title: Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?
abstract: OBJECTIVE
  We sought to evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes.
  
  
  METHODS
  This was a cohort study of a random sample of deliveries performed at 25 hospitals over 3 years. Condition-specific protocols were collected from all hospitals and categorized independently by 2 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 estimated blood loss >1000 mL. 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 intensive care unit admissions (odds ratio, 0.28; 95% confidence interval, 0.18-0.44) and fewer cases of severe maternal hypertension (odds ratio, 0.86; 95% confidence interval, 0.77-0.96).
  
  
  CONCLUSIONS
  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.
authors: Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH. Electronic address: jbailit@metrohealth.org.
authors: Jennifer L
authors: JL
authors: Bailit
authors: Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Chicago, IL.
authors: William A
authors: WA
authors: Grobman
authors: Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, DC.
authors: Paula
authors: P
authors: McGee
authors: Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
authors: Uma M
authors: UM
authors: Reddy
authors: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
authors: Ronald J
authors: RJ
authors: Wapner
authors: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT.
authors: Michael W
authors: MW
authors: Varner
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
authors: John M
authors: JM
authors: Thorp
authors: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Kenneth J
authors: KJ
authors: Leveno
authors: Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH.
authors: Jay D
authors: JD
authors: Iams
authors: Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors: Alan T N
authors: ATN
authors: Tita
authors: Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX.
authors: George
authors: G
authors: Saade
authors: Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.
authors: Yoram
authors: Y
authors: Sorokin
authors: Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI.
authors: Dwight J
authors: DJ
authors: Rouse
authors: Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
authors: Sean C
authors: SC
authors: Blackwell
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011225:Pre-Eclampsia / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome
keywords: obstetrics; protocols; quality of care