CC BY-NC-ND 4.0 · AJP Rep 2019; 09(04): e328-e336
DOI: 10.1055/s-0039-1697656
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Trend of Cesarean Section Rates and Correlations with Adverse Maternal and Neonatal Outcomes: A Secondary Analysis of Thai Universal Coverage Scheme Data

1  Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Jarawee Sukmanee
1  Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Jutatip Thungthong
2  National Health Security Office (NHSO) Thailand, Chaengwattana Road, Lak Si, Bangkok, Thailand
Pisake Lumbiganon
3  Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
› Author Affiliations
Further Information

Publication History

04 May 2019

16 July 2019

Publication Date:
30 October 2019 (online)


Objectives The main purpose of this article is to estimate the trend and projection of cesarean section rates (CSRs) and explore correlations between CSRs with adverse maternal and perinatal outcomes, namely maternal mortality ratios (MMRs), rates of postpartum hemorrhage (PPH), neonatal mortality rates (NMRs), and birth asphyxia per 1,000 live births across all regions of Thailand.

Study design A secondary analysis of the hospital-based database of pregnant women and newborns under the Thai Universal Coverage Scheme between January 2009 and December 2017 was conducted.

Results Overall annual CSR significantly increased from 23.2% in 2009 to 32.5% in 2017. With the same rate of increase, the CSR of 59.1% was projected by the year 2030 that could be reduced to 30.0% if an annual rate of CS reduction of 1% was assumed using Joinpoint regression. The increasing CSRs were significantly correlated with higher MMRs (r= 0.20, p = 0.03) and birth asphyxia (r= 0.39, p < 0.001). The correlation trends were similar when the analyses were stratified by year in the majority of years. Overall correlations between CSRs and rates of PPH or NMRs were not statistically significant.

Conclusion CSRs in Thailand continuously increased and were correlated with adverse maternal and perinatal outcomes. More effort at the national level to reduce unnecessary CS is urgently required.

Disclosure of Any Source of Financial Support or Funding

All authors declare no conflict of interest. No funding sources were involved in this secondary analysis.

Contributions to Authorship

All authors participated in the concept of the study. TL obtained the necessary permissions for data utilization, and participated in data analysis and interpretation, and drafting the manuscript. JS participated in data analysis and interpretation. JT participated in data extraction and management. PL helped with data interpretation. All authors reviewed the draft of the manuscript and approved the final manuscript for submission.

Details of Ethical Approval

A study protocol of secondary analysis was approved by the Institute Ethics Committee of the Faculty of Medicine, Prince of Songkla University with the reference number of REC 60–439–18–1 (Exempt determination), date of approval on 27 November 2017.