title: Tertiary care improves the chance for vaginal delivery in women with preeclampsia.
abstract: 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.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal-Fetal Medicine, Saint Louis University, MO, USA.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Mostello
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Droll
authors.forename: S Michelle
authors.initials: SM
authors.lastname: Bierig
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
authors.forename: Terry
authors.initials: T
authors.lastname: Leet
mesh_terms: 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