Singleton, Term, Vertex Cesarean Delivery on a Midwife Service Compared With an Obstetrician Service
| Autor: | Ella A Damiano, Samantha G. Auty, Kristen A Gerjevic, Jaylon Von Mertens |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Midwifery Odds Young Adult 03 medical and health sciences 0302 clinical medicine Obstetrics and gynaecology Pregnancy medicine Humans New Hampshire 030212 general & internal medicine Propensity Score reproductive and urinary physiology Home Childbirth Retrospective Studies 030219 obstetrics & reproductive medicine Cesarean Section business.industry Obstetrics Infant Newborn Pregnancy Outcome Obstetrics and Gynecology Retrospective cohort study Odds ratio medicine.disease female genital diseases and pregnancy complications Parity Logistic Models Propensity score matching Apgar Score Female Apgar score business Body mass index |
| Zdroj: | Obstetrics & Gynecology. 135:1353-1361 |
| ISSN: | 0029-7844 |
| DOI: | 10.1097/aog.0000000000003748 |
| Popis: | Objective To evaluate the difference in odds of cesarean delivery in term, singleton, vertex pregnancies between the midwife and obstetrician-led services at the same rural tertiary care center. Methods A retrospective cohort study of term, singleton, and vertex deliveries in patients without a history of cesarean delivery was performed. Patients self-selected a delivery service. The primary outcome was the odds of cesarean delivery between midwife and obstetrician-led services. After propensity score matching, logistic regression was performed on the matched sample to assess the adjusted odds of cesarean delivery. Results From January 2015 to December 2017, 1,787 (80.2% of total) deliveries were analyzed with management of 956 (53.5%) by the midwife service and 831 (46.5%) by the obstetrician-led service. The rate of cesarean delivery was 20.7% (n=172) in the obstetrician-led service and 13.1% (n=125) in the midwife service. In the matched sample, the odds of cesarean delivery were lower in the midwife service compared with the obstetrician-led service in unadjusted and adjusted analyses (odds ratio [OR] 0.62, 95% CI 0.47-0.81; adjusted odds ratio [aOR] 0.58, 95% CI 0.44-0.80). Older maternal age (OR 1.02, 95% CI 1.00-1.06; aOR 1.07, 95% CI 1.04-1.10) and higher delivery body mass index (OR 1.06, 95% CI 1.04-1.08; aOR 1.07, 95% CI 1.04-1.09) were associated with higher odds of cesarean delivery. Increased parity was associated with decreased odds of cesarean delivery (OR 0.41, 95% CI 0.31-0.55; aOR 0.35, 95% CI 0.26-0.48). There were no differences in neonatal outcomes. Conclusion At a single rural tertiary care center, patients on the midwife service have significantly lower adjusted odds of cesarean delivery than patients on the obstetrician-led service. |
| Databáze: | OpenAIRE |
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