Secular trends in caesarean section rates over 20 years in a regional obstetric unit in Hong Kong.

INTRODUCTION: Although caesarean section rates have been increasing over the years in both public and private sectors in Hong Kong, there has been a paucity of formal surveys on local trends in such rates. This study aimed to examine the trends in caesarean section rates over a 20-year period at a public regional obstetric unit in Hong Kong using the Robson's Ten-group Classification System. METHODS: All deliveries in a single obstetric unit during a 20-year period (1995-2014) were classified into 10 subgroups according to the Robson's classification. The annual caesarean section rate for each subgroup was calculated and then stratified into 5-year intervals to analyse any significant trends. RESULTS: The caesarean section rates in a total of 86 262 births with complete data were analysed. The overall caesarean section rate increased modestly from 15.4% to 24.6% during the study period. There was an obvious increasing trend for caesarean section in those with previous caesarean section (Robson's category 5), breech presentation at delivery (category 6 and 7), multiple pregnancy (category 8), and preterm labour (category 10). A gradual fall in caesarean section rate from 14.4% to 10.8% was seen in primiparous women with term spontaneous labour (category 1). Statistically significant differences (P<0.001) in these trends were confirmed when the data were stratified into 5-year intervals for comparison. CONCLUSION: The rising caesarean section rate may be associated with clinical management policies that allow women with relative risk factors (such as breech, previous caesarean section, or multiple pregnancy) to opt for caesarean section. This rise was counterbalanced by a decrease in primary caesarean section rate in primiparous women with spontaneous labour. The trend for caesarean section was more in line with patient expectations rather than evidence-based practice.

Seatbelt use by pregnant women: a survey of knowledge and practice in Hong Kong.

INTRODUCTION: The use of motor vehicles is common during pregnancy. Correct seatbelt use during pregnancy has been shown to protect both the pregnant woman and her fetus. This survey aimed to evaluate the practices, beliefs, and knowledge of Hong Kong pregnant women of correct seatbelt use, and identify factors leading to reduced compliance and inadequate knowledge. METHODS: A self-administered survey was completed by postpartum women in the postnatal ward at the United Christian Hospital, Hong Kong, from January to April 2015. Eligible surveys were available from 495 women. The primary outcome was the proportion of pregnant women who maintained or reduced seatbelt use during pregnancy. Secondary outcomes were analysed and included knowledge of correct seatbelt use, as well as contributing factors to non-compliance and inadequate knowledge. RESULTS: There was decreased compliance with seatbelt use during pregnancy and the decrease was in line with increasing gestation. Pregnant women's knowledge about seatbelt use was inadequate and only a minority had received relevant information. Women who held a driving licence and had a higher education level were more likely to wear a seatbelt before and during pregnancy. Women with tertiary education or above knew more about seatbelt use. CONCLUSIONS: Public health education for pregnant women in Hong Kong about road safety is advisable, and targeting the lower-compliant groups may be more effective and successful.