Rates of labor induction and primary cesarean delivery do not correlate with rates of adverse neonatal outcome in level I hospitals

Glantz, J. Christopher

doi:10.3109/14767058.2010.514629

Cited by 11 publications

(20 citation statements)

References 21 publications

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“…41 42 Different practice styles and clinical decision-making around obstetric intervention have been postulated in other studies as being related to overall hospital IOL 11 and CS rate variation. 41 42 Apart from hospital size and type of care, there may be other hospital factors such as staffing or resources that may also contribute to variation and warrant further investigation.…”

Section: Discussionmentioning

confidence: 97%

“…Large differences in overall IOL rates have been described between countries,9 provinces10 and hospitals 1112 However, only one small study has previously reported overall interhospital IOL rates adjusting for patient characteristics12 and another report described hospital IOL rates for women by parity 13.…”

Section: Introductionmentioning

confidence: 99%

“…8 Large differences in overall IOL rates have been described between countries, 9 provinces 10 and hospitals. 11 12 However, only one small study has previously reported overall interhospital IOL rates adjusting for patient characteristics 12 and another report described hospital IOL rates for women by parity. 13 Hospital populations differ in the proportions of women with factors (such as parity, prior caesarean section (CS), gestational age, number of fetuses and fetal presentation) that play a substantial role in clinical management of pregnant women; for example, most women who reach ≥41 weeks gestation are offered IOL, as perinatal outcomes are improved.…”

Section: Introductionmentioning

confidence: 99%

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Variation in hospital rates of induction of labour: a population-based record linkage study

et al. 2015

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ObjectivesTo examine interhospital variation in rates of induction of labour (IOL) to identify potential targets to reduce high rates of practice variation.DesignPopulation-based record linkage cohort study.SettingNew South Wales, Australia, 2010–2011.ParticipantsAll women with live births of ≥24 weeks gestation in 72 hospitals.Primary outcome measureVariation in hospital IOL rates adjusted for differences in case-mix, according to 10 mutually exclusive groups derived from the Robson caesarean section classification; groups were categorised by parity, plurality, fetal presentation, prior caesarean section and gestational age.ResultsThe overall IOL rate was 26.7% (46 922 of 175 444 maternities were induced), ranging from 9.7% to 41.2% (IQR 21.8–29.8%) between hospitals. Nulliparous and multiparous women at 39–40 weeks gestation with a singleton cephalic birth were the greatest contributors to the overall IOL rate (23.5% and 20.2% of all IOL respectively), and had persisting high unexplained variation after adjustment for case-mix (adjusted hospital IOL rates ranging from 11.8% to 44.9% and 7.1% to 40.5%, respectively). In contrast, there was little variation in interhospital IOL rates among multiparous women with a singleton cephalic birth at ≥41 weeks gestation, women with singleton non-cephalic pregnancies and women with multifetal pregnancies.Conclusions7 of the 10 groups showed high or moderate unexplained variation in interhospital IOL rates, most pronounced for women at 39–40 weeks gestation with a singleton cephalic birth. Outcomes associated with divergent practice require determination, which may guide strategies to reduce practice variation.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variation in hospital rates of induction of labour: a population-based record linkage study

et al. 2015

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“…1 This dual outcome is particularly important given the potential competing risks between maternal and fetal care. [3][4][5] Moreover, hospital benchmarking in obstetrics has frequently focused on "intermediate" patient outcomes, rather than ultimate health outcomes. For example, excessive use of cesarean may not harm infants but can expose mothers to higher risk of surgical complications, whereas overly restrictive use of cesarean could protect mothers against the risk of surgery but may increase morbidities in infants.…”

Section: Introductionmentioning

confidence: 99%

“…For example, excessive use of cesarean may not harm infants but can expose mothers to higher risk of surgical complications, whereas overly restrictive use of cesarean could protect mothers against the risk of surgery but may increase morbidities in infants. 3,4 Therefore, while current benchmarks for hospital obstetric care quality provide useful and valid information, use of these metrics alone may not fully capture the comparative performance of hospitals. Efforts to identify hospital practices and characteristics associated with optimal obstetric care need to consider performance in both maternal and neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

Optimal maternal and neonatal outcomes and associated hospital characteristics

Campbell

Illuzzi

Lee

et al. 2018

Birth

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Background: This study aims to examine hospital variation in both maternal and neonatal morbidities and identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. Methods: Using the California Linked Birth File containing data from birth certificate and hospital discharge records, we identified 1 322 713 term births delivered at 248 hospitals during 2010-2012. For each hospital, a risk-standardized rate of severe maternal morbidities and a risk-standardized rate of severe newborn morbidities were calculated after adjusting for patient clinical risk factors. Hospitals were ranked based on combined information on their maternal and newborn morbidity rates. Results: Risk-standardized severe maternal and severe newborn morbidity rates varied substantially across hospitals (10th to 90th percentile range = 67.5-148.2 and 141.8-508.0 per 10 000 term births, respectively), although there was no significant association between the two (P = 0.15). Government hospitals (non-Federal) were more likely than other hospitals to be in worse rank quartiles (P value for trend = 0.004), whereas larger volume was associated with better rank among hospitals in the first three quartiles (P = 0.004). The most prevalent morbidities that differed progressively across hospital rank quartiles were severe hemorrhage, disseminated intravascular coagulation, and heart failure during procedure/surgery for mothers, and severe infection, respiratory complication, and shock/resuscitation for neonates. Conclusions: Hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance. Hospitals with smaller volume and government ownership tend to have less desirable outcomes and warrant additional attention in future quality improvement efforts. K E Y W O R D Schildbirth, hospital variation, morbidity, obstetric, quality and safety 290 | CAMPBELL Et AL.

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Relation between induced labour indications and neonatal morbidity

Hernández‐Martínez

Pascual-Pedreño²,

Baño-Garnés³

et al. 2014

Arch Gynecol Obstet

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Rates of labor induction and primary cesarean delivery do not correlate with rates of adverse neonatal outcome in level I hospitals

Abstract: Crude and adjusted rates of labor induction and PCD vary among level I hospitals, but with no consistent effect on neonatal outcome.

Cited by 11 publications

References 21 publications

Variation in hospital rates of induction of labour: a population-based record linkage study

Variation in hospital rates of induction of labour: a population-based record linkage study

Optimal maternal and neonatal outcomes and associated hospital characteristics

Relation between induced labour indications and neonatal morbidity

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