PT  - JOURNAL ARTICLE
AU  - Benjamin W. Chaska
AU  - Mark S. Mellstrom
AU  - Patricia M. Grambsch
AU  - Robert E. Nesse
TI  - Influence Of Site Of Obstetric Care And Delivery On Pregnancy Management And Outcome
AID  - 10.3122/jabfm.1.3.152
DP  - 1988 Jul 01
TA  - The Journal of the American Board of Family
                Practice
PG  - 152--163
VI  - 1
IP  - 3
4099  - http://www.jabfm.org/content/1/3/152.short
4100  - http://www.jabfm.org/content/1/3/152.full
SO  - J Am Board Fam Med1988 Jul 01; 1
AB  - A retrospective cohort study of 863 pregnancies cared for by family physicians at three sites—rural-rural (RR), rural-urban (RU), and urban-urban (UU)—was designed to test the hypothesis that ready on-site access to perinatal subspecialists would improve pregnancy outcome. No differences in delivery type, length of gestation, birth weight, or nursery care were found. An Apgar score of < 7 at 1 minute or < 8 at 5 minutes was 2.17 and 2.31 times more likely at RU and 2.48 and 2.60 times more likely at UU, respectively, than at RR. The overall Cesarean section rate was 9.6 percent, forceps rate was 7.2 percent, and nonroutine nursery care rate was 7.9 percent. Neonatal and perinatal mortality rates were 3.5 and 4.6 per 1,000 live births. There is no evidence that on-site perinatal subspecialists improve perinatal outcome when care is provided by board-certified family physicians. Small obstetric centers provide quality perinatal care with outcome dependent on physician’s skill rather than on technology.