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Thijssen KMJ, Frenken MWE, Van der Hout-van der Jagt MB, Li W, Mo Z, Westerhuis MEMH, Swan GO. A randomized controlled trial reducing cesarean delivery rates in China by introducing trial of labor after cesarean and electrohysterography. J Matern Fetal Neonatal Med 2024; 37:2376661. [PMID: 39004516 DOI: 10.1080/14767058.2024.2376661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE A cesarean delivery (CD) can affect health of both mother and child and future pregnancies. Since the abandonment of the one-child policy in China, obstetricians tend to perform a repeat CD rather than a trial of labor after cesarean (TOLAC). This study aims to reduce CD rates by increasing vaginal births after cesarean (VBAC) rates and introducing electrohysterography (EHG) for accurate monitoring. METHODS In total, 82 women received counseling regarding TOLAC at the Shijiazhuang Sixth Hospital in China. Women opting for TOLAC were randomized for either external tocodynamometry (TOCO, i.e. standard care) or EHG. The primary outcome was the VBAC rate. Secondary outcomes were indications for CD, percentage of assisted vaginal deliveries, labor duration, maternal blood loss, complications and neonatal outcomes. RESULTS After accounting for preterm delivery and dropouts, all counseled women opted for a TOLAC (100%). After randomization, 42 women were included in the TOCO-group and 37 in the EHG-group. Women did not receive pain medication and labor was not augmented with oxytocin. The VBAC rate was 71.4% in the TOCO-group, versus 78.4% in the EHG-group (p = .48). Birth was assisted with forceps in 11.9% of TOCO-group versus 2.7% of EHG-group (p = .21). One secondary CD (i.e. a shift from intended vaginal delivery to surgical delivery within the same labor) was performed because of a suspicion of uterine rupture (TOCO-group). Other indications for CD were: fetal distress, labor dystocia, fetal position, cephalopelvic disproportion. There were no significant differences in secondary study outcomes. No complications were reported. CONCLUSION This study showed an average VBAC rate of 75%, without any complications, in a hospital with no previous experience with TOLAC. The VBAC rate with EHG-monitoring was higher than TOCO, although this difference was not significant. To demonstrate a significant difference, larger clinical studies are necessary. TRIAL REGISTRATION The Daily Board of the Medical Ethics Committee of The Maternal and Child Hospital of Shijiazhuang approved the study protocol (number 20171018, Dutch Trial Register NL8199).
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Affiliation(s)
- Kirsten Martine Johanna Thijssen
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- University MC Utrecht, Utrecht, The Netherlands
| | - Maria Wilhelmina Elisabeth Frenken
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Marieke Beatrijs Van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Wang Li
- Department of Obstetrics and Gynaecology, The Maternal and Child Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, P.R. China
| | - Zhongfu Mo
- Department of Obstetrics and Gynaecology, The Maternal and Child Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, P.R. China
| | | | - Guid Oei Swan
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Fernandez MG, Coutinho de Carvalho SF, Martins BA, Santos FDSM, Neto FAFP, Medeiros MODA, Bastos Metzger P. Uterine Artery Embolization Versus Hysterectomy in Postpartum Hemorrhage: A Systematic Review With Meta-Analysis. J Endovasc Ther 2024:15266028241252730. [PMID: 38733296 DOI: 10.1177/15266028241252730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
PURPOSE The objective of this study is to perform a meta-analysis comparing the effectiveness of uterine artery embolization (UAE) versus peripartum hysterectomy for acute refractory postpartum hemorrhage (PPH) control. MATERIALS AND METHODS We systematically searched 6 medical databases for studies comparing UAE and hysterectomy in PPH. Outcomes examined were mortality, hospitalization duration (HD) in days, and red blood cells (RBC) units utilization. Statistical analysis used RevMan 5.1.7 and random-effects models. Odds ratios (OR) and mean differences (MDs) with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. RESULTS We included 833 patients from 4 cohort studies, with 583 (70%) undergoing UAE. The UAE population required fewer RBC units (MD: -7.39; 95% CI: -14.73 to -0.04; p=0.05) and had shorter HD (MD: -3.22; 95% CI: -5.42 to -1.02; p=0.004). Lower mortality rates were noted for UAE in the pooled analysis, but no statistical significance. Uterine artery embolization demonstrated lower procedural complications (16.45% vs. 28.8%), in which UAE had less ureter and bladder lesions (OR: 0.05; 95% CI: 0.01-0.38; p=0.004 and OR: 0.02; 95% CI: 0.00-0.15; p<0.001, respectively). Only 35 (6%) required conversion to hysterectomy, while 27 (4.6%) underwent re-embolization with 100% bleeding control. Uterine artery embolization did not hinder fertility, with normal menstruation restored in 19 patients with postoligomenorrhea. CONCLUSION Uterine artery embolization for the control of PPH is associated with lower use of RBC units and HD, but similar rates of mortality are noted when compared to hysterectomy. These results associated with uterine preservation could support its importance for refractory PPH management. CLINICAL IMPACT Uterine Artery Embolization is associated with a shorter hospitalization duration and reduced use of red blood cell units when compared with hysterectomy in refractory postpartum hemorrhage. Although demonstrating similar mortality rates, these findings, together with fertility preservation, support the method incorporation as a valuable option in obstetric services.
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Wang D, Wei T, Zhao F, Huang J. Fertility policy changes, maternal and foetal characteristics and birth timing patterns at a tertiary referral centre in Beijing: a ten-year retrospective study. BMJ Open 2024; 14:e076987. [PMID: 38331854 PMCID: PMC10860061 DOI: 10.1136/bmjopen-2023-076987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE This study aimed to explore the impacts of the changing national fertility policy on maternal and fetal characteristics, and birth timing patterns and provide a basis for the management of the obstetric and midwifery workforce. DESIGN Retrospective cohort study. SETTING Data from medical register of a tertiary referral centre in Beijing, China. PARTICIPANTS We included 20 334 births with a gestational age more than 28 weeks during January 2013-September 2023. MAIN OUTCOMES The main outcomes included birth numbers, maternal age, parity, birth modes, premature rates, neonatal birth weight, and birth timings. RESULTS The birth rates showed a general rising trend before 2016. Afterwards, the birth rates kept decreasing and reached the bottom level in 2022. The caesarean section rates showed a declining trend, while the assisted birth rates were progressively rising, especially among primiparous women. From 2013 to 2022, the proportions of multiparous women (increasing from 9.3% to 36.6%) and women with advanced maternal age (increasing from 11.4% to 34.5%) were on the rise, together with increasing rates of premature birth (increasing from 5.7% to 8.5%) and neonatal low birth weight (rising from 4.3% to 7.2%) in this population. This study found a significant peak of births between 14:00 and 15:00, which remained unchanged despite shifts in the fertility policy (p<0.001 and [Formula: see text] values close to 1, respectively). CONCLUSION The 'three-child' policy did not boost the birth rate further 2 years later after its enactment, and the proportion of multiparous women and women with advanced maternal age were on the rise, accompanied by an increase in rates of premature birth and low birth weight. Targeted training should be offered to healthcare professionals to empower them to deal with possible negative pregnancy outcomes and childbirth complications. Prepregnancy and antepartum education should be parity specific. Adequate midwifery staffing during this 14:00-15:00 is vital to promote a safe birth.
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Affiliation(s)
- Dehui Wang
- Department of Obstetrics and Gynaecology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R.China
| | - Tao Wei
- Department of Obstetrics and Gynaecology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R.China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Jing Huang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Zhu C, Zhang S, Shen L, Ye L, Zhan M, Cai S, Huang J, Wang Z, Chen H. Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China's universal two-child policy: a real-world retrospective study, 2010-2021. BMC Public Health 2024; 24:336. [PMID: 38297279 PMCID: PMC10829306 DOI: 10.1186/s12889-024-17810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND In 2016, the "universal two-child" policy, allowing each couple to have two children, was introduced in China. The characteristic change of the long-term period after the implementation of the universal two-child policy was unclear. We studied trends in the obstetric characteristics and their potential impact on the rates of cesarean section and preterm birth in the era of China's universal two-child policy. METHODS A tertiary center-based study (2010-2021) retrospectively focused single high-risk pregnancies who delivered from the one-child policy period (OCP, 2010-2015) to the universal two-child policy period (TCP, 2016-2021). A total of 39, 016 pregnancies were enrolled. Maternal demographics, complications, delivery mode and obstetric outcomes were analyzed. Furthermore, logistic regression analysis was used to explore the association between the cesarean section rate, preterm birth and implementation of the universal two-child policy, adjusting maternal age, parity, and fetal distress. RESULTS Ultimately a total of 39,016 pregnant women met the criteria and were included in this analysis. The proportion of women with advanced maternal age (AMA) increased from 14.6% in the OCP to 31.6% in the TCP. The number of multiparous women increased 2-fold in the TCP. In addition, the overall rate of cesarean section significantly decreased over the policy change, regardless of maternal age, whereas the risk of preterm birth significantly increased in the TCP. Adjusting for maternal age, parity and fetal distress, the universal two-child policy showed a significantly favorable impact on the cesarean section rate (RR 0.745, 95%CI (0.714-0.777), P < 0.001). Compared to the OCP group, a higher increase in fetal distress and premature rupture of membranes (PROM) were observed in the TCP group. In pregnancies with AMA, there was no increase in the risk of postpartum hemorrhage, whereas more women who younger than 35 years old suffered from postpartum hemorrhage in TCP. The logistic regression model showed that the universal two-child policy was positively associated with the risk of postpartum hemorrhage (RR: 1.135, 95%CI: 1.025-1.257, P = 0.015). CONCLUSIONS After the implementation of the universal two-child policy in China, the rate of the cesarean section significantly decreased, especially for women under 35 years old. However, the overall risk of postpartum hemorrhage increased in women under 35 years old, while there was no change in women with AMA. Under the new population policy, the prevention of postpartum hemorrhage in the young women should not be neglected.
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Affiliation(s)
- Caixia Zhu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaofeng Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lixia Shen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lisha Ye
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minjin Zhan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shiqin Cai
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingwan Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Haitian Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Xie D, Wei J, Wang A, Xiong L, Zou K, Xie Z, Fang J. The effect of China's many-child policy on the number of births and the prevalence of serious teratogenic and disabling defects in Hunan Province. BMC Public Health 2023; 23:2226. [PMID: 37951872 PMCID: PMC10640731 DOI: 10.1186/s12889-023-16583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/22/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND To research the effect of China's many-child policy on the number of births and the prevalence of serious teratogenic and disabling defects (STDDs) in Hunan province. METHODS We performed an observational study based on the Birth Defect (BD) Surveillance System of Hunan Province and chose STDD case cards. From 2012-2022, we defined the following 4 periods: the one-child policy (OCP) (2012.01-2013.12), partial two-child policy (PTCP) (2014.1-2015.12), universal two-child policy (UTCP) (2016.1-2020.12), and the early stage of the three-child policy (ETCP) (2021.1-2022.12). Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the association of policy changes with STDDs. Crame'r's V was calculated to estimate the effect sizes. Joinpoint regression analysis and annual percent change (APC) were used for each segment of the trend. RESULTS A total of 1,652,079 births were included in this analysis. Joinpoint regression analysis showed that the number of perinatal births increased from 2012 to 2017, with APC = 9.52 (95% CI: 7.2 to 11.8), and decreased from 2017 to 2022, with an APC = -10.04 (95% CI: -11.9 to -8.1). The number of mothers over 30 years old gradually increased, from 25.54% during the OCP period to 54.05% during the ETCP period (Ptrend < 0.001). With policy changes, the total prevalence of STDDs increased from 28.10 per 10,000 births during the period of OCP into 46.77 per 10,000 births during the ETCP period by 66.44%. The live birth prevalence of STDDs increased only during the ETCP period (PTCP: OR = 1.27, 95% CI: 0.99-1.24, p = 0.057, UTCP: OR = 1.22, 95% CI: 0.99-1.52, p = 0.067, ETCP: OR = 1.75, 95% CI: 1.37-2.24, p < 0.001). Over the past ten years, there was a decrease in the gestational age at diagnosis (*F = 772.520, p < 0.001), from 24.49 ± 5.65 weeks in 2012 to 20.77 ± 5.17 weeks in 2022. From 2012 to 2022, the percentage of deaths within 7 days decreased with APC = -18.85 (95% CI: -26.4- -10.5, P > 0.05). CONCLUSION Many-child policies were associated with a moderate increase in fertility especially for women in urban areas and older women. However, they have lost the ability to control birth since 2017. The total prevalence of STDDs increased over the entire period, but the live birth prevalence increased only during the ETCP period. The gestational age at diagnosis decreased and the percentage of deaths within 7 days decreased.
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Affiliation(s)
- Donghua Xie
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
- NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital), 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Jianhui Wei
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Aihua Wang
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Lili Xiong
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Kehan Zou
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China
| | - Zhiqun Xie
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
| | - Junqun Fang
- Department of Information Management, Maternal and Child Health Hospital of Hunan Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
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Xiong Y, Jiao G, Zheng J, Gao J, Xue Y, Tian B, Cheng J. Fertility Intention and Influencing Factors for Having a Second Child among Floating Women of Childbearing Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16531. [PMID: 36554418 PMCID: PMC9779096 DOI: 10.3390/ijerph192416531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
In recent years, an increasing number of women participate in population mobility and most of them are of childbearing age. With the continuous expansion of the population size of this group, their fertility intention will have a great impact on the development of China's population. Therefore, the aim of this study was to evaluate the fertility intention and influencing factors on having a second child in floating women. This study employed the data from the 2018 National Migrants Dynamic Monitoring Survey data. A self-designed questionnaire was used to collect information, such as socio-demographics and fertility intention. Descriptive statistical analysis was carried out to obtain the basic characteristics of the main variables. Chi-square and ANOVA tests were used to analyze the differences in the basic characteristics between three groups of women (with intention, without intention and unsure about having a second child). Multinomial logistic regression was employed to analyze influencing factors associated with fertility intention among the floating women. The results of this study indicated that only 13.07% of the floating women had the intention to have a second child, while 67.73% had no intention of having another child. In the multivariate analysis, age, gender and age of the first child, reproductive health education, employment status and medical insurance were found to be significant influencing factors of fertility intention (p < 0.05), while education level and household registration type were not associated with the desire to have a second child (p > 0.05). Overall, after the implementation of the universal two-child policy, floating women of childbearing age have reduced intention to have a second child. Reproductive health education and medical insurance play an important role in ensuring the fertility of floating women. This reminds government departments to consider the above factors comprehensively when formulating the next work plan.
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Affiliation(s)
- Yan Xiong
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
- School of Management, Shanxi Medical University, Taiyuan 030001, China
| | - Guojin Jiao
- School of Management, Shanxi Medical University, Taiyuan 030001, China
| | - Jiaming Zheng
- School of Management, Shanxi Medical University, Taiyuan 030001, China
| | - Jian Gao
- School of Management, Shanxi Medical University, Taiyuan 030001, China
| | - Yaqing Xue
- School of Public Health, Southern Medical University, Guangzhou 510515, China
- School of Health Management, Southern Medical University, Guangzhou 510515, China
| | - Buwei Tian
- School of Management, Shanxi Medical University, Taiyuan 030001, China
| | - Jingmin Cheng
- School of Management, Shanxi Medical University, Taiyuan 030001, China
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Yuan H, Zhang C, Maung ENT, Fan S, Shi Z, Liao F, Wang S, Jin Y, Chen L, Wang L. Epidemiological characteristics and risk factors of obstetric infection after the Universal Two-Child Policy in North China: a 5-year retrospective study based on 268,311 cases. BMC Infect Dis 2022; 22:878. [PMID: 36418982 PMCID: PMC9682668 DOI: 10.1186/s12879-022-07714-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obstetrical infection is one of the causes of maternal death and a difficult problem for many clinicians. Changes in the demographic and obstetric background of pregnant women following the Universal Two-Child Policy may have an impact on some fertility phenomena. And with the increase in the number of deliveries, the limited medical resources become more scarce. How will China's health system quickly adapt to the growing needs and expectations for maternal health and ensure the provision of qualified and accessible medical services? In addition, what social support measures should be provided to reduce preventable obstetric complications? Given the relatively low per capita share of medical resources in China, how should China deal with the impact of the Universal Two-Child Policy? Therefore, more studies based on the change of fertility policy are needed. We try to analyze the epidemiological characteristics and risk factors of obstetric infection before and after the Universal Two-Child Policy, with a view to providing reference for the prevention and control of obstetric infection in regions after the change of fertility policy, and also hope to make corresponding contributions to the solution of the above problems through relevant studies. METHODS The subjects of the survey were 268,311 pregnant women from Hebei Province Maternal Near Miss Surveillance System (HBMNMSS) of Hebei Women and Children's Health Center from January 1, 2013 to December 31, 2017. We analyzed the region, time and population distribution characteristics of obstetric infection, compared the epidemiological factors of obstetric infection before and after the Universal Two-Child Policy, and analyzed the relevant risk factors of obstetric infection. RESULTS The incidence of obstetric infection increased nearly twice after the Universal Two-Child Policy. The incidence of obstetric infection was highest in Chengde (1.9%), a city with a northward geographical distribution, Baoding (1.6%), Cangzhou (1.5%) followed; The higher the hospital grade, the higher the incidence; The incidence of obstetric infections in hospitals at all levels has increased; The age of onset before the Universal Two-Child Policy was (27.82 ± 5.047) years old, and the age after the Universal Two-Child Policy was (28.97 ± 4.880) years old; The incidence of obstetric infections is higher in winter. The rate of abortion-related infection (increased from 0.61 to 1.65%) and the rate of pregnant women with high school education (increased from 0.35 to 0.74%) increased significantly. The results of multivariate Logistic regression analysis after the Universal Two-Child Policy showed that anemia (OR = 1.249, 95%CI: 1.071-1.458), chronic hypertension (OR = 1.934, 95%CI: 1.375-2.722), mild preeclampsia (OR = 2.103, 95%CI: 1.323-3.344) and severe preeclampsia (OR = 2.228, 95%CI: 1.703-2.916) were independent risk factors for obstetric infection. Gestational age ≥ 37 weeks was a protective factor. CONCLUSION After the Universal Two-Child Policy, the prevention and control of obstetric infections should be strengthened, especially for abortion-related infections and elderly maternal with obstetric complications and complication in high-grade hospitals in winter. Educational background is also one of the factors that should be considered in the prevention of obstetric sensation. Prolonging gestational age is helpful to reduce the incidence of obstetric infection.
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Affiliation(s)
- Huiqing Yuan
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051, China
- Graduate School of Hebei Medical University, Shijiazhuang, 050071, China
| | - Cui Zhang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Ei Ni Tar Maung
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, 519000, Guangdong, China
| | - Songli Fan
- Hebei Women and Children's Health Center, Shijiazhuang, 050000, China
| | - Zijia Shi
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051, China
- Graduate School of Hebei Medical University, Shijiazhuang, 050071, China
| | - Fang Liao
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051, China
- Graduate School of North China University of Technology, Tangshan, 063000, China
| | - Shuo Wang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051, China
- Graduate School of North China University of Technology, Tangshan, 063000, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Le Chen
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, 519000, Guangdong, China.
| | - Li Wang
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, 519000, Guangdong, China.
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Huang J, Zheng Q, Nie K, Wei H, Liu L. Association between Gestational Age, Birth Weight, Parental Age at Childbirth, Mode of Delivery, and Infantile Esotropia. Optom Vis Sci 2022; 99:794-799. [PMID: 36413631 PMCID: PMC9704814 DOI: 10.1097/opx.0000000000001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
SIGNIFICANCE This study investigated the potential perinatal risk factors associated with infantile esotropia in a Chinese population, including advanced parental age at childbirth and mode of delivery. The findings may be significant in developing better intervention strategies for infantile esotropia. PURPOSE This study aimed to investigate the associations between gestational age, birth weight, parental age at childbirth, mode of delivery, family history of strabismus, and infantile esotropia in the Chinese population. METHODS Ninety-nine patients with infantile esotropia and 117 control subjects were enrolled between March 2018 and March 2021. Detailed questionnaires were administered to parents to collect relevant information. Univariate and multivariate logistic regression models were used to identify possible risk factors of infantile esotropia. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS Infantile esotropia was associated with low birth weight (<2500 g; OR, 4.235; 95% CI, 1.460 to 12.287; P = .008) and emergency cesarean delivery (OR, 2.230; 95% CI, 1.127 to 4.413; P = .02). CONCLUSIONS The findings suggest that low birth weight and emergency cesarean deliveries are risk factors for infantile esotropia, highlighting a need for collaborative care between obstetricians, pediatricians, and vision care providers.
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Affiliation(s)
- Junting Huang
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Qianwen Zheng
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, China
| | - Kailai Nie
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Wei
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Longqian Liu
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
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Zhang J, Williams GJ, Wang G, Chen J, Zhang M, Du W, Zhu J, Zhang J, Hua J. Early-term birth and its association with universal two-child policy: a national cross-sectional study in China. BMJ Open 2021; 11:e054959. [PMID: 34876437 PMCID: PMC8655521 DOI: 10.1136/bmjopen-2021-054959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and ETB, so as to explain the potential reason for such a relationship and provide evidence for future ETB interventions in the era of the new birth control policy. DESIGN Cross-sectional study. PARTICIPANTS The cross-sectional study used data from China Labour and Delivery Survey between 2015 and 2016. A total of 75 132 survey data collected from 89 hospitals in 25 provinces were included in the analysis. We further explored the association between the universal two-child policy and ETB. RESULTS The weighted incidence of ETB was 30.1 per 100 all births (95% CI 30.06% to 30.14%) or 29.88 per 100 live births (95% CI 29.97% to 30.05%) between 2015 and 2016 in China. There was an association between the universal two-child policy and ETB (relative risk, RR 1.19, 95% CI 1.15 to 1.23), which was not mediated by maternal age (RR 1.17, 95% CI 1.13 to 1.22), previous uterine scars (RR 1.18, 95% CI 1.14 to 1.22), parity (RR 1.19, 95% CI 1.15 to 1.24) and other measured conditions (each p<0.05). Stratified analysis showed that the association between universal two-child policy and ETB were the strongest in multiparous young women or women without previous uterine scars (each p<0.05), and disappeared in all women of advanced maternal age (each p>0.05). CONCLUSION The incidence of ETB was high in China when compared with most of reported countries, and there might be a link between two-child policy and ETB. Obstetric practice such as selective induced labour and caesarean section should be revised with ETB risks in mind, when ETB is more likely to happen under the universal two-child policy. Preventing ETB should not be neglected in multiparous young women or those without previous uterine scars under the new policy.
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Affiliation(s)
- Jie Zhang
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Gareth J Williams
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Guanghua Wang
- Department of Obstetrics and Gynecology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingjing Chen
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Mengyu Zhang
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Jing Zhu
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Hua
- Department of Women and Children's Health Care, School of Medicine,Tongji University, Shanghai, China
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine,Tongji University, Shanghai, China
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Hajimirzaie SS, Tehranian N, Mousavi SA, Golabpour A, Mirzaii M, Keramat A, Khosravi A. Predicting the Relation between Biopsychosocial Factors and Type of Childbirth using the Decision Tree Method: A Cohort Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:437-443. [PMID: 34840384 PMCID: PMC8611215 DOI: 10.30476/ijms.2021.88777.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/13/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Background With the growing rate of cesarean sections, rising morbidity and mortality thereafter is an important health issue. Predictive models can identify individuals with a higher probability of cesarean section, and help them make better decisions. This study aimed to investigate the biopsychosocial factors associated with the method of childbirth and designed a predictive model using the decision tree C4.5 algorithm. Methods In this cohort study, the sample included 170 pregnant women in the third trimester of pregnancy referring to Shahroud Health Care Centers (Semnan, Iran), from 2018 to 2019. Blood samples were taken from mothers to measure the estrogen hormone at baseline. Birth information was recorded at the follow-up time per 30-42 days postpartum. Chi square, independent samples t test, and Mann-Whitney were used for comparisons between the two groups. Modeling was performed with the help of MATLAB software and C4.5 decision tree algorithm using input variables and target variable (childbirth method). The data were divided into training and testing datasets using the 70-30% method. In both stages, sensitivity, specificity, and accuracy were evaluated by the decision tree algorithm. Results Previous method of childbirth, maternal body mass index at childbirth, maternal age, and estrogen were the most significant factors predicting the childbirth method. The decision tree model's sensitivity, specificity, and accuracy were 85.48%, 94.34%, and 89.57% in the training stage, and 82.35%, 83.87%, and 83.33% in the testing stage, respectively. Conclusion The decision tree model was designed with high accuracy successfully predicted the method of childbirth. By recognizing the contributing factors, policymakers can take preventive action.It should be noted that this article was published in preprint form on the website of research square (https://www.researchsquare.com/article/rs-34770/v1).
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Affiliation(s)
- Saiedeh Sadat Hajimirzaie
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Najmeh Tehranian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Abbas Mousavi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Amin Golabpour
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mehdi Mirzaii
- Department of Basic Sciences, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Khosravi
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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11
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Zhou Y, Mu Y, Chen P, Xie Y, Zhu J, Liang J. The incidence, risk factors and maternal and foetal outcomes of uterine rupture during different birth policy periods: an observational study in China. BMC Pregnancy Childbirth 2021; 21:360. [PMID: 33952183 PMCID: PMC8098017 DOI: 10.1186/s12884-021-03811-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background Currently, there are no studies on changes in the incidence of uterine rupture or maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China. Moreover, the results of association studies of maternal age, parity and previous caesarean section number with the risk of maternal and foetal outcomes in women with uterine rupture have not been consistent. This research aims to conduct and discuss the above two aspects. Methods We included singleton pregnant women with no maternal complications other than uterine rupture from January 2012 to June 2019 in China’s National Maternal Near Miss Surveillance System. The data in this study did not differentiate between complete and partial uterine rupture and uterine dehiscence. Through Poisson regression analysis with a robust variance estimator, we compared the incidences of uterine rupture and maternal and foetal outcomes in women with uterine rupture during different birth policy periods in China and determined the relationship between maternal age, parity or previous caesarean section number and uterine rupture or maternal and foetal outcomes in women with uterine rupture. Results This study included 8,637,723 pregnant women. The total incidences of uterine rupture were 0.13% (12,934) overall, 0.05% during the one-child policy, 0.12% during the partial two-child policy (aRR = 1.96; 95% CI: 1.53–2.52) and 0.22% (aRR = 2.89; 95% CI: 1.94 4.29) during the universal two-child policy. The maternal near miss and stillbirth rates in women with uterine rupture were respectively 2.35% (aRR = 17.90; 95% CI: 11.81–27.13) and 2.12% (aRR = 4.10; 95% CI: 3.19 5.26) overall, 5.46 and 8.18% during the first policy, 1.72% (aRR = 0.60; 95% CI: 0.32–1.17) and 2.02% (aRR = 0.57; 95% CI: 0.37–0.83) during the second policy, and 1.99% (aRR = 0.90; 95% CI: 0.52–1.53) and 1.04% (aRR = 0.36; 95% CI: 0.24–0.54) during the third policy. The risk of uterine rupture increased with parity and previous caesarean section number. Conclusion The uterine rupture rate in China continues to increase among different birth policy periods, and the risk of maternal near miss among women with uterine rupture has not significantly improved. The Chinese government, obstetricians, and scholars should work together to reverse the rising rate of uterine rupture and improve the pregnancy outcomes in women with uterine rupture. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03811-8.
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Affiliation(s)
- Yangwen Zhou
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China
| | - Yanxia Xie
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China. .,Key Laboratory of Birth Defects And Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China. .,National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, No. 17 Ren Min Nan Lu, Chengdu City, Sichuan Province, 610041, P. R. China.
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12
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Song C, Xu Y, Ding Y, Zhang Y, Liu N, Li L, Li Z, Du J, You H, Ma H, Jin G, Wang X, Shen H, Lin Y, Jiang X, Hu Z. The rates and medical necessity of cesarean delivery in China, 2012-2019: an inspiration from Jiangsu. BMC Med 2021; 19:14. [PMID: 33487165 PMCID: PMC7831243 DOI: 10.1186/s12916-020-01890-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) in 2015 stated that every effort should be made to provide cesarean delivery (CD) for women in need. In China, the two-child policy largely prompts the number of advanced age childbirth, which raises the possibility of an increasing number of women who need a c-section. The aim of this study was to assess the trends in the overall and medical indication-classified CD rates in the era of the two-child policy in Jiangsu, China. METHODS A retrospective cross-sectional study of 291,448 women who delivered in 11 hospitals in Jiangsu province between 2012 and 2019 was conducted. Medical cesarean indication for each woman was ascertained by manually reviewing the medical records. The 291,448 women were divided into two subgroups according to the presence of the indications: the indicated group (7.80%) and the non-indicated group (92.20%). We then fitted joinpoint regression and log-binomial regression models to estimate trends in the CD rates across the study period. RESULTS The overall CD rate was observed with a declining trend from 52.51% in 2012-2015 to 49.76% in 2016-2019 (adjusted RR, 0.92; 95% CI, 0.91-0.93; P < 0.001), along with an annual percentage change (APC) to be - 1.0 (95% CI, - 2.1 to 0.0) across the period. The participants were then divided into two subgroups according to the presence of medical CD indications: the indicated group (7.80%) and the non-indicated group (92.20%).We found the declining trend was most pronounced in the non-indicated group, with the CD rates decreased from 50.02% in 2012-2015 to 46.27% in 2016-2019 (adjusted RR, 0.90; 95% CI, 0.89-0.90; P < 0.001). By contrast, we observed a steady trend in the CD rate of the indicated group, which maintained from 87.47% in 2012-2015 to 86.57% in 2016-2019 (P = 0.448). In the indicated group, a higher risk of adverse pregnancy outcomes was revealed for those women who delivered vaginally as compared with those who received c-section. We further investigated that women with following specific indications had a higher proportion of vaginal delivery, i.e., pregnancy complications, fetal macrosomia, and pregnancy complicated with tumor (34.70%, 10.84%, and 16.34%, respectively). Women with the above 3 indications were observed with a higher risk of adverse pregnancy outcomes if delivered vaginally. The incidence rates of the medical indications among the general population increased considerably over the 8-year period (P < 0.001). CONCLUSIONS Although the overall CD rate apparently decreased in the recent years, along with the decline of the unnecessary CD rate, a considerable proportion of indicated women were not provided with CD service in Jiangsu, China. Instead of targeting the overall CD rate, we need to take actions to reduce unnecessary CD rate and provide adequate c-section service for women with indications, particularly for those with underlying diseases and suspected fetal macrosomia.
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Affiliation(s)
- Ci Song
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yan Xu
- Department of Maternal and Child Health, Jiangsu Commission of Health, Nanjing, 210008, China
| | - Yuqing Ding
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yanfang Zhang
- Department of Group Health, Women and Children Branch Hospital of Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing Medical University, Nanjing, 210036, China
| | - Na Liu
- Department of Group Health, Women and Children Branch Hospital of Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing Medical University, Nanjing, 210036, China
| | - Lin Li
- Department of Group Health, Women and Children Branch Hospital of Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing Medical University, Nanjing, 210036, China
| | - Zhun Li
- Department of Group Health, Women and Children Branch Hospital of Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing Medical University, Nanjing, 210036, China
| | - Jiangbo Du
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Hua You
- Department of Social Medicine & Health Education, Nanjing Medical University, Nanjing, 211166, China
| | - Hongxia Ma
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Guangfu Jin
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xudong Wang
- Department of Group Health, Women and Children Branch Hospital of Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing Medical University, Nanjing, 210036, China
| | - Hongbing Shen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yuan Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Xiaoqing Jiang
- Department of Group Health, Women and Children Branch Hospital of Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing Medical University, Nanjing, 210036, China.
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China. .,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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13
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Ji J, He Z, Qu P, Gao J, Zhang W, Wu P, Wei J, Zhang T, Ma ZF, Luo X, Mi Y. The Xi'an longitudinal mother-child cohort study: design, study population and methods. Eur J Epidemiol 2021; 36:223-232. [PMID: 33420871 DOI: 10.1007/s10654-020-00704-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022]
Abstract
The large-scale Xi'an longitudinal mother-child cohort study has started to enroll pregnant women who attended Northwest Women's and Children's Hospital (NWCH) for antenatal care in early pregnancy (less than 20 weeks' gestation) from January 2013 and the enrollment will be ended in January 2023. We aimed to investigate the role of external factors (i.e., diet and environment) and internal (i.e., biological, genetic and epigenetic) on the short- and long-term outcomes of mothers and children up to at least 12 years. Mothers completed all routine prenatal care during pregnancy and four times of follow-up at 42 days, 3, 6 and 12 years after delivery, respectively. For children, birth information were obtained from routine medical records and the follow-up information were obtained from child health care clinics of NWCH at age 42 days, 6, 12 and 24 months, then by interviewing mothers every two years until 12 years old. A range of data (including biological, demographic, birth outcomes/birth defects and nutritional factors from both maternal and off-spring) were collected by both interviews and laboratory tests. By June 30th 2019, a total of 114,946 mothers and 124,454 live births had been recruited.
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Affiliation(s)
- Jing Ji
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Zhangya He
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Pengfei Qu
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Jiayi Gao
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Wanyu Zhang
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Pei Wu
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Junxiang Wei
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Tianxiao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zheng Feei Ma
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, 215123, China
| | - Xiaoqin Luo
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Yang Mi
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China.
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14
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Sun G, Lin Y, Lu H, He W, Li R, Yang L, Liu X, Wang H, Yang X, Cheng Y. Trends in cesarean delivery rates in primipara and the associated factors. BMC Pregnancy Childbirth 2020; 20:715. [PMID: 33228631 PMCID: PMC7684937 DOI: 10.1186/s12884-020-03398-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have focused on cesarean delivery (CD) trends among primipara under the one-child and the two-child policies. This study aimed to explore the trends in CD rates among primipara during 1995–2019 and the associated factors with CD risk. Methods This study obtained clinical data on primiparous mothers and newborns from 1995 to 2019 at a large tertiary hospital in Wuhan, China. Trends in CD rates were calculated using the joinpoint regression analysis. The Chi-square tests and log-binomial regression analyses were used to evaluate the associations between primary variables and CD risk. Results CD rates showed a significant upward trend with an average annual percentage change (APC) of 2.2% (95% CI: 0.6, 3.8%) during the study period. In 1995–2006, the CD rates continued to increase with an APC of 7.8% (95% CI: 4.8, 10.9%). After 2006, the CD rates started to decline by an APC of − 4.1% (95% CI: − 5.5, − 2.6%). The CD rates non-significantly increased from 36.2% in 2016 to 43.2% in 2019. Moreover, the highest CD rate during 2015–2019 was observed on August 30 (59.2%) and the lowest on September 1 (29.7%). Primipara of older age and those with >3pregnancies had higher risks of CD. Furthermore, primipara who gave birth to newborns with low birth weight and macrosomia had higher risks of CD. Conclusions Maternal and fetal as well as social and cultural factors may contribute to the rising trend of CD rates. Effective measures should be taken to control CD under the two-child policy, especially for primipara. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03398-6.
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Affiliation(s)
- Guoqiang Sun
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Ying Lin
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Honglian Lu
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Wenjing He
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Ruyan Li
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Lijun Yang
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Xian Liu
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Hongyan Wang
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Xuewen Yang
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China
| | - Yao Cheng
- Obstetrics Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuluo Road 745#, Hongshan District, Wuhan, 430070, Hubei, China.
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15
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Liu X, Huang D, Wang Y, Gao Y, Chen M, Bai Y, Wu M, Luo X, Qi H. Birth and birth-related obstetrical characteristics in southwestern China associated with the current adjustment of family planning policy: a 7-year retrospective study. Sci Rep 2020; 10:15949. [PMID: 32994428 PMCID: PMC7525438 DOI: 10.1038/s41598-020-73039-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022] Open
Abstract
In China, the adjustment of the family planning policy was expected to increase the number of births and trigger a change in the demographic and obstetrical background of pregnant women. The policy itself, and corresponding background variations of the pregnant mothers, might have various influences on certain birth-related characteristics. Moreover, the adaption of the medical system to the policy needs to be demonstrated. To address these issues, over 50,000 individual records from January 2012 to December 2018 were collected from a large tertiary care centre of southwest China as a representative. The monthly numbers of deliveries and births showed stabilized patterns after remarkable upward trends. Policy-sensitive women, among whom older age and multiparity were typical features, contributed considerably to the remarkable additional births. Indeed, multivariable logistic regression analysis identified the child policy and these two background characteristics as factors influencing CS (caesarean section) rate and certain pregnancy complications or adverse outcomes. After the implementation of the two-child policy, a care provider was faced with fewer but more difficult cases. Briefly speaking, more individual-based studies on family planning policy and more efforts to improve obstetrical service are needed to better guide clinical practice in the new era.
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Affiliation(s)
- Xiyao Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Dongni Huang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Yu Wang
- First Clinical Institute, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Yuwen Gao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Miaomiao Chen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.,Maternal and Child Health Hospital of Hubei Province, No. 745 Wuluo Road, Hongshan District, Wuhan, 430070, Hubei, China
| | - Yuxiang Bai
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Mengshi Wu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Xin Luo
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China. .,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China. .,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
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Nabizadeh-Gharghozar Z, Adib-Hajbaghery M, Bolandianbafghi S. Nurses' Job Burnout: A Hybrid Concept Analysis. J Caring Sci 2020; 9:154-161. [PMID: 32963984 PMCID: PMC7492971 DOI: 10.34172/jcs.2020.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction: Job burnout can significantly affect nurses’ physical and mental health and the quality of the care services they provide. Yet, there is no clear definition for job burnout in nursing. This study aimed to analyze the concept of nurses’ occupational burnout. Methods: This concept analysis was conducted, using the three-phase hybrid model. In the theoretical phase, online databases, namely Iranmedex, Scientific Information Database (SID), Science Direct, MagIran, ProQuest, Web of Sciences, Scopus, and PubMed were searched to retrieve studies published from 2007 to 2018. In the fieldwork phase, twelve semi-structured interviews were conducted with nurses and head-nurses selected from teaching hospitals in Isfahan, Iran. The interviews were transcribed and analyzed through thematic analysis. In the final analytic phase, the findings of the first and the second phases were combined. Results: Based on the findings of the theoretical and the fieldwork phases, job burnout can be defined as, “a state of physical, mental, emotional, and social exhaustion resulting from the negative effects of unmanaged occupational stress and inadequate managerial and social support, which reduces interest in and motivation for work, affects care quality, and results in negative attitudes and behavior towards self, clients, and the work”. Conclusion: This study provides an in-depth understanding of the concept of job burnout in the nursing context of Iran. Managers need to develop strategies for job burnout prevention and management based on its contributing factors.
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Zhao F, Xu Y, Chen YT, Cheng JY, Pan XY. Influence of the universal two-child policy on obstetric issues. Eur J Obstet Gynecol Reprod Biol 2020; 252:479-482. [PMID: 32758858 DOI: 10.1016/j.ejogrb.2020.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The universal two-child policy was implemented in January 2016 in China. The objective of this study was to compare the influence of change in fertility policy on obstetric issues. STUDY DESIGN 2016 was taken as the cut-off point, and a retrospective study was conducted on data of patients who delivered in the China-Japan Friendship Hospital from January 2014 to December 2018. Maternal characteristics, mode of delivery, and pregnancy outcomes were studied in detail. RESULTS Total 8931 babies were delivered from 2014 to 2018. There was a marked increase in the birth rate after the two-child policy. The percentage of elderly pregnant women and rate of cesarean sections increased significantly in 2017 and 2018. The primary cesarean section rates in 2017 and 2018 were significantly lower than those in 2014, 2015, and 2016. Increased incidence of placenta previa and postpartum hemorrhage were observed; however, no significant differences were seen in the rates of hypertensive disorders, gestational diabetes mellitus, and neonatal asphyxia within these five years. CONCLUSION The implementation of two-child policy has changed the mode of obstetrics and has presented great challenges. With hierarchical management of high-risk patients and control of the cesarean section rate, we can ensure the safety of pregnant women and newborns.
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Affiliation(s)
- Fang Zhao
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yang Xu
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yan-Ting Chen
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jiao-Ying Cheng
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiao-Yu Pan
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China.
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18
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Fan SL, Xiao CN, Zhang YK, Li YL, Wang XL, Wang L. How does the two-child policy affect the sex ratio at birth in China? A cross-sectional study. BMC Public Health 2020; 20:789. [PMID: 32460822 PMCID: PMC7251839 DOI: 10.1186/s12889-020-08799-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The One-Child Policy led to the imbalance of the sex ratio at birth (SRB) in China. After that, Two-Child Policy was introduced and gradually liberalized at three stages. If both the husband and wife of one couple were the only child of their parents, they were allowed to have two children in policy (BTCP). If only one of them was the only child, they were allowed to have two children in policy (OTCP). The Universal Two-Child Policy (UTCP) allowed every couple to have two children. The objective of this study was to explore the changing trend of SRB at the stages of Two-Child Policy, to analyze the effect of population policy on SRB in terms of maternal age, delivery mode, parity, maternal education, delivery hospital, and to figure out what factors have greater impact on the SRB. METHODS The data of the study came from Hebei Province Maternal Near Miss Surveillance System, covered the parturients delivered at 28 gestation weeks or more in 22 hospitals from January 1, 2013 to December 31, 2017. We compared the SRB at different policy stages, analyzed the relationship between the SRB and population policy by logistic regression analysis. RESULTS Total 270,878 singleton deliveries were analyzed. The SRB, 1.084 at BTCP, 1.050 at OTCP, 1.047 at UTCP, declined rapidly (χ2 = 15.97, P < 0.01). With the introduction of Two-Child Policy, the percentage of parturients who were 30-34, ≥35 years old rose significantly, and the percentage of multiparous women increased significantly (40.7, 47.2, 56.6%). The neonatal mortality declined significantly (8.4‰, 6.7‰, 5.9‰, χ2 = 44.49, P < 0.01), the mortality rate of female infant gradually declined (48.2, 43.7, 43.9%). The logistic regression analysis showed the SRB was correlated to the three population policy stages in terms of maternal age, delivery mode, parity, maternal education, delivery hospital. CONCLUSIONS The SRB has declined to normal level with the gradually liberalizing of Two-Child Policy in China. Advanced maternal age, cesarean delivery, multiparous women, middle level education, rural hospital are the main factors of effect on the decline of the SRB.
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Affiliation(s)
- S L Fan
- Hebei Women and Children's Health Center, Shijiazhuang, 050000, Hebei, China
| | - C N Xiao
- Department of Obstetrics and Gynecology, Hebei General Hospital, No. 348 Heping Road, Shijiazhuang, 050051, Hebei, China
| | - Y K Zhang
- Hebei Women and Children's Health Center, Shijiazhuang, 050000, Hebei, China
| | - Y L Li
- Hebei Women and Children's Health Center, Shijiazhuang, 050000, Hebei, China
| | - X L Wang
- Department of Obstetrics and Gynecology, Hebei General Hospital, No. 348 Heping Road, Shijiazhuang, 050051, Hebei, China
| | - L Wang
- Department of Obstetrics and Gynecology, Hebei General Hospital, No. 348 Heping Road, Shijiazhuang, 050051, Hebei, China.
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Jia L, Ji F, Wu J, Wang Y, Wu C. Paternal depressive symptoms during the early postpartum period and the associated factors following the implementation of the two-child policy in China. Arch Psychiatr Nurs 2020; 34:43-49. [PMID: 32248933 DOI: 10.1016/j.apnu.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/15/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
AIM To evaluate the prevalence of paternal depressive symptoms during the first three days of childbirth, as well as the associated factors, following the implementation of the two-child policy in China in 2015, which allows couples to have two children in the Chinese mainland. METHODS A cross-sectional study was conducted among 318 fathers. Paternal depressive symptoms and self-efficacy of fathers were screened using the Edinburgh Postnatal Depression Scale and the General Self-Efficacy Scale, respectively. In addition, basic information of all parents and neonates was collected. Univariate analysis, binary logistic regression analysis, and principal component analysis (PCA) were used to identify the relationship between paternal depressive symptoms and its associated factors. RESULTS Twenty-two percentage of fathers had depressive symptoms during the first three days of childbirth. Binary logistic regression analysis revealed that older fathers, those who slept for more than 8 h per night, or were dissatisfied with their living conditions were more susceptible to developing the symptoms. On the contrary, protective factors such as the educational level of fathers, planned pregnancy, prenatal guidance, having the second-born child, and higher self-efficacy were found to reduce the development of paternal depressive symptoms. PCA showed that the main components that influenced the paternal depressive symptoms were parental age and parity. CONCLUSIONS The prevalence of paternal depressive symptoms during the postpartum period did not increase significantly after the implementation of the two-child policy in China. However, focusing on the associated factors is necessary in order to manage postpartum depression during the early postpartum period.
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Affiliation(s)
- Lei Jia
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China
| | - Fangyuan Ji
- Shuguang Hospital Affiliated To Shanghai University of TCM, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China
| | - Yin Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China
| | - Caiqin Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China.
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Deng Y, Li H, Dai Y, Yang H, Morse AN, Liang H, Lin Y. Are there differences in pain intensity between two consecutive vaginal childbirths? A retrospective cohort study. Int J Nurs Stud 2020; 105:103549. [PMID: 32199151 DOI: 10.1016/j.ijnurstu.2020.103549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 02/01/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pain assessment is crucial for in-labour pain management. Even though women's self-rated pain intensity is the standard for pain relief or analgesic administration, multiparas appear to receive worse in-labour pain management than primiparas do. The discrepancy in pain perception between primiparas and multiparas remains unclear. Healthcare providers tend to think that multiparas endure the pain and report less pain because they have experienced childbirth. OBJECTIVE To retrospectively analyse the intensity of in-labour pain during first and second vaginal childbirth within the same group of women and explore whether parity may be an influential factor in labour pain intensity. DESIGN Retrospective cohort study. SETTING Labour and delivery in a large academic specialized hospital in Guangzhou, China. PARTICIPANTS Women were included if they had two consecutive vaginal childbirths with singleton cephalic presentations and cervical dilation ≤ 3 cm for the first childbirth and ≤ 2 cm for the second childbirth. The final study sample consisted of 417 women. METHODS All childbirth case records between January 2015 and August 2018 were scanned using a structured electronic medical system. Maternal and neonatal demographics as well as obstetric and neonatal outcomes were extracted. The in-labour pain for each childbirth was compared between first and second births. Paired t-tests, McNemar's chi-square tests and mixed-effects modelling were applied to compare the differences in labour pain intensity between the two vaginal childbirths and explore the factors that influenced maximum labour pain scores during the second childbirth. RESULTS Four hundred seventeen women were included, with an average birth interval of 1.7 years. The average maximum labour pain score during the latent phase was 6 (5,6) for the first childbirth and 5 (4,6) for the second childbirth (paired t =-6.13, P <0.001). Pain scores decreased in 28.1% (117/417) of women and increased in 13.7% (57/417) of women from the first to the second childbirth. More than half of the women in our study experienced the same maximum labour pain score during the first and second labour. Mixed-effects modelling revealed that parity, education and pregnancy complications were independently associated with maximum labour pain scores. CONCLUSIONS From a clinical point of view, in-labour pain is not clinically different for women when comparing their first and second labours. Health care professionals may underestimate in-labour pain in primiparas when comparing them with nulliparas. More studies are warranted to explore options for achieving better pain management for women with more childbirths.
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Affiliation(s)
- Yongfang Deng
- Dlivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Rd, Tianhe District, Guangzhou 510623, China
| | - Huixian Li
- Statistician, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Dai
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Hongmei Yang
- Department of Pediatric operation room, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Abraham N Morse
- Department of Urogynecology, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China.
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Yan Lin
- Department of Nursing Administrative Office, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, No.9 Jinsui Rd, Tianhe District, Guangzhou 510623, China.
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Zhang X, Chen L, Wang X, Wang X, Jia M, Ni S, He W, Zhu S. Changes in maternal age and prevalence of congenital anomalies during the enactment of China's universal two-child policy (2013-2017) in Zhejiang Province, China: An observational study. PLoS Med 2020; 17:e1003047. [PMID: 32092053 PMCID: PMC7039412 DOI: 10.1371/journal.pmed.1003047] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China implemented a partial two-child policy (2013) followed by a universal two-child policy (2015), replacing the former one-child policy mandated by the government. The changes affect many aspects of China's population as well as maternal and infant health, but their potential impact on birth defects (BDs) remains unknown. In this study, we investigated the associations of these policy changes with BDs in Zhejiang Province, China. METHODS AND FINDINGS We used data from the BD surveillance system in Zhejiang Province, China, which covers 90 hospitals in 30 urban districts and rural counties, capturing one-third of the total births in this province. To fully consider the time interval between conception and delivery, we defined the one-child policy period as data from 2013 (births from October 2012 to September 2013), the partial two-child policy period as data from 2015 (births from October 2014 to September 2015), and the universal two-child policy period as data from 2017 (births from October 2016 to September 2017). Data from 2009 and 2011 were also used to show the changes in the proportion of births to women with advanced maternal age (35 years and older) prior to the policy changes. Main outcome measures were changes in the proportion of mothers with advanced maternal age, prevalence of BDs, rankings of BD subtypes by prevalence, prenatal diagnosis rate, and live birth rate of BDs over time. A total of 1,260,684 births (including live births, early fetal losses, stillbirths, and early neonatal deaths) were included in the analyses. Of these, 644,973 (51.16%) births were to women from urban areas, and 615,711 (48.84%) births were to women from rural areas. In total, 135,543 (10.75%) births were to women with advanced maternal age. The proportion increased by 85.68%, from 8.52% in 2013 to 15.82% in 2017. However, it had remained stable prior to policy changes. Overall, 23,095 BDs were identified over the policy changes (2013-2017). The prevalence of BDs during 2013, 2015, and 2017 was 245.95, 264.86, and 304.36 per 10,000 births, respectively. Trisomy 21 and other chromosomal defects increased in both risk and ranking from 2013 to 2017 (crude odds ratio [95% confidence interval] 2.13 [1.75-2.60], from ranking 10th to 5th, and 3.63 [2.84-4.69], from ranking 16th to 6th, respectively). The prenatal diagnosis rate increased by 3.63 (2.2-5.1) percentage points (P < 0.001), from 31.10% to 34.72%, and identification of BDs occurred 1.88 (1.81-1.95) weeks earlier (P < 0.001). The live birth rate for infants with BDs born before 28 gestational weeks increased from 1.29% to 11.45%. The major limitations of this observational study include an inability to establish causality and the possible existence of unknown confounding factors, some of which could contribute to BDs. CONCLUSIONS In this study, we observed significant increases in maternal age and the prevalence of total and age-related anomalies following China's new two-child policy. Increases in live birth rate for infants with BDs born before 28 gestational weeks suggest that healthcare for very preterm births with BDs may be warranted in the future, as well as updating the definition of perinatal period.
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Affiliation(s)
- Xiaohui Zhang
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Women’s Health, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lijin Chen
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xuemiao Wang
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Wang
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Menghan Jia
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Saili Ni
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei He
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shankuan Zhu
- Chronic Disease Research Institute, School of Public Health, and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
- * E-mail:
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Liu J, Liu M, Zhang S, Ma Q, Wang Q. Intent to have a second child among Chinese women of childbearing age following China's new universal two-child policy: a cross-sectional study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 46:bmjsrh-2018-200197. [PMID: 31754062 PMCID: PMC6978559 DOI: 10.1136/bmjsrh-2018-200197] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 05/03/2023]
Abstract
INTRODUCTION China's one-child policy was replaced by a new universal two-child policy in 2015; however, few studies have addressed the intent to have a second child and resulting related issues. METHODS We performed a cross-sectional study on 11 991 Chinese women, 18-49 years of age, from 11 provinces in 2016-2017, in order to assess the intent for a second child among Chinese women of childbearing age and other related factors after the introduction of China's new universal two-child policy. RESULTS We found that the overall prevalence of the intent to have a second child was 39.4% and that economic, childrearing, and health barriers affected fertility intent. Multivariate logistic regression models showed that the age range of 25-39 years (aOR 1.28-1.30), living in Eastern (aOR 1.28, 95% CI 1.10 to 1.50) or Central China (aOR 1.52, 95% CI 1.27 to 1.78), living in a rural area (aOR 1.62, 95% CI 1.47 to 1.78), being a farmer (aOR 1.43, 95% CI 1.09 to 1.88), having a higher household income (aOR 1.13, 95% CI 1.00 to 1.28), having a history of abortion (aOR 1.18, 95% CI 1.05 to 1.31), and already having one child (aOR 3.65 for girls, aOR 2.70 for boys) were associated with a greater intent to have a second child (all p<0.05). Conversely, economic, health, childrearing, and educational barriers were associated with a lower intent to have a second child (aOR 0.65-0.75). CONCLUSION Four in ten women of childbearing age demonstrated an intent for a second child. We maintain that fertility-related factors be given full consideration when promoting the two-child policy.
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Affiliation(s)
- Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shikun Zhang
- Chinese Association for Maternal and Child Health Studies, Beijing, China
| | - Qiuyue Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qiaomei Wang
- National Health and Family Planning Commission of the Peoples Republic of China, Beijing, Beijing, China
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Wang R, Yu Y, Xi Q, Jiang Y, Zhu H, Li S, Liu R, Zhang H. Analysis of prenatal diagnosis before and after implementation of the two-child policy in northeastern China. Medicine (Baltimore) 2019; 98:e17200. [PMID: 31567968 PMCID: PMC6756619 DOI: 10.1097/md.0000000000017200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The universal two-child policy has now been fully implemented in China. This change requires adaptations to maternal care and childcare systems, but the features of prenatal diagnosis before and after implementation of the policy have not been reported.We conducted a retrospective study of 6736 prenatal cytogenetic diagnoses performed on amniotic fluid cells over a 4-year period, including 2 years before and after implementation of the second child policy. Amniotic fluid cells collected through amniocentesis were cultured, harvested, and stained for chromosome analysis using standard laboratory protocols.The study included 3222 pregnant women referred before implementation of the policy, which we used as a control group, and 3514 pregnant women referred after policy implementation as an investigational study group. There were significantly fewer pregnant women aged <25 years in the investigational group than in the control group (P < .001). There were no significant between-group differences for other pregnant women aged >31 years and 27-28 years old (P > .05). A total of 358 cases with chromosomal abnormalities were diagnosed, including 129 (4%, 129/3222) in the control group which was significantly lower than the 229 (6.5%, 229/3514) in the study group (P < .001). In particular, significantly more trisomy 21 cases were observed in the study group than in the control group (120 vs 59). More pregnant women underwent non-invasive prenatal testing (NIPT) in the study group (46%) than in the control group (20%). In the study group, the average age of pregnant women who underwent NIPT was significantly higher than that of women who did not receive NIPT (P < .05). However, there were no significant between-group differences for the control group (P > .05).The number of cases with chromosomal abnormalities increased in northeastern China in the 2 years after implementation of the two-child policy. The number of pregnant women of advanced maternal age did not increase significantly, perhaps because of the widespread application of NIPT. However, the number of fetuses with Down syndrome increased significantly, suggesting that prenatal screening and diagnosis should be strengthened.
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Affiliation(s)
- Ruixue Wang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Yang Yu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Qi Xi
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Yuting Jiang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Haibo Zhu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Shibo Li
- Department of Pediatrics, Genetics Laboratory at University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ruizhi Liu
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Hongguo Zhang
- Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
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Li HT, Xue M, Hellerstein S, Cai Y, Gao Y, Zhang Y, Qiao J, Blustein J, Liu JM. Association of China's universal two child policy with changes in births and birth related health factors: national, descriptive comparative study. BMJ 2019; 366:l4680. [PMID: 31434652 PMCID: PMC6699592 DOI: 10.1136/bmj.l4680] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To measure the association of China's universal two child policy, announced in October 2015, with changes in births and health related birth characteristics. DESIGN National, descriptive before-and-after comparative study. SETTING Every county in 28 of 31 provinces of mainland China. PARTICIPANTS Births included in two national databases: 67 786 749 births from county level monthly aggregated data between January 2014 and December 2017; and 31 786 279 deliveries from individual level delivery information records between January 2015 and December 2017. MAIN OUTCOME MEASURES Monthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries. RESULTS The study had two phases: the baseline period (up to and including June 2016, nine months after the policy announcement) and the effective period (from July 2016 to December 2017). The estimated number of additional births attributable to the new policy between July 2016 and December 2017 was 5.40 million (95% confidence interval 4.34 to 6.46). The monthly mean percentage of multiparous mothers and mothers aged 35 and over increased by 9.1 percentage points (95% confidence interval 6.4 to 11.7) and 5.8 percentage points (5.2 to 6.4), respectively. This increase in older mothers, however, was not associated with a concurrent increase in the overall rate of preterm birth. The monthly mean caesarean delivery rate among multiparous mothers increased by 1.2 percentage points (0.8 to 1.6) from 39.7% to 40.9%, and decreased by 3.0 percentage points (-3.5 to -2.5) among nulliparous mothers from 39.6% to 36.6%. CONCLUSIONS Since its announcement in October 2015, the universal two child policy has been associated with a rise in births in China and with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. No evidence of concurrent worsening outcomes (that is, premature births) was seen.
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Affiliation(s)
- Hong-Tian Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Centre, Beijing 100191, China
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Centre, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Ming Xue
- Centre for Health Statistics and Information, National Health Commission of China, Beijing, China
| | - Susan Hellerstein
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yue Cai
- Centre for Health Statistics and Information, National Health Commission of China, Beijing, China
| | - Yanqiu Gao
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Centre, Beijing, China
- Department of Maternal and Child Health, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yali Zhang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Centre, Beijing 100191, China
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Centre, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China
- Reproductive Health Research Centre, Peking University Health Science Centre, Beijing, China
| | - Jan Blustein
- Robert F Wagner Graduate School of Public Service, New York University, New York, NY, USA
- Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | - Jian-Meng Liu
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Centre, Beijing 100191, China
- Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Centre, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Reproductive Health Research Centre, Peking University Health Science Centre, Beijing, China
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Impact of the Universal Two-Child Policy on the Workload of Community-Based Basic Public Health Services in Zhejiang Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162880. [PMID: 31408983 PMCID: PMC6720011 DOI: 10.3390/ijerph16162880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023]
Abstract
We aimed to quantitatively estimate the amount of pressure that was placed on basic public health care services (BPHS) due to the universal two-child policy issued in 2015 by comparing the workload change in maternal and child health management and the immunization of children. BPHS performance surveillance data from 2014 to 2018 in Zhejiang Province, China were analyzed to calculate the workload of the above three services using the equivalent method of BPHS cost estimation of community health services. From 2014 to 2018, the numbers of births from the Statistical Yearbook in Zhejiang Province were 578,000, 581,000, 624,000, 670,000, and 628,000, respectively, and those from the surveillance data were 416,941, 41,490, 434,163, 546,816, and 45,964, respectively. The number of births reached a peak in 2017, with the yearbook and surveillance data showing increases of 15.92% and 31.15%, respectively, over 2014. The workload of maternal and child health management and children’s immunization also peaked in 2017, increasing by 30.37%, 12.70%, and 4.33% over 2014, respectively. In 2018, the workload of maternal and child health management and children’s immunization dropped to 107.34%, 107.73%, and 98.81% over 2014, respectively. The indicators of maternal and child health management and children’s immunization services remained stable, and the related services did not decline, even in 2017. The maternal health management workload was more affected by the universal two-child policy than child health management and children’s immunization.
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Liu Y, Qin Q, Xiao Y, Li H, Guang S, Tao S, Hu Y. Changes of second-time mothers and their infants under the universal two-child policy in Changsha, China. Midwifery 2019; 77:32-36. [PMID: 31252314 DOI: 10.1016/j.midw.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND China announced the implementation of the universal two-child policy in Oct, 2015; every couple was allowed to have two children. However, its influences on maternal well-being and infants' outcomes are still to be discovered. OBJECTIVES To detect influences of the universal two-child policy. To provide information for maternal health care under the new policy. STUDY DESIGN This study enrolled 859 and 1230 women who delivered their second child (hereafter second-time mothers) before and after the policy's implementation, respectively, and the data included maternal demographic characteristics, gestational complications, delivery mode and infants' outcomes. RESULTS After the policy's implementation, the proportion of second-time mothers with advanced age increased significantly. The advanced gestational age is well acknowledged to correlate with higher risk during the pregnancy, both for pregnant women and their babies. However, in our study, the incidence of hypertensive disorders in pregnancy, placenta previa and postpartum haemorrhage decreased significantly after the introduction of the policy and no differences were noted in other gestational complications. Moreover, the hospitalization time was shortened, and caesarean delivery was chosen less frequently. As for the infants, foetal distress exhibited an alleviation and the incidence of premature labour and low birth weight decreased as well. CONCLUSIONS Even though the age of second-time mothers increased after the introduction of the universal two-child policy, their general gestational health condition improved and their infants also exhibited a better outcome, which might be attributed to the improvement of China's maternal medical care system.
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Affiliation(s)
- Yuhao Liu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China.
| | - Qilin Qin
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Ying Xiao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Herui Li
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Shiqi Guang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Sifan Tao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China
| | - Yun Hu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province 410011, China.
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Liao Z, Zhou Y, Li H, Wang C, Chen D, Liu J. The Rates and Medical Necessity of Cesarean Delivery in the Era of the Two-Child Policy in Hubei and Gansu Provinces, China. Am J Public Health 2019; 109:476-482. [PMID: 30676790 DOI: 10.2105/ajph.2018.304868] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the cesarean rates in different child policy periods and assess the medical necessity of cesareans during the 2-child policy period. METHODS We collected hospital-level aggregate data on 93 745 deliveries and individual-level data on 27 977 deliveries from 6 hospitals in the Hubei and Gansu provinces of China from 2013 to 2016. Experts in gynecology and obstetrics assessed the medical necessity of 1024 randomly selected cesareans in 2016. RESULTS The overall cesarean rate decreased significantly from 45.1% in the 1-child policy period (January 2013-September 2014) to 40.4% in the selective 2-child policy period (October 2014-July 2016) and further to 38.9% in the universal 2-child policy period (August 2016-December 2016). The rate of cesarean delivery on maternal request decreased by 46.3%, whereas the rate of cesarean delivery indicated by a previous cesarean delivery increased by 118.8% (P < .001). The experts assessed 222 (21.6%) cesareans as lacking medical necessity. CONCLUSIONS The overall cesarean rate in Hubei and Gansu provinces decreased after the implementation of the 2-child policy, and one fifth of cesareans might be nonessential.
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Affiliation(s)
- Zijun Liao
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yubo Zhou
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hongtian Li
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Cheng Wang
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dunjin Chen
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jianmeng Liu
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Long Q, Kingdon C, Yang F, Renecle MD, Jahanfar S, Bohren MA, Betran AP. Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in China: A mixed-methods systematic review. PLoS Med 2018; 15:e1002672. [PMID: 30325928 PMCID: PMC6191094 DOI: 10.1371/journal.pmed.1002672] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND China has witnessed a rapid increase of cesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and reasons for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs, which are those performed in the absence of medical indications. METHODS AND FINDINGS We conducted a mixed-methods systematic review and included longitudinal, cross-sectional, and qualitative studies in mainland China, Hong Kong, and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, and one Chinese database (CNKI) using a combination of the key terms 'caesarean section', 'preference', 'choice', 'knowledge', 'attitude', 'culture', 'non-clinical factors', and 'health professionals-patient relations' between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%-17%) and 21% in late pregnancy (95% CI 15%-26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%-20%), 22% in late pregnancy (95% CI 18%-25%), and 30% postpartum (95% CI 19%-40%). Women's preferences for CS were found to rise as pregnancy progressed (preference change across longitudinal studies: mean difference 7%, 95% CI 1%-13%). One longitudinal study reported that the preference for CS among women's partners increased from 8% in late pregnancy to 17% in the immediate postpartum period. In addition, 18 quantitative studies revealed that some pregnant women, ranging from 4% to 34%, did not have a straightforward preference for a mode of delivery, even in late pregnancy. The qualitative meta-synthesis found that women's perceptions of CS as preferable were based on prioritising the baby's and woman's health and appeared to intensify through interactions with the health system. Women valued the convenience of bypassing labour because of fear of pain, antagonistic relations with providers, and beliefs of deteriorating quality of care during labour and vaginal birth, fostering the feeling that CS was the safest option. Health professionals' preference for CS was influenced by financial drivers and malpractice fears. This review has some limitations, including high heterogeneity (despite subgroup and sensitivity analysis) in the quantitative analysis, and the potential for over-reporting of women's preferences for CS in the qualitative synthesis (due to some included studies only including women who requested CS). CONCLUSIONS Despite a minority of women expressing a preference for CS, individual, health system, and socio-cultural factors converge, contributing to a high CS rate in mainland China, Hong Kong, and Taiwan. In order to reduce unnecessary CSs, interventions need to address all these non-clinical factors and concerns. SYSTEMATIC REVIEW REGISTRY Prospero CRD42016036596.
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Affiliation(s)
- Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Fan Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael Dominic Renecle
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa, United States of America
| | - Shayesteh Jahanfar
- School of Public Health, Central Michigan University, Mount Pleasant, Michigan, United States of America
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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