RT Journal Article
SR Electronic
T1 Influence Of Site Of Obstetric Care And Delivery On Pregnancy Management And Outcome
JF The Journal of the American Board of Family
                Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 152
OP 163
DO 10.3122/jabfm.1.3.152
VO 1
IS 3
A1 Benjamin W. Chaska
A1 Mark S. Mellstrom
A1 Patricia M. Grambsch
A1 Robert E. Nesse
YR 1988
UL http://www.jabfm.org/content/1/3/152.abstract
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.