Tertiary care improves the chance for vaginal delivery in women with preeclampsia.
OBJECTIVE
The purpose of this study was to determine whether the level of hospital care affects cesarean delivery rates for women with preeclampsia.


METHODS
We conducted a population-based cohort study using Missouri birth certificate data for 1993 through 1999. Logistic regression was used to analyze data from 13,646 nulliparous women with preeclampsia who were delivered of singleton live births.


RESULTS
After adjustment was made for gestational age and birth weight, the data showed that women with preeclampsia at primary and secondary hospitals were more likely to be delivered by cesarean delivery (odds ratio, 1.37; 95% CI, 1.24,1.51; and odds ratio, 1.16; 95% CI, 1.07,1.26, respectively) than at tertiary hospitals. For women who were delivered at >or=37 weeks of gestation, cesarean delivery rates were 38.0%, 33.7%, and 30.0% for primary, secondary, and tertiary hospitals, respectively. Dysfunctional labor, cephalopelvic disproportion, and fetal distress were more commonly noted at primary and secondary hospitals (P<.001).


CONCLUSIONS
Levels of expertise and staffing at tertiary hospitals may allow greater attempts and success with vaginal delivery among women with preeclampsia compared with primary or secondary hospitals.
Mostello
Dorothea
D
Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal-Fetal Medicine, Saint Louis University, MO, USA.
Droll
Deborah A
DA
Bierig
S Michelle
SM
Cruz-Flores
Salvador
S
Leet
Terry
T
D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D010298:Parity; D010360:Patient Transfer; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy