Clinical and Economic burden of Caesarean-section

• Author / Creator

  Tun, Mon Hnin

• Rising caesarean section (CS) rate remains a public health issue. Induction of labour (IOL) rates have been rising steadily in Canada from 12.9% in 1991 to 21.3% in 2004. Failed IOL occurs in 20% of induced pregnancies and is the major risk factor for CS. The purpose of this study was to investigate the impact of clinical and economic burden of CS. A rapid review of the literature was conducted to examine the risk factors for CS. Using data from the CHILD birth cohort, an emergency CS risk prediction tool was developed with six antennal factors: maternal age, height, BMI, pregnancy-induced hypertension, antenatal depression and birth order of the infant (area under the curve (AUC), 0.77 (0.71-0.82). This thesis also includes a retrospective cohort study of all singleton births in Alberta from 2005-2014 that evaluated the trends of CS, induction of labour (IOL), the association of IOL and CS, the impact of CS on childhood hospitalization or emergency department attendance with asthma or gastroenteritis. Understanding these associations will be beneficial in terms of offering the labour induction at appropriate gestation weeks in particular low-risk expectant mothers. Findings indicate that infants delivered by CS increased the healthcare service utilization by visiting emergency department with asthma and gastroenteritis than vaginally delivered infants. In addition, the results from the retrospective cohort demonstrated that IOL before reaching 39 weeks increased the risk of emergency CS when compared to expectant management. Moreover, IOL at 41 weeks is the most cost-effective strategy because it provides the most net health benefit (NHB) at a willingness-to-pay (WTP) threshold of $50,000 per QALY. This the first study conducting an economic evaluation of IOL at different gestation weeks in Canada. Implications of study results for clinicians and public health are discussed and future research directions are suggested.

• Subjects / Keywords

  • caesarean-section
  • labour induction
  • childhood health outcomes
  • economic evaluation
  • caesarean risk prediciton

• Graduation date

  Fall 2021

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-5wh8-kb08

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.