Cesarean Section Rates Differences among Hospitals in Jakarta

Basalamah A.; Suradi R.; Wiknyosastro G. H.

doi:10.14238/pi35.1-2.1995.8-17

Basalamah A. Department of Obstetric and Gynecology, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Suradi R. Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Wiknyosastro G. H. Department of Obstetric and Gynecology, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta

DOI: https://doi.org/10.14238/pi35.1-2.1995.8-17

Keywords: caesarean section rate, caesaren section, antepartum hemorrhage

Abstract

The incidence cesarean section (CS) has increased in the world as well as Indonesia. This fenomenon creates a concern among professionals. This study was undertaken to determine the incidence of CS and its indications among hospitals in Jakarta in 1992. Hospitals were divided into 3 groups according to the management and ownership: government (type A), semiprivate (type B) and private (type C) hospitals. Twelve hospitals belonged to type A, 17 to type B, and 34 to type C. Total deliveries in type A, B and C hospitals wereÂ respectively: 11 803; 19 130 and 17 665. The median number of deliveries was higher in type A than in type B or C. Most of type A hospitals (83.3%) and only 47.9% of type B and 11.8% of type C hospitals were open for referral cases. The mean CS rates were respectively 12.7%; 16,6% and 29.9% in type A, D. and C hospitals. Cephalopelvic disproportion was the most frequent indication in all 3 groups. In type A and B hospitals the second most frequent indication was antepartum hemorrhage while in type C hospitals it was previous CS. It is widely accepted that 80% of pregnancy with a CS scar can be delivered vaginally; so that the high incidence
of CS due to previous CS might be related to difference in interest or concept. In type C hospitals the 6th most frequent indication of CS was on mother's request, which was not found in type 8 or A hospitals. The length of stay was longer in type C than in type G or A hospitals.

References

1. Pernoll ML. Cesarean section. ln: Obstetric and gynecologic diagnosis and treatment. 7th ed. Norwalk: Appleton & Lange; 1984. p. 554-67.
2. Savage W, Francome C. British cesarean section rates; have we reached a plateau? Br J Obstet Gynecol. 1993; 100:493-6
3. Porreca RP. High cesarean rate: a new perspective. Obstet & Gynecol. 1985; 65: 307.
4. Ophir E, Oettinger M, Yagoda A, Markovits Y, Rojanski N, Shapiro H. Breech presentation after cesarean section: always a section? Am J Obstet Gynecol. 1989; 161: 25-8.
5. Patrikovski BM, Cohen M, Tancer ML. Usefulness of continuous fetal heart rate monitoring during cesarean section. Am J Obstet Gynecol. 1989; 161:36-7.
6. Ratnam SS, Rao B, Arulkamaran S. Obstetric and gynecology for postgraduates. Madras: Orient Longman; 1992. p. 134-42
7. Warsito B. Peningkatan mutu pelayanan rumah sakit. Jakarta: Kongres PERSI VI dan Hospital VI Nopember 1993.
8. Gani A. Aspek ekonomi pelayanan kesehatan. Jakarta: Kongres PERSI VI dan Hospital Expo VI Nopember 1933.
9. Myerscough PR, Cesarean section. In: Munro Kerr's. Operation obstetrics 10th ed. New York: Macmillan Publ; 1982. p. 295.
10. Nageotte M. How we can lower the cesarearl section rate. Contemp Obstet Gynecol. 1990; 35:63-88.
11.Barros FC, Vaughan JP, Victora CG, Hutttly SRA. Epidemic of cesarean section in Brazil. Lancet. 1991;338:167-9.
12. Phelan JP. Medical-legal considerations of cesarean delivery. ln: Cesarear1 delivery. Phelan JP, Clark SL, eds. New York: Elsevier Science Publ; 1988. p. 541-55.
13. Gould JB, Davey B, Stafford RS. Sosioeconomic differences in rates of cesarean section. N Engl J Med. 1989;321 :233-9
14.Haynes de Regt R, Minkoff HL, Felgman J, Scharz RH. Relation of private or clinic care to the cesarean birth rate. N Engl J Med. 1986:315:619-24.
15. Cunninghani FG, Mac Donald PC, Gant NF. Cesarean section and cesarean hysterectomy. In: Williams Obstetrics 17th ed. New York: Appleton & Lange; 1985. p. 867-86
16. Jones DL. Fundamentals of obstetrics and gynaecology. 4th ed. Australia: English Language Book Society Faber & Faber Ltd.; 1986. p. 483-5
17.Boylan P, Frankowski RR, Rounter R, Selwyn B, PanishK. Effect of active management of labor on the incidence of cesarean section for dystocia in nulliparas. Obstet Gynecol Swvey. 1992; 47: 389-91.
18. Paul RH. Reducing the cesarean delivery rate. In: Cesarean delivery. Phelan JP, Clark SL, eds. New York: Elsevier Science Puyblishing; 1988. p. 541-55.
19. Porreca RP. Once a cesarean, always a cesarean. In: Cesarean delivery. Phelan JP, Clark SL, eds. New York : Elsevier Science Publishing; 1988. p. 467-75.
20. Hornstein J, Phelan JP. Vaginal birth after cesarean: the role of oxytocin. ln: Cesarean delivery. Phelan JP, Clark SL, eds. New York : Elsevier Science Publishing; 1988. p. 500-18.
21. Phelan JP, Clark SL, Diaz F, Paul RH. Vaginal birthafter multiple prior cesarean section. Am J Obstet Gynecol. 1987; 157: 1510-5.
22. Grant JM, Serle E, Mahmood T, Sannandel P, Conway Dl. Management of prelabour rupture of the membranes in term primigravida, report of randomized trial. BRJ ObstetGynecol. 1992; 99: 557-62.