{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:29:26Z","timestamp":1790810966640,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,5,13]],"date-time":"2016-05-13T00:00:00Z","timestamp":1463097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"IPMCHH"},{"name":"Shanghai Jiaotong University"},{"name":"The Ohio State University College of Medicine"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the trends of caesarean delivery (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>) after an intervention to lower the high rate of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> at a Chinese maternity hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A large tertiary obstetric centre in Shanghai, China, from 2007 to 2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>81 459 nulliparous women who delivered a term singleton infant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Logistic regression was used to calculate the odds of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> while adjusting for confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measure<\/jats:title><jats:p>Rate of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> before and after the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The rate of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> decreased from 51.5% in 2008 to 36.1% in 2014, mostly due to a reduction in non\u2010indicated antepartum <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> from 27.9% in 2010 to 11.9% in 2014. After adjustment, a period effect remained with delivery between 2011 and 2014 associated with a 31% reduction in the odds of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> compared with delivery between 2007 and 2010 [odds ratio (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>): 0.69, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.66\u20130.71)] and a 33% reduction in the odds of antepartum <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>: 0.67, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.64\u20130.69). The frequencies of perinatal mortality (0.5 versus 0.4\/1000), hypoxic ischaemic encephalopathy (0.9 versus 1.2\/1000), meconium aspiration syndrome (0.5\/1000), birth trauma (0.6\/1000), respiratory distress syndrome (0.5% versus 0.4%) and necrotising enterocolitis (0.9 versus 0.6\/1000) were similar. The frequency of neonatal infection increased slightly (0.6% versus 0.8%), although this could be explained by other factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A marked reduction in <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> has occurred at an urban tertiary care centre as a result of efforts to reduce the high rate of caesarean delivery. No notable differences in neonatal outcomes were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>High rates of caesarean delivery can be lowered without increases in neonatal morbidity and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14057","type":"journal-article","created":{"date-parts":[[2016,5,13]],"date-time":"2016-05-13T08:11:24Z","timestamp":1463127084000},"page":"1620-1628","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Lowering the high rate of caesarean delivery in China: an experience from Shanghai"],"prefix":"10.1111","volume":"123","author":[{"given":"X","family":"Liu","sequence":"first","affiliation":[{"name":"Obstetrics Department International Peace Maternity &amp; Child Health Hospital Shanghai Jiaotong University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CD","family":"Lynch","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics &amp; Gynaecology The Ohio State University College of Medicine Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WW","family":"Cheng","sequence":"additional","affiliation":[{"name":"Obstetrics Department International Peace Maternity &amp; Child Health Hospital Shanghai Jiaotong University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MB","family":"Landon","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics &amp; Gynaecology The Ohio State University College of Medicine Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,5,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.03.044"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2006.00118.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.058"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61870-5"},{"key":"e_1_2_6_6_1","first-page":"1","article-title":"Births: final data for 2011","volume":"62","author":"Martin JA","year":"2013","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12971"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.01.043"},{"key":"e_1_2_6_9_1","unstructured":"Shanghai City health care statistics. [www.smhb.gov.cn\/website\/b\/62348.shtml]. Accessed 18 May 2012."},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.035808"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.090399"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0719"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31816e349e"},{"key":"e_1_2_6_14_1","first-page":"39","article-title":"China's National cesarean rate: analysis and suggestions","volume":"5","author":"Qian J","year":"2012","journal-title":"J Popul Dev"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005982"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.389"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0043906"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0041436"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016349.2010.484044"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182952242"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182854b36"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0043-6"},{"key":"e_1_2_6_23_1","first-page":"436","article-title":"Appropriate technology for birth","volume":"2","author":"World Health Organization","year":"1985","journal-title":"Lancet"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1407120"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.1.8"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182a5d539"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1471-0528.14057","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.14057","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T08:53:24Z","timestamp":1696323204000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.14057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,13]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.1111\/1471-0528.14057"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.14057","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,13]]},"assertion":[{"value":"2016-02-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-05-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}