Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Am J Perinatol. 2019 May;36(6):653-658. doi: 10.1055/s-0038-1672140. Epub 2018 Oct 18.
A recent document by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine introduced the concept of uniform levels of maternal care (LMCs).
We assessed LMC across hospitals and measured their association with maternal morbidity, focusing on women with high-risk conditions.
We collected data from hospitals from May to November 2015 and linked survey responses to Statewide Inpatient Databases (SID) hospital discharge data in a retrospective cross-sectional study of 247,383 births admitted to 236 hospitals. Generalized logistic regression models were used to examine the associations between hospitals' LMC and the risk of severe maternal morbidity. Stratified analyses were conducted among women with high-risk conditions.
High-risk pregnancies were more likely to be managed in hospitals with higher LMC ( < 0.001). Women with cardiac conditions had lower odds of maternal morbidity when delivered in level I compared with level IV units (adjusted odds ratio: 0.29; 95% confidence interval: 0.08-0.99; = 0.049). There were no other significant associations between the LMC and severe maternal morbidity.
A higher proportion of high-risk pregnancies were managed within level IV units, although there was no overall evidence that these births had superior outcomes. Further prospective evaluation of LMC designation with patient outcomes is necessary to determine the impact of regionalization on maternal outcomes.
美国妇产科医师大会（ACOG）和母胎医学学会最近发布了一份文件，提出了统一的孕产妇护理水平（LMC）概念。
我们评估了各医院的 LMC，并测量了其与孕产妇发病率的关联，重点关注高危产妇。
我们于 2015 年 5 月至 11 月期间从医院收集数据，并将调查回复与全州住院患者数据库（SID）的医院出院数据进行了关联，对 236 家医院收治的 247383 例分娩进行了回顾性横断面研究。使用广义逻辑回归模型来检验医院 LMC 与严重孕产妇发病率风险之间的关联。在高危产妇中进行了分层分析。
高危妊娠更可能在 LMC 较高的医院接受治疗（ < 0.001）。与 IV 级单位相比，患有心脏疾病的女性在 I 级单位分娩时发生孕产妇发病率的几率较低（调整后的优势比：0.29；95%置信区间：0.08-0.99； = 0.049）。LMC 与严重孕产妇发病率之间没有其他显著关联。
尽管高危妊娠中 IV 级单位管理的比例较高，但总体上没有证据表明这些分娩的结果更好。需要进一步前瞻性评估 LMC 与患者结局的关联，以确定区域化对孕产妇结局的影响。
