Comparison of Indications for Cesarean Sections at Teaching Hospital with Private Medical Centers in Tabriz, 1999

Abstract

Abstract: Introduction: Cesarean section rate in medical centers of Tabriz has increased of 36.2 percent (1995-1996) to 48.1 percent in 1998 and has outstripped Brazil and Chile in having the highest reported cesarean section rate in the world also in view of the world health organization (1997), expansion of the research initiative on the role increasing rate of cesarean section, investigator decide to determine and compare the rate and indications for cesarean sections at educational-treatment and private medical centers in Tabriz town. Method & Material: This study is one descriptive comparative study. This study with simple sampling method was conducted to assess 550 pregnant women (275 samples of educational treatment medical centers and 275 from private medical centers) amongst pregnant women referring to educational- medical and private centers for delivery and with cesarean section. Data collection instrument including interview data sheet, questionnaire sheet and checklist for data were used. Our statistical method were descriptive statistics (Calculation of absolute and percentage frequency, mean, standard deviation and analytical methods for x^2 test, corrected x^2 with Yates correction. Exact fisher test and t-test). Results: Results between two centers showed that there is significant difference in cesarean rate (i.e 31.5% at educational-treatment medical centers and 80.5% in private medical centers, Pv=0.000). There was significant difference in emergency indications (i.e 37.5% at educational-treatment medical centers and 6.9% in private medical centers. Pv=0.000). Emergency indications had no significant difference before labor (Pv=0.6), but during labor it showed difference statistically (34.2% at educational-medical centers and 4.7% percent at private medical centers, Pv=0.000). Elective indications had difference statistically (62.5% at educational-treatment medical centers and 93.1% at private medical centers, Pv=0.000). Breech presentation was one of elective indications (14.2% at educational-treatment medical and 4.4 % at private medical centers, Pv=0.000), mother’s demand (5.1% at educational treatment medical centers and 25.1% at private medical centers, Pv=0.000) and physician offer (5.1% at educational-treatment medical centers and 21.5% at private medical centers, Pv=0.0000) had significant difference. There was significant difference in desire to cesarean amongst cesarean delivery women between two center (i.e 19.6% at educational-treatment medical centers and 47.6% at private centers, Pv=0.0000). In relation to desire causes to cesarean delivery from point of view cesarean delivery women with desire to this method, there was no found significant difference except in statements about fear of vaginal delivery pain safety of cesarean delivery for fetal and newborn health compared with vagina delivery and negative experiences of friends from vaginal delivery. Also the most stated cause at two center was fear of vaginal delivery pain. The most cause for selection cesarean from view point of obstetricians was fear of uterus rupture in pregnant women with cesarean history. Discussion & Conclusion: In summery the findings of this study in relation ti study hypotheses showed that the rate of and the indications for cesarean delivery were not the same at two centers and had significant difference statistically. Cesarean rate, elective indications, mother’s request, physician offer, intent to cesarean at private medical centers and rate of emergency indications at educational-treatment medical centers was further. According the findings of this study suggestions have presented for future investigations.