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; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

doi:10.1016/j.ajog.2015.01.055

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

Am J Obstet Gynecol. 2015 Jul;213(1):86.e1-86.e6. doi: 10.1016/j.ajog.2015.01.055. Epub 2015 Feb 4.

Authors

Jennifer L Bailit¹, William A Grobman², Paula McGee³, Uma M Reddy⁴, Ronald J Wapner⁵, Michael W Varner⁶, John M Thorp⁷, Kenneth J Leveno⁸, Jay D Iams⁹, Alan T N Tita¹⁰, George Saade¹¹, Yoram Sorokin¹², Dwight J Rouse¹³, Sean C Blackwell¹⁴; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network:
B Mercer, C Milluzzi, W Dalton, T Dotson, P McDonald, C Brezine, A McGrail, G Mallett, M Ramos-Brinson, A Roy, L Stein, P Campbell, C Collins, N Jackson, M Dinsmoor, J Senka, K Paychek, A Peaceman, M Talucci, M Zylfijaj, Z Reid, R Leed, J Benson, S Forester, C Kitto, S Davis, M Falk, C Perez, K Hill, A Sowles, J Postma, S Alexander, G Andersen, V Scott, V Morby, K Jolley, J Miller, B Berg, K Dorman, J Mitchell, E Kaluta, K Clark, K Spicer, S Timlin, K Wilson, L Moseley, M Santillan, J Price, K Buentipo, V Bludau, T Thomas, L Fay, C Melton, J Kingsbery, R Benezue, S Caritis, H Simhan, M Bickus, D Fischer, T Kamon, D DeAngelis, P Shubert, C Latimer, L Guzzo, F Johnson, L Gerwig, S Fyffe, D Loux, S Frantz, D Cline, S Wylie, J Iams, M Wallace, A Northen, J Grant, C Colquitt, J Moss, A Salazar, A Acosta, G Hankins, N Hauff, L Palmer, P Lockhart, D Driscoll, L Wynn, C Sudz, D Dengate, C Girard, S Field, P Breault, F Smith, N Annunziata, D Allard, J Silva, M Gamage, J Hunt, J Tillinghast, N Corcoran, M Jimenez, F Ortiz, P Givens, B Rech, C Moran, M Hutchinson, Z Spears, C Carreno, B Heaps, G Zamora, J Tolosa, J Seguin, M Rincon, J Snyder, C Farrar, E Lairson, C Bonino, W Smith, K Beach, S Van Dyke, S Butcher, E Thom, M Rice, Y Zhao, P McGee, V Momirova, R Palugod, B Reamer, M Larsen, T Williams, C Spong, S Tolivaisa, J P Van Dorsten

Affiliations

¹ Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH. Electronic address: [email protected].
² Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Chicago, IL.
³ Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, DC.
⁴ Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
⁵ Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
⁶ Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT.
⁷ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
⁸ Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
⁹ Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH.
¹⁰ Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
¹¹ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX.
¹² Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.
¹³ Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI.
¹⁴ Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.

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.

Keywords: obstetrics; protocols; quality of care.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Clinical Protocols*
Female
Humans
Postpartum Hemorrhage / therapy*
Pre-Eclampsia / therapy
Pregnancy
Pregnancy Complications / therapy*
Pregnancy Outcome*

Abstract

Publication types

MeSH terms

Grants and funding