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Physician cesarean delivery rates and severe perinatal morbidity among low-risk nulliparas

Journal of Perinatology volume 43, pages 34–38 (2023)Cite this article

Subjects

Abstract

Objective

To estimate the individual physician cesarean delivery rate associated with serious perinatal morbidity.

Study design

Study of nulliparous, term, singleton, vertex deliveries with maternal-neonatal dyad data (2015–2017) in the MarketScan Research Database. An individual cesarean delivery rate was calculated for all delivering physicians. The primary maternal outcome included transfusion of ≥4 units of blood, intensive care unit (ICU) admission, venous thromboembolism, or hysterectomy. The primary neonatal outcome included hypoxic ischemic encephalopathy, seizure, cardiopulmonary resuscitation or ventilator use (within 24 h), or ICU admission. Multivariable modeling of the association between physician cesarean delivery rate and each outcome was performed.

Results

Among 77,058 maternal-neonatal dyads, the maternal composite occurred in 1.3% of deliveries and neonatal composite in 3.6% of deliveries. The likelihood of the maternal (aOR 1.03 for each 3% increase in physician cesarean delivery rate, 95% CI 1.021–1.043) and neonatal (aOR 1.02 for each 3% increase, 95% CI 1.014–1.027) composite outcome increased linearly with increasing physician cesarean delivery rate.

Conclusions

Severe perinatal morbidity was associated with increasing individual physician cesarean delivery rates.

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Fig. 1: Maternal severe perinatal morbidity by delivery mode and physician cesarean delivery rate.
Fig. 2: Neonatal severe perinatal morbidity by physician cesarean delivery rate with vaginal and cesarean deliveries reported separately.

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Data availability

The dataset analyzed during the current study is available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the University of Utah Department of Surgery and the Surgical Population Analysis Research Core for their role in facilitating data collection, database management, and analysis. There was no funding for this work.

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Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, UT, USA

    Ann M. Bruno, Amanda A. Allshouse, Robert M. Silver & Torri D. Metz

  2. Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Intermountain Healthcare, Murray, UT, USA

    Ann M. Bruno, Robert M. Silver & Torri D. Metz

  3. Department of Surgery, University of Utah Health, Salt Lake City, UT, USA

    Joshua J. Horns, Rupam Das & Niraj Paudel

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  1. Ann M. Bruno
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  5. Niraj Paudel
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  7. Torri D. Metz
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Contributions

AMB participated in study conception, planning, interpretation of results, and manuscript drafting. JJH, RD, and NP contributed to data collection, data cleaning and statistical analysis. AAA contributed to study conception, planning, and interpretation of results. RMS contributed to study conception, study planning, and manuscript edits. TDM contributed to study conception and planning, interpretation of results, and manuscript edits.

Corresponding author

Correspondence to Ann M. Bruno.

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Bruno, A.M., Horns, J.J., Allshouse, A.A. et al. Physician cesarean delivery rates and severe perinatal morbidity among low-risk nulliparas. J Perinatol 43, 34–38 (2023). https://doi.org/10.1038/s41372-022-01540-0

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