| Objective Caesarean section is one of the most commonly used methods to save the lives of pregnant women and perinatal babies when high-risk pregnancy complications,abnormal pregnancy,or abnormal delivery occur.With the advancement of medical technologies,the rate of cesarean section in our country has increased gradually,meanwhile the detrimental consequences of cesarean section have also been increased.In view of the long-standing high cesarean section rate in China,how to reduce the cesarean section rate has become an important public health problem.With the full release of the two-child policy on January 1,2016,it is unknown whether this fertility policy will have an impact on the choice of maternal mode of delivery.Therefore,the purpose of this study was to describe the rate of caesarean section before and after the release of two-child policy based on data from a top-level hospital in Shandong province,and to explore the changes in risk factors for cesarean section.Methods We collected information on 1244 pregnant women(before the release of two-child policy:n=656 and after the release of two-child policy:n=588)from February 2015 to June 2015 before the release of two-child policy and February 2017 to June 2017 after the release of two-child policy in a top-level hospital in Shandong Province,including the basic information of pregnant women and newborns,medical indications related to cesarean section,and social factors.A case-control study was used.EpiData 3.1 was used for data collection and R 3.3.3 was used for statistical analysis.Continuous variables were described as mean ± standard deviation(x±s).Categorical variables were represented by n(%).If the variances of continuous variables between two groups were equalt test was used to compare the differences between groups.If not,the t'test was used.The chi-square test was used for comparing the differences in categorical variables between groups and the Fisher's exact test was used if the theoretical frequency was less than 1.Univariate logistic regression model was used to select significant variables,and the multivariate logistic regression model was conducted to analyze the factors that affect the cesarean section before and after the release of the two-child policy.P<0.05 indicated that the difference was statistically significant.Results The cesarean section rate before the release of the two-child policy(40.9%)was significantly higher than the rate after the release of two-child policy(29.6%)and the difference was statistically significant(P<0.01).The basic characteristics of pregnant women and newborn babies were compared between the cesarean section group and the natural delivery group before and after the release of the two-child policy,respectively.The main results showed that:(1)for the continuous variables,age,weight,body mass index,number of pregnancies,number of previous cesarean sections,number of years to last pregnancy,and neonatal weight were higher in the cesarean section group than in the normal delivery group,and the difference was statistically significant(all P<0.05).The maternal gestation period and the number of previous births in the natural delivery group were higher than those in the cesarean section group and the difference between the two groups was statistically significant.For the categorical variables,the rate of pregnant women in the cesarean section group who had scar uterus,uterine fibroids,pregnancy with diabetes,abnormal fetal position,fetal distress composition ratio was higher than that in natural delivery group.For neonates who are macrosomia or twins,the proportion of cesarean section was higher than the natural delivery.(2)The factors which were significantly different before the release of two-child policy,but not significantly different after the release of policy were:hypertension,pregnancy with hypertension,premature rupture of membranes and social factors;(3)Factors that were not significantly different before the release of two-child policy,but were significantly different after the release of policy were heights and preterm birth.The results of univariate logistic models showed that:(1)both before and after the release of the two-child policy,those with older maternal age,heavier body weight and higher body mass index,more times of maternal birth and cesarean sections,longer years to the previous pregnancy,amniotic fluid problems,and those with scarred uterus,pregnancy diabetes,uterine fibroids,abnormal fetal position,fetal distress,or overweight newborn children or twins were more likely to choose caesarean section;(2)the number of previous births was a protective factor for cesarean section both before and after the release of two-child policy;(3)systolic blood pressure,diastolic blood pressure,hypertension,and pregnancy-associated hypertension were risk factors for cesarean section before the release of two-child policy,but became non-significant variables after the release of two-child policy;(4)height had no effect on cesarean section before the release of two-child policy but became a risk factor after the release of two-child policy.The multivariate logistic regression analyses for examining the affecting factors of cesarean section before and after the release of the two-child policy were performed,separately.The results were as follows:(1)the risk factors for caesarean section before and after the release of two-child policy were:older maternal age(before release:OR = 1.15,95%CI:1.07?1.24;after release:OR=1.13,95%CI:1.03?1.23),scarring the uterus(before release:OR=49.90,95%CI:18.14?180.69;after release:OR=47.94,95%CI:19.10?142.19),macros(before release:OR=8.85,95%CI:4.14?19.94;after release:OR=7.32,95%Cl:2.71?20.61),abnormal fetal position(before release:OR= 208.51,95%CI:39.18 to 3918.36;after release:OR=42.95,95%CI:11.67 to 216.16),pregnancy with hypertension(before release:OR=5.93,95%CI:2.35?15.81;after release:OR=3.94,95%CI:1.00 to 14.86),amniotic fluid factor(before release:OR=3.94,95%Cl:2.02 to 7.66;after release:OR=2.80,95%CI:1.21?6.34);(2)the protective factor for cesarean section before and after the release of the two-child policy was the number of previous normal deliveries(before release:OR=0.09,95%CI:0.04 to 0.22;after release:OR=0.07,95%CI:0.02?0.20);(3)the body mass index(kg/m2)did not affect the occurrence of cesarean section whether before or after the release of the two-child policy;(4)pregnancy with diabetes was a risk factor for cesarean section before the release of two-child policy,but the effect on the cesarean section was not statistically significant after the release of policy(before release:OR=3.60,95%CI:2.07?6.30;after release:OR=1.60,95%CI:0.80?3.17);(5)Twins(OR=12.94,95%CI:2.13 to 109.85),intrauterine distress(OR=35.52,95%CI:8.09 to 262.51),and uterine fibroids(OR=8.17,95%CI:1.37-68.31)were three major risk factors for cesarean section before the release of two-child policy,but there were no statistically significant effects on cesarean section after the release of policy.Conclusions 1.The rates of cesarean section were both at relatively high levels regardless of the release of two-child policy,but the rate of caesarean section after the release of policy has decreased significantly.2.The older maternal age,scarring uterus,macrosomia,abnormal fetal position,pregnancy with hypertension,amniotic fluid factors were the main risk factors for cesarean section both before and after the release of the two-child policy.3.The different risk factors for caesarean section before and after the release of two-child policy were as follows:(1)before the release of two-child policy,pregnancy-associated diabetes was a risk factor for cesarean section,but not after the release of policy.(2)Prior to the release of the two-child policy,twins,fetal distress and uterine fibroids were three major risk factors for cesarean section,but not after the release of policy. |
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