A national measure to reduce primary cesarean rates in Turkey

Purpose: To examine the influence of the Physician Unit Performance Coefficient (PUPC) regulation, taken into force by the TR Ministry of Health in January 2013 in our country, based on the cesarean rates in our clinic. Methods: The pregnant women who gave birth at the Diyarbakir Maternity and Pediatrics Hospital within a period of three years before the PUPC has been taken into force and the pregnant women who have birth within a period of three years after January 2013, when the regulation has been taken into force, have been divided into two groups as Group 1 and Group 2, respectively. Comparisons have been made between the two groups with respect to primary cesarean, total cesarean, neonatal mortality, and maternal mortality rates. Results: From the 125,816 pregnant women who gave birth between February 2010 and January 2016, 58,856 (46.7%) are included in Group 1 and the remaining 66,960 (53.3%) are in Group 2. The total Cesarean Rate is 27% in Group 2 and 24.8% in Group 1. The primary Cesarean Rate is 11.3% in Group 2 and 13.5% in Group 1. The neonatal mortality rate is 7.81 parts per thousand in Group 2 and 10 parts per thousand in Group 1. The differences in the total cesarean rates, primary cesarean rates and neonatal mortality rates have been found statistically significant. Maternal mortality rates have been found to be 5.1 in 100,000 in Group one and 4.48 in 100,000 in Group 2 and the difference between the two groups has not been found as statistically significant. Conclusions: A meaningful reduction has been achieved in the primary cesarean rates without increasing maternal and neonatal mortality rates after the PUPC, implemented by the TR Ministry of Health, has been taken into force.