Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term

Adams, Nicole, Gibbons, Kristen S. and Tudehope, David (2017) Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term. Australian and New Zealand Journal of Obstetrics and Gynaecology, 57 2: 176-185. doi:10.1111/ajo.12591


Author Adams, Nicole
Gibbons, Kristen S.
Tudehope, David
Title Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term
Journal name Australian and New Zealand Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1479-828X
0004-8666
Publication date 2017-03-22
Sub-type Article (original research)
DOI 10.1111/ajo.12591
Open Access Status Not yet assessed
Volume 57
Issue 2
Start page 176
End page 185
Total pages 10
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2018
Language eng
Formatted abstract
Background: Prelabour caesarean section (CS) at early term (370-386 weeks) is associated with higher rates of adverse short-term neonatal outcomes and higher costs than those performed at full term (390-406 weeks). Prelabour CS is more common in private than in public hospitals in Australia, particularly at early term.

Aims: To evaluate the impact of hospital sector (public or private) and timing of delivery on short-term neonatal outcomes following prelabour CS at term.

Materials and methods: A retrospective cohort study of 22 954 viable singleton prelabour CS births at term (370-406 weeks) at a single centre encompassing co-located public and private hospitals during 1998-2013 was undertaken. Propensity score analysis was used to adjust for confounding differences between sectors. The primary outcome was Neonatal Critical Care Unit (NCCU) admission with serious morbidity. Secondary outcomes included respiratory distress, vigorous resuscitation and jaundice.

Results: The private hospital performed prelabour CS at over double the rate of the public hospital (33.7% of all private births vs 14.7% public) and more private than public prelabour CSs occurred at early term (66.8% vs 47.9%). Public babies were more than twice as likely as private babies to require admission to NCCU with serious morbidity (adjusted odds ratio (AOR) 2.54, 95% CI 1.77-3.65) but were less likely to need vigorous resuscitation (AOR 0.53, 95% CI 0.45-0.62). Disparities in outcomes between public and private cohorts were accentuated at full term.

Conclusion: Despite early-term prelabour CSs occurring more often in the private hospital, public babies had more adverse outcomes and treatment escalations.
Keyword Insurance status
Morbidity
Newborn
Propensity score
Term birth
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
HERDC Pre-Audit
School of Medicine Publications
 
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