Details

Autor(en) / Beteiligte

• Bailit, Jennifer L., MD, MPH
• Grobman, William A., MD, MBA
• McGee, Paula, MS
• Reddy, Uma M., MD, MPH
• Wapner, Ronald J., MD
• Varner, Michael W., MD
• Thorp, John M., MD
• Leveno, Kenneth J., MD
• Iams, Jay D., MD
• Tita, Alan T.N., MD, PhD
• Saade, George, MD
• Sorokin, Yoram, MD
• Rouse, Dwight J., MD
• Blackwell, Sean C., MD

Titel

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

Ist Teil von

• American journal of obstetrics and gynecology, 2015-07, Vol.213 (1), p.86.e1-86.e6

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.