Obstetric Complications by the Accessibility to Local Obstetric Service

Abstract

Objectives: Pregnant women in rural areas do not have access to sufficient obstetric services in their own communities due to the shortage of obstetricians. Therefore, most of these women must seek obstetrician outside of their communities. The purpose of this study was to investigate the relationship between obstetric complications and accessibility to local obstetric care in Korea. Methods: This study was an ecological study in which the unit of analysis was an administrative district. Using Korea National Health Insurance Corporation data, the total number of deliveries and the delivery proportion within and outside of the community from 2001 to 2008 were calculated for 232 administrative districts nationwide. Three outflow levels were categorized based on each district’s out-of-community delivery proportion: high outflow (upper one third), moderate outflow (middle one third), and low outflow (lower one third). In addition, three obstetric complication rates (the rate of complications following abortion, ectopic and molar pregnancy, the abortion rate, and the eclampsia rate) were calculated for the 232 districts. One-way ANOVA and multivariate linear regression were used to evaluate obstetric complications among the three outflow levels. Results: The high outflow districts had higher rates of eclampsia and complications following abortion, ectopic, and molar pregnancy compared to the other districts (ANOVA, p<0.05). However, there was no significant difference in the abortion rate among the three groups. Multiple linear regression analysis showed that high outflow districts were statistically significant in the rate of complications following abortion, ectopic and molar pregnancy and eclampsia rate after adjusting for local tax per capita (p<0.01). Conclusion: These results indicate that poor access to local obstetric care correlate with poor obstetric outcomes (delayed or excessive bleeding, embolism, genital tract or pelvic infection, shock or other complications following abortion and ectopic or molar pregnancy, or eclampsia).