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Re: large uterine fibroids and natural labor**Now elective C SectionsFrom: ainsron (ainsron@sbcglobal.net)Thu Jun 3 22:32:43 2004
Here's the abstract:
Intrapartum Elective Cesarean Delivery: A Previously Unrecognized Clinical
Entity
Robin B. Kalish, MD*, Laurence McCullough, PhD*, Meruka Gupta*, Howard T.
Thaler, PhD and Frank A. Chervenak, MD*
>From the *Division of Maternal-Fetal Medicine, Department of Obstetrics and Address reprint requests to: Robin B. Kalish, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 525 East 68th Street, Room J-130, New York 10021; e-mail: robinkal@aol.com. OBJECTIVE: The purpose of the study was to investigate the incidence of intrapartum patient choice cesarean delivery-patients' requesting cesarean delivery and physicians' offering it during labor-and factors possibly influencing these requests and offers. METHODS: For a 6-month period from May 1, 2002, to October 31, 2002, obstetricians were asked to complete a questionnaire after all intrapartum cesarean deliveries regarding whether cesarean delivery was offered by the obstetrician or requested by the patient before being medically indicated. Patient medical records and physician demographic information were reviewed. RESULTS: There were 422 cases that met inclusion criteria. Questionnaires were completed in 100% of cases. Cesarean delivery was offered in 13% before a clear medical indication and requested in 8.8%. Older obstetricians, maternal-fetal medicine specialists, and full-time faculty were significantly more likely to offer cesarean delivery (P = .009, P < .001, and P = .015, respectively). Patients who were unmarried or undergoing labor induction were less likely to request cesarean delivery (P = .029 and P .035, respectively). Maternal age, parity, stage or length of labor, epidural use, gestational age, insurance status, day of week, and time of delivery did not affect whether patients requested or were offered cesarean delivery. CONCLUSION: This study documents a heretofore unrecognized clinical entity: intrapartum elective cesarean delivery. Physician characteristics, as opposed to patient characteristics or intrapartum factors, are a major determinant of whether laboring patients are being offered cesarean delivery. LEVEL OF EVIDENCE: III Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Thursday, June 03, 2004 7:27 PM To: Multiple recipients of list OB-GYN-L Subject: Re: large uterine fibroids and natural labor**Now elective C Sections The lead article in this month's Green is about primary sections on request, termed an elective section. It sights MD characteristics, not patient ones, as the primary determinant of agreeing to that request. Older Obstetricians, and Academic ones were more likely to grant the request, and there may have been another category, but, alas, the article is at the office and I can't remember that much detail since I only scanned it. Garry
At Thu, 3 Jun 2004, Theresa333@aol.com wrote:
>
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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