A comparison of cesarean section morbidity in urban and rural hospitals. A three-year retrospective review of 1,177 charts.

To determine whether there was a significant difference in morbidity rates from cesarean section between urban and rural hospitals, we reviewed 742 maternal records from three urban hospitals and 435 records from 11 rural hospitals, along with the corresponding infant charts. When a comparison was made of advance in diet, day of discharge, elevations of temperature, number of positive cultures, use of two or more antibiotics, use of blood transfusions, and incidence of major complications, significant differences were found only in the number of positive cultures and use of antibiotics, which occurred more frequently in rural hospitals. Pediatric morbidity was evaluated by comparing Apgar scores, temperatures less than 36 degrees C, use of oxygen for longer than 15 minutes, number of infants intubated, use of intravenous fluids and antibiotics, incidence of respiratory distress syndrome and transient tachypnea, number of neonatal transfers, and major complications. Urban hospitals had significantly more Apgar scores of 4 to 6 at 5 minutes (p less than 0.01). Temperatures less than 36 degrees C were found more frequently in rural hospitals (p less than 0.001). No statistical difference was found in any other category. The results show little difference in maternal or pediatric morbidity rates between urban and rural hospitals and between obstetricians and family practitioners.