Índice de Robson: riesgo de cesárea en un centro de primer nivel en México / Robson index, c-section risk in a first level center in Mexico

Resumen OBJETIVO: Determinar, conforme al Índice de Robson, la tasa de cesáreas en pacientes atendidas, en un periodo de nueve meses, en el Centro de Investigación Materno-Infantil del Grupo de Estudios al Nacimiento. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal, descriptivo y monocéntrico efectuado en pacientes embarazadas atendidas en el Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento, (CIMIGen) que finalizaron el embarazo por cesárea y en quienes se utilizó el índice de Robson para su clasificación. Parámetros de estudio: indicaciones de la cesárea, riesgo de pérdida del bienestar fetal, alta de progresión del trabajo de parto, falla en la inducción del trabajo de parto, macrosomía, periodo intergenésico corto (menos de 18 meses). RESULTADOS: Se obtuvieron 569 pacientes de las que 228 finalizaron el embarazo mediante cesárea y 341 por parto, lo que representó una tasa de cesáreas del 39.9%. Al aplicar el método de clasificación de Robson, los grupos con mayor contribución relativa a la tasa global de cesáreas fueron: grupo 1 (17.62%), grupo 2, subdividido en sus dos categorías: 2a con 19.38% y 2b 17.18%; y el grupo 5.1 (22.91%) y grupo 5.2 (3.96%). Las principales indicaciones de cesárea fueron: 1) riesgo de pérdida del bienestar fetal (18.9%), 2) falta de progresión del trabajo de parto (16.7%), 3) falla en la inducción del trabajo de parto (11.1%), 4) macrosomía (7.2%) y 5) periodo intergenésico corto (7.2%). CONCLUSIONES: El índice de Robson señaló a los grupos 1, 2 y 5 como los mayores contribuyentes a la tasa de cesáreas en CIMIGen. Esta tendencia, grupos 1 y 2 con porcentajes elevados, también se observa en otros centros de atención en México, lo que pudiera indicar una práctica de atención obstétrica que debe revisarse. Esto también se ve en otros países, aunque los porcentajes son distintos pero siguen siendo considerables en los grupos 1, 2 y 5.

Abstract OBJECTIVE: To determine, according to the Robson Index, the caesarean section rate in patients attended, over a period of nine months, at the Maternal and Infant Research Centre of the Childbirth Studies Group. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive, single-centre study carried out in pregnant patients attended at the Maternal and Infant Research Centre of the Childbirth Study Group (CIMIGen) who terminated gestation by caesarean section and in whom the Robson index was used for classification. Study parameters: indications for caesarean section, risk of loss of fetal well-being, high labour progression, failure of labour induction, macrosomia, short inter-gestational period (less than 18 months). RESULTS: We obtained 569 patients of whom 228 terminated pregnancy by caesarean section and 341 by delivery, representing a caesarean section rate of 39.9%. Applying Robson's classification method, the groups with the highest relative contribution to the overall caesarean section rate were: group 1 (17.62%), group 2, subdivided into its two categories: 2a with 19.38% and 2b 17.18%; and group 5.1 (22.91%) and group 5.2 (3.96%). The main indications for caesarean section were 1) risk of loss of fetal well-being (18.9%), 2) failure of labour to progress (16.7%), 3) failure of induction of labour (11.1%), 4) macrosomia (7.2%) and 5) short inter-gestational period (7.2%). CONCLUSIONS: Robson's index pointed to groups 1, 2 and 5 as the largest contributors to the caesarean section rate at CIMIGen. This trend, groups 1 and 2 with high percentages, is also seen in other facilities in Mexico, which may indicate an obstetric care practice that needs to be reviewed. This is also seen in other countries, although the percentages are different but still considerable in groups 1, 2 and 5.

Aplicación de la clasificación de Robson para el análisis de la tasa de cesárea en el Hospital Doctor Peset / Review of cesarean rate in Hospital Doctor Peset using the Robson classification

OBJECTIVE: To analyze the caesarean deliveries attended in our hospital, grouping them according to the Robson Classification System and to establish measures in order to reduce caesarean delivery rates. METHOD: Prospective study of all the deliveries attended at Hospital Doctor Peset in 2019 using the Robson classification. RESULTS: A total of 1113 births have been analyzed with a total cesarean section rate of 25.3%. The largest contribution to the total cesarean delivery rate with 34.4% was group 2A (nulliparous women with a single fetus in cephalic presentation, 37 weeks or more pregnant who started labor by induction). Secondly, group 5 (multiparous women with at least previous cesarean section, with single cephalic fetus, 37 weeks or more pregnant) which represents the 20.1% of the total. Inductions in nulliparas multiply the cesarean section rate by 3 compared to nulliparas that initiate labor spontaneously. CONCLUSIONS: Robsons classification is a tool that allows to easily classify and analyze the groups in which to implement measures to reduce the number of caesarean sections performed. Analyzing the induction indications and reviewing action protocols could suppose a substantial decrease in the caesarean section rate in our center.

OBJETIVO: Analizar las cesáreas realizadas en nuestro centro agrupándolas según la clasificación de Robson para establecer medidas que permitan reducir la tasa de cesáreas. MÉTODO: Auditoría prospectiva de los nacimientos asistidos en el Hospital Doctor Peset en el año 2019 mediante la clasificación de Robson. RESULTADOS: Se han analizado 1113 nacimientos con una tasa de cesárea del 25.3%. El grupo que más contribuyó al total de cesáreas realizadas, con un 34.4%, fue el 2A (nulíparas con feto único en presentación cefálica, de 37 semanas o más de embarazo, que iniciaron el parto mediante inducción). En segundo lugar, el grupo 5 (multíparas con al menos una cesárea previa, con un feto único en presentación cefálica, de 37 semanas o más de embarazo), con un 20.1%. Las inducciones en nulíparas multiplican por tres la tasa de cesárea respecto a las nulíparas que inician el trabajo de parto de manera espontánea. CONCLUSIONES: La clasificación de Robson es una herramienta que permite clasificar y analizar de manera sencilla los grupos en los que implantar medidas para reducir el número de cesáreas realizadas. Analizar las indicaciones de inducción y revisar los protocolos de actuación podría suponer una disminución sustancial en la tasa de cesáreas en nuestro centro.

Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary Care hospitals in the united arab emirates

Abstract Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS.The rate of vaginal birth after cesarean was 261(6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Are cesarean delivery rates and indications changing?

Background: There seems to be gradual raising trend in cesarean deliveries over decades with associated decrease in perinatal mortality rate. This study was undertaken to compare the caesarean delivery (CS) rates along with its indications over the last decade and to examine whether it is changing.Methods: The aim is to compare the rate and indications of CS in a retrospective manner from the data collected between January 1 and December 31 in the year 2006, 2011, and 2016 in a zonal hospital. The rates and indications of CS were analyzed to find whether they are changing if yes which are the factors contributing for the same. Categorical variables were compared using chi-square test.Results: The CS rate showed an increasing trend from 26 % in 2006 to 27.6 % in 2011 to 32.4 % in 2016. Of the total CS, repeat CS rate was significantly increased from 76 (6.61%) in 2006 to 106 (10.34%) in 2011 to 128 (13.72%). Primary CS percent remained more or less same during the study period. Post cesarean pregnancy (p=0.00001) and fetal distress (p=0.012) showed significant rise as an indication for CS which were major contributor for rise in last decade while failed induction decreased.Conclusions: Over the decade there is increase in the total CS rate mainly attributable to repeat CS while post CS pregnancies and foetal distress were leading cause for CS. There is need for reducing primary CS along with increase in trial of labor after cesarean in properly selected women.

Investigation and analysis of cesarean section rate and indications in Shanghai / 中国实用妇科与产科杂志

OBJECTIVE:To study the current status of cesarean section rate(CSR)and cesarean section(CS)indications in Shanghai,and to provide basic evidence for reducing the rate of CS.METHODS:Six general and maternal and child hospi⁃tals(MCH)in Shanghai were selected,and all data of childbirth of these hospitals in 2016 were collected.The total CSR was calculated for all hospitals and the Chi-square tests were used to compare the CSR among different hospitals.The constitution of CS indications were reported by using the data collected from two out of the six hospitals.RESULTS:The to⁃tal CSR of all hospitals in this study was 47.88%(95% CI 47.30%-48.46%).The CSR in suburb an hospitals was signifi⁃cantly higher than that in outer suburbs and city center(51.72% vs. 50.54% vs. 43.24%,P<0.01),The CSR in secondary hospitals was significantly higher than that in tertiary hospitals(49.73% vs. 46.36%,P<0.01).The CSR in general hospi⁃tals was higher than that in MCH(54.54% vs. 43.81%,P<0.01).The CS without medical indications or for social reasons accounted for 25.15% of all CS,while the scar uterus(36.31%),maternal pregnancy-related complications(13.17%)and abnormal fetal head position(6.33%)were the three leading medical indications of CS.CONCLUSION:The CSR in Shang⁃hai is at a high level.There are significant differences in CSR among different hospitals.The scar uterine and social rea⁃sons are the leading causes of CS in Shanghai.

Caracterización de cesáreas primitivas en Santa Cruz del Norte / Characterization of Primitive Cesareans in Santa Cruz Del Norte

Introducción: la operación cesárea ha incrementado en Latinoamérica y en gran parte del mundo en los últimos años. Objetivo: establecer el comportamiento de las cesáreas primitivas en Santa Cruz del Norte en un período de 15 meses. Métodos: se realizó un estudio descriptivo transversal desde julio de 2012 hasta septiembre de 2013 con un universo de 127 pacientes sometidas a cesárea primitiva y una muestra que se hizo coincidir con el universo. Los datos se recolectaron mediante la revisión del libro de registro de nacimientos, la historia clínica obstétrica y hospitalaria. Estadísticamente se empleó la distribución de frecuencias, porcentaje, índice, prueba t de Student y chi cuadrado. Resultados: el índice de cesáreas primitivas fue elevado (34,9 por ciento) con tendencia temporal mantenida, sobre todo por meconio anteparto con malas condiciones obstétricas (29,9 por ciento), estado fetal intranquilizante (14,2 por ciento) y desproporción céfalo-pélvica (14,2 por ciento). La clasificación de la cesárea fue incorrecta en 59,8 por ciento, así como la profilaxis con antimicrobianos en 74,8 por ciento. Las complicaciones neonatales más frecuentes fueron el distrés respiratorio (8,7 por ciento) y la asfixia perinatal (6,3 por ciento); y en las puérperas el sangramiento postparto (10,2 por ciento) y la endometritis (8,7 por ciento). Conclusiones: se evidenció un elevado índice de cesáreas primitivas, muchas de ellas con indicaciones injustificadas y un mal manejo de la clasificación y profilaxis quirúrgica que conllevó a complicaciones neonatales y puerperales(AU)

Introduction: The cesarean section has increased in great scale in Latin America and all over the world in the last years. Objective: Establish the actual state of cesarean section in Santa Cruz del Norte in a period of 15 months. Methods: a cross section study was conducted from July 2012 to September 2013 in a universe of 127 patients with cesarean section for the first time; the whole universe was intentionally selected to compose the sample. The data were collected by the review of book of births, clinical and obstetric records and they were processed using frequency distribution, percentage, rate, Student's test and Ji-square. Results: The cesarean section rate was elevated (34,9 percent) keeping the same temporal tendency, mostly due to antepartum meconium with poor cervix conditions (29,9 percent), non-reassuring fetal status (14,2 percent) and cephalo-pelvic disproportion (14,2 percent ). 59,8 percent had incorrect cesarean classification and prophylaxis with antibiotics was mainly incorrect in 74,8 percent. Respiratory distress (8,7 percent) and perinatal asphyxia (6,3 percent) were the most frequently neonatal complications, whereas postpartum hemorrhage (10,2 percent) and endometritis (8,7 percent) were the most frequently in mothers. Conclusions: High rate of cesarean sections was found, most of them with unjustified indications and a wrong management of the classification and surgical prophylaxis leading to neonatal and maternal complications(AU)

Effect of B-ultrasound combined with intravenous terbutaline sulfate for external cephalic version / 实用医学杂志

Objective To investigate the effect of ultrasound combined with intravenous terbutaline sulfate for external cephalic version and the impact of this therapy on maternal and neonatal complications.Methods 126 singleton pregnant women who were diagnosed by B-ultrasound breech pregnancy at 34-36 weeks in regular antenatal examination from January 2014 to June 2016 were randomly divided into an observation group (n =70)and a control group (n =50).The observation group was treated with intravenous drip of terbutaline sulfate after epidural anesthesia,and then received external cephalic version under B-ultrasound monitoring.The control group received traditional knee-chest position for correcting breech presentation.The success rate of breech correction,breech version rate,cesarean section rate,vaginal delivery rate,adverse reactions,postpartum hemorrhage volume,neonatal asphyxia,and neonatal birth injury were noted and compared between the two groups.Results As compared with the control group,the observation group had a higher success rate of breech correction and a higher rate of vaginal delivery while a lower rate of cesarean section,with a significant difference (x2 =20.210,8.564;P ＜0.05).The rate of postpartum hemorrhage,neonatal asphyxia,or neonatal birth injury did not differ significantly between the two groups (P ＞ 0.05).Conclusions Application of ultrasound combined with intravenous terbutaline sulfate in external cephalic version is easy to operate and has a higher success rate and greater safety,significantly reducing the rate of cesarean section and improve the success rate of vaginal delivery.

The effects of the policy measures to control the rate of cesarean section in four counties / 中国卫生政策研究

Objective:To explore the propagable experience and methods of controlling the rate of cesarean sec-tion through the summary of the innovative measures in four counties. Methods:The cases of natural birth and cesare-an section from 2009 to 2013 in four counties were analyzed respectively. The interventions of controlling cesarean section rate have been summarized. Results:The average cesarean section rate of four counties in five years is on the decline, since 2009 the rate were 60. 2%,62. 3%,59. 3%,51. 4%,48. 1%. Conclusions: The interventions really worked, but did not do the best. Improving the social attention on these innovative measures, strengthening surveil-lance mechanism, regulating the medical behaviors of delivery hospitals, enhancing the midwifery training and promo-ting the interventions under the coordination of local government can further reduce the rate of cesarean section.

Analysis on the rate and indications of cesarean section in Minhang District of Shanghai in recent five years / 上海预防医学

To analyze the changes in cesarean section rate and its indication in recent 5 years (from 2008 to 2012), then providing evidence for intervention measures . [Methods] Retro-spective analysis of recent 5 years was done for Minhang District maternity and infant quarterly statements and cesarean section clinical data . [ Results ] The rate of cesarean section still showed an upward trend, and vaginal birth rate declined year by year .The cesarean section rate of Shanghai census register was significantly higher than that of non Shanghai registration , but the gap was smaller and smaller .The first 4 indications for cesarean section were fetal distress , cephalopelvic disproportion , scar uterus , and so-cial factors.Scar uterus increased year by year , and in 2012 rose to the first one.Fetal distress, cephalo-pelvic disproportion decreased year by year , and social factors had no obvious change . [ Conclusion] The main reasons for the high rate of cesarean section were social factors , medical factors , economic factors and others.Comprehensive intervention measures should be taken actively for controlling the cesarean sec -tion rate in the reasonable scope .

Changes in the Cesarean Section Rate in Korea (1982-2012) and a Review of the Associated Factors

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.

Analysis of increased rate and changed indications of cesarean section in recent Years / 中国综合临床

Objective To analyse and understand the main reasons for cesarean section,in order to reduce the rate of cesarean section. Methods Clinical analysis was performed in 6781 patients who underwent cesarean section from January 2004 to December 2008. Results ①Cesarean section rate was increasing from 2004 to 2008, which was 32. 00% (840/2625) , 35. 00% (966/2760) , 39. 08% (1186/3035), 45. 98% (1669/3630) and 51. 88% (2120/4086) .respectively. Compared to 2004, the cesarean section rate in 2008 increased significantly (P <0.01). ②The proportion of the main cesarean section indications changed, the proportion of social factors ,fetal factors and maternal factors were increasing gradually. Cephatopelvic disproportion in 2008 decreased significantly compared to that in 2004(x2 = 194. 805 ,P <0. 01). There was significent difference in each indication from 2004 to 2008. Conclusions The cesarean section rate has increased due to medical reasons and social reasons. To ensure the safety of the mothers and children, vaginal delivery should be adopted as far as possible. The cesarean section without medical indication should be prohibited.

Differences of Cesarean Section Rates according to San-Yin-Jiao(SP6) Acupressure for Women in Labor / 간호학회지

PURPOSE: The purpose of this study was to explain differences of cesarean section rates according to San-Yin-Jiao(SP6) acupressure for women in labor. METHOD: A noneqivalent control group pre test - post test design was used to explain differences of cesarean section rates according to SP6 acupressure. The participants were 209 women who were assigned to one of three groups SP6 acupressure(n=86), SP6 touch(n=47), and control group(n=76). For 30 minutes, the SP6 acupressure group received SP6 acupressure,and the SP6 touch group received SP6 touch for the duration of each uterine contraction. The Control group was encouraged to deep breath and relax for the duration of each uterine contraction for 30 minutes. RESULT: The rates of cesarean section were 12.8%, 29.8%, and 22.4% for the SP6 acupressure group, SP6 touch group, and control group respectively. There was a significant difference among groups (p=0.049). Cesarean section rateswere significantly different between the SP6 acupressure and non-SP6 acupressure group(p=0.035). CONCLUSION: This finding shows that 30 minutes of SP6 acupressure was effective in decreasing the cesarean section rate. Therefore, SP6 acupressure during labor could be applied as an effective nursing intervention.

Trends of caesarean section and related social and demographic factors in China from 1971 to 2003 / 中华围产医学杂志

Objective To investigate the occurrence of cesarean section (CS) among reproductive age women in last thirty years, and explore the factors related to high CS rate. Methods Population proportional to size sampling method was employed in sampling. The sampled women were interviewed face to face. Data were double entered by EPIDATA 2.1 and analyzed by SPSS 11.5. Results The CS rate continuously increase from 0.9% in 1971-1980 to 20.2% in 2001-2002 and the speed is more and more rapid. More and more CSs were required by the women themselves and the rate increased from 19.3% in 1971-1985 to 49.7% in 2001-2002. Logistic regression analysis showed that women who were less than 30, senior high education or above and white-collar or jobless women had more than 8 times of antenatal visits, lived in eastern region and had B-ultrasound exam, were more likely to have caesarean section. Conclusions The caesarean section rate was increasing rapidly in the last thirty years especially after 1990. There are two reasons for this increase, on one hand caesa- rean sections with medical indications increase because of the progress of perinatal care and related technology; on the other hand unnecessary caesarean sections increase because of some social and demographic factors, which result in more caesarean section required by the pregnant women.

Can Cesarean Section Rate Be Used as a Hospital-Wide Quality Indicator in Korean Hospitals? / 대한산부인과학회잡지

With the sharply increasing practice of cesarean section(C/S), formerly known as a landmark of developing medical technology, appropriateness of the procedure has been widely inquired into. Appropriateness of a specific procedure could be an indicator for quality, at the individual or organizational level. Cesarean section rate is regarded as a sensitive indicator reflecting clinical quality at the hospital level. We are interested in the validity and significance of C/S rate as a quality indicator in Korean hospitals, in addition to the current status of the practice. This study was carried out retrospectively based on the clinical records of cesarean sections in 32 hospitals nationwide from March to May 1996. Standardized survey format was distributed, and reviews were performed by volunteer surveyors from each hospital after two sessions of pre-survey education. The results were as follows : 1. There were 13,241 deliveries with 4,599 cases of cesarean sections, giving an incidence of 38.5%. This result shows the incidence of cesarean section was 1.6 times higher than U.S. and about four times higher than European countries. 2. The monthly incidence of cesarean section was not variable, but it shows great differences among the hospitals. 3. The incidences of cesarean sections were variable among different age groups with marked higher rate in older one. 4. Most of deliveries were with gestational period from 37 to 44 weeks(91%), in which C/S rate was 39%. For pregnancies with less than or equal to 32 weeks, the rate was 21% and for more than or equal to 45 weeks the rate was 25%. 5. The most frequent indication of cesarean birth was previous cesarean section(37.7%), followed by cephalopelvic disproportion and dystocia(24.4%). 6. There were no statistical differences in cesarean section rates by hospital variables such as ownership, teaching status, proportion of specialists, number of physicians per bed, number of nurses per bed, regional location, and number of beds. Exceptionally, hospitals with independent obstetrics department, separated from gynecology, showed significant lower rate than hospitals with conventional obstetrics-gynecology department. We could confirm higher C/S rate than any other countries. However, C/S rate, not significantly different among hospitals with variable quality level in structural aspect, was not acceptable as a sensitive indicator for clinical quality at the hospital level. Different rates between comparable organizational settings, sometimes indirectly related to the clinical quality, suggested that more studies focused on other aspects of quality than structure should be needed.

Cesarean section rate and perinatal mortality rate at Siriraj Hospital during 1980-1990.

Cesarean section rates have increased markedly in many centers all over the world in the past 20 years. A retrospective analysis was made using the obstetrics data from one teaching hospital in Bangkok in order to see trends in cesarean section and perinatal mortality during the years 1980-1990. We analysed the annual cesarean section rate, the perinatal mortality rate, and the major indications for cesarean section. Z-test was used to investigate statistical significance. There was a significant increase in the primary cesarean section rate, the repeated cesarean section rate and the total cesarean section rate in the year 1980-1987. After 1987, the rates reached a plateau until December, 1990. Cephalo-pelvic disproportion, breech presentation and fetal distress were the three leading causes of cesarean section in this study. There were significant increase in cephalopelvic disproportion and fetal distress in the second half of the decade compared with the first half. Breech presentation at the time of delivery slightly increased during this time without statistical significance. Perinatal mortality rate decreased significantly from an average of 13.53 between 1980-1984 to 11.12 between 1985-1990. Increasing vaginal birth after cesarean section may be an important means to reduce the cesarean section rate by decreasing the repeated cesarean section rate. This practice has been reposted to lower cesarean section rates in many centers.

Regional Variations in the Cesarean Section Rate and It's Determinants in Korea / 예방의학회지

The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows: It was found that, cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible(15-49 years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities: 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates: In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three dependent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the variance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has been found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.

Clinical Analysis of Cases of Cersarean Section under General Anesthesia / 대한마취과학회지

The anesthesia for cesarean section is concerned not only with the fetus but also with mother. The physiological changes of the patient are manifold and drugs which are used during cesarean section may have effects on the fetus. The rate of cesarean section has increased during recent years due to frequent fetal monitoring, medical insurance and the threat of malpractice suits. A total of 1225 cesarean sections were performed under general anesthesia during the year period from 1983 to 1987. The following are the clinical observations: 1) The cesarean section rate was 19.03% and this has been increasing during recent year. 2) The delivery time from induction was less than 15 min in 80.5% of cases. 3) Apgar scores were: more than 7 in 1 minute: 92% more than 7 in 5 minutes: 95.8%. 4) The infant resuscitation rate was 4.57% and more than 7 of the Apgar scores were noted after resuscitation. 5) The mean hemoglobin was 10gm% and the blood transfusion rate was 7.92%.