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Relationship Between Obstetricians’ Practice Years and Delivery Outcomes Among Cephalic Nulliparous Term Singleton Laboring Women: A Retrospective Cohort Study
Abstract Number: S5B-3
Abstract Type: Original Research
Several studies have demonstrated significant variation in cesarean delivery (CD) rates among parturients with cephalic, nulliparous, term, singleton (CeNTS) presentations. Although numerous interventions to decrease the CD rate have been explored, it remains unclear how variables such as subjective clinical CD indications, obstetrician experience and use of vacuum and forceps influence outcomes.
This is a retrospective cohort study of 30 months of perinatal data from a large, academic medical center. The sample included all CeNTS women between 2015-2017. Obstetricians were stratified by years in practice into Group 1-5, representing practice length ≥31 yrs, 21-30 yrs, 11-20 yrs, 6-10 yrs and 0-5 yrs after residency training. Similarly, subgroup analyses were conducted for the indications for CD and indications for labor induction.
A total of 7495 women received care by different obstetrician groups. The overall CD rate was 22.7%. There were significant differences in CD rates (p≤0.001) and in unscheduled CD rates (p≤0.001) between the 5 groups of obstetric providers. Group 1 had the lowest CD rate (21.59%) and lowest unscheduled CD rate (63.55%) while Group 5 had the highest CD rate (29.51%) and highest unscheduled CD rate (95.71%). There were also significant differences in forceps rates and 3rd degree laceration rates between the 5 groups of obstetrician based on years in practice. Group 1 (practice length ≥31 years) had the highest forceps rate (4.58%) whereas while Group 5 (practice length 0-5 years) had the lowest rate (1.4%) (p≤0.001). Group 5 (practice length 0-5 years) had the highest 3rd degree laceration rate (P < 0.001). There was no significantly difference between 5 groups in anesthesia method and induction method.
Provider experience has repeated been associated with patient outcomes. Operative delivery, especially the forceps use, has declined nearly 40% of maternity hospitals in the U.S. Our data demonstrated that obstetricians with more years in practice are associated with higher vaginal delivery rates and lower unscheduled CD rates in CeNTS women. We also found higher forceps-assisted delivery rates in more experienced obstetricians as compared with their less experienced colleagues. Improving the training of obstetricians in techniques such as forceps may be able to improve patient care and satisfaction.
1. Lynn M. Am J Ob Gyn 2015.
2. Kyser KL, Acad Med 2014.