[Rates of caesarean sections tn two types of private hospitals: restriced-access and open-access].
BACKGROUND
In recent years, rising rates of caesarean section are of concern in the medical community in many countries, especially in Latin America.


OBJECTIVE
Determine if there is a difference in the rate of Caesarean sections in a restricted-access hospital (HC) and an open-access hospital (HA) using the Robson classification to explain potential differences.


METHODS
A prospective cohort study was conducted. This in volved all patients that attended the obstetrics sector in the two hospitals in Buenos Aires where they gave birth between 1 June 2009 and 25h January 2010. The open-access hospital is open to doctors with varying professional training and differing clinical practice. The restricted-access hospital, on the other hand, can only be attended by specified doctors with certain professional training; their medical) conduct is based on service standards and clinical practice.


RESULTS
Over the study period 762 patients who fulfilled the study criteria were included from the open-access hospital and 768 from the restricted-access hospital. The global rate of caesarean sections in the HAwas 53.5%, and 48.7% in the HC, RR 1.09 (CI 0.99-1.21) a difference that was not statistically significant (p = 0.058). The onset of spontaneous labour in the HAwas significantly more than in the HC (74.9% vs. 41.8%) RR 2.66 (CU.98-3.57). The induced labour was significantly lower in HA (9,7% vs. 28,3%); RR 0.34 (CI 0.27-0.44). Elective caesarean sections were significantly lower in the HA (15.3% vs. 29.9%) RR 0.51 (CI 0.42-0.62).


CONCLUSIONS
This study reveals a similar rate of caesarean sections in two private hospitals with different systems of care. However, it observed that the HA has a greater tendency to operate on patients at the onset of spontaneous labour and the HC has a greater number of induced labour and elective caesarean section.
Programa de Efectividad Clínica, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Instituto Universitario CEMIC, Buenos Aires, Argentina. lpalearif@hotmail.com
Leonardo
L
Paleari
Luz
L
Gibbons
Sandra
S
Chacón
Verónica
V
Ramil
José M
JM
Belizán
D000293:Adolescent; D000328:Adult; D001118:Argentina / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D016304:Hospitals, Private / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult