Maternal complications linked to where obstetricians train

A report in the Journal of the American Medical Association (9/23-9/30/09) suggests that if information about maternal complication rates at training hospitals were generally available, a woman would do well to choose her obstetrician on the basis of where he or she did residency.

In a retrospective analysis of maternal complications that used data from nearly 5 million deliveries, more than 4,000 obstetricians, and more than 100 residency programs, researchers showed that a woman who chooses an obstetrician trained in a top-tier program has a 10.3% risk of a major complication compared with 13.6% if her obstetrician trained at a bottom-tier residency program (absolute difference, 3.3%; 95% confidence interval, 2.8%-3.8%).

These differences remained significant (P<.001) across 6 individual complication measures, conditional on delivery mode. For vaginal deliveries, investigators measured rates of laceration, hemorrhage, and "all others," including infectious and thrombotic complications. For cesarean deliveries, they measured hemorrhage, infection, and "all others," such as operative and thrombotic complications.