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Title of Journal: Arch Gynecol Obstet

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Abbravation: Archives of Gynecology and Obstetrics

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Springer-Verlag

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DOI

10.1007/s40242-013-2382-6

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1432-0711

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Analyzing the impact of private service on the ces

Authors: Podjanee Phadungkiatwattana Naiyana Tongsakul
Publish Date: 2011/02/27
Volume: 284, Issue: 6, Pages: 1375-1379
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Abstract

The computerized delivery records collected from June 2006 to May 2009 at Rajavithi Hospital were retrospectively reviewed Of these 11049 term singleton nulliparous pregnant women without maternal chronic medical disease were divided into two groups private and nonprivate group Demographic data cesarean section rate indication for cesarean section time of delivery maternal and neonatal outcomes were assessed and analyzedThe cesarean section rate was markedly different between both groups The cesarean rates of all pregnant women women in private group and nonprivate group were 257 2841 out of 11049 673 1187 out of 1765 and 178 1654 out of 9284 respectively The private group’s odds of having a cesarean delivery was 944 times 95 confidence interval 95 CI 8372–10655 higher than the nonprivate group’s after adjusting for background differences maternal age race gestational age and birth weight The most common indications for cesarean delivery in private group were elderly gravida unfavorable cervix and cephalopelvic disproportion The private group had significantly higher operation rate in the office hours than that of nonprivate group 701 vs 418 p  00001After adjusted for background differences postpartum hemorrhage was significant higher in private group Conversely there was fewer admission to neonatal intensive care unit in private group Low Apgar score at 5 min and perinatal death were not statistically significant in both groups No cesarean hysterectomy and maternal death in both groups were notedPrivate patients had a significantly higher rate of cesarean section than nonprivate patients NICU admission was significantly lower in the private group but postpartum hemorrhage was significantly higher There were no significant differences in maternal mortality low Apgar score at 5 min perinatal death in both group This study suggests that a significant number of cesarean sections among private services may be unnecessary To safely reduce a cesarean section rate an appropriate policy and guideline for auditing cesarean section among private service should be developed

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