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Am J Obstet Gynecol. 2015 Jul;213(1):86.e1-6. doi: 10.1016/j.ajog.2015.01.055. Epub 2015 Feb 4.

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

Author information

1
Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH. Electronic address: jbailit@metrohealth.org.
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

PMID:
25659468
PMCID:
PMC4485531
DOI:
10.1016/j.ajog.2015.01.055
[Indexed for MEDLINE]
Free PMC Article

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