Trend of Cesarean Section Rates and Correlations with Adverse Maternal and Neonatal Outcomes: A Secondary Analysis of Thai Universal Coverage Scheme Data

Abstract

Objectives The main purpose of this article is to estimate the trend and projection of cesarean section rates (CSRs) and explore correlations between CSRs with adverse maternal and perinatal outcomes, namely maternal mortality ratios (MMRs), rates of postpartum hemorrhage (PPH), neonatal mortality rates (NMRs), and birth asphyxia per 1,000 live births across all regions of Thailand. Study design A secondary analysis of the hospital-based database of pregnant women and newborns under the Thai Universal Coverage Scheme between January 2009 and December 2017 was conducted. Results Overall annual CSR significantly increased from 23.2% in 2009 to 32.5% in 2017. With the same rate of increase, the CSR of 59.1% was projected by the year 2030 that could be reduced to 30.0% if an annual rate of CS reduction of 1% was assumed using Joinpoint regression. The increasing CSRs were significantly correlated with higher MMRs (r= 0.20, p = 0.03) and birth asphyxia (r= 0.39, p < 0.001). The correlation trends were similar when the analyses were stratified by year in the majority of years. Overall correlations between CSRs and rates of PPH or NMRs were not statistically significant. Conclusion CSRs in Thailand continuously increased and were correlated with adverse maternal and perinatal outcomes. More effort at the national level to reduce unnecessary CS is urgently required.

Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand

“…Currently, cesarean section rates have been rising globally. Cesarean section rates in Thailand have been significantly increasing during the past three decades from 15.2% in 1990 to 32.5% in 2017 [ 3 , 4 ]. Factors contributing to this increase include delayed childbearing, policies promoting repeat cesarean section, refusal to offer vaginal birth after cesarean section, wide use of continuous electronic fetal monitoring, use of epidural analgesia, fear of malpractice liability, professional practice style, professional expectations for work-life balance, reimbursement systems, financial incentives, maternal request and lack of regulations [ 5 – 8 ].…”

Why do pregnant women prefer cesarean birth? : a qualitative study in a tertiary care center in Southern Thailand

“…Currently, cesarean section rates have been rising globally, including Thailand. Cesarean section rates in Thailand have been signi cantly increasing during the past three decades from 15.2% in 1990 to 32.5% in 2017 [3,4]. Factors contributing to this increase include delayed childbearing, policies promoting repeat cesarean section, refusal to offer vaginal birth after cesarean section, wide use of continuous electronic fetal monitoring, use of epidural analgesia, fear of malpractice liability, professional practice style, professional expectations for work-life balance, reimbursement system, nancial incentives, maternal request, and lack of regulations [5][6][7][8].…”

Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical-trend analysis, 2009–2016

“…After careful data cleaning, a total of 4,297,321 T2DM admitted cases of 2,689,642 UCS patients aged 15 to 100 years in Thailand between 2009 and 2016 were included in this study. Although Thailand achieved UHC in 2002, we decided to use only data from 2009 onwards for our analyses since there were a number of missing values and errors in data before 2009 [14,15]. Ages of below 15 years were excluded because T2DM was rare in children until recently [16] and above 100 years were considered to be primarily caused by typing errors.…”