Bailit Jennifer L, Grobman William A, McGee Paula, Reddy Uma M, Wapner Ronald J, Varner Michael W, Thorp John M, Leveno Kenneth J, Iams Jay D, Tita Alan T N, Saade George, Sorokin Yoram, Rouse Dwight J, Blackwell Sean C
Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH.
Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Chicago, IL.
Am J Obstet Gynecol. 2015 Jul;213(1):86.e1-86.e6. doi: 10.1016/j.ajog.2015.01.055. Epub 2015 Feb 4.
We sought to evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes.
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.
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).
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.
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