Obstetric outcomes worse for hospitals with low-volume operative vaginal deliveries
Key takeaways:
- Operative vaginal delivery volume was associated with outcomes for mothers and neonates.
- Risks for severe perinatal outcomes were higher among hospitals with low operative vaginal delivery volume.
Hospitals with a low volume of operative vaginal deliveries were more likely to have higher proportions of adverse perinatal outcomes, including newborns with shoulder dystocia, subgaleal hemorrhage and NICU admission, data show.
“The complications related to operative vaginal deliveries are higher in lower volume settings — that is where fewer operative vaginal deliveries are performed,” Aaron B. Caughey, MD, PhD, MPH, professor and chair of the department of obstetrics and gynecology at Oregon Health & Science University, told Healio. “It might be that these differences could be remedied by additional simulation training in lower-volume settings, but it also might be that a minimum of operative vaginal deliveries should be performed to improve outcomes.”
For the retrospective study, researchers analyzed data from 306,818 full-term, singleton operative vaginal deliveries in California between 2008 and 2020, using linked vital statistics and hospital discharge data. The mean maternal age was 28.5 years and 50.6% of patients had public insurance.
Researchers defined operative vaginal delivery volume as low (< 5.2%), medium (5.2%-7.4%) and high ( 7.4%) volume.
The primary outcome for mothers included obstetric anal sphincter injuries, cervical lacerations and postpartum hemorrhage. Neonatal outcomes included shoulder dystocia, subgaleal hemorrhage, intracranial hemorrhage, facial nerve injury and brachial plexus injury.
The findings were published in JAMA Network Open.
Researchers found that hospitals with low operative vaginal delivery volume had an increased proportion of obstetric anal sphincter injury compared with hospitals with medium and high volumes (12.16% vs. 11.07% vs. 9.45%, respectively).
Hospitals with a low volume of operative vaginal deliveries also had a higher proportion of adverse neonatal outcomes, including shoulder dystocia (3.84% vs. 3.5% vs. 2.8%, respectively), subgaleal hemorrhage (0.27% vs. 0.18% vs. 0.1%, respectively) and brachial plexus injury (0.41% vs. 0.3% vs. 0.2%, respectively) compared with hospitals with medium and high volume.
After adjusting for confounders, being born in hospitals with low operative vaginal delivery volume was still associated with increased risk for shoulder dystocia, subgaleal hemorrhage and brachial plexus injury, as well as higher risk for obstetric anal sphincter injury for the mother, according to the researchers.
“These findings underscore the importance of further research and interventions aimed at improving neonatal outcomes, particularly in low-volume settings,” the researchers wrote.
Researchers noted that the dataset did not include variables such as the hospital’s trauma level, NICU size and level, physician type and experience and birthing parent and fetal medicine coverage, all of which are potential confounders.
“A prospective trial of simulation training in low-volume settings would be helpful,” Caughey told Healio. “Studies of specific operative vaginal delivery volumes by provider would be informative as well.”
For more information:
Aaron B. Caughey, MD, PhD, MPH, can be reached at caughey@ohsu.edu.