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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Tong Li, PhD1, George Rhoads, MD, MPH1, John Smulian, MD MPH2, Kitaw Demissie, MD PhD1, D Wartenberg3, and Lakota K. Kruse, MD, MPH4. (1) Division of Epidemiology, UMDNJ-School of Public Health, 25 Trewbridge CT, Princeton, NJ 08540, (609)683-5737, lito@umdnj.edu, (2) Robert Wood Johnson Medical School, 254 Easton Avenue, New Brunswick, NJ 08855, (3) Environmental and Community Medicine, UMDNJ-Robert Wood Johnson Medical School, 170 Frelinghuysen Road, Piscataway, NJ 08855, (4) Division of Family Health Services, New Jersey Department of Health and Senior Services, P O Box 364, Trenton, NJ 08625
It is well known that there is considerable variation among physicians in cesarean delivery rates. However, little information is available about perinatal outcomes associated with these divergent practices. To examined this issue, we conducted a retrospective cohort study based on 171,295 singleton deliveries in New Jersey hospitals between January 1, 1996 and December 31, 1997. Linked vital certificate and maternal and infant hospital discharge records were used. Attending physicians were divided into three groups (low, medium, and high) based on their cesarean rate during the study period. Perinatal mortality, rates of birth injury and uterine rupture were compared among the physician groups after adjusting differences in patient risks using multivariate models. Higher rate physicians performed more cesarean deliveries for all types of patients, regardless of patient characteristics. The three physician groups achieved comparable perinatal mortality rates. Low- and very low birthweight infants delivered by the high rate physicians did not have lower risk of mortality. Rate of intracranial hemorrhage was higher in the low rate group compared to the medium rate group. Rate of uterine rupture was lower for the low rate group compared to the medium rate group. Medium and high rate groups were similar in the occurrence of birth injury and uterine rupture. These data suggest that a lower rate of cesarean delivery is not associated with increased perinatal mortality, and that the rate of uterine rupture is reduced. However, a low cesarean rate was associated with a small increase in risk of intracranial hemorrhage.
Learning Objectives:
Keywords: Birth Outcomes, Maternal and Child Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.