Epidemiological Characteristics and Risk Factors of Obstetric Infection After the Universal Two-child Policy in North China: A 5-year Retrospective Study Based on 268, 311 Cases

Abstract

PurposeObstetrical infection is one of the causes of maternal death and a difficult problem for many clinicians. Changes in the demographic and obstetric background of pregnant women following the Universal Two-Child Policy may have an impact on some fertility phenomena. Therefore, more studies based on the change of fertility policy are needed. We try to analyze the epidemiological characteristics and risk factors of obstetric infection before and after the Universal Two-Child Policy, with a view to providing reference for the prevention and control of obstetric infection in regions after the change of fertility policy. MethodsThe subjects of the survey were 268,311 pregnant women from Hebei Province Maternal Near Miss Surveillance System (HBMNMSS) of Hebei Women and Children's Health Center from January 1, 2013 to December 31, 2017. We analyzed the region , time and population distribution characteristics of obstetric infection, compared the epidemiological factors of obstetric infection before and after the Universal Two-Child Policy , and analyzed the relevant risk factors of obstetric infection. ResultsThe incidence of obstetric infection increased nearly twice after the Universal Two-Child Policy. The incidence of obstetric infection was highest in Chengde(1.9%), a city with a northward geographical distribution, Baoding (1.6%), Cangzhou (1.5%) followed; The higher the hospital grade, the higher the incidence; The incidence of obstetric infections in hospitals at all levels has increased; The age of onset before the Universal Two-Child Policy was (27.82±5.047) years old, and the age after the Universal Two-Child Policy was (28.97±4.880) years old; The incidence of obstetric infections is higher in winter. The rate of abortion-related infection (increased from 0.61% to 1.65%) and the rate of pregnant women with high school education (increased from 0.35% to 0.74%) increased significantly. The results of multivariate Logistic regression analysis after the Universal Two-Child Policy showed that anemia (OR=1.249, 95%CI: 1.071-1.458), chronic hypertension (OR=1.934, 95%CI: 1.375-2.722), mild preeclampsia (OR=2.103, 95%CI: 1.323-3.344) and severe preeclampsia (OR=2.228, 95%CI: 1.703-2.916) were independent risk factors for obstetric infection. Gestational age ≥37 weeks was a protective factor. ConclusionsAfter the Universal Two-Child Policy, the prevention and control of obstetric infections should be strengthened, especially for abortion-related infections and elderly maternal with obstetric complications and complication in high-grade hospitals in winter. Educational background is also one of the factors that should be considered in the prevention of obstetric sensation. Prolonging gestational age is helpful to reduce the incidence of obstetric infection.