Practice patterns during the third stage of labor: the effect of physician age and specialty.
BACKGROUND
Elective manual removal of the placenta and routine uterine exploration following vaginal delivery are controversial procedures. Although advocated in the past, little is known about current attitudes and practices related to these procedures.


METHODS
Using a mailed questionnaire, we surveyed all 178 Iowa obstetrician-gynecologists and a random sample of 163 Iowa family physicians to determine their practice patterns related to selected aspects of the third stage of labor. The data were analyzed using odds ratios and multiple logistic regression.


RESULTS
The analysis was based on answers from 302 physicians. Physicians in the oldest age quartile were three times more likely than physicians in the youngest age quartile to routinely explore the uterus after a vaginal delivery (P < .01). After controlling for specialty, younger physicians were more likely to believe that manual removal of the placenta is a risk factor for endometritis (adjusted odds ratio [OR] 0.7 for each 10-year increase in age, 95% confidence interval [CI] 0.6 to 1.0). Controlling for age, family physicians were more likely than obstetrician-gynecologists to routinely order prophylactic antibiotics after manually removing the placenta (adjusted OR 2.0, 95% CI 1.1 to 3.7).


CONCLUSIONS
Both physician age and specialty were associated with selected practice patterns involving the third stage of labor. Older physicians were less likely to believe that manually removing a placenta increases the risk of postpartum endometritis, and they were more likely to routinely explore the uterus after a vaginal delivery.
Ely
J W
JW
University of Iowa Hospitals and Clinics, Department of Family Practice, Iowa City 52242, USA.
Howser
D M
DM
Dawson
J D
JD
Bowdler
N C
NC
Rijhsinghani
A
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004716:Endometritis / Q000209:etiology / Q000517:prevention & control; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data; D006801:Humans; D007484:Iowa; D007743:Labor, Obstetric; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data; D010808:Physical Examination; D010920:Placenta; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D014599:Uterus
D000900:Anti-Bacterial Agents