Physician cesarean delivery rates and severe perinatal morbidity among low-risk nulliparas

Abstract

Objective: To estimate the individual physician cesarean delivery rate associated with serious perinatal morbidity.

Study design: Study of nulliparous, term, singleton, vertex deliveries with maternal-neonatal dyad data (2015-2017) in the MarketScan Research Database. An individual cesarean delivery rate was calculated for all delivering physicians. The primary maternal outcome included transfusion of ≥4 units of blood, intensive care unit (ICU) admission, venous thromboembolism, or hysterectomy. The primary neonatal outcome included hypoxic ischemic encephalopathy, seizure, cardiopulmonary resuscitation or ventilator use (within 24 h), or ICU admission. Multivariable modeling of the association between physician cesarean delivery rate and each outcome was performed.

Results: Among 77,058 maternal-neonatal dyads, the maternal composite occurred in 1.3% of deliveries and neonatal composite in 3.6% of deliveries. The likelihood of the maternal (aOR 1.03 for each 3% increase in physician cesarean delivery rate, 95% CI 1.021-1.043) and neonatal (aOR 1.02 for each 3% increase, 95% CI 1.014-1.027) composite outcome increased linearly with increasing physician cesarean delivery rate.

Conclusions: Severe perinatal morbidity was associated with increasing individual physician cesarean delivery rates.