The relationship of health care delivery system characteristics and legal factors to mode of delivery in women with prior cesarean section: a systematic review.
OBJECTIVE
To evaluate the relationship of health care delivery system characteristics and legal factors to mode of delivery in women with prior cesarean section.


METHODS
We identified relevant studies by searching MEDLINE and HealthSTAR (1980 to May 2002), reference lists of pertinent articles, and recommendations of local and national experts. We also searched the online Cochrane systematic reviews and controlled trials registries, Database of Abstracts and Reviews on Effectiveness, and EMBASE databases.


RESULTS
Studies of guidelines suggested that opinion leaders influence provider behavior regarding repeat cesarean delivery versus trial of labor decisions. Studies of hospital and insurance characteristics provided inconsistent results. There was insufficient evidence to evaluate the relationship between provider characteristics and delivery outcomes. Legislation and liability-related factors effected limited change.


CONCLUSIONS
Studies of health care system characteristics and other factors focused primarily on rates of delivery modes (vaginal birth after cesarean or repeat cesarean delivery) rather than patient safety or health outcomes. Future studies must account for case mix, time trends, and other potential confounders, especially concerning associations of provider characteristics.
Kraemer
Dale F
DF
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon 97239, USA. kraemerd@ohsu.edu
Berlin
Michelle
M
Guise
Jeanne-Marie
JM
D017604:Cesarean Section, Repeat / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D003696:Delivery Rooms / Q000331:legislation & jurisprudence*; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D016365:Liability, Legal; D011247:Pregnancy; D014481:United States; D016064:Vaginal Birth after Cesarean / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data