Dissecting the current caesarean section rate in Shanghai, China

The high caesarean section (CS) rate has been of great public concern around the world. Yet, large-scale studies of dissecting such a high CS rate are few in the Chinese population. We carried out a cross-sectional survey randomly selecting 10,855 births from 20 hospitals in Shanghai from January to June, 2016. Labor and delivery information was extracted from medical records. The Robson classification system for CS was used to classify all women into ten groups. The overall CS rate was 41.5%. Prelabor CS in nulliparous, term singleton vertex women was the predominant contributor (37.4%) to the total CS and accounted for the second highest proportion of total births (15.5%) in all hospital types. The vast majority of women with a previous CS had a repeat CS (96.6%). CS rate was still high in Shanghai. Nulliparous women in low risk and having CS before labour, often without any medical indication, was a major contributor to the high CS rate.