PubMed · 15391776
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K SKAJAA. 1949-09-15. Cesarean. https://pubmed.ncbi.nlm.nih.gov/15391776/
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OBJECTIVE: To examine the trend in the rate of cesarean delivery in primiparous women and to analyse individual socioeconomic factors driving the escalation of cesarean delivery rates in urban China. STUDY DESIGN: Data were drawn from three national household health surveys conducted in 1993, 1998, and 2003. This analysis was based on data from the primiparous women only. RESULTS: The cesarean delivery rate in urban cities of China rose from 18.2% in 1990 to 1992 to 39.5% in 1998 to 2002. The adjusted odds ratio for cesarean delivery associated with living in a large city, having university/colleague education, and having health insurance were respectively 2.39, 4.46, and 1.25 in 1998 to 2002. CONCLUSION: The cesarean delivery rate in urban cities of China has been rising dramatically since 1990. Many nonmedical causes related to individual social and economic factors might have played an important role in such a rapid rise of cesarean delivery rates.
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A prospective cohort study was undertaken to evaluate the effect of pregnancy and childbirth in nulliparous pregnant women. The focus of this paper is on the difference in the prevalences and risk factors for lower urinary tract symptoms (LUTS) between woman who delivered vaginally or by cesarean and secondly the effect of LUTS on the quality of life between these two groups was analyzed. Included were 344 nulliparous pregnant women who completed four questionnaires with the Urogenital Distress Inventory and the Incontinence Impact Questionnaire (IIQ). Two groups were formed: vaginal delivery group (VD), which included spontaneous vaginal delivery and an instrumental vaginal delivery and cesarean delivery group (CD). No statistical significant differences were found in the prevalences of LUTS during pregnancy between the two groups. Three months after childbirth, urgency and urge urinary incontinence (UUI) are less prevalent in the CD group, but no statistical difference was found 1 year postpartum. Stress incontinence was significantly more prevalent in the VD group at 3 and 12 months postpartum. The presence of stress urinary incontinence (SUI) in early pregnancy is predictive for SUI both in the VD as in CD group. A woman who underwent a CD and had SUI in early pregnancy had an 18 times higher risk of having SUI in year postpartum. Women were more embarrassed by urinary frequency after a VD. After a CD, 9% experienced urge urinary incontinence. Urge incontinence affected the emotional functioning more after a cesarean, but the domain scores on the IIQ were low, indicating a minor restriction in lifestyle. In conclusion, after childbirth, SUI was significantly more prevalent in the group who delivered vaginally. Besides a vaginal delivery, we found both in the VD and in the CD group that the presence of SUI in early pregnancy increased the risk for SUI 1 year after childbirth. Further research is necessary to evaluate the effect of SUI in early pregnancy on SUI later in life. Women were more embarrassed by urinary frequency after a vaginal delivery. UUI after a CD compared to a vaginal birth limited the women more emotionally; no difference was found for the effect of SUI on the quality of life between the two groups.