Family practice obstetrics in a teaching hospital. Does a tertiary care environment make a difference?

Abstract

Objective: To determine referral rates, to study the nature of consultations with obstetricians, and to examine how both patient and physician characteristics affect referrals.

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 admitted consecutively for delivery under the care of family physicians from October 1, 1990, to September 31, 1991.

Outcome measure: The number and types of obstetrical consultations obtained for the study population.

Results: Of the 50.7% of cases requiring consultation, half were delivered by obstetricians. The most common reasons for consultation were failure to progress in labour, induction of labour, posterior presentation, fetal distress, and pregnancy-induced hypertension. The most common reasons for obstetricians to attend delivery were to perform forceps rotations and cesarean sections.

Conclusions: Parity and risk classification were the two most important factors for predicting whether consultation would occur. The high rate of consultation in this study might relate to ease of access to consultation in a tertiary care environment. More study is needed to examine the reasons for consultation because it seems that some of the situations for which obstetricians were consulted could have been safely managed by family physicians.