An audit of obstetric care in a university family medicine department and an obstetrics-gynecology department.
The care of obstetric patients in a university family medicine department was compared with that in the obstetrics-gynecology department of the same university. The obstetric service patients tended to be at higher risk due to a higher black population (24.2 percent vs 6.3 percent), greater prepregnancy weight (mean 154.0 lbs vs 113.9 lbs), and a greater number of patients referred from the community because of prenatal complications. However, the family medicine patients had a higher incidence of premature rupture of membranes (26 percent vs 11 percent), and were therefore at risk for several complications. Family medicine nulliparas had first stages of labor which lasted an average of 12.2 hours as opposed to obstetric service nulliparas whose first stages averaged only 9.2 hours. There were more family medicine than obstetric service patients who received no anesthesia (18.0 percent vs 10.2 percent). Elective low forceps were used more often by obstetric service physicians than by family physicians (28.2 percent vs 15.3 percent). Mothers on the family medicine service had more puerperal complications than those on the obstetric service (16.0 percent vs 5.6 percent). No serious discrepancies in quality of care could be found between the two services.