More quality criteria needed for obstetric care

A recent population-based study showed a lack of correlation between Joint Commission indicators of elective delivery at 39 weeks’ gestation and cesarean delivery and rates of maternal and neonatal complications in deliveries at New York City hospitals in 2010.

Led by researchers at the Icahn School of Medicine at Mount Sinai, the observational study used linked New York City discharge and birth certificate data sets from 2010. Delivery hospitalizations were identified and 2 Joint Commission obstetric quality measures (elective, nonmedically indicated deliveries at ≥37 weeks’ and < 39 weeks’ gestation; cesarean delivery performed in low-risk mothers) were assessed. Algorithms were used to identify severe maternal morbidity (delivery associated with a life-threatening complication or performance of a lifesaving procedure) and morbidity in term neonates with no anomalies (including births associated with complications like hypoxia, prolonged length of stay, and birth trauma). Mixed-effect logistic regression models, which included risk-adjustment for patient sociodemographic and clinical characteristics, were used to examine the association between neonatal and maternal morbidity and hospital-level quality measures.

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Of 103,416 neonates without anomalies, 8057 experienced neonatal morbidity (7.8%), whereas severe maternal morbidity was identified in 2372 of 115,742 deliveries (2.4%). Among 41 hospitals, the rates for elective deliveries performed before the 39^th week of gestation ranged from 15.5 to 41.9 per 100 deliveries. In low-risk mothers, the rates of cesarean deliveries were 11.7 to 39.3 per 100. Rates of neonatal morbidity per 100 births ranged from 3.1 to 21.3 and rates of maternal morbidity per 100 deliveries ranged from 0.9 to 5.7.

Overall, the maternal quality indicators elective delivery prior to 39 weeks’ gestation and cesarean deliveries to low-risk mothers had little association with severe maternal complications (RR, 1.00; 95% CI, 0.98-1.02 and RR, 0.99; 95% CI, 0.96-1.01, respectively) or neonatal morbidity (risk ratio [RR], 0.99; 95% confidence interval [CI], 0.97-1.01 and RR, 1.01; 95% CI, 0.99-1.03, respectively).

The investigators concluded that the 2 quality indicators examined were not associated with lower morbidity. They believe that the findings show the need for a larger number of obstetric quality measurements, such as whether protocols for hemorrhage and preeclampsia were followed in the delivery suite.

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