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Research article
Guohong Li
Shanghai Jiao Tong University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0445-5363
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objectives: This study proposes a mathematical analysis framework to estimate the proportion of cesarean section (CS) with non-medical indications and of CS cases correctly diagnosed, examine the excessive use of CS, and investigate its contributing factors in Shanghai.
Design and Settings A mathematical model (C-model), developed by the World Health Organization, was employed to estimate the expected proportion of women having CS based on clinical indicators. Cases in which CS occurred but vaginal delivery (VD) was recommended instead by the C-model were regarded as "Suspicious CS". Cases that are “CS of suspected non-medical indications” were identified and used for categorical principal component analysis to explore causes of "Suspicious CS". A Bayesian model was used to calculate the proportion of correctly diagnosed CS. The use of CS and medical conditions were collected from 5,686 pregnant women delivered in twenty public hospitals with obstetrics departments in 2016, which were randomly selected in Shanghai. The excessive use of CS in Shanghai and the cost of "CS suspected non-medical indications" were estimated.
Results 43.96% of pregnant women performed CS in Shanghai in 2016, much higher than the expected CS rate of 30.13% according to the C-model. A total of 1271 CS cases were classified as “Suspicious CS”, representing 22.35% of the sample. There were 784 cases classified as “CS of suspected non-medical indications”, including CS caused by fetal heart rate abnormality/fetal distress and cesarean delivery on maternal request (CDMR), accounting for 13.79% of the sample. Based on Bayes estimation, only 42.5% of pregnant women who had CS were medically necessary. If the CS with non-medical indications were appropriately controlled, the hospitalization costs in the whole year in Shanghai would drop by about US$ 60 million (408 million RMB).
Conclusion The study provides empirical evidence on non-medical indications of CS in Shanghai, and uses a mathematical model to estimate the excessive use of CS. The high rate of CS in Shanghai was associated with non-medical indications. Establishing clinical standards of CS, especially in relations to abnormal fetal heart rate/fetal distress, would help reduce CS without medical indications, which would significantly lower medical expenses of hospitalization.
Keywords
Excessive use, Cesarean section, Non-medical indications
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This is a preprint. It has not completed peer review.
Research article
Guohong Li
Shanghai Jiao Tong University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0445-5363
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 22 Nov, 2019
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objectives: This study proposes a mathematical analysis framework to estimate the proportion of cesarean section (CS) with non-medical indications and of CS cases correctly diagnosed, examine the excessive use of CS, and investigate its contributing factors in Shanghai.
Design and Settings A mathematical model (C-model), developed by the World Health Organization, was employed to estimate the expected proportion of women having CS based on clinical indicators. Cases in which CS occurred but vaginal delivery (VD) was recommended instead by the C-model were regarded as "Suspicious CS". Cases that are “CS of suspected non-medical indications” were identified and used for categorical principal component analysis to explore causes of "Suspicious CS". A Bayesian model was used to calculate the proportion of correctly diagnosed CS. The use of CS and medical conditions were collected from 5,686 pregnant women delivered in twenty public hospitals with obstetrics departments in 2016, which were randomly selected in Shanghai. The excessive use of CS in Shanghai and the cost of "CS suspected non-medical indications" were estimated.
Results 43.96% of pregnant women performed CS in Shanghai in 2016, much higher than the expected CS rate of 30.13% according to the C-model. A total of 1271 CS cases were classified as “Suspicious CS”, representing 22.35% of the sample. There were 784 cases classified as “CS of suspected non-medical indications”, including CS caused by fetal heart rate abnormality/fetal distress and cesarean delivery on maternal request (CDMR), accounting for 13.79% of the sample. Based on Bayes estimation, only 42.5% of pregnant women who had CS were medically necessary. If the CS with non-medical indications were appropriately controlled, the hospitalization costs in the whole year in Shanghai would drop by about US$ 60 million (408 million RMB).
Conclusion The study provides empirical evidence on non-medical indications of CS in Shanghai, and uses a mathematical model to estimate the excessive use of CS. The high rate of CS in Shanghai was associated with non-medical indications. Establishing clinical standards of CS, especially in relations to abnormal fetal heart rate/fetal distress, would help reduce CS without medical indications, which would significantly lower medical expenses of hospitalization.
Figure 1
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