Poster Session 2
Category: Obstetric Quality and Safety
Poster Session 2
Haley Grayson, BS (she/her/hers)
Columbia University
New York, New York, United States
Alexander M. Friedman, MD, MPH
Professor of Obstetrics and Gynecology
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Dena Goffman, MD (she/her/hers)
Professor, Women's Health in Obstetrics & Gynecology; Vice Chair, Quality & Patient Safety
Columbia University
New York, New York, United States
Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief
Willard C. Rappleye Professor and Chair
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Maria Andrikopoulou, MD
Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Timothy Wen, MD, MPH
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego
San Diego, California, United States
The NY Safe Motherhood Initiative (SMI), a statewide quality improvement effort, was convened in 2013 and included 117 of the 123 hospitals in NY State. A bundle to optimize management of obstetric hypertension was developed and disseminated. The purpose of this study was to evaluate trends in statewide outcomes related to hypertensive disorders of pregnancy (HDP) including gestational hypertension and preeclampsia.
Study Design:
Delivery hospitalizations in the 2007-2022 NY State Inpatient Database (SID) were analyzed for this repeated cross-sectional analysis. The NY SID includes all acute care inpatient discharge data for NY State. First, HPD diagnoses among all delivery hospitalizations were trended. Then, among deliveries with HDP, the following outcomes were trended: (i) transfusion, (ii) non-transfusion severe maternal morbidity (SMM), and (iii) disseminated intravascular coagulation (DIC). Trends analyses were performed with joinpoint regression to determine the average annual percent change (AAPC). Because of small numerators, stroke risk during two 8-year periods (2007-2014 and 2015-2022) was compared with the chi square test.
Results:
Among 3,579,336 delivery hospitalizations, HDP increased from 6.1% in 2007 to 15.6% in 2022 (Figure 1). In joinpoint analysis, transfusion among deliveries with PPH increased from 2007 to 2012 but then decreased from 2012 to 2016 (AAPC -4.9%, 95% CI -10.9%, -0.2%) before increasing after 2016 (Figure 2). SMM increased from 2007 to 2014 before decreasing from 2014 to 2017 (AAPC -7.9%, 95% CI -11.5%, -1.4%), before rising again from 2017 to 2022. DIC increased from 2007 to 2013, decreased from 2013 to 2017 (AAPC -13.2%, 95% CI -19.4%, -7.9%) and increased non-significantly from 2017 on. From 2007 to 2014, 44 cases of HDP-associated stroke occurred compared to 19 from 2015 to 2022 (3.5 vs 1.0 per 10,000, p< 0.01).
Conclusion:
The initiation of the NY SMI was associated decreased risk for a range of adverse outcomes among deliveries with HDP including stroke. Decreases in risk continued for approximately 3-4 years after initiation of the program.