Poster Session 2
Category: Obstetric Quality and Safety
Poster Session 2
Annika Willy, MD (she/her/hers)
Resident
Mayo Clinic
Rochester, Minnesota, United States
.jpg "Bharti Garg, MBBS, MPH (she/her/hers) photo")
Bharti Garg, MBBS, MPH (she/her/hers)
Biostatistician 3
Oregon Health & Science University
Oregon Health & Science University, Oregon, United States
Marie J. Boller, MD
Fellow Physician, Maternal-Fetal Medicine
Oregon Health and Science University
Portland, Oregon, United States
Isha Garg
Oregon Health and Science University
Portland, Oregon, United States
Aaron B. Caughey, MD, PhD
Chair and Professor of Obstetrics and Gynecology
Oregon Health & Science University
Oregon Health & Science University, Oregon, United States
Obstetric anal sphincter injuries (OASIS) are associated with both acute and long-term maternal morbidity and rate of OASIS has been used as a quality measure. Risk for OASIS is increased by operative vaginal delivery, which in turn may prevent cesarean delivery (CD). Thus, as we seek to reduce rate of CD by using OASIS as a quality measure we may be inadvertently disincentivizing hospitals from lowering their CD rate.
Our objective was to evaluate the association between hospital-level rates of CD and OASIS among nulliparous individuals.
Study Design:
We conducted a retrospective cohort study using linked California birth certificate and hospital discharge data from 2008-2020.We included nulliparous, term, singleton, vertex-presenting (NTSV), non-anomalous births. We further excluded hospitals with less than 50 deliveries per year. Proportions of cesarean deliveries and OASIS were calculated at each hospital. Pearson correlation coefficient was calculated to examine the correlation between cesarean deliveries and lacerations at the hospital level. Multivariable logistic regression model was used to determine association of cesarean deliveries with lacerations at hospital level.
Results:
The mean rate of primary NTSV cesarean was 23.9% ± 5.0%, and the mean rate of NSTV deliveries with OASIS was 9.7% ± 4.2%. The proportion of primary cesarean deliveries is overall negatively correlated with the proportion of OASIS among NSTV deliveries (correlation coefficient = -0.19, p< 0.001). Hospitals with higher cesarean deliveries had lower OASIS (aOR=0.010 (95% CI: 0.008-0.012).
Conclusion:
We found that patients delivering vaginally at hospitals with lower CD rates may have higher likelihood of OASIS, and vice versa. These findings suggest a tradeoff between reducing CD and OASIS. As we seek to identify metrics that reflect quality obstetric care, it is critical to understand the tradeoffs between such metrics and other obstetric outcomes.