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What is an appropriate cesarean delivery rate for China: a multi-center survey.

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机构： [1]Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. [2]UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, and Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland. [3]Obstetrics and Gynecology Hospital of Fudan University. [4]Dongguan City Maternal and Child Health Hospital, Southern Medical University, Guangdong, China. [5]Department of Obstetrics and Gynecology, The Second Hospital Affiliated to Shaanxi University of Chinese Medicine, Shaanxi, China. [6]Department of Obstetrics, The Maternal and Child Health Hospital of Xinxiang, Henan, China. [7]Department of Obstetrics, The Maternal and Child Health Hospital of Dalian, Liaoning, China. [8]Department of Obstetrics and Gynecology, Southwest Medical University, Sichuan, China. [9]Department of Obstetrics and Gynecology, The First Hospital Affiliated to Kunming Medical University, Yunnan, China. [10]Department of Obstetrics, Jiangsu Women and Child Health Hospital, Jiangsu, China. [11]The First People's Hospital of Zhaotong, Kunming medical University, Yunnan, China. [12]Department of Obstetrics, The Maternal and Child Health Hospital of Qujing, Yunnan, China. [13]Suining Central Hospital, Chongqing Medical University, Sichuan, China. [14]Taizhou Hospital of Zhejiang Province, Zhejiang, China. [15]Yangzhou Maternal and Child Care Service Centre, Jiangsu, China. [16]Qingdao Chengyang People's Hospital, Shandong First Medical University, Shandong, China. [17]Department of Obstetrics, The Maternal and Child Health Hospital of Baoji, Shaanxi, China. [18]Yanshi City People's Hospital, Henan, China. [19]Department of Obstetrics and Gynecology, Aviation Hospital of Beijing, China Medical University, Beijing, China. [20]Department of Obstetrics, The Maternal and Child Health Hospital of Luohu District, Shenzhen, China. [21]Yanan University Affiliated Hospital, Shaanxi, China. [22]Haikou Hospital of the Maternal And Child Health, Hainan, China. [23]The First People's Hospital of Taizhou, Wenzhou Medical University, Zhejiang, China. [24]The Second Affiliated Hospital of Hebei North University, Hebei, China. [25]Department of Obstetrics and Gynecology, The 174th Hospital of the Chinese People's Liberation Army, Xiamen University, Fujian, China. [26]Puyang Maternal and Child Care Centers, Henan, China. [27]Luzhou People's Hospital, Sichuan, China. [28]Affiliated Hospital of Jiangsu University, Jiangsu, China. [29]The Second People's Hospital of Tongxiang, Zhejiang, China. [30]The Central Hospital of Shaoyang, University of South China, Hunan, China. [31]Affiliated Hospital of Zunyi Medical University, Guizhou, China. [32]The First Affiliated Hospital of Anhui Medical University, Anhui, China. [33]Department of Obstetrics, The Maternal and Child Health Hospital of Cangzhou, Hebei, China. [34]The Second People's Hospital of Qingyuan City, Guangdong, China. [35]Department of Obstetrics and Gynecology, Fujian Medical University Union Hospital, Fujian Medical University, Fujian, China. [36]The People's Hospital of Pengzhou, Sichuan, China. [37]Department of Obstetrics, Eastern District of The Fourth Hospital of Hebei Medical University, Hebei, China. [38]Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. [39]Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. [40]Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto (SP), Brazil. [41]Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. [42]Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.

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To assess the current status of cesarean delivery (CD) in China, propose reference CD rates for China overall and by regions, investigate the main indications for CDs, and identify possible areas for safe reduction.A multi-center cross-sectional study.A total of 94 hospitals across 23 provinces in China.A total of 73977 randomly selected deliveries.We used a modified Robson classification to characterize CDs in subgroups and by regions, and the WHO C-Model to calculate reference CD rates.CD rates in China.In 2015 and 2016, the overall CD rate in China was 38.9% (95% CI: 38.6% to 39.3%). Considering the obstetric characteristics of the population, the multivariable model-based reference CD rate was estimated at 28.5% (95%CI: 28.3% to 28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% of relative reduction) may be considered. The CD rate varied substantially by regions. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labor dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). 12.7% women had prelabor CDs, contributing to 32.8% of the total CDs.Nearly 39% of births were delivered by cesarean in China but a quarter of reduction may be considered. Repeat CD contributed more than one-third of total CDs. Given the large variation in maternal characteristics, region-specific or even hospital-specific reference CD rates are needed for precision management of CD.This article is protected by copyright. All rights reserved.

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出版当年[2022]版：

大类 | 1 区

医学

小类 | 1 区妇产科学

最新[2023]版：

大类 | 1 区

医学

小类 | 1 区妇产科学

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出版当年[2021]版：

Q1 OBSTETRICS & GYNECOLOGY

最新[2023]版：

Q1 OBSTETRICS & GYNECOLOGY

影响因子： 4.8 最新[2023版] 6 最新五年平均 7.331 出版当年[2021版] 7.37 出版当年五年平均 6.531 出版前一年[2020版] 5.8 出版后一年[2022版]

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第一作者机构： [1]Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.

通讯作者：

通讯机构： [38]Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. [41]Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. [42]Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China. [*1]Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Rd, Shanghai, 200092, China. [*2]Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of medicine, 2699 West Gaoke Rd, Pudong New District, Shanghai 201204, China. [*3]The First Affliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuzhong District, Chongqing, 40000, China.

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