Adverse perinatal events and subsequent cesarean rate

Objective: To determine whether severe intrapartum complications resulting in poor neonatal outcome increased obstetricians' cesarean delivery rates. Methods: From July 1996 through Tune 1998 we prospectively studied 3008 del iveries by 12 obstetricians. We chose adverse neonatal outcomes that would be viewed by obstetricians as anxiety-provoking experiences that are rare i n obstetric practice. Index events included head entrapment of breech infan ts, Apgar score less than 3 at 10 minutes, shoulder dystocia resulting in p ersistent brachial plexus injury, and intrapartum fetal death. After an ind ex event was identified, the obstetrician's cesarean delivery rate for the 50 deliveries before the index event was compared with the 50 deliveries af ter the index event. Obstetricians who had no intrapartum complication duri ng the observational period were matched as controls. Results: Six index events were identified, three cases of shoulder dystocia and three intrapartum fetal deaths. In three of: these six cases, the Apga r score at 10 minutes was less than 3. Obstetricians who attended a deliver y with severe intrapartum complications had an average increase in their ce sarean delivery rate of 37% in the 50 deliveries after the index event (21. 0% to 28.7%, P < .05). This rate was greater (P < .05) than that of matched control obstetricians observed during the same observation period (19.0% t o 18.7%). Conclusion: Intrapartum complications such as persistent neonatal brachial plexus injury or fetal death increased the cesarean delivery rate of the ob stetrician experiencing these events. Obstetricians should be aware of the effect of these adverse events on their practice of obstetrics. (C) 1999 by The American College of Obstetricians and Gynecologists.