Document Detail


Physician cesarean delivery rates and risk-adjusted perinatal outcomes.
MedLine Citation:
PMID:  12798526     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare perinatal outcomes in obstetric practices with high and low cesarean delivery rates. METHODS: We conducted a population-based study based on 171295 singleton births in New Jersey in 1996 and 1997. Vital certificate data for each birth were linked to the corresponding hospital discharge records. Nonsubspecialist obstetricians were divided into three groups based on their cesarean delivery rates during the study period: low (less than 18%), medium (18-27%), and high (greater than 27%). Perinatal mortality, rates of birth injury, and uterine rupture were compared among the physician groups after adjustment for differences in patient risks. RESULTS: Physicians in the frequent cesarean delivery group performed more cesarean deliveries for all major indications. Perinatal mortality rates were comparable among the three physician groups. Low and very low birth weight infants delivered by the high-rate physicians did not have a lower risk of mortality. The risk of intracranial hemorrhage was significantly higher for infants delivered by low-rate physicians than for those delivered by medium-rate physicians (adjusted relative risk [RR] 1.53; 95% confidence interval [CI] 1.07, 2.19). Relative to deliveries by medium-rate physicians, deliveries by low-rate physicians were associated with a lower overall risk of uterine rupture (adjusted RR 0.56; 95% CI 0.34, 0.92). Medium- and high-rate groups had similar occurrences of birth injury and uterine rupture. CONCLUSION: Low cesarean delivery rates reduced the rate of uterine rupture and were not associated with increased perinatal mortality. The data suggest a small increase in intracranial hemorrhages in infants delivered by physicians who perform relatively few cesarean deliveries.
Authors:
Tong Li; George G Rhoads; John Smulian; Kitaw Demissie; Daniel Wartenberg; Lakota Kruse
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  101     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-11     Completed Date:  2003-07-03     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1204-12     Citation Subset:  AIM; IM    
Affiliation:
Division of Epidemiology, School of Public Health, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey 08540, USA. lito@umdnj.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cesarean Section / statistics & numerical data*,  utilization
Female
Humans
Infant Mortality
Infant, Newborn
Intracranial Hemorrhages / epidemiology
Logistic Models
New Jersey / epidemiology
Obstetrics / statistics & numerical data
Physician's Practice Patterns / statistics & numerical data*
Pregnancy
Pregnancy Outcome*
Risk Adjustment
Uterine Rupture / epidemiology
Grant Support
ID/Acronym/Agency:
R03HS10795-01/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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