Professor Renki Kobayashi of the University of Tokyo, in collaboration with Akita University and Saitama Medical University, clarified for the first time the implementation status of royal incision surgery nationwide.According to it, the national Caesarean section rate (2013) is 18.5%, which is an appropriate level among developed countries.However, the “planned caesarean section rate”, which is scheduled and implemented, tends to be higher in areas where the number of doctors, facilities, and perinatal medical care system are inadequate.

 Caesarean section rates are on the rise worldwide.The World Health Organization (WHO) recommends 10-15%, but the Organization for Economic Co-operation and Development (OECD) member countries average 28%.The background is the increase in advanced maternal age and multiple pregnancies, avoidance of litigation risk, and ease of planning.Efforts are being made in each country to reduce unnecessary caesarean sections due to the dangers associated with surgery and anesthesia and the impact on the next pregnancy and childbirth.

In Japan, there are no national statistics throughout the year, and detailed analysis has not been conducted.Therefore, this time, we investigated the implementation status of cesarean section nationwide in 2013 by analyzing the medical receipts of all insurers prepared for research and the data of specific medical examinations.As a result, out of 102 births, the number of receipts including cesarean section was 9,816, and the nationwide cesarean section rate was 19%.It is low among developed countries, and it is said that the high level of perinatal medical care in Japan has been confirmed again.

On the other hand, the caesarean section rate adjusted for the age of mothers by prefecture ranges from 14.4% to 26.4%.The planned cesarean section rate tended to be higher in prefectures with a small number of doctors in charge of delivery, in prefectures with a small number of beds in the neonatal intensive care unit (NICU), and in prefectures with a high proportion of births in clinics.It is suggested that there may be differences in the regional perinatal medical system in the background.However, there was no regional difference in the rate of emergency cesarean section due to deterioration of maternal and fetal conditions.

This study is expected to be a valuable resource for discussions aimed at improving regional perinatal care.

Paper information:[The Journal of Obstetrics and Gynaecology Research]: Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

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