ResearchObstetricsDoes the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?
Section snippets
Materials and Methods
From 2008 through 2011, we performed a cohort study at 25 hospitals in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. This study, the Assessment of Perinatal Excellence (APEX), was designed to develop quality measures for intrapartum obstetrical care. The APEX study was approved by the institutional review board at each participating institution under a waiver of informed consent. This is a planned secondary analysis of
Results
Data were collected from 115,502 women. Unadjusted outcome rates are shown in Table 2. The frequencies of hemorrhage outcomes and ICU admission for preeclampsia were significantly different between hospitals with and without protocols in place. Hospitals with a hemorrhage protocol had higher rates of hemorrhage and hospitals that did not have a preeclampsia protocol in place had higher rates of ICU admissions.
Variables included in the final risk-adjustment models are shown in Table 1 and the
Comment
In these analyses, we did not find a consistent relationship between the presence of condition-specific protocols and the severity of obstetrics complications. The presence of hemorrhage or shoulder dystocia protocols did not appear to affect the frequency of the outcome itself or the severity of related adverse outcomes. Conversely, the presence of a preeclampsia protocol was associated with less hypertensive morbidity by some measures.
It is important to recognize the importance of risk
Acknowledgment
The authors thank the following subcommittee members who participated in protocol development and coordination between clinical research centers (Cynthia Milluzzi, RN, and Joan Moss, RNC, MSN), protocol/data management and statistical analysis (Madeline M. Rice, PhD, and Elizabeth Thom, PhD), and protocol development and oversight (Brian M. Mercer, MD, and Catherine Y. Spong, MD).
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2021, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :Putatively, the utilization of a shoulder dystocia protocol, which would include identification of the risk factors and management of the impacted shoulder, may lower the morbidity associated with this obstetrical emergency. Bailit et al,45 however, reported on a cohort study of deliveries at 25 hospitals over 3 years. They noted that there were no differences in the odds of a shoulder dystocia occurring or the severity of the shoulder dystocia in hospitals with vs without a shoulder dystocia protocol.
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2017, American Journal of Obstetrics and GynecologyCitation Excerpt :Despite this hypothesis, one study found that <50% of hospitals have massive transfusion protocols.86 The use of a standardized protocol for obstetric hemorrhage has been associated with mixed results regarding blood loss and transfusion rates.87,88 Because most evidence supports rapid treatment to prevent the sequelae of massive obstetric hemorrhage, the workshop attendees recommended that all hospital labor units develop the infrastructure to enable a prompt response to this emergent scenario as part of a coordinated treatment regimen.
Other members of the Maternal-Fetal Medicine Units Network are listed in the Appendix.
This study was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, HD53118) and the National Center for Research Resources (UL1 RR024989; 5UL1 RR025764).
Comments and views of the authors do not necessarily represent views of the NICHD.
The authors report no conflict of interest.
Cite this article as: Bailit JL, Grobman WA, McGee P, et al. Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes? Am J Obstet Gynecol 2015;213:86.e1-6.