caa a22 4500 445309814 CHVBK 20180317142625.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s00404-011-1867-0 doi (NATIONALLICENCE)springer-10.1007/s00404-011-1867-0 Analyzing the impact of private service on the cesarean section rate in public hospital Thailand [Elektronische Daten] [Podjanee Phadungkiatwattana, Naiyana Tongsakul] Objective: To assess the cesarean section rate and compare the risk profiles of cesarean delivery in nulliparous women between private and non-private service. Materials and methods: The computerized delivery records, collected from June 2006 to May 2009 at Rajavithi Hospital were retrospectively reviewed. Of these, 11,049 term singleton nulliparous pregnant women without maternal chronic medical disease were divided into two groups; private and non-private group. Demographic data, cesarean section rate, indication for cesarean section, time of delivery, maternal and neonatal outcomes were assessed and analyzed. Results: The cesarean section rate was markedly different between both groups. The cesarean rates of all pregnant women, women in private group and non-private group were 25.7% (2,841 out of 11,049), 67.3% (1,187 out of 1,765), and 17.8% (1,654 out of 9,284), respectively. The private group's odds of having a cesarean delivery was 9.44 times [95% confidence interval (95% CI) 8.372-10.655] higher than the non-private 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 non-private group (70.1 vs. 41.8%; p<0.0001). After 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 5min and perinatal death were not statistically significant in both groups. No cesarean hysterectomy and maternal death in both groups were noted. Conclusions: Private patients had a significantly higher rate of cesarean section than non-private 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 5min, 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. Springer-Verlag, 2011 Cesarean section rate nationallicence Operative delivery nationallicence Private delivery nationallicence Phadungkiatwattana Podjanee Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, 10400, Bangkok, Thailand aut Tongsakul Naiyana Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, 10400, Bangkok, Thailand aut Archives of Gynecology and Obstetrics Springer-Verlag 284/6(2011-12-01), 1375-1379 0932-0067 284:6<1375 2011 284 404 https://doi.org/10.1007/s00404-011-1867-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00404-011-1867-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Phadungkiatwattana Podjanee Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, 10400, Bangkok, Thailand aut NATIONALLICENCE 700 1- Tongsakul Naiyana Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, 10400, Bangkok, Thailand aut NATIONALLICENCE 773 0- Archives of Gynecology and Obstetrics Springer-Verlag 284/6(2011-12-01), 1375-1379 0932-0067 284:6<1375 2011 284 404 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer