| Objectives:In the recent20years, the cesarean delivery rate has been growing steadily all over the world. In China, the rates of many hospitals maintained at40%-60%which are much higher than those of other countries. At the same time, the indications for cesarean delivery have changed a lot which non-medical-indication cesarean delivery rate rises rapidly. Many major multi-center clinical researches abroad have approved that high cesarean delivery rate can’t reduce the morbidities and improve the prognosis of newborns. What is the current situation in China? We lack multi-center clinical data nationwide so far. Thus, one purpose of this thesis is to establish a nationwide newborn database. Furthermore, we aim at finding out the cesarean delivery rate, analyzing the indications for cesarean delivery and understanding the clinical characteristics of cesarean delivery newborns. In this way, we want to provide basic data for further researches and inspect the possibility of setting up a nationwide newborn network for a long period.Methods:(1) Clinical form of newborns was designed and a standardized database was established.(2) We contacted with hospitals nationwide, confirmed the cooperative ones then provided trainings on filling the form and inputting the data.(3) Data collection:100308neonatals borned from May1st2010to December31st2011were enrolled in the study.(4)Analysis:Input the data into the database and analyze it using SPSS software.Results:(1) Cesarean delivery rate:Among the100308newborns from52hospitals during the research period, there were46823cesarean delivery newborns. The overall cesarean delivery rate was46.68%(range11.49-73.79%). The proportion of elective cesarean delivery among all cesarean delivery was84.41%.(2) Basic characteristics of cesarean delivery newborns:The gestational age was38.6±1.9wk (range21+5-49+5wk); preterm birth rate was10.28%(n=4815); birth weight was3248.0±583.9g (range265-7795g); macrosomia rate was8.74%(n=4092); LBW rate was8.02%(n=3753). There were32ELBW infants.(3)Maternal history of cesarean delivery newborns:1.03%(n=480) cesarean delivery newborns were test tube babies.30.10%(n=570) mothers of GA less than or equal to34wk received antenatal dexamethasone treatment.7.49%(n=3509) were diagnosed as fetal distress.2.93%(n=1372) at1min postnatal age and0.82%(n=383) at5min postnatal age had an Apgar score less than or equal to7.(4) Indications for cesarean delivery:50.33%cesarean deliveries were non-medical-indication ones followed by indications as PROM (11.15%, n=5223), macrosomia (8.74%, n=4092), fetal distress (7.49%, n=3509), multiple births (5.71%, n=2672), PIH (5.11%, n=2394), previous cesarean delivery (4.34%, n=2032), diabetes (including IGT,2.89%, n=1352) etc.(5) Symptoms and signs:The major symptoms were jaundice (14.47%, n=6775), dyspnea (4.62%, n=2161) and cyanosis (2.86%, n=1338). All three incidences were higher as to cesarean delivery newborns (p<0.05).(6) Discharge diagnosis and disease spectrum: The most popular diagnosis was hyperbilirubinemia (15.11%, n=7076) which mainly caused by pathological and physiological reasons. Both incidences were higher than those of vaginal delivery infants (p<0.05). And the morbidities of RDS, TTN, pneumonia and asphyxia were all higher in cesarean delivery newborns (p<0.05). As to term cesarean delivery newborns, the risk of RDS at GA of37wk was higher than that of39wk (OR=7.312). The risk of RDS of cesarean delivery in labor was lower than that of elective cesarean delivery (OR=0.640). The risk of TTN had no relationship with labor (p>0.05). The circulatory morbidities were all higher in cesarean delivery newborns (p>0.05). The morbidities of IVH and SAH were higher in vaginal delivery newborns (p<0.05) while that of brain injury was lower (p<0.05). In cesarean delivery newborns, the morbidities of anemia, infectious pneumonia and sepsis were higher (p<0.05).(7) Treatments:Main treatments of cesarean delivery newborns included inhaling oxygen (4.57%, n=2140), photo therapy (6.96%, n=3260), intravenous nutrition (4.19%, n=1960) and anti-infective therapy (2.97%, n=1390). The treatment rates were higher in cesarean delivery newborns except photo therapy (p<0.05). The smaller the GA and the lower the birth weight were, the higher the treatment rates were.(8) Prognosis:82.21%(n=38494) cesarean delivery newborns stayed with their mothers after born. The overall length of hospitalization was6.0±4.4d and longer than that of vaginal delivery newborns (p<0.05). Only1.06%(n=494) cesarean delivery newborns registered hospitalization costs. The overall prognosis of all newborns was good. The mortality rate of cesarean delivery newborns was0.41%(n=191) which had no significant difference with that of vaginal delivery ones (p>0.05). The main causes of death were RDS, preterm birth and asphyxia.Conclusions:(1) The overall cesarean delivery rate nationwide was46.68%which was much higher than the appropriate rate:20-25%.(2) The proportion of elective cesarean delivery among all cesarean delivery was84.41%.(3) The rate of proper treatment of antenatal dexamethasone in mothers of GA less than or equal to34wk was low.(4)50.33%cesarean deliveries were non-medical-indication ones followed by indications as PROM, fetal problems (e.g. macrosomia, fetal distress, multiple births) and maternal problems (e.g. PIH, previous cesarean delivery, diabetes).(6) Three main symptoms of cesarean delivery newborns were jaundice, dyspnea and cyanosis which the incidences were higher than those in vaginal delivery ones.(7) Hyperbilirubinemia, preterm, macrosomia, LGA and LBW listed top5among all the discharge diagnosis. The respiratory morbidities were higher in cesarean delivery newborns, especially that of TTN. The morbidities of IVH and SAH were higher in vaginal delivery newborns while that of brain injury was lower. As to other systems, the morbidities were generally higher in cesarean delivery newborns.(8) The treatment rates of respiratory support, photo therapy, intravenous nutrition and anti-infective therapy were higher in cesarean delivery newborns. The smaller the GA and the lower the birth weight were, the higher the treatment rates were.(9) In cesarean delivery newborns, the hospitalization rate was higher and the length was longer. The smaller the GA and the lower the birth weight were, the longer the hospitalization length was.(10) The overall prognosis of cesarean delivery newborns was good. The mortality rate was0.41%which had no significant difference with that of vaginal delivery ones. GA and birth weight were bigger in cesarean delivery newborns. The main causes of death were RDS, preterm birth and asphyxia. |
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