Peer-reviewed article
Current status of cesarean section in secondary maternal and child health hospitals under new fertility policies: using the Robson classification system.
Hu J, Hu M, Yu W, Wang Y, Dong L et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined cesarean section rates at a Chinese hospital between 2019 and 2023 using the Robson classification system. Overall cesarean rates were 41.4%, with most procedures occurring in first-time mothers with normal pregnancies (40.7%) and women with previous cesareans (35.9%). The cesarean rate for first-time mothers increased significantly over the five-year period, while annual deliveries declined by 24.5% and maternal age increased. The study identifies key patient groups where targeted clinical interventions could reduce unnecessary cesarean deliveries.
Key points
- Overall cesarean section rate of 41.4% at the hospital during 2019-2023
- 76.6% of all cesareans occurred in two groups: nulliparous women with term singleton vertex pregnancies (40.7%) and women with prior cesarean (35.9%)
- Cesarean rate in nulliparous women showed significant upward trend (p < 0.001)
- Annual deliveries declined 24.5% from 2019 to 2023; maternal age increased significantly
- Study identifies need for targeted interventions including standardized labor management and promotion of vaginal birth after cesarean
Limitations
This is a descriptive study at a single secondary hospital and does not establish causality with fertility policy changes. The study does not compare outcomes between cesarean and vaginal deliveries or evaluate the appropriateness of individual cesarean decisions.
Abstract
BACKGROUND: This study was conducted during the implementation period of China’s recent fertility policies, a context in which the management of cesarean section (CS) rates faces evolving challenges. This study evaluated temporal trends in CS practices using the modified Robson Classification System (RCS) at a coastal Chinese secondary maternal and child health(MCH) hospital. METHODS: We analyzed 11,755 deliveries (2019–2023) using electronic medical records categorized via the modified RCS. Statistical analyses included trend tests and regression models. RESULTS: Annual deliveries declined by 24.5% from 2019 to 2023, while maternal age increased significantly (p < 0.001). The overall CS rate was 41.4% (4,865/11,755). Most CSs were associated with nulliparous term singleton vertex pregnancies (R1; 40.7% of CSs) and women with a previous CS (R3; 35.9% of CSs), together constituting 76.6% of all CSs. The CS rate in R1 showed a significant upward trend (p < 0.001). CONCLUSION: This descriptive study of a secondary MCH hospital identifies notable obstetric practice and demographic trends against the backdrop of evolving fertility policies, with a high overall cesarean section rate driven predominantly by two patient groups. Annual delivery volumes see a substantial cumulative decline over the five-year study period, while maternal age rises significantly across the cohort. The overall cesarean section rate remains high, with the majority of cesarean procedures occurring in nulliparous women with term singleton vertex pregnancies and women with a prior cesarean section, who together account for the vast majority of all cesarean deliveries. The cesarean section rate for nulliparous women with term singleton vertex pregnancies also exhibits a marked upward trend during the study period. These trends indicate the need for targeted clinical interventions for key patient groups, including standardized labor management for nulliparous women and the promotion of vaginal birth after cesarean. Notably, this analysis coincides with national demographic and fertility policy shifts, but no causal relationship between the policies and the observed trends is established.