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McCarthy L, Tavella NF, Wetzler S, Ardente L, Chadwick M, Paul D, Sabet N, Stern T, Bianco A. Examining provider practice-level disparities in delivery outcomes among patients with a history of Cesarean Delivery. BMC Pregnancy Childbirth 2024; 24:243. [PMID: 38580908 PMCID: PMC10996110 DOI: 10.1186/s12884-024-06458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Choosing whether to pursue a trial of labor after cesarean (TOLAC) or scheduled repeat cesarean delivery (SRCD) requires prenatal assessment of risks and benefits. Providers and patients play a central role in this process. However, the influence of provider-associated characteristics on delivery methods remains unclear. We hypothesized that different provider practice groups have different obstetric outcomes in patients with one prior cesarean delivery (CD). METHODS This was a retrospective cohort study of deliveries between April 29, 2015 - April 29, 2020. Subjects were divided into three cohorts: SRCD, successful VBAC, and unsuccessful VBAC (patients who chose TOLAC but had a CD). Disparities were reviewed between five different obstetric provider practice groups, determined from a breakdown of different providers delivering at the study site during the study period. Proportional differences were examined using Chi-squared tests and logistic regression models. RESULTS 1,439 deliveries were included in the study. There were significant proportional disparities between patients in the different groups. Specifically, patients from Group D were significantly more likely to undergo successful VBAC, while patients seeing a provider from Group A were more likely to deliver by SRCD. In our multivariate analysis of successful versus unsuccessful VBAC, patients from Group D had greater odds ratios of successful VBAC compared to Group A. Patients delivered by Group E had a significantly lower odds ratio of successful VBAC. CONCLUSION This study suggests an association between provider practice groups and delivery outcomes among patients with one prior CD. These data contribute to a growing body of literature around patient choice in pregnancy and the interplay of patients and providers. These findings help to guide future investigations to improve outcomes among patients with a history of CD.
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Affiliation(s)
- Lily McCarthy
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
| | - Nicola F Tavella
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA.
- Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA.
| | - Sara Wetzler
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
| | - Lily Ardente
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
| | | | - Dexter Paul
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
| | - Nikki Sabet
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
| | - Toni Stern
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
| | - Angela Bianco
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
- Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, 10029, USA
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