title: Change in cesarean section rate as a reflection of the present malpractice crisis.
abstract: OBJECTIVE
  To examine the potential effect of the malpractice crisis on the cesarean section rates of practicing obstetricians.
  
  
  METHODS
  We reviewed the medical records of primagravid women, from both clinic and private practice settings, having singleton deliveries at Hartford Hospital from 1994 to 2003. The records of cesarean sections due to fetal distress and cephalopelvic disproportion (CPD) were further analyzed for three different two-year periods; 1994-1995, 1999-2000, and 2002-2003. Cases with accepted indications for elective cesarean sections were excluded. These included breech position, HIV, herpes, preeclampsia, placenta previa, and abruptio placenta.
  
  
  RESULTS
  The private cesarean rate in 1994-1995 was 15.6%, 1999-2000 15.7%, and in 2002-2003 24.8%, a 58% increase. This is a significant increase that was not equally seen in the clinic population during the same period.
  
  
  CONCLUSIONS
  The private, primagravid cesarean section rate has increased significantly in the last two years. A concurrent rise in medical malpractice actions and malpractice insurance premiums, without other attributable explanations, suggests this may be a major factor.
authors.affiliation: Department of OB/GYN, University of Connecticut School of Medicine, Hartford, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Ryan
authors.forename: Peter
authors.initials: P
authors.lastname: Schnatz
authors.forename: John
authors.initials: J
authors.lastname: Greene
authors.forename: Stephen
authors.initials: S
authors.lastname: Curry
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D003237:Connecticut / Q000453:epidemiology; D003675:Defensive Medicine / Q000706:statistics & numerical data*; D005249:Fees and Charges / Q000639:trends; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology*; D020073:Gravidity; D006801:Humans; D007351:Insurance, Liability / Q000191:economics; D008318:Malpractice / Q000706:statistics & numerical data / Q000639:trends; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D009774:Obstetrics / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D011247:Pregnancy