Nijagal Malini Anand, Kuppermann Miriam, Nakagawa Sanae, Cheng Yvonne
Prima Medical Foundation, Novato, CA and Department of Obstetrics and Gynecology, Marin General Hospital, Greenbrae, CA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA.
Am J Obstet Gynecol. 2015 Apr;212(4):491.e1-8. doi: 10.1016/j.ajog.2014.11.014. Epub 2014 Nov 13.
The objective of the study was to examine the association between labor and delivery practice model and cesarean delivery rates at a community hospital.
This was a retrospective cohort study of 9381 singleton live births at 1 community hospital, at which women were provided labor and delivery care under 1 of 2 distinct practice models: a traditional private practice model and a midwife-physician laborist practice model. Cesarean rates were compared by practice model, adjusting for potential sociodemographic and clinical confounders. Statistical comparisons were performed using the χ(2) test and multivariable logistical regression.
Compared with women managed under the midwife/laborist model, women in the private model were significantly more likely to have a cesarean delivery (31.6% vs 17.3%; P < .001; adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.73-2.58). Women with nulliparous, term, singleton, vertex gestations also were more likely to have a cesarean delivery if they were cared for in the private model (29.8% vs 15.9%; P < .001; aOR, 1.86; 95% CI, 1.33-2.58) as were women who had a prior cesarean delivery (71.3% vs 41.4%; P < .001; aOR, 3.19; 95% CI, 1.74-5.88).
In this community hospital setting, a midwife-physician laborist practice model was associated with lower cesarean rates than a private practice model.
本研究的目的是探讨一家社区医院的分娩实践模式与剖宫产率之间的关联。
这是一项对一家社区医院9381例单胎活产的回顾性队列研究，在该医院，女性在两种不同的实践模式之一接受分娩护理：传统私人执业模式和助产士 - 医生分娩专家实践模式。根据实践模式比较剖宫产率，并对潜在的社会人口统计学和临床混杂因素进行调整。使用χ(2)检验和多变量逻辑回归进行统计比较。
与在助产士/分娩专家模式下管理的女性相比，私人执业模式下的女性剖宫产的可能性显著更高（31.6%对17.3%；P <.001；调整后的优势比[aOR]，2.11；95%置信区间[CI]，1.73 - 2.58）。初产妇、足月、单胎、头位妊娠的女性如果在私人执业模式下接受护理，剖宫产的可能性也更高（29.8%对15.9%；P <.001；aOR，1.86；95% CI，1.33 - 2.58），有剖宫产史的女性也是如此（71.3%对41.4%；P <.001；aOR，3.19；95% CI，1.74 - 5.88）。
在这家社区医院环境中，助产士 - 医生分娩专家实践模式与比私人执业模式更低的剖宫产率相关。
