Family medicine in a tertiary care hospital. Obstetrical outcomes and interventions

Abstract

Objective: To examine the rates of obstetrical complications and interventions among patients managed or comanaged by family physicians.

Design: Case series. Retrospective review of hospital records.

Setting: Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont.

Participants: Five hundred forty-two women in labour admitted consecutively by family physicians from October 1, 1990, to September 31, 1991. There were no exclusions based on antenatal risk.

Main outcome measures: Degree of risk on admission, and rates of cesarean sections, inductions, epidurals, forceps deliveries, episiotomies, perineal tears, postpartum hemorrhages, and postpartum fever for mothers. For newborns, Apgar scores and rate of need for a pediatric critical care unit or special observation nursery.

Results: Except for rates of inductions and episiotomies, which were lower than those reported elsewhere, results were all comparable to those in previous North American studies of low-risk family medicine obstetric patients.

Conclusion: Family physicians care for women with a range of antenatal risks. Even when practising in tertiary care environments, family physicians can minimize many obstetrical interventions while maintaining good maternal and neonatal outcomes.