Quality Indicators Not Tied to Maternal, Neonatal Morbidity

Elective delivery before 39 weeks, cesareans not linked to maternal complications, neonatal morbidity

WEDNESDAY, Oct. 15, 2014 (HealthDay News) -- Hospital-level perinatal indicators (elective delivery before 39 weeks and cesarean delivery) are not significantly associated with maternal or neonatal morbidity, according to a study published in the Oct. 15 issue of the Journal of the American Medical Association.

Elizabeth A. Howell, M.D., M.P.P., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined whether two Joint Commission obstetric quality indicators correlate with maternal and neonatal morbidity in a population-based observation study. Data were collected from linked New York City discharge and birth certificate data sets.

The researchers found that severe maternal morbidity occurred among 2.4 percent of deliveries and neonatal morbidity occurred among 7.8 percent of term newborns without anomalies. Among 41 hospitals, the rates for elective deliveries performed before 39 weeks of gestation varied from 15.5 to 41.9 per 100 deliveries. In low-risk mothers there were 11.7 to 39.3 cesarean deliveries per 100 deliveries. Per 100 deliveries, maternal morbidity ranged from 0.9 to 5.7 mothers with complications per 100 deliveries. Per 100 births, neonatal morbidity varied from 3.1 to 21.3 neonates with complications. Elective delivery before 39 weeks of gestation and cesarean delivery in low-risk mothers were not significantly associated with severe maternal complications or neonatal morbidity.

"Current quality indicators may not be sufficiently comprehensive for guiding quality improvement in obstetric care," the authors write.

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