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Does the Presence of a Condition-Specific Obstetric Protocol Lead to Detectable Improvements in Pregnancy Outcomes?


Bailit, Jennifer L.; Grobman, William A.; McGee, Paula L.; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Leveno, Kenneth J.; Iams, Jay D.; Tita, Alan T. N.; & Saade, George R., et al. (2015). Does the Presence of a Condition-Specific Obstetric Protocol Lead to Detectable Improvements in Pregnancy Outcomes?. American Journal of Obstetrics & Gynecology, 213(1), 86.e1-6. PMCID: PMC4485531


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.


Reference Type

Journal Article

Year Published


Journal Title

American Journal of Obstetrics & Gynecology


Bailit, Jennifer L.
Grobman, William A.
McGee, Paula L.
Reddy, Uma M.
Wapner, Ronald J.
Varner, Michael W.
Leveno, Kenneth J.
Iams, Jay D.
Tita, Alan T. N.
Saade, George R.
Sorokin, Yoram
Rouse, Dwight J.
Blackwell, Sean C., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network [John M. Thorp, Jr., Member]