Determinants of cesarean section at Phayao Hospital
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Abstract
BACKGROUND: The cesarean section (CS) rate has increased globally and in Thailand without a corresponding reduction in maternal and neonatal mortality. Phayao Hospital has also experienced a continuous rise in CS rates.
OBJECTIVE: To identify factors associated with the decision to perform CS, classify deliveries according to the Robson classification system, and examine characteristics of women in Robson groups 1–4, who are generally eligible for vaginal delivery.
METHODS: A retrospective study of women delivering at Phayao Hospital from October 1, 2023 to April 30, 2025 was conducted. Descriptive statistics and multivariable logistic regression were used to identify factors associated with the decision to perform CS.
RESULTS: Among 562 women who delivered, factors significantly associated with CS were chronic hypertension (aOR 53.09, 95% CI 2.33–1209.02, p=0.013), nulliparity (aOR 13.62, 95% CI 1.19–154.84, p=0.035), morning shift delivery (aOR 6.51, 95% CI 2.67–15.87, p<0.001), afternoon shift delivery (aOR 2.81, 95% CI 1.05–7.48, p=0.038), and antenatal care at private clinics (aOR 3.70, 95% CI 1.83–7.47, p<0.001). According to the Robson classification, Group 5 had the highest proportion (29.7%), followed by Group 2 (21.2%) and Group 1 (15.9%). In Robson groups 1–4, most women were Thai, aged 20–34 years, covered by the universal health coverage scheme, with a height of 145–160 cm, estimated fetal weight 2,500–3,500 g, morning shift delivery, and antenatal care at private clinics.
CONCLUSIONS AND RECOMMENDATIONS: Factors associated with the decision to perform CS were chronic hypertension, nulliparity, morning shift delivery, and antenatal care at private clinics. Robson Group 5 had the highest CS rate. In Groups 1–4, most women were Thai, aged 20–34 years, with morning delivery and antenatal care at private clinics. Reducing unnecessary CS should emphasize patient education and regular antenatal care.
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References
Royal Thai College of Obstetricians and Gynecologists. IC-005: Cesarean section [Internet]. Bangkok: RTCOG; 2011 [cited 2025 Jun 30]. Available from: https://www.rtcog.or.th/photo/cpg/IC005.pdf
Yukaew N. Cesarean section rate according to Robson’s classification. J Prev Med Assoc Thail. 2017;7(3):262-71.
Chaitanuwong S. Cesarean section in term pregnancy rate based on the Robson 10 – group classification at Lamphun Hospital from 2020-2022. J Environ Community Health. 2023;9(1):680-9.
Isaranurugchai W, Karunarathne P, Lumpikarnon P, Khunyuson C, Phitsanu K. Rising cesarean section rate in Thailand: is it time for serious discussion? [Internet]. Nonthaburi: Health Intervention and Technology Assessment Program; 2022 [cited 2025 Jun 30]. Available from: https://www.hitap.net/th/document/policybrief-139-rising-cesarean-rate-thailand/
Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gulmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality: a worldwide ecological study. BJOG. 2016;123(5):745-53.
Robson MS. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12(1):23–39.
Khornwong S, Kovavisarach E. Cesarean section rate based on the Robson 10-group classification at Rajavithi Hospital 2015-2018. Thai J Obstet Gynecol. 2021;29(4):191-7.
Anekpornwattana S, Yangnoi J, Jareemit N, Boriboonhirunsarn D. Cesarean section rate in Siriraj Hospital according to the Robson classification. Thai J Obstet Gynecol. 2020;28(1):6-15.
Ministry of Public Health. Cesarean section rate statistics [Internet]. Nonthaburi: Ministry of Public Health; 2020 [cited 2025 Jun 30]. Available from: https://cmi.moph.go.th/isp/sp_obs/index?menu_id=6
Obstetrics Department, Phayao Hospital. Annual delivery statistics. Phayao: Phayao Hospital; 2025. Unpublished data.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373-9.
Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165(6):710-8.
Janoudi G, Kelly S, Yasseen A, Hamam H, Moretti F, Walker M. Factors associated with increased rates of caesarean section in advanced maternal age. J Obstet Gynaecol Can. 2015;37(6):517-26.
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. Fetal macrosomia [Internet]. Chiang Mai: Chiang Mai University; [cited 2025 Sep 28]. Available from: https://w1.med.cmu.ac.th/obgyn/lecturestopics/topic-review/6721
Tangwiwat P. Promoting childbearing for quality children. J DMS. 2024;49(3):5-9.
Khunpradit S, Patumanond J, Tawichasri C. Risk indicators for CS due tocephalopelvic disproportion in Lamphun Hospital. J Med Assoc Thai. 2005;88 Suppl 2:S63-8.
Tsu VD. Maternal height and age: risk factors for cephalopelvic disproportion in Zimbabwe. Int J Epidemiol. 1992;21(5):941-6.
Royal Thai College of Obstetricians and Gynaecologists. Obstetric and gynaecological bulletin [Internet]. Bangkok: RTCOG; 2001 [cited 2025 Oct 4]:17-22. Available from: https://www.rtcog.or.th/photo/bulletin_10254402.pdf
