title: Influence of site of obstetric care and delivery on pregnancy management and outcome.
abstract: 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 less than 7 at 1 minute or less than 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.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN 55905.
authors.forename: B W
authors.initials: BW
authors.lastname: Chaska
authors.forename: M S
authors.initials: MS
authors.lastname: Mellstrom
authors.forename: P M
authors.initials: PM
authors.lastname: Grambsch
authors.forename: R E
authors.initials: RE
authors.lastname: Nesse
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards; D010821:Physicians, Family / Q000592:standards; D011247:Pregnancy; D011255:Pregnancy Maintenance; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population