A Comparison of Cesarean Delivery Outcomes for Rural Family Physicians and Obstetricians

Article Figures & Data

Table 1. Demographic Indicators of Study Population

Demographics	Family Medicine (n = 125)	Obstetrics (n = 125)	P
Age, years (mean ± SD)	26.2 ± 5.4	27.2 ± 5.1	.14
Pregnancies (mean ± SD)	2.25 ± 1.3	2.23 ± 1.3	.88
Prior births (mean ± SD)	0.78 ± 0.97	0.75 ± 1.0	.76
Insurance
Public	59 (47.2)	72 (58.1)	.2
Private	62 (49.6)	50 (40.3)
Self-pay	4 (3.2)	2 (1.6)
Not specified	0 (0)	1 (0.8)
Race
White	116 (95.9)	120 (96.8)	.71
Asian/Hispanic/Native American	5 (4.0)	4 (0.8)
Not specified	4 (3.2)	1 (0.8)

Table 2. Prenatal Risk Factors

Risk Factors	Family Medicine (n = 125)	Obstetrics (n = 125)	P
Total prenatal risks (mean ± SD)	0.77 ± 2.1	0.44 ± 1.2	.61
Advanced maternal age	10 (8)	11 (8.8)	.82
Diabetes
All types	16 (12.8)	14 (11.2)	.70
Gestational	13 (11)	13 (10)
Type 1	0 (0)	1 (1)
Type 2	3 (2)	0 (0)
Hypertension
All types	18 (14.4)	7 (5.6)	.02
Pregnancy Induced	12 (11)	7 (5)
Chronic Hypertension	6 (5)	0 (0)
Obesity	60 (48)	54 (43.2)	.45
Excess weight gain	76 (62.8)	70 (56)	.55
Preterm labor	4 (3.2)	6 (4.8)	.52
Psychiatric illness	31 (24.8)	23 (18)	.22
Smoking	35 (28.8)	31 (25)	.89
Twin gestation	2 (2)	2 (2)	1.0
Substance abuse	4 (3.2)	8 (6.4)	.38
Significant other issues^*:	11 (8.8)	6 (4.8)	.31
Chlamydia	0	2
Coagulopathy	1	2
IUGR	2	1
Active herpes	0	1
PROM	1	1
Hepatitis C	2	0
Oligohydramnios	4	0

Values are n (%) unless otherwise indicated.
↵* Total is >100% because of multiple issues per patient.
SD, standard deviation; IGUR, intrauterine growth restrictions; PROM, premature rupture of membranes.

Table 3. Indications for Cesarean Delivery

Indications	Family Medicine (n = 125)	Obstetrics (n = 125)	P
Arrest of dilation	21 (16)	25 (20)	.51
Arrest of descent	18 (14.4)	19 (15.2)	.86
Fetal distress	22 (17.6)	20 (16.0)	.74
Scheduled repeat	38 (30.4)	40 (32.0)	.79
Malpresentation	12 (9.6)	18 (14.4)	.24
Placental abruption	4 (3.2)	0 (0)	.12^*
Elective primary caesarian section	0 (0)	2 (1.6)^{^†}	1.0
Placenta previa	1 (0.8)	0 (0)	1.0^*
Other indications (eg, macrosomia with gestational diabetes, twins, active herpes, preeclampsia, failed post-dates induction)	11 (8.8)	9 (7.2)	.64

Values are n (%). The totals are greater than 100% because of multiple indications per patient.
↵* Fisher's exact test.
↵† One had the relative indication of a prior fourth-degree tear. The other was a true elective primary section.

Table 4. Maternal Outcomes

Outcomes	Family Medicine (n = 125)	Obstetrics (n = 125)	P
Intraoperative complications
Total (mean ± SD)	0.02 ± 0.18	02 ± 0.20	1.0
Caesarian section/hysterectomy for placenta accreta	0	1
Uterine artery laceration	1	0
Cervical laceration	0	1
Intraoperative hematuria, no source	1	0
Infectious complications
Total (mean ± SD)	0.03 ± 0.18	0.04 ± 0.20	.74
Endometritis or endomyometritis	1	5
Transient fever to 100.4°F	2	0
Fever/UTI	1	0
Postoperative complications
Total (mean ± SD)	0.03 ± 0.18	0.12 ± 0.41	.03
ICU transfer	0	2
Return to operating room	0	1
Transfusion	1	5
Readmission for pregnancy-related diagnosis
	2	7
Readmission for other diagnosis	1	0
Maternal length of stay (mean ± SD)	3.0 ± 0.68	2.6 ± 0.87	<.01

Table 5. Newborn Outcomes

Outcomes	Family Medicine (n = 125)	Obstetrics (n = 125)	P
Gestational age (weeks)
<37.0	8 (6.2)	10 (7.8)	.40
≥37.0	120 (93.8)	118 (92.2)
Apgar score
1 minute	8.0 ± 1.8	8.0 ± 1.6	.80
5 minutes	8.7 ± 1.3	8.8 ± 1.1	.68
Length of stay	3.0 ± 0.89	2.9 ± 1.3	.21
Transfer to neonatal intensive care unit	5 (3.9)	8 (6.3)	.22
Fetal death at community hospital	1^*	0^*	1.0
Readmission	3 (2.3)	7 (5.5)	.35

Table 6. Cesarean Section Quality Indicators

Indicators	Family Medicine	Obstetrics	P
Decision to incision time (minutes)^*	44.0 ± 16.8	55.1 ± 22.5	.08
Total surgical time (minutes)	55.2 ± 14.7	42.5 ± 13.7	<.01
Scheduled at ≥39 weeks^{^†}	29/32 (91%)	26/32 (82%)	.47

↵* Only cases in which fetal distress is an indication for surgery: 22 cases at family medicine site, 20 cases at obstetrics site.
↵† Only cases for which a Cesarean section was scheduled.