Is there an obstetric July phenomenon?

OBJECTIVE: To estimate whether variations in intrapartum management and complications exist with regard to the time of delivery within the academic year. METHODS: The delivery records of 7814 patients were separated by both term half year and. quarter. Statistical comparisons were made using chi(2) tests of association (P <.05) with respect to the academic time of the year and perineal trauma (third- or fourth-degree tear), episiotomy usage, cesarean delivery, postpartum hemorrhage, chonioamnionitis, shoulder dystocia, neonatal intensive care unit admission, 1- or 5-minute Apgar scores less than 7, and low umbilical cord pH. RESULTS: There were 4082 deliveries in the first half and 3732 in the second half of the year from April 1996 through March 1999. The first half-year overall cesarean rate was higher (15.8% versus 14.3%, P <.03). Primary cesarean rates were similar. No other differences were found by term half year. More perineal trauma was noted in the fourth quarter (first 3.3%, second 4.5%, third 3.7%, fourth 5.5%, P <.037). Episiotomy usage was higher in both the first and fourth quarters (13.0%,11.3%,10.6%, and 14.8%, P <.002). More cases of chorioamnionitis occurred in the fourth quarter (first 3.4%, second 3.1%, third 2.6%, fourth 4.0%, P <.038, third versus fourth quarter). Chorioamnionitis occurred more frequently in July (July 5.0% versus August-June 3.1%, P <.005). There were no other clinically significant differences. Neonatal outcomes were not affected by academic time of year. CONCLUSION: Although small differences in outcome exist with respect to the academic time of the year, the timing of these differences indicates that there is not a "July phenomenon" in obstetrics at our institution. (C) 2003 by The American College of Obstetricians and Gynecologists.