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

Abstract

Objective To evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes. Study Design Cohort study of a random sample of deliveries performed at 25 hospitals over three years. Condition-specific protocols were collected from all hospitals and categorized independently by two 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 EBL >1000cc. 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 ICU admissions (OR 0.28, 95% CI 0.18–0.44) and fewer cases of severe maternal hypertension (OR 0.86, 95% CI 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.

Decreased rates of shoulder dystocia and brachial plexus injury via an evidence‐based practice bundle

“…Several studies have evaluated the impact of shoulder dystocia protocols and drills on maternal and neonatal outcomes with mixed results. [13][14][15][16][17][18][19] The present findings are consistent with those of Grobman et al, 15 who found that a standardized shoulder dystocia protocol with defined roles, general announcements, and improvement of documentation during the event decreased the rate of brachial plexus injury. As who suggested that a standardized note template would probably be more effective in documenting shoulder dystocia events.…”

“…In a review of specific policies and procedures targeted to managing shoulder dystocia in a cohort of 25 hospitals in the Maternal–Fetal Medicine Units Network, Bailit et al . found no associated decrease in the incidence of shoulder dystocia.…”

“…In a review of specific policies and procedures targeted to managing shoulder dystocia in a cohort of 25 hospitals in the Maternal-Fetal Medicine Units Network, Bailit et al 13 found no associated decrease in the incidence of shoulder dystocia. That study did not examine the quality of the protocol or team simulation, or assess compliance, and there was no standard protocol agreement among the 25 institutions.…”

A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study

“…Although recent studies of hospital-level factors have found null associations between some hospital-level factors (eg, the obstetric hospitalist staffing model 32 and condition-specific obstetric protocols 35 ) and perinatal outcomes, the search for meaningful hospital-level factors should continue. Research on hospital-level factors in obstetric care (eg, staffing models and use of protocols) has grown in recent years.…”

Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs

“…8,39 Hospitals vary substantially in outcomes and processes of obstetric care. [40][41][42][43] Recent work has demonstrated 5-fold variation in hospital-level rates of maternal complications during delivery 41 and 10-fold variation in hospital cesarean rates. 43 These and other emerging examples of hospital-level variability in obstetric outcomes demonstrate that hospital factors (e.g., teaching status, and hospital geography) affect both utilization and patient outcomes of care.…”