RESEARCH ARTICLE
Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term – A retrospective cohort study Woonji Jang1, Christopher Flatley1, Ristan M. Greer1, Sailesh Kumar1,2*
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1 Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia, 2 Faculty of Medicine, The University of Queensland, Brisbane, Australia *
[email protected]
Abstract OPEN ACCESS Citation: Jang W, Flatley C, Greer RM, Kumar S (2017) Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term – A retrospective cohort study. PLoS ONE 12(11): e0187040. https://doi.org/ 10.1371/journal.pone.0187040 Editor: Kristine Hopkins, University of Texas at Austin, UNITED STATES
Background Perinatal outcomes may be influenced by a variety of factors including maternal demographics and medical condition as well as socio-economic status. The evidence for disparities in health outcomes stratified by type of care (public or private) is lacking. The aim of this study was to investigate short term neonatal outcomes following category 1 and 2 emergency cesareans at term between publicly and privately funded women at a single major tertiary centre in Australia. Category 1—immediate threat to life (maternal or fetal); Category 2— maternal or fetal compromise that is not immediately life-threatening.
Received: May 23, 2016 Accepted: October 10, 2017 Published: November 17, 2017 Copyright: © 2017 Jang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data relevant to this paper is in an identifiable format and is therefore not available for public access. All data requests require a written application submitted to the Mater Human Research Ethics and Governance Committee. Level 2 Aubigny Place, Raymond Terrace, Brisbane, Queensland 4101, Australia. Email:
[email protected]. Funding: The author(s) received no specific funding for this work.
Methods This was a retrospective, cross sectional study of 61355 term singleton babies born at the Mater Mother’s Hospital in Brisbane, Australia in 2007–2014. We collected data from the hospital’s maternity database and compared maternal demographics, indications for cesarean and neonatal outcomes for publicly and privately funded women.
Results Over the study period there were 32477 public and 28878 private, term singleton births. Compared to the publicly funded cohort, privately insured women were older, had lower BMI, were of Caucasian ethnicity, Australian born, nulliparous, had shorter labors and had lower rates of hypertensive disorders and diabetes. The most common indications for category 1 and category 2 cesareans in combination were non-reassuring fetal status followed by failure to progress in labor and malpresentation. For both category 1 and 2 cesareans, neonatal outcomes (Apgar score
