Search

Pregnancy outcomes were compared between a stratified random sample of 796 women delivering a live birth at a maternity center (BMC) and a frequency matched sample of 804 women delivering a live birth at a tertiary hospital (TJUH) in 1977-1978. The relationship of use of obstetric procedures with pregnancy outcomes was investigated within and between the two samples. The neonatal morbidity rate, as measured by Hobel's neonatal risk score, was significantly higher and mean birth weights were lower at TJUH than at BMC when adjusted for institutional differences in use of obstetric procedures, medical-obstetric risk, and demographic characteristics. Conversely, the proportion of newborns with low 1-minute Apgar scores (fewer than seven) was significantly greater at BMC. The relationship of use of obstetric procedures with each outcome varied between the two institutions as well as across the three measures of pregnancy outcomes. The relationship of use of some procedures with each outcome may be explained in part by use of the procedure because of a suspected poor outcome of pregnancy, rather than an elevated risk of poor outcomes because of use of the procedure. Self-selection of some patients to BMC cannot be ruled out as a possible explanation for institutional differences.

The use of seven obstetric procedures was studied in two institutions that use different approaches to maternity care. The study population included 796 women delivering at Booth Maternity Center and 804 women with similar sociodemographic characteristics delivering at Thomas Jefferson University Hospital during 1977 and 1978. Several differences were found between the two institutions. The majority of selected procedures were used more often at Thomas Jefferson University Hospital than at Booth Maternity Center. The greatest differences were found for women at low intrapartum risk, while differences were smallest for women at high prenatal and intrapartum risk. The two institutions differed in their use of procedures for women at various levels of prenatal and intrapartum risk. The findings suggested that most of the differences did not reflect different levels of risk in the populations served, but were due to other unidentified factors.