广州市出生队列研究:孕产妇综合干预降低剖宫产率
创作:Epi汪 审核:Epi汪 2019年07月11日
  • 广东省分别在2010-2014、2014-2016年针对孕产妇实施了两个阶段的干预措施,主要包括健康教育、专业技能培训、设备技术支持以及电子信息系统等方面;
  • 将2008-2010年的产妇作为基线,共纳入三个时期共192万余名孕产妇信息;
  • 三个时期平均剖宫产率(CS)在42.4%、39.8%和35.0%,趋势检验提示下降有统计学意义;
  • CS率的下降主要集中在初次妊娠的女性中;
  • 全面二孩正常颁布前后对CS率无影响;
  • 两干预阶段的孕产妇、围产儿死亡率均下降。
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Epi汪
本文通过前后对照研究设计,以政策实施的前后时间点作为分组依据,比较不同政策实施前后剖宫产率以及孕产妇死亡率的差别,结果提示这种综合干预措施在降低剖宫产率以及孕产妇、新生儿死亡率方面作用显著,尤其是第二阶段。这是我国大型出生队列研究取得的阶段性成果,值得其他地区参考和借鉴。
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PLoS Medicine [IF:10.5]

Effect of a two-stage intervention package on the cesarean section rate in Guangzhou, China: A before-and-after study

广州两阶段干预方案对剖宫产率的影响:一项前后对照研究

10.1371/journal.pmed.1002846

2019-07-08, Article

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Background: The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China.
Methods and findings: This intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010–September 2014 and October 2014–December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period. A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: −0.09 [95% CI −0.16 to −0.02] between Stage 1 and baseline, p = 0.014; −0.11 [95% CI −0.20 to −0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = −4.368, p < 0.001) and PMR (Z = −13.142, p < 0.001) declined by stage over the intervention period. One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed.
Conclusions: Apparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou’s experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS.

First Authors:
Xiaoyan Xia,Zehong Zhou

Correspondence Authors:
Huimin Xia,Xiu Qiu

All Authors:
Xiaoyan Xia,Zehong Zhou,Songying Shen,Jinhua Lu,Lifang Zhang,Peiyuan Huang,Jia Yu,Li Yang,Ping Wang,Kin-bong Hubert Lam,Bo Jacobsson,Ben Willem Mol,Huimin Xia,Xiu Qiu

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