Fetal monitoring in a community hospital: analysis of health maintenance organization, fee-for-service, and clinic populations.
This paper was a review of 2,210 deliveries in a community hospital in which electronic fetal monitoring was used. Patients were evaluated from three different types of group practices-health maintenance organization, fee-for-service, and clinic populations. Electronic fetal monitoring was used in 48%, 41%, and 70% of these groups, respectively. The respective cesarean section rates were 13%, 20%, and 10%. Monitored and nonmonitored, high- and low-risk groups were identified. A higher cesarean section rate for cephalopelvic disproportion was found in the monitored groups. However, this difference was most marked in the fee-for-service group. Perinatal morbidity and mortality results did not differ significantly among the three groups despite differences in electronic fetal monitoring use and cesarean section rates. The use of electronic fetal monitoring did not correlate with the cesarean section rate. Reasonable perinatal morbidity and mortality are compatible with relatively high electronic fetal monitoring rates (70%) and low cesarean section rates (10%). Within certain groups, use of electronic fetal monitoring may increase the cesarean section rate because of an increased diagnosis of cephalopelvic disproportion.
D001291:Attitude of Health Personnel; D002585:Cesarean Section; D005251:Fees, Medical; D005260:Female; D005323:Fetal Monitoring; D006279:Health Maintenance Organizations; D006764:Hospitals, Community; D006801:Humans; D007226:Infant Mortality; D010044:Outpatient Clinics, Hospital; D011247:Pregnancy; D012306:Risk