Epidemiological Characteristics, Economic Burden and Trend of Changes in Cesarean Sections Performed in Medical University Educational Centers in Mashhad City: A 12-Year Study

Due to the increase in the frequency of cesarean section over the past few decades, the Ministry of Health and Medical Education of Iran compiled the guideline to promote natural childbirth within the framework of the health reform plans and communicated it to the country's medical science centers. The present study was conducted with aim to determine the epidemiological characteristics and changes trend of the frequency of cesarean section performed in the three educational hospitals of Mashhad University of Medical Sciences.

In this cross-sectional study, the information of all mothers admitted to the three educational hospitals of Mashhad University of Medical Sciences (Imam Reza, Ghaem and Omol-Banin hospitals) due to pregnancy termination during 12 years period (2007-2018) was extracted from the hospital information system. The analyzed information included age, hospitalization center, type of admission (elective or emergency), number of babies, need to transfer mother to ICU, total hospitalization cost, duration of hospitalization, and mother's insurance coverage status. Data was analyzed by SPSS software (version 26). P<0.05 was considered statistically significant.

Overall, 163070 pregnant women have been admitted for pregnancy termination, of which, 68258 mothers (41.9%) had cesarean section. The median of duration of hospitalization was 1 and 2 days for vaginal and cesarean section, respectively. Also, 150089 (92%) of hospitalized mothers were covered by insurance and median hospitalization cost considering inflation rate (until 2018) was 2.6 and 1.35 million Toman for cesarean section and vaginal delivery, respectively. In elective and emergency admission, the frequency of cesarean delivery was 76% and 365, respectively. In general, the rate of performing cesarean section during this period has been increasing from 36% in 2017 to 44.2% in 2018.

Despite the guidelines for promoting natural childbirth within the framework of the Health reform plans in 2014, cesarean delivery rate is still increasing.