Changes in the Rate of Some Rare Neonatal Outcomes After the Implementation of the Health System Reform Plan in Iran: A 70-Month Case Study of an Educational Hospital Research

Background: The health system reform plan (HSRP) was launched in Iran on 15 May 2014, with three approaches to protect people from the financial system, create equity in access to health services, and improve the quality of services. Objectives: The present study aimed at investigating the changes in the rate of some rare neonatal outcomes after the implementation of HSRP in Iran. Methods: The present cross-sectional study was conducted in Izadi Hospital in Qom Province, in which 52,817 vaginal delivery and cesarean sections were evaluated for the incidence of complications from 15 June 2011 to 15 April 2017. The complications included hypoxic-ischemic encephalopathy, low Apgar score, cephalohematoma, clavicle fracture, the Erb palsy, and intracerebral hemorrhage. Complications were compared per 10,000 births before and after the implementation of the plan. Data were analyzed with SPSS software using t- and chi-squared tests. Results: There was a significant increase after the implementation of HSRP compared to before that in the rate of complications per 10,000 vaginal deliveries for stage 2 hypoxic-ischemic encephalopathy (P = 0.001), birth with a low Apgar score (P < 0.001), cephalohematoma (P < 0.001), and clavicle fracture (P = 0.002). In the case of cesarean section, there was a significant increase in the 2 (P = 0.001) and 3 (P = 0.034) stages of hypoxic-ischemic encephalopathy and birth with a low Apgar score (P < 0.001). Conclusions: It can be concluded that HSRP could somewhat achieve its goals on the promotion of vaginal delivery. However, the implementation of the plan was associated with an increase in some minor neonatal complications.