Objective To more deeply ascertain the status of cesarean section in a central district of Shanghai in 2015 before implementation of the new family planning strategy of two-child policy in China, and to apply Robson classification to form a cesarean section(CS) rate and classification indicators comparable to the international; then laying a solid foundation for scientific classification.
Methods Childbirth records of pregnant women were collected from all hospitals with maternity service in a central district of Shanghai from January 1 to December 31 of 2015, covered all livebirths with at least 28 weeks gestation or 1 000 g birth weight, which were classified and analyzed according to the Robson classification system.
Results The CS rate in the study district was 44.49% in 2015.Robson classification analysis showed the top three groups with the greatest contribution to overall CS rate was group 2 (nulliparous women with single cephalic pregnancy, 37 weeks gestation who either had labor induced or were delivered by CS before labor)19.68%, group 5(all multiparous women with at least one previous uterine scar, with single cephalic pregnancy, 37 weeks gestation)10.74%, and group 1 (nulliparous women with single cephalic pregnancy, 37 weeks gestation in spontaneous labor) 3.88%.This trend was similar in other hospitals except the secondary general hospital, where the top three groups were indicated as group 5, group 1 and group 2.Among all nulliparous women, group 2 (27.37%) contributed the most to the nulliparous CS rate; while group 5 (38.25%) ranked the top among multiparous women.
Conclusion The CS rate in the study district is higher than that in other districts.The CS is mainly conducted in the nulliparous women and multiparous women with previous CS.The secondary general hospitals mainly reduce the rate of CS in the multiparous women with scar uterus, while other medical institutions mainly reduce the rate of CS in the nulliparous women.
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