PMID- 30870288
OWN - NLM
STAT- MEDLINE
DCOM- 20200116
LR  - 20211204
IS  - 1873-233X (Electronic)
IS  - 0029-7844 (Linking)
VI  - 133
IP  - 4
DP  - 2019 Apr
TI  - Safety Assessment of a Large-Scale Improvement Collaborative to Reduce 
      Nulliparous Cesarean Delivery Rates.
PG  - 613-623
LID - 10.1097/AOG.0000000000003109 [doi]
AB  - OBJECTIVE: To evaluate maternal and neonatal safety measures in a large-scale 
      quality improvement program associated with reductions in nulliparous, term, 
      singleton, vertex cesarean delivery rates. METHODS: This is a cross-sectional 
      study of the 2015-2017 California Maternal Quality Care Collaborative (CMQCC) 
      statewide collaborative to support vaginal birth and reduce primary cesarean 
      delivery. Hospitals with nulliparous, term, singleton, vertex cesarean delivery 
      rates greater than 23.9% were solicited to join. Fifty-six hospitals with more 
      than 119,000 annual births participated; 87.5% were community facilities. Safety 
      measures were derived using data collected as part of routine care and submitted 
      monthly to CMQCC: birth certificates, maternal and neonatal discharge diagnosis 
      and procedure files, and selected clinical data elements submitted as 
      supplemental data files. Maternal measures included chorioamnionitis, blood 
      transfusions, third- or fourth-degree lacerations, and operative vaginal 
      delivery. Neonatal measures included the severe unexpected newborn complications 
      metric and 5-minute Apgar scores less than 5. Mixed-effect multivariable logistic 
      regression model was used to calculate odds ratios (Ors) and 95% CIs. RESULTS: 
      Among collaborative hospitals, the nulliparous, term, singleton, vertex cesarean 
      delivery rate fell from 29.3% in 2015 to 25.0% in 2017 (2017 vs 2015 adjusted OR 
      [aOR] 0.76, 95% CI 0.73-0.78). None of the six safety measures showed any 
      difference comparing 2017 to 2015. As a sensitivity analysis, we examined the 
      tercile of hospitals with the greatest decline (31.2%-20.6%, 2017 vs 2015 aOR 
      0.54, 95% CI 0.50-0.58) to evaluate whether they had greater risk of poor 
      maternal and neonatal outcomes. Again, no measure was statistically worse, and 
      the severe unexpected newborn complications composite actually declined 
      (3.2%-2.2%, aOR 0.71, 95% CI 0.55-0.92). CONCLUSION: Mothers and neonates 
      participating in a large-scale Supporting Vaginal Birth collaborative had no 
      evidence of worsened birth outcomes, even in hospitals with large cesarean 
      delivery rate reductions, supporting the safety of efforts to reduce primary 
      cesarean delivery using American College of Obstetricians and Gynecologists and 
      Society for Maternal-Fetal Medicine guidelines and enhanced labor support.
FAU - Main, Elliott K
AU  - Main EK
AD  - California Maternal Quality Care Collaborative, Stanford University School of 
      Medicine, Stanford, California.
FAU - Chang, Shen-Chih
AU  - Chang SC
FAU - Cape, Valerie
AU  - Cape V
FAU - Sakowski, Christa
AU  - Sakowski C
FAU - Smith, Holly
AU  - Smith H
FAU - Vasher, Julie
AU  - Vasher J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
SB  - IM
CIN - Obstet Gynecol. 2019 Apr;133(4):611-612. PMID: 30870282
MH  - Adolescent
MH  - Adult
MH  - California
MH  - Cesarean Section/adverse effects/*statistics & numerical data
MH  - Child
MH  - Cross-Sectional Studies
MH  - Delivery, Obstetric/methods
MH  - Ethnicity
MH  - Female
MH  - Hospitals/statistics & numerical data
MH  - Humans
MH  - Infant, Newborn
MH  - Middle Aged
MH  - *Parity
MH  - Pregnancy
MH  - Pregnancy Outcome
MH  - *Quality Improvement
MH  - *Safety
MH  - Young Adult
EDAT- 2019/03/15 06:00
MHDA- 2020/01/17 06:00
CRDT- 2019/03/15 06:00
PHST- 2019/03/15 06:00 [pubmed]
PHST- 2020/01/17 06:00 [medline]
PHST- 2019/03/15 06:00 [entrez]
AID - 00006250-201904000-00002 [pii]
AID - 10.1097/AOG.0000000000003109 [doi]
PST - ppublish
SO  - Obstet Gynecol. 2019 Apr;133(4):613-623. doi: 10.1097/AOG.0000000000003109.