ABSTRACT
In a community hospital, the rate of cesarean delivery varied significantly for uncomplicated
nulliparous patients managed by four practice groups, although the rate of shoulder
dystocia did not. Among four practice groups in a single center, our objective was
to discern the rate of cesarean delivery (CD) among uncomplicated, term nulliparous
parturients, and the likelihood of shoulder dystocia and admission to the neonatal
intensive care unit (NICU). The inclusion criteria for this retrospective study were
uncomplicated nullipara ≥ 37 weeks. Multivariable models were used for analysis. Over
2 years, 1217 women met the inclusion criteria. The overall rate of primary CD was
21%, with rates of 15%, 24%, 17%, and 32% for the four groups. After controlling for
confounding variables, the rate of primary CD was significantly higher for group 2
(odd ratio [OR] 1.68; 95% confidence interval [CI] 1.17, 2.42) and 4 (OR 1.83; 95%
CI, 1.25, 2.68) versus groups 1 and 3 combined. Shoulder dystocia and admission to
NICU did not vary between groups. Among uncomplicated term nulliparous patients, the
rate of primary CD varied significantly by practice groups, without an effect on rate
of shoulder dystocia or NICU admission.
KEYWORDS
Nulliparous - primary cesarean delivery - shoulder dystocia - neonatal intensive care
unit
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Suneet P ChauhanM.D.
Aurora Health Care, 8901 W. Lincoln Avenue, PAC, West Allis
WI 53227; reprints not available from the author
