Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?

Jennifer L. Bailit, William A. Grobman, Paula McGee, Uma M. Reddy, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Kenneth J. Leveno, Jay D. Iams, Alan T.N. Tita, George Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Kennedy Shriver National Institute of Child Health Eunice Kennedy Shriver National Institute of Child Health, Development Maternal-Fetal Medicine Units Network Human Development Maternal-Fetal Medicine Units Network

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: We sought to evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes.

STUDY DESIGN: This was a cohort study of a random sample of deliveries performed at 25 hospitals over 3 years. Condition-specific protocols were collected from all hospitals and categorized independently by 2 authors. Data on maternal and neonatal outcomes, as well as data necessary for risk adjustment were collected. Risk-adjusted outcomes were compared according to whether the patient delivered in a hospital with condition-specific obstetric protocols at the time of delivery.

RESULTS: Hemorrhage-specific protocols were not associated with a lower rate of postpartum hemorrhage or with fewer cases of estimated blood loss >1000 mL. Similarly, in the presence of a shoulder dystocia protocol, there were no differences in the frequency of shoulder dystocia or number of shoulder dystocia maneuvers used. Conversely, preeclampsia-specific protocols were associated with fewer intensive care unit admissions (odds ratio, 0.28; 95% confidence interval, 0.18-0.44) and fewer cases of severe maternal hypertension (odds ratio, 0.86; 95% confidence interval, 0.77-0.96).

CONCLUSION: The presence of condition-specific obstetric protocols was not consistently shown to be associated with improved risk-adjusted outcomes. Our study would suggest that the presence or absence of a protocol does not matter and regulations to require protocols are not fruitful.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume213
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Pregnancy Outcome
Dystocia
Obstetrics
Mothers
Odds Ratio
Confidence Intervals
Risk Adjustment
Postpartum Hemorrhage
Pre-Eclampsia
Intensive Care Units
Cohort Studies
Hemorrhage
Hypertension

Keywords

  • obstetrics
  • protocols
  • quality of care

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Bailit, J. L., Grobman, W. A., McGee, P., Reddy, U. M., Wapner, R. J., Varner, M. W., ... Human Development Maternal-Fetal Medicine Units Network, D. M-F. M. U. N. (2015). Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes? American Journal of Obstetrics and Gynecology, 213(1). https://doi.org/10.1016/j.ajog.2015.01.055

Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes? / Bailit, Jennifer L.; Grobman, William A.; McGee, Paula; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Iams, Jay D.; Tita, Alan T.N.; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Eunice Kennedy Shriver National Institute of Child Health, Kennedy Shriver National Institute of Child Health; Human Development Maternal-Fetal Medicine Units Network, Development Maternal-Fetal Medicine Units Network.

In: American Journal of Obstetrics and Gynecology, Vol. 213, No. 1, 01.07.2015.

Research output: Contribution to journalArticle

Bailit, JL, Grobman, WA, McGee, P, Reddy, UM, Wapner, RJ, Varner, MW, Thorp, JM, Leveno, KJ, Iams, JD, Tita, ATN, Saade, G, Sorokin, Y, Rouse, DJ, Blackwell, SC, Eunice Kennedy Shriver National Institute of Child Health, KSNIOCH & Human Development Maternal-Fetal Medicine Units Network, DM-FMUN 2015, 'Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?', American Journal of Obstetrics and Gynecology, vol. 213, no. 1. https://doi.org/10.1016/j.ajog.2015.01.055
Bailit, Jennifer L. ; Grobman, William A. ; McGee, Paula ; Reddy, Uma M. ; Wapner, Ronald J. ; Varner, Michael W. ; Thorp, John M. ; Leveno, Kenneth J. ; Iams, Jay D. ; Tita, Alan T.N. ; Saade, George ; Sorokin, Yoram ; Rouse, Dwight J. ; Blackwell, Sean C. ; Eunice Kennedy Shriver National Institute of Child Health, Kennedy Shriver National Institute of Child Health ; Human Development Maternal-Fetal Medicine Units Network, Development Maternal-Fetal Medicine Units Network. / Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?. In: American Journal of Obstetrics and Gynecology. 2015 ; Vol. 213, No. 1.
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AU - Saade, George

AU - Sorokin, Yoram

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