title: The influence of hospital type on induction of labor and mode of delivery.
abstract: OBJECTIVE
  The purpose of this study was to compare labor induction and cesarean delivery rates at term in community vs university hospitals.
  
  
  METHODS
  A population-based retrospective cohort study of births was performed. Primary outcomes were term gestation at <39 weeks, labor induction, and cesarean delivery. After we adjusted for comorbidities, malpresentation, and previous cesarean delivery, logistic regression assessed the association between hospital type and primary outcomes.
  
  
  RESULTS
  Births occur less often in week 37 (n = 24390 [11%] vs 4006 [13%]; adjusted odds ratio [OR], 0.9; 95% confidence interval [CI], 0.8-0.9) and are similar in week 38 in community vs university hospitals. Inductions occur more commonly in community vs university settings at 37 weeks (n = 6440 [27%] vs 757 [19%]; adjusted OR, 1.7; 95% CI, 1.5-1.8) and at 38 weeks (n = 16586 [31%] vs 1530 [21%]; adjusted OR, 1.8; 95% CI, 1.7-1.9). Cesarean rates are no different between hospital types.
  
  
  CONCLUSIONS
  Induction is 70-80% more likely at community vs university hospitals before the optimal gestational age of ≥ 39 weeks, but cesarean delivery rates do not differ at term.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA. candice.snyder@uc.edu
authors.forename: Candice C
authors.initials: CC
authors.lastname: Snyder
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Wolfe
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Loftin
authors.forename: Sammy
authors.initials: S
authors.lastname: Tabbah
authors.forename: David F
authors.initials: DF
authors.lastname: Lewis
authors.forename: Emily A
authors.initials: EA
authors.lastname: Defranco
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies