Table 2.
Patient demographic data for objective 1 (risk assessment prediction) and objective 2 (perinatal outcomes before and after tool implementations)
| Patient variables | Objective 1 | p-Value | Objective 2 | p-Value | |||
|---|---|---|---|---|---|---|---|
| Low | Medium | High | Before implementation | After implementation | |||
| (n = 14,885) | (n = 26,326) | (n = 15,974) | (n = 39,027) | (n = 71,606) | |||
| Delivery type | |||||||
| CD | 1,202 (8%) | 12,773 (49%) | 7,312 (46%) | <0.0001 | 13,406 (34%) | 25,458 (36%) | <0.0001 |
| Vaginal | 13,635 (92%) | 13,364 (51%) | 8,490 (53%) | 25,298 (65%) | 45,636 (64%) | ||
| VBAC | 48 (0.3%) | 189 (0.7%) | 172 (1%) | 232 (1%) | 512 (1%) | ||
| Race/ethnicity | |||||||
| Black | 2,376 (16.0%) | 4,069 (14.5%) | 3,453 (21.6%) | <0.0001 | 6,060 (16%) | 12,082 (17%) | <0.0001 |
| White | 7,528 (50.6%) | 14,820 (54.2%) | 7,852 (49.2%) | 19,551 (50%) | 35,989 (50%) | ||
| Asian | 713 (4.8%) | 1,097 (4.2%) | 700 (4.4%) | 1,452 (4%) | 3,095 (4%) | ||
| Other/unknown | 4,268 (28.6%) | 6,880 (26.1%) | 3,969 (24.9%) | 11,964 (30%) | 20,440 (29%) | ||
| Insurance | |||||||
| Medicaid | 4,928 (33.1%) | 8,835 (33.6%) | 4,924 (30.9%) | <0.0001 | 3,379 (9%) | 22,573 (32%) | <0.0001 |
| Private | 8,304 (55.8%) | 14,036 (53.3%) | 9,167 (57.4%) | 9,095 (23%) | 38,184 (53%) | ||
| Uninsured | 401 (2.7%) | 952 (3.6%) | 279 (1.8%) | 336 (1%) | 1,990 (3%) | ||
| Other/unknown | 1,252 (8.4%) | 2,503 (9.5%) | 1,604 (10.0%) | 26,217 (67%) | 8,859 (12%) | ||
| Marital status | |||||||
| Married | 7,111 (47.7%) | 12,968 (49.3%) | 7,845 (49.1%) | 0.0007 | 19,102 (49%) | 34,463 (48%) | <0.0001 |
| Single | 7,015 (47.1%) | 11,893 (45.2%) | 7,265 (45.5%) | 16,123 (41%) | 31,701 (44%) | ||
| Other/unknown | 759 (5.1%) | 1,465 (5.5%) | 864 (5.4%) | 3,802 (10%) | 5,442 (8%) | ||
| Gestational diabetes | 550 (3.7%) | 1,775 (6.7%) | 1,450 (9.1%) | <0.0001 | 2,022 (5%) | 4,467 (6%) | <0.0001 |
| Pregestational diabetes | 71 (0.5%) | 323 (1.2%) | 304 (1.9%) | <0.0001 | 899 (2%) | 2,460 (3%) | <0.0001 |
| Chronic hypertension | 77 (0.5%) | 398 (1.5%) | 440 (2.8%) | <0.0001 | 509 (1.3%) | 1,069 (1.5%) | 0.011 |
| Smoking during pregnancy | 636 (4.3%) | 1,263 (4.8%) | 811 (5.1%) | 0.0033 | 11,257 (29%) | 3,210 (4%) | <0.0001 |
| Preeclampsia | 128 (0.9%) | 693 (2.6%) | 647 (4.1%) | <0.0001 | 1,140 (3%) | 1,714 (2%) | <0.0001 |
| Interpregnancy interval <1 y | 234 (1.57%) | 542 (2.06%) | 346 (2.17%) | <0.0001 | 541 (1.4%) | 1,346 (1.9%) | <0.0001 |
| Placenta previa | 45 (0.03%) | 104 (0.40%) | 255 (1.6%) | <0.0001 | 220 (0.6%) | 492 (0.7%) | 0.014 |
| DIC | 0 (0%) | 2 (0.01%) | 19 (0.03%) | <0.0001 | 5 (0.01%) | 20 (0.03%) | 0.11 |
| History of postpartum hemorrhage | 127 (0.9%) | 621 (2.4%) | 1,168 (7.3%) | <0.0001 | 252 (0.7%) | 2,020 (2.8%) | <0.0001 |
| Dinoprostone use | 478 (3.2%) | 2,434 (9.3%) | 1,917 (12.0%) | <0.0001 | 3,036 (8%) | 5,506 (8%) | 0.59 |
| Misoprostol use | 1,098 (7.4%) | 3,570 (13.6%) | 2,831 (17.7%) | <0.0001 | 4,073 (10%) | 8,736 (12%) | <0.0001 |
| Oxytocin use | 12,233 (82.2%) | 23,836 (90.5%) | 14,484 (90.7%) | <0.0001 | 15,469 (40%) | 29,720 (42%) | <0.0001 |
| Use of any antibiotics | 6,333 (42.6%) | 16,564 (62.9%) | 10,473 (65.6%) | <0.0001 | 21,069 (54%) | 40,026 (56%) | <0.0001 |
| Vacuum-assisted delivery | 434 (2.9%) | 1,600 (6.1%) | 1,154 (7.2%) | <0.0001 | 1,971 (5%) | 3,781 (5%) | 0.1 |
| Forceps-assisted delivery | 92 (0.6%) | 211 (0.8%) | 256 (1.6%) | <0.0001 | 511 (1.3%) | 718 (1.0%) | <0.0001 |
| Eclampsia | 15 (0.1%) | 61 (0.2%) | 50 (0.3%) | 0.0003 | 74 (0.2%) | 150 (0.2%) | 0.48 |
| HELLP | 3 (0.02%) | 15 (0.06%) | 10 (0.06%) | 0.1758 | 17 (0.04%) | 35 (0.05%) | 0.7 |
| Number of previous CD | |||||||
| 0 | 14,778 (99.3%) | 23,183 (88.1%) | 14, 204 (88.9%) | <0.0001 | 36,090 (95%) | 65,806 (92%) | <0.0001 |
| 1 | 73 (0.5%) | 1,911 (7.3%) | 1,030 (6.5%) | 1,267 (3%) | 3,509 (5%) | ||
| 2 | 23 (0.2%) | 868 (3.3%) | 488 (3.1%) | 608 (2%) | 1,565 (2%) | ||
| 3+ | 11 (0.07%) | 364 (1.4%) | 252 (1.6%) | 243 (1%) | 726 (1%) | ||
| Gestational age <39 wk | 5,573 (37.9%) | 9, 253 (35.5%) | 6, 080 (38.5%) | <0.0001 | 12,647 (33%) | 25,819 (37%) | <0.0001 |
| Intrapartum abruption | 58 (0.4%) | 469 (0.8%) | 299 (1.9%) | <0.0001 | 201 (0.8%) | 556 (0.8%) | 0.92 |
| Placenta accreta | 0 (0%) | 3 (0.01%) | 38 (0.24%) | <0.0001 | 28 (0.07%) | 53 (0.07%) | 0.89 |
| Intrapartum bleeding | 22 (0.04%) | 74 (0.3%) | 212 (1.3%) | <0.0001 | 279 (0.7%) | 331 (0.5%) | <0.0001 |
| Platelets <150,000 | 1,431 (9.6%) | 2,723 (10.3%) | 1,631 (10.2%) | <0.0001 | 3,795 (10%) | 7,068 (10%) | 0.43 |
| Hematocrit <32% | 2,135 (14.3%) | 4,747 (18.0%) | 294 (18.4%) | <0.0001 | 5,859 (15%) | 11,649 (16%) | <0.0001 |
| Parity | |||||||
| 0 | 2,434 (17.3%) | 4,057 (16.0%) | 2,751 (18.1%) | <0.0001 | 8,740 (24%) | 12,390 (19%) | <0.0001 |
| 1 | 7,148 (50.7%) | 12,411 (49.0%) | 7,373 (48.5%) | 19,202 (53%) | 32,786 (49%) | ||
| 2 | 2,337 (16.6%) | 4,265 (16.8%) | 2,262 (14.9%) | 4,022 (11%) | 10,222 (15%) | ||
| 3+ | 2,169 (15.4%) | 4,595 (18.1%) | 2,802 (18.5%) | 4,085 (11%) | 11,002 (17%) | ||
| Multiple gestation | 14 (0.09%) | 314 (1.2%) | 424 (2.7%) | <0.0001 | 327 (0.8%) | 795 (1.1%) | <0.0001 |
Abbreviations: CD, cesarean deliveries; DIC, disseminated intravascular coagulation; HELLP, hemolysis, elevated liver enzymes, low platelets; VBAC, vaginal birth after cesarean.