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

15 Scopus citations

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)
Article number10256
Pages (from-to)86.e1-86.e6
JournalAmerican journal of obstetrics and gynecology
Volume213
Issue number1
DOIs
StatePublished - Jul 1 2015

Keywords

  • obstetrics
  • protocols
  • quality of care

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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