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.

Keywords: Universal Coverage Scheme; cesarean section rates; maternal and perinatal outcomes; trend.

Fig. 1

Projection of cesarean section rates (CSRs) from 2018 to 2030 by Joinpoint regression (CSRs 2009–2017—red dots; fitted and predicted line by regression—blue line; trend of CSR until 2030 projected using annual rates during 2009–2017—dashed line; and trend of CSR until 2030 projected using annual rates during 2009–2017 followed by decreasing annual rates after 2020 in different expected estimation: decreasing annual rate of 0.5%—triangle dashed line, decreasing annual rate of 1%—square dashed line, and decreasing annual rate of 2% – diamond dashed line).

Fig. 2

Trend of maternal mortality ratios, rates of postpartum hemorrhage, neonatal mortality rates per 1,000 live births, and rates of birth asphyxia per 1,000 live births from 2009 to 2017 (mean and 95% confidence interval).

Fig. 3

Correlation of cesarean section rates with maternal mortality ratios by year.

Fig. 4

Correlation of cesarean section rates with rates of postpartum hemorrhage by year.

Fig. 5

Correlation of cesarean section rates with neonatal mortality rates by year.

Fig. 6

Correlation of cesarean section rates with birth asphyxia rates by year.