To determine whether severe intrapartum complications resulting in poor neonatal outcome increased obstetricians'cesarean delivery rates.
From July 1996 through June 1998 we prospectively studied 3008 deliveries by 12 obstetricians.
We chose adverse neonatal outcomes that would be viewed by obstetricians as anxiety-provoking experiences that are rare in obstetric practice.
Index events included head entrapment of breech infants, Apgar score less than 3 at 10 minutes, shoulder dystocia resulting in persistent brachial plexus injury, and intrapartum fetal death.
After an index event was identified, the obstetrician's cesarean delivery rate for the 50 deliveries before the index event was compared with the 50 deliveries after the index event.
Obstetricians who had no intrapartum complication during the observational period were matched as controls.
Six index events were identified, three cases of shoulder dystocia and three intrapartum fetal deaths.
In three of these six cases, the Apgar score at 10 minutes was less than 3. Obstetricians who attended a delivery with severe intrapartum complications had an average increase in their cesarean delivery rate of 37% in the 50 deliveries after the index event (21.0% to 28.7%, P<. 05).
This rate was greater (P<. 05) than that of matched control obstetricians observed during the same observation period (19.0% to 18.7%). (...)
Mots-clés Pascal : Césarienne, Taux, Complication, Périnatal, Nouveau né pathologie, Médecin, Obstétrique, Epidémiologie, Prise décision, Influence, Homme, Femelle, Etats Unis, Amérique du Nord, Amérique, Chirurgie, Personnel sanitaire
Mots-clés Pascal anglais : Cesarean section, Rate, Complication, Perinatal, Newborn diseases, Physician, Obstetrics, Epidemiology, Decision making, Influence, Human, Female, United States, North America, America, Surgery, Health staff
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0417729
Code Inist : 002B20G02. Création : 22/03/2000.