Obstetric consultations during labor and delivery in a university-based family practice

This study retrospectively examined the use of obstetrical consultants by family medicine residents and faculty at the University of Washington Hospital from July 1, 1980, to June 30, 1981. Of 125 deliveries, 104 (83 percent) were vaginal deliveries, 99 percent of which were performed by the family physician involved. There were 21 (17 percent) cesarean sections. Before the audit began, 13 complications of labor and delivery were established as criteria suggesting the need for consultation. Medical records were retrospectively examined for complications meeting these criteria. Formal consultations occurred in 32 percent of all deliveries. Of the patients with at least one of the 13 complications, 75 percent had consultations obtained. Patients with these complications had intrapartum risk scores that were significantly higher than patients without the listed complications. Apgar scores at 1 and 5 minutes were significantly lower in the group of patients meeting the consultation criteria (7.0 vs 8.0 at 1 minute; 8.3 vs 9.0 at 5 minutes). The criteria successfully identified a group of high-risk patients and could be an appropriate guide for decision making in the specific setting studied. Patients without one of the predetermined complications had a low rate of surgical intervention (cesarean section or midforceps deliveries); the negative predictive value was 98 percent.