Abstract 【Abstract】 Objective To analyze the maternal characteristics and indications of caesarean section afterthe implementation of the comprehensive two-child policy, in order to reduce adverse pregnancy outcomes and to promote natural delivery. Methods A total of 3 823 pregnant women who delivered in General Hospital of Northern Theater Command from January 2013 to December 2018 were enrolled. During the three years after the implementation of the comprehensive two-child policy (from January 2016 to December 2018), 2 219 cases of cesarean section women were randomly selected as study group, 1 329 primiparous and 890 multiparas. During the three years before the implementation of the comprehensive two-child policy (form January 2013 to December 2015), 1 609 cases of cesarean section women were randomly selected as control group, 1 302 primiparas and 307 multiparas. The characteristics of pregnant women, the pregnancycomplications and the indications of cesarean section were compared between the study group and control group. Chi-square test was used for statistical analysis. Results There was no statistically significant difference about the age and pregnancy complications between primiparas of the two groups (P>0.05). Thegestational week of primiparas in the study group were higher than those in the control group (χ2= 6.744,P<0.05). The age, the incidence of hypertensive disorders of pregnancy, gestational diabetes mellitus andpostpartum hemorrhage in the multiparas of study group were higher than those in the control group (χ2=57.104, 3.932, 4.145 and 4.030, P<0.05). Among 1 329 primiparas in the study group, the first six indications for cesarean section were fetal distress [36.5% (n=485)], social factors [29.1% (n=387)], pregnancy complications[11.9% (n=158)], dystocia [9.9% (n=132)], abnormal fetal position [6.7% (n=89)] and macrosomia [5.9%(n=78)]. Among 1 302 primiparas in the control group, the first six indications for cesarean section were social factors [34.3% (n=447)], fetal distress [24.2% (n=315)], dystocia [16.4% (n=213)], pregnancy complications [11.0% (n=143)], abnormal fetal position [7.3% (n=95)] and macrosomia [6.8% (n=89)]. The proportions of social factors and dystocia of primiparas in study group were lower than those in control group (χ2=30.884 and 40.502, P<0.01), and the proportions of fetal distress and pregnancy complications were higher than those in control group (χ2=26.025 and 8.647, P<0.01). Among 890 multiparas in the study group, the first six indicators of cesarean section were scarred uterus[70.0% (n=623)], pregnancy complications [12.0% (n=107)], fetus distress [9.9% (n=88)], macrosomia [4.7% (n=42)], abnormal fetal position [2.8% (n=25)] and social factors [0.6% (n=8)]. Among 307 multiparas in the control group, the first six indicators of cesarean section were scar uterus [59.2% (n=182)], fetal distress [14.3% (n=44)], abnormal fetal position [10.1% (n=31)],pregnancy complications [9.1% (n=28)], macrosomia [6.2% (n=19)] and social factors [0.1% (n=3)]. Theproportions of fetal distress, abnormal fetal position and macrosomia in study group were lower than thosein control group (χ2=4.596, 76.265 and 4.513, P<0.05), and the proportions of scarred uterus and pregnancycomplications were higher than those in control group (χ2=11.903 and 4.153, P<0.05). Conclusion After the implementation of two-child policy, the number of primiparas who have cesarean section due to social factors decreases; and in the multiparas, the age and the proportion of cesarean section due to scarreduterus increases.
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Received: 18 March 2021
Published: 29 September 2021
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2021, Vol. 9 
