Document Detail

Nulliparous term singleton vertex cesarean delivery rates: institutional and individual level predictors.
MedLine Citation:
PMID:  18538157     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study was undertaken to determine individual and institutional level variables predictive of variations in nulliparous term singleton vertex cesarean delivery rates. STUDY DESIGN: Retrospective cohort study of 28,863 nulliparous term singleton vertex births at 40 Arizona hospitals. RESULTS: The average nulliparous term singleton vertex cesarean delivery rate was 22.0%, the lowest hospital rate was 10.3%, high, 34.2%. The following individual level variables increased the nulliparous term singleton vertex cesarean delivery rate in a multivariable model: increased mother's age, African American race, increased birthweight, labor induction, and the presence of medical conditions such as diabetes and hypertension. Of the institutional variables, after adjustment, the highest level of nursery or a higher percentage of government-paid births was associated with lower risks, whereas delivery at a hospital with the lowest level of care or with an obstetric and gynecology residency was associated with an increased risk of cesarean delivery. CONCLUSION: Substantial variations in nulliparous term singleton vertex cesarean delivery rates were seen in this comparative analysis of 40 hospitals.
Dean V Coonrod; David Drachman; Paula Hobson; Maria Manriquez
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  198     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-09     Completed Date:  2008-07-08     Revised Date:  2009-04-20    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  694.e1-11; discussion 694.e11     Citation Subset:  AIM; IM    
Department of Obstetrics, Maricopa Integrated Health System/MedPro, Phoenix, AZ, USA.
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MeSH Terms
Arizona / epidemiology
Cesarean Section / statistics & numerical data*
Hospitals / statistics & numerical data
Labor Presentation*
Retrospective Studies
Risk Factors
Comment In:
Am J Obstet Gynecol. 2009 May;200(5):e8; author reply e8   [PMID:  19375563 ]

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