Introduction

There were 6,244 deliveries at Hanoi French Hospital over a four-year period (from August 2020 to August 2024). The number of childbirths peaked around October and November each year. However, the monthly number of deliveries decreased from a high of 200 cases in November 2020 to a low of approximately 75 cases in April 2022, before rising consistently to a new peak of 250 cases in July 2024.

Delivery Types

Regarding the modes of delivery, cesarean section and natural labor accounted for more than 90% of total cases. From 2020 to 2023, the proportion of cesarean deliveries fluctuated between 40% and 50%, with notable increases in the second and third quarters. The C-section rate rose significantly to around 54% in the first quarter of 2024, then declined to just under 50% before surging again to over 60% in the third quarter. Compared to the previous period, the surgical delivery rate was significantly higher (0.60 vs. 0.49, p = 0.0005).

## 
##  2-sample test for equality of proportions with continuity correction
## 
## data:  c(x1, x2) out of c(n1, n2)
## X-squared = 10.807, df = 1, p-value = 0.0005056
## alternative hypothesis: greater
## 95 percent confidence interval:
##  0.05756628 1.00000000
## sample estimates:
##    prop 1    prop 2 
## 0.6045455 0.4893758

Blood transfusion

There were 54 out of 6244 cases required blood transfusions over 4 years. Although the transfusion rate was higher among C-section patients, the difference was not statistically significant (Fisher’s Exact test, p = 0.6957).

##              NULL Yes Transfusion_Rate
## Cesarean     3051  30             0.97
## Instrumental  228   1             0.44
## Spontaneous  2911  23             0.78
## 
##  Fisher's Exact Test for Count Data
## 
## data:  table_delivery_lab
## p-value = 0.6957
## alternative hypothesis: two.sided

The line graph below compares the transfusion rates across different delivery modes over time. Overall, the general transfusion rate remained low but showed a steady increase, whereas the rates for C-sections and spontaneous labor exhibited significant fluctuations. Notably, only one patient undergoing instrumental delivery required a blood transfusion.

The general transfusion rate rose from 0% to 1 % in the last quarter of 2020, followed by 3 years of fluctuations between 0.5% and 1%. From the third quarter of 2023 onward, the rate increased significantly to 1.5% in in the beginning of 2024, then surged to nearly 2% in July 2024. In contrast, the transfusion rate for Cesarean and natural labor showed marked instability. The rate for the spontaneous group plummeted from over 7% to below 2% during late 2020 to early 2021. Interestingly, no transfusions were recorded among C-sections during this period. However, the Cesarean transfusion rate climbed sharply to around 6% between mid-2021 and mid-2022, then skyrocketed from below 2% to 7% in the last quarter of 2023. Despite dropping to 2% over the following nine months, the rate experienced a threefold increase—from 2% to 6%—by July 2024. Natural labor cases generally had a lower transfusion rate compared to C-sections, ranging from 2% to 3.5%. However, the rate for natural labor nearly tripled while that of C-sections dropped significantly from Q3 2023 to Q1 2024. Additionally, the rate for natural labor declined noticeably to 2% by July 2024.

Comparision between before and after August 2022

## # A tibble: 4 × 4
##   Measure                      Period_1 Period_2 p_value
##   <chr>                           <dbl>    <dbl>   <dbl>
## 1 Cesarean Rate                 0.485    0.501     0.208
## 2 Transfusion Rate              0.00783  0.00944   0.583
## 3 Cesarean Transfusion Rate     0.00457  0.00503   0.934
## 4 Spontaneous Transfusion Rate  0.00294  0.00440   0.454

Conclusion

In summary, there was a rising trend in the rate of Cesarean delivery and blood transfusion in HFH, especially during the third quarter of 2024.