The labor-adjusted cesarean section rate - A more informative method than the cesarean section ''rate'' for assessing a practitioner's labor and delivery skills

被引:18
作者
Elliott, JP
Russell, MM
Dickason, LA
机构
[1] GOOD SAMARITAN REG MED CTR,DIV MATERNAL FETAL MED,PHOENIX,AZ
[2] GOOD SAMARITAN REG MED CTR,DEPT OBSTET & GYNECOL,PHOENIX,AZ
关键词
cesarean section rate; acuity adjusted; labor management; labor-adjusted cesarean section rate;
D O I
10.1016/S0002-9378(97)70452-6
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: Our purpose was to determine the benefits of an acuity-adjusted labor management tool. STUDY DESIGN: A retrospective review was performed of all deliveries at Good Samaritan Regional Medical Center in Phoenix, Arizona, for a I-year period from Jan. 1 to Dec. 31, 1994. All physicians with greater than or equal to 20 deliveries were included in the analysis. Patients with indications for which most practitioners would perform a cesarean delivery were removed from consideration. Physicians were then compared with respect to labor management in the remaining patients without relative contraindications to vaginal delivery. RESULTS: The total number of deliveries (n = 6062) was performed by 47 attending obstetricians, 9 perinatologists, an obstetrics-gynecology clinic, and a family practice clinic. The ''raw'' cesarean section rate was 20.1%. Those at high risk for cesarean delivery (n = 534) were excluded, leaving 684 cesarean sections performed in 5528 patients (12.4%) who were appropriate to labor. Differences were observed between the nulliparous cesarean section rate (16%) compared with that for parous patients (10.1%) (p < 0.0001 by Fisher's exact test (two-tailed) but not between attending obstetrician-gynecologists (12.4%) and perinatologists (13.8%) (not significant). CONCLUSION: A labor-adjusted cesarean section rate is more appropriate than just ''raw'' data. Medical, obstetric, and fetal factors affect a ''raw'' rate that is out of the control of the obstetrician. This method of assessing the labor and delivery skills of each practitioner and hospital would allow meaningful comparison with others.
引用
收藏
页码:139 / 143
页数:5
相关论文
共 16 条
[1]  
BASKETT TF, 1981, CAN MED ASSOC J, V125, P723
[2]  
EVARD JR, 1980, J REPROD MED, V24, P147
[3]   THE PHYSICIAN FACTOR IN CESAREAN BIRTH-RATES [J].
GOYERT, GL ;
BOTTOMS, SF ;
TREADWELL, MC ;
NEHRA, PC .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (11) :706-709
[4]  
GRIBBLE RK, 1991, OBSTET GYNECOL, V78, P231
[5]   SALINE AMNIONINFUSION FOR RELIEF OF REPETITIVE VARIABLE DECELERATIONS - A PROSPECTIVE RANDOMIZED STUDY [J].
MIYAZAKI, FS ;
NEVAREZ, F .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1985, 153 (03) :301-306
[6]  
NAGEOTTE MP, 1985, AM J OBSTET GYNECOL, V153, P557, DOI 10.1016/0002-9378(85)90473-9
[7]  
ODRISCOLL K, 1984, OBSTET GYNECOL, V63, P485
[8]   TRENDS IN THE FREQUENCY OF CESAREAN BIRTHS [J].
PHILIPSON, EH ;
ROSEN, MG .
CLINICAL OBSTETRICS AND GYNECOLOGY, 1985, 28 (04) :691-696
[9]  
PORRECO RP, 1990, OBSTET GYNECOL, V75, P133
[10]  
PORRECO RP, 1985, OBSTET GYNECOL, V65, P307