[Cesarean delivery rate and indications in mainland China: a cross sectional study in 2011]

To estimate cesarean delivery rates and indications by region in mainland China.

A cross sectional survey of all deliveries in 39 hospitals in 14 provinces of mainland China from January 1 to December 31, 2011 was evaluated for mode of delivery, cesarean delivery rates and indications for delivery.

(1) A survey of a total of 112 138 women at delivery with gestations greater than 24 weeks was analyzed. 79 631 and 32 507 deliveries were obtained from the tertiary and secondary hospitals respectively. 90 971 were primipara, 21 167 were multipara. Of these pregnancies, 61 084, 49 734 and 1 320 cases resulted in cesarean delivery, vaginal delivery and operative vaginal delivery respectively, the cesarean delivery rate was 54.472% (61 084/112 138). Among 61 084 women who had cesarean delivery, 14 998 cases of the cesarean deliveries were performed without medical indications, 46 086 cases of the cesarean deliveries had medical indications. The cesarean delivery rate of the tertiary hospitals was 55.927% (44 535/79 631), and was significant higher than that in the secondary hospitals (50.909%, 16 549/32 507; P < 0.01). (2) Overall 24.553 % (14 998/61 084) of cesarean deliveries were performed without medical indications. 19.744% (8 793/44 535) of the cesarean deliveries without medical indications were performed in the tertiary hospitals, and was significant lower than in the secondary hospitals (37.495%, 6 205/16 549;P < 0.01). (3) Maternal request was the most common indication (24.553% of all cesarean deliveries), followed by fetal distress (12.507% , 7 640/61 084), cephalopelvic disproportion (11.787%, 7 200/61 084), previous uterine surgery (10.374%, 6 337/61 084), malpresentation (5.815%, 3 552/61 084), failure to progress (5.710%, 3 488/61 084) and suspected macrosomia (5.594%, 3 417/61 084).

The increasing caesarean section rate in mainland China is explained mainly by the high non-indicated caesarean section rate. The main medical indications of the cesarean deliveries included fetal distress, cephalopelvic disproportion, previous uterine surgery, malpresentation and failure to progress.