Cesarean Section Trend in a University Hospital in Thailand

Abstract

Background: An increasing trend of cesarean section (CS) rates has been observed worldwide, including Thailand. Various interventions to decrease unnecessary CS have been implemented as per recommendations. This study is aimed at evaluating a trend in CS rate during a 42-month period in a university-based tertiary care hospital in Thailand. Methods: In a cross-sectional study, women who delivered at Siriraj Hospital between January 2021 and June 2024 were included. Those with private services were excluded. All women were categorized into 10 groups according to Robson classification. Overall and group-specific CS rates and their contribution to CS rate were evaluated. Trend of CS rate was evaluated by locally weighted scatterplot smoothing (LOESS) method. Results: Of 13,645 deliveries, 2868 had private services, leaving 10,777 deliveries included in the analysis. Overall CS rate was 42.9% (95% CI: 42.1%–43.8%) and did not significantly change during the study period. Women in Groups 1 and 5 had the highest CS contribution of 25%–27%. Overall CS rate in Group 1 was 33.9% and the rates did not change significantly but showed a slight decrease to 31.4% in 2024. The LOESS regression showed that overall CS rate slightly increased during 2021, slightly decreased during 2022, and remained relatively stable during 2023 and 2024 at approximately 43%. CS rate in Group 1 slightly decreased during 2021, slightly increased during 2022, and a more obvious decrease during 2023–2024 was observed. Conclusion: Over a 42-month period, a relatively stable high overall CS rate of 42.9% was observed, with the highest contribution from women in Groups 1 and 5 of the Robson classification. For women in Group 1, the CS rate showed a notable decrease during 2023–2024.