Primary Cesarean Delivery among Uncomplicated Term Nulliparous Parturients: The Influence of Group Practice Within a Community Hospital

Abstract

In a community hospital, the rate of cesarean delivery varied significantly for uncomplicated nulliparous patients managed by four practice groups, although the rate of shoulder dystocia did not. Among four practice groups in a single center, our objective was to discern the rate of cesarean delivery (CD) among uncomplicated, term nulliparous parturients, and the likelihood of shoulder dystocia and admission to the neonatal intensive care unit (NICU). The inclusion criteria for this retrospective study were uncomplicated nullipara > or = 37 weeks. Multivariable models were used for analysis. Over 2 years, 1217 women met the inclusion criteria. The overall rate of primary CD was 21%, with rates of 15%, 24%, 17%, and 32% for the four groups. After controlling for confounding variables, the rate of primary CD was significantly higher for group 2 (odd ratio [OR] 1.68; 95% confidence interval [CI] 1.17, 2.42) and 4 (OR 1.83; 95% CI, 1.25, 2.68) versus groups 1 and 3 combined. Shoulder dystocia and admission to NICU did not vary between groups. Among uncomplicated term nulliparous patients, the rate of primary CD varied significantly by practice groups, without an effect on rate of shoulder dystocia or NICU admission.