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

作者：Bailit Jennifer L^*; Grobman William A; McGee Paula; Reddy Uma M; Wapner Ronald J; Varner Michael W; Thorp John M; Leveno Kenneth J; Iams Jay D; Tita Alan T N; Saade George; Sorokin Yoram; Rouse Dwight J; Blackwell Sean C

来源：American Journal of Obstetrics and Gynecology, 2015, 213(1): 86.e1.

DOI：10.1016/j.ajog.2015.01.055

• obstetrics
• protocols
• quality of care

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.

• 出版日期2015-7
• 单位西北大学