of abortion, demanding on receiving knowledge about delivery, wether warring about fetus'health, suggestion from parents and law in parents, maternal willingness of caesarean section.By using multivariate logistic regression model, it show that the risk of medical indiction CS inclding married life (OR=3.165,95% CI =1.271-7.881), number of obstetric examinations (OR=3.933,95% CI =1.286-12.035), wether the results of pregnant women's obstetric examinations were abnomal (OR=4.114 , 95% CI =1.180-14.342), wether had history of abortion (OR=2.987,95% CI =1.016-8.785), desired style of accouchement (OR=14.062,95% CI =2.645-74.761), proposions from pregnant women's parent(OR=8.763,95% CI =1.623-47.304), and the protective factors included hospital styles(OR=0.280,95% CI =0.079-0.990), wether the final mode of delivery and the wishing model before were coincidence (OR=0.008, 95% CI =0.002-0.027). Summarily, the risk factors of elective CS are as follows: number of obstetric examinations (OR=3.283,95% CI =1.056-10.208), the kind of wanting to receive knowledge about delivery (OR=7.004,95% CI =1.268-38.685), one's own hoping style of accouchement (OR=25.948,95% CI =4.837-139.190). Conclusions The rate of cesarean section in Wuhu has been rising during the recent ten years, and the proportion of elective CS in total CS is increasing. A variety of sociological factors impact on elective CS. Low quality of health services during pregnancy and maternal willingness of caesarean section are risk factors for elective CS.