Adverse perinatal events and subsequent cesarean rate

Area of Science:

• Obstetrics and Gynecology
• Neonatal Outcomes
• Surgical Intervention Rates

Background:

• Intrapartum complications can be anxiety-provoking for obstetricians.
• The impact of these rare but severe events on obstetric practice, specifically cesarean delivery rates, is not well-documented.

Purpose of the Study:

• To investigate if severe intrapartum complications leading to poor neonatal outcomes influence obstetricians' cesarean delivery rates.
• To quantify the change in cesarean delivery rates following specific adverse obstetric events.

Main Methods:

• Prospective study of 3008 deliveries by 12 obstetricians over two years.
• Identification of index events: head entrapment, low Apgar score, shoulder dystocia with injury, or intrapartum fetal death.
• Comparison of cesarean delivery rates in the 50 deliveries before and after an index event, with matched controls.

Main Results:

• Six index events were identified (3 shoulder dystocia, 3 fetal deaths).
• Obstetricians experiencing severe complications showed a 37% average increase in cesarean delivery rates post-event (21.0% to 28.7%).
• This increase was statistically significant compared to control obstetricians.

Conclusions:

• Severe intrapartum complications significantly elevate an obstetrician's cesarean delivery rate.
• Obstetricians should recognize and be aware of the psychological and practice-based effects of managing adverse neonatal outcomes.