LIANG Junhao, SHUI Yanli, ZHOU Yubo, ZHAO Tingting, ZHANG Lirong, LI Hongtian, LU Shichun, LIU Jianmeng
Chinese Journal of Reproductive Health. 2026, 37(4): 301-309.
Objective The aims of this study were to describe the cesarean section rates according to key obstetric characteristics, estimate their contributions to the overall rate, and analyze the recorded indications for performing cesarean sections in low-risk women, demonstrating the typical characteristics of cesarean sections performed in similar institutions and ascertaining crucial populations to control cesarean overuses. Methods A descriptive study. This study included all women who delivered babies at a referral hospital in Anhui between July 2017 and April 2024. Maternal demographic characteristics, obstetric characteristics, and delivery modes were extracted from medical records. Women were first stratified into nulliparous and multiparous groups. They were then divided into eight groups according to modified Robson classification. ≥37 weeks gestation, singleton, cephalic nulliparous women were defined as low-risk women. The primary outcomes were the obstetric-characteristic-specific cesarean section rates, their proportional contributions to the overall cesarean rate, and the distribution of recorded indications among low-risk women. Results A total of 48 627 women were included, with 54.4% being multiparous and 45.6% nulliparous. The cesarean section rate were 37.9% overall, 46.3% for multiparous women, 27.8% for the nulliparous(P<0.001 for multiparous vs. nulliparous), and 23.2% for the low-risk women. The cesarean rate for ≥37 weeks gestation, singleton, cephalic and multiparous women with a uterine scar was 94.1%, being 16.8 times that for the women without a scar(5.6%, P<0.001). The cesarean rates for women with other key obstetric characteristics, including transverse lie, breech, and multiple pregnancy, all stayed high, ranging from 88.3% to 97.4%, despite whether they were multiparous or nulliparous. After adjusting population compositions, the proportional contribution to the overall cesarean rate were 52.3% for ≥37 weeks gestation, singleton, cephalic and multiparous women with a uterine scar, 25.4% for ≥37 weeks gestation, singleton, cephalic and nulliparous women, and 9.6% for all singleton breech women. The contribution made by women with transverse lie or multiple pregnancies, due to the low prevalence in population, was only about 3.0%. In stratified analyses, ≥37 weeks gestation, singleton, and cephalic women with a uterine scar contributed 78.6% to the cesarean rate for multiparous women, and corresponding figure was 75.8% for nulliparous women, i.e. low-risk women. Of the low-risk women with cesarean section, 13.4% had no indications; and other most commonly recorded indications were fetal distress(21.6%), cephalopelvic disproportion(15.4%), and dystocia(10.9%). Conclusion The overall rate of cesarean section was 19% lower than the national average for referral institutions, and the rate for low-risk women was even close to that in Japan or Finland known as low cesarean nations, strongly indicating that the overuse of cesarean section in China could be controlled. To control the overuse, low-risk nulliparous women, ≥37 weeks gestation, singleton, cephalic, multiparous women with a uterine scar, and women with a singleton breech should be targeted. Herein low-risk nulliparous women recorded indications for performing cesarean sections, such as fetal distress and cephalopelvic disproportion, merited further evaluation.
