Study On The Changes Of Cesarean Section Rate,Pregnancy Outcome,Indications Of Cesarean Section Before And After The Opening Of The Two-child Policy In Suzhou Xiangchenng People' Hospital

Objective:To analyze the changes of cesarean section rate,complications of pregnancy,pregnancy outcome and indications before and after the opening of the comprehensive two-child policy,and to further explore the clinical prevention and control measures and hospital management measures for the increase of cesarean section rate.Method:A retrospective study included 15143 deliveries at the Suzhou xiangcheng People' hospital,during 2013-2016.The deliveries were classified by the TGCS.The deliveries were separated into three subgroups,Tl(before the selected two-child policy was conducted),T3(after the universal two-child policy was conducted),T2(interval between the two policies).?2 tests and logistic regression were chosen to Statistical analysis.Results:(1)Among the 15,143 parturients,5204 were delivered by cesarean section,with a rate of 34.37%.Before and after the two-child policy,the cesarean section rates of T1,T2 and T3 were 35.76%,34.34%and 32.96%respectively,showing a decreasing trend,and the differences were not statistically significant.In group 2b(single head first mother,>37 weeks,cesarean section before labor),the number of patients(T3 vs.T 1,6.04%vs.12.46%),the number of cesarean sections(T3 vs.T1,18.32%vs.34.85%),and the total cesarean section rate(T3 vs.T1,6.04%vs.12.46%)were all decreased(p<0.05).In the 5 groups(single head meriparia,?37 weeks,previous cesarean section),the proportion of the number of cesarean sections(T3 vs.T1,17.90%vs.13.67%),the proportion of the number of cesarean sections(T3 vs.T1,53.80%vs.38.02%)and the total cesarean section rate(T3 vs.T1,17.74%vs.13.60%)all increased(p<0.05).(2)The number of repregnancies(T3 vs.T1,57.14%vs.50.34%),cesarean section rate(T3 vs.T1,41.51%vs.37.01%),and scar uterus composition ratio(T3 vs.T1,31.84%vs.27.42%)all increased(p<0.05).(3)Before and after the implementation of the two-child policy,the incidence of pregnancy complications,such as hypertension during pregnancy,uterine fibroids complicated by pregnancy,and anemia complicated by pregnancy,all showed a trend of first increasing and then slightly decreasing,and the overall incidence increased.There were statistically significant differences in the incidence of macrosomia in pregnancy outcomes(T3 vs.T1,10.27%vs.6.01%).The other placenta previa,postpartum hemorrhage,neonatal asphyxia and premature infants had no statistically significant changes in the incidence before and after the policy.(4)After the implementation of the two-child policy,for first-time mothers,macrosomia as the indicator of cesarean section increased from the third line of stage T1 to the first line of stage T3,while cesarean section without indication was at the bottom of stage T2 and T3 after the implementation of the two-child policy.Scar uterus was used as the primary indication in the three stages of parturient women.Conclusion:After the opening of the two-child policy,the total cesarean section rate in our hospital showed a decreasing trend,and the proportion of the number of repregnancies increased significantly,which had a certain impact on the changes of pregnancy complications,pregnancy outcome and cesarean section indications.The management strategy for the implementation of the two-child policy should focus on controlling the rate of cesarean section with "social factors" and increasing the trial rate of scar uterus and vagina.