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Am J Obstet Gynecol. 2015 Mar;212(3):380.e1-9. doi: 10.1016/j.ajog.2014.09.026. Epub 2014 Sep 28.

The impact of hospital obstetric volume on maternal outcomes in term, non-low-birthweight pregnancies.

Author information

1
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR. Electronic address: snowden@ohsu.edu.
2
Department of Obstetrics, Gynecology, California Pacific Medical Center, San Francisco, CA.
3
School of Nursing, Oregon Health & Science University, Portland, OR.
4
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.

Abstract

OBJECTIVE:

The impact of hospital obstetric volume specifically on maternal outcomes remains under studied. We examined the impact of hospital obstetric volume on maternal outcomes in low-risk women who delivered non-low-birthweight infants at term.

STUDY DESIGN:

We conducted a retrospective cohort study of term singleton, non-low-birthweight live births from 2007-2008 in California. Deliveries were categorized by hospital obstetric volume categories and separately for nonrural hospitals (category 1: 50-1199 deliveries per year; category 2: 1200-2399; category 3: 2400-3599, and category 4: ≥3600) and rural hospitals (category R1: 50-599 births per year; category R2: 600-1699; category R3: ≥1700). Maternal outcomes were compared with the use of the chi-square test and multivariable logistic regression.

RESULTS:

There were 736,643 births in 267 hospitals that met study criteria. After adjustment for confounders, there were higher rates of postpartum hemorrhage in the lowest-volume rural hospitals (category R1 adjusted odds ratio, 3.06; 95% confidence interval, 1.51-6.23). Rates of chorioamnionitis, endometritis, severe perineal lacerations, and wound infection did not differ between volume categories. Longer lengths of stay were observed after maternal complications (eg, chorioamnionitis) in the lowest-volume hospitals (16.9% prolonged length of stay in category 1 hospitals vs 10.5% in category 4 hospitals; adjusted odds ratio, 1.91; 95% confidence interval, 1.01-3.61).

CONCLUSION:

After confounder adjustment, few maternal outcomes differed by hospital obstetric volume. However, elevated odds of postpartum hemorrhage in low-volume rural hospitals raises the possibility that maternal outcomes may differ by hospital volume and geography. Further research is needed on maternal outcomes in hospitals of different obstetric volumes.

KEYWORDS:

maternal complication; obstetric volume; obstetrics; quality

PMID:
25263732
PMCID:
PMC4346499
DOI:
10.1016/j.ajog.2014.09.026
[Indexed for MEDLINE]
Free PMC Article

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