PRACTICE PATTERNS DURING THE 3RD STAGE OF LABOR - THE EFFECT OF PHYSICIAN AGE AND SPECIALTY

BACKGROUND. Elective manual removal of the placenta and routine uterin e exploration following vaginal delivery are controversial procedures. Although advocated in the past, little is known about current attitud es and practices related to these procedures. METHODS. Using a mailed questionnaire, we surveyed all 178 Iowa obstetrician-gynecologists and a random sample of 163 Iowa family physicians to determine their prac tice patterns related to selected aspects of the third stage of labor. The data were analyzed using odds ratios and multiple logistic regres sion. RESULTS. The analysis was based on answers from 302 physicians. Physicians in the oldest age quartile were three times more likely tha n physicians in the youngest age quartile to routinely explore the ute rus after a vaginal delivery (P< 0.1). After controlling for specialty , younger physicians were more likely to believe that manual removal o f the placenta is a risk factor for endometritis (adjusted odds ratio [OR] 0.7 for each 10-year increase in age, 95% confidence interval [CI ] 0.6 to 1.0). Controlling for age, family physicians were more likely than obstetrician-gynecologists to routinely order prophylactic antib iotics after manually removing the placenta (adjusted OR 2.0, 95% CI 1 .1 to 3.7). CONCLUSIONS. Both physician age and specialty were associa ted with selected practice patterns involving the third stage of labor . Older physicians were less likely to believe that manually removing a placenta increases the risk of postpartum endometritis, and they wer e more likely to routinely explore the uterus after a vaginal delivery .