Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA.
Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA.
BMC Pregnancy Childbirth. 2024 Apr 5;24(1):243. doi: 10.1186/s12884-024-06458-3.
Choosing whether to pursue a trial of labor after cesarean (TOLAC) or scheduled repeat cesarean delivery (SRCD) requires prenatal assessment of risks and benefits. Providers and patients play a central role in this process. However, the influence of provider-associated characteristics on delivery methods remains unclear. We hypothesized that different provider practice groups have different obstetric outcomes in patients with one prior cesarean delivery (CD).
This was a retrospective cohort study of deliveries between April 29, 2015 - April 29, 2020. Subjects were divided into three cohorts: SRCD, successful VBAC, and unsuccessful VBAC (patients who chose TOLAC but had a CD). Disparities were reviewed between five different obstetric provider practice groups, determined from a breakdown of different providers delivering at the study site during the study period. Proportional differences were examined using Chi-squared tests and logistic regression models.
1,439 deliveries were included in the study. There were significant proportional disparities between patients in the different groups. Specifically, patients from Group D were significantly more likely to undergo successful VBAC, while patients seeing a provider from Group A were more likely to deliver by SRCD. In our multivariate analysis of successful versus unsuccessful VBAC, patients from Group D had greater odds ratios of successful VBAC compared to Group A. Patients delivered by Group E had a significantly lower odds ratio of successful VBAC.
This study suggests an association between provider practice groups and delivery outcomes among patients with one prior CD. These data contribute to a growing body of literature around patient choice in pregnancy and the interplay of patients and providers. These findings help to guide future investigations to improve outcomes among patients with a history of CD.
选择经剖宫产（TOLAC）试产还是择期再次剖宫产（SRCD）需要对风险和益处进行产前评估。提供者和患者在这个过程中起着核心作用。然而，提供者相关特征对分娩方式的影响尚不清楚。我们假设在有一次剖宫产史的患者中，不同的提供者实践群体有不同的产科结局。
这是一项回顾性队列研究，纳入了 2015 年 4 月 29 日至 2020 年 4 月 29 日期间的分娩。受试者分为三组：SRCD、成功 VBAC 和不成功 VBAC（选择 TOLAC 但行剖宫产的患者）。通过对研究期间在研究地点分娩的不同提供者的分类，审查了五个不同产科提供者实践群体之间的差异。使用卡方检验和逻辑回归模型检查比例差异。
共纳入 1439 例分娩。不同组患者之间存在显著的比例差异。具体来说，来自 D 组的患者行成功 VBAC 的可能性显著更高，而来自 A 组的患者更倾向于行 SRCD。在我们对成功 VBAC 与不成功 VBAC 的多变量分析中，与 A 组相比，D 组患者行成功 VBAC 的比值比更高。来自 E 组的患者行成功 VBAC 的比值比显著更低。
这项研究表明，提供者实践群体与有一次剖宫产史的患者的分娩结局之间存在关联。这些数据为围绕妊娠患者选择和患者与提供者相互作用的不断增长的文献做出了贡献。这些发现有助于指导未来的研究，以改善有剖宫产史的患者的结局。
