Wang Tiffany, Brown Inga, Huang Jim, Kawakita Tetsuya, Moxley Michael
Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia.
Department of Obstetrics and Gynecology, Virginia Hospital Center, Arlington, Virginia.
AJP Rep. 2021 Dec 15;11(4):e142-e146. doi: 10.1055/s-0041-1740563. eCollection 2021 Oct.
This study aimed to identify factors associated with meeting the Obstetric Care Consensus (OCC) guidelines for nulliparous, term, singleton, and vertex (NTSV) cesarean births. This was a retrospective case control study of women with NTSV cesarean births between January 2014 and December 2017 at single tertiary care center. Demographics and clinical characteristics were compared between women with NTSV cesarean births which did or did not meet OCC guidelines. A multivariable logistic regression model was used to evaluate the effect of each variable on the odds of meeting OCC guidelines. There were 1,834 women with NTSV cesarean births of which 744 (40.6%) met OCC guidelines for delivery and 1,090 (59.4%) did not. After controlling for confounding factors, the odds of meeting OCC guidelines were increased for in-house providers managing with residents (adjusted odds ratio [aOR] = 2.03, 95% confidence interval [CI]: 1.44-2.87) and without residents (aOR = 1.66, 95% CI: 1.30-2.12), compared with non-in-house providers managing without residents. There was no significant difference in the odds of meeting OCC guidelines for in-house providers managing with or without residents (aOR = 1.23, 95% CI: 0.84-1.79). After adjusting for confounding factors, in-house provider coverage, regardless of resident involvement, is associated with increased odds of NTSV cesarean births meeting OCC guidelines. Frequency of adherence to OCC guidelines for NTSV cesarean births was 40.6%.Neither patient demographics nor comorbidities was associated with the odds of meeting OCC guidelines.In-house providers are associated with increased odds of meeting OCC guidelines.
本研究旨在确定与符合未产妇、足月、单胎及头位（NTSV）剖宫产的产科护理共识（OCC）指南相关的因素。 这是一项对2014年1月至2017年12月期间在单一三级医疗中心进行NTSV剖宫产的女性进行的回顾性病例对照研究。比较了符合或不符合OCC指南的NTSV剖宫产女性的人口统计学和临床特征。使用多变量逻辑回归模型评估每个变量对符合OCC指南几率的影响。 共有1834名进行NTSV剖宫产的女性，其中744名（40.6%）符合分娩的OCC指南，1090名（59.4%）不符合。在控制混杂因素后，与不由住院医师协助的非院内医疗人员相比，由住院医师协助的院内医疗人员（调整后的优势比[aOR]=2.03，95%置信区间[CI]：1.44-2.87）和不由住院医师协助的院内医疗人员（aOR=1.66，95%CI：1.30-2.12）符合OCC指南的几率增加。对于由住院医师协助或不由住院医师协助的院内医疗人员，符合OCC指南的几率没有显著差异（aOR=1.23，95%CI：0.84-1.79）。 在调整混杂因素后，无论住院医师是否参与，院内医疗人员的覆盖与NTSV剖宫产符合OCC指南的几率增加相关。NTSV剖宫产符合OCC指南的频率为40.6%。患者的人口统计学特征和合并症均与符合OCC指南的几率无关。院内医疗人员与符合OCC指南的几率增加相关。
