Evaluating the Efficiency of the Health Care Reform Plan on the Cesarean Section and its Related Factors in Alzahra Academic and Medical Center in Rasht

Recently, cesarean section (CS) has gone beyond the reasons for maintaining the health and safety of mother and baby, and the personal desires of individuals have been very influential in it. Studies have shown that the number of CS in Iran is high. The aim of this study was to determine the efficiency of the health care reform plan on cesarean delivery and its associated factors in Alzahra Hospital in Rasht during 2019.

The present study was conducted in Alzahra Educational and Medical Center as a cross-sectional study. Files of all women who had CS and vaginal deliveries in 2019 in this center were examined. The total amount of CS was calculated through the statistics of the vaginal deliveries and CS registered in this center and then the cause of CS was extracted from patients' files and recorded in the checklist. To describe quantitative variables with normal distribution, mean and standard deviation, for quantitative variables with non-normal distribution, median (first quartile - third quartile) and for qualitative variables, number and percentage were used. The normal distribution of quantitative variables was measured using kurtosis and skewness values, Q-Q Plot and Shapiro-Wilk tests. Chi-square and Fisher tests were used for comparisons. The statistical significance level of the tests (P > 0.05) was considered.

2460 vaginal births and 1268 Cs were performed in Alzahra hospital during 2019, and in this study, the files of 416 women with Cs were examined. The percentage of Cs in this center was 34.01% in this year. The mean age of women referring to Alzahra Hospital in Rasht for CS was 30.87±6.05 years. 0.1% of them were under 18 years old and 24.5% were over 35 years old. The mean gestational week was 37 weeks with a minimum-maximum of 28-41 weeks. The causes of CS in 211 (50.7%) patients were related to uterus, 49.3% (49.3%) were related to placenta and fetus and 27.5 (6.5%) were related to maternal underlying diseases. Among them, the history of previous CS, fetal distress and preeclampsia were more frequent in each section, respectively. In total, history of previous CS (45.9%), fetal distress (19.0%), meconium excretion (13.9%), multiple births (7.2%) and breach view (0.6%), respectively were most causes of CS in this center. Based on the results, a significant relationship was observed between maternal age and number of pregnancies with causes related to uterus, placenta and fetus.

The frequency of CS in Alzahra Hospital in 2019 has decreased significantly compared to the time before the Health Reforming Plan. Although this percentage has decreased compared to the previous study, it is still higher than the statistics defined by the World Health Organization and it is still necessary to try to reduce this frequency by considering the safety of mother and baby.