The executive deputy minister of health assigned us to evaluate the cesarean section (CS) rate in Riyadh city after complaints from the populace and articles in the press about unnecessary CS. He needed assurance that CS rates as reported from hospitals (1.2% to 9.4%) were accurate and low in relation to rates in other countries.
Methodology
For each Ministry of Health (MOH) hospital performing deliveries in Riyadh city, we selected a random sample of days in the Hejira year 1414 (June 1993 to May 1994). For each day in each hospital we reviewed logbooks of the delivery room, operating room, nursery, death registry and abortion registry for all deliveries of live and dead fetuses over 500 grams. We counted deliveries only once per mother for multiple births. CS was defined as a record of a CS in the records examined. We computed deliveries and CS for the year for each hospital using formula for single-stage cluster sampling and CS rates using ratio estimates for cluster samples.
Results
The five different hospitals were using different criteria for births and abortions, particularly among preterm and extreme preterm deliveries. There was also no linkage between the files of the mother and of the infant. Estimated CS rates for three major hospitals were 6.5% (95% confidence interval [CI] 4.7-8.4), 7.2% (95% CI 5.3-9.1) and 8.4% (95% CI 6.6-10.4). The highest rate was in the referral hospital. This hospital also reported more deliveries (11,937) than our estimate (9992; 95% CI 9204- 10780). CS rates for two birthing centers were 2.9% (95% CI 0.6-5.1) and 3.2% (95% CI 1.6-4.9).
Conclusion
The estimated CS rates for MOH hospitals in Riyadh city are low when compared with Western countries and other Middle Eastern countries. Statistics from hospitals may be inaccurate because of lack of standardization of obstetrical definitions.