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Improvements in US Maternal Obstetrical Outcomes From 1992 to 2006

Srinivas, Sindhu K., MD, MSCE*†; Epstein, Andrew J., MPP, PhD†‡; Nicholson, Sean, PhD†§; Herrin, Jeph, PhD; Asch, David A., MD, MBA†¶

doi: 10.1097/MLR.0b013e3181d68840
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Background: Over 4 million women give birth annually in the United States, making delivery one of the most common reasons for hospital care.

Objective: We examined 15-year trends in risk-adjusted maternal complications following childbirth.

Research Design: We examined maternal obstetrical outcomes from 1992–2006 among women undergoing cesarean delivery (CD) and vaginal delivery (VD). A composite measure of major maternal complications including infection, hemorrhage, laceration, and other major operative and thrombotic complications was evaluated.

Subjects: Population-based sample of over 6 million women from Florida and New York hospital discharge data.

Measures: Obstetric procedures and maternal complications postdelivery.

Results: During the 15-year time period, the CD rate decreased from 24.7% in 1992 to 23% in 1996 and increased to 34.7% in 2006. The risk-adjusted rate of any major complication declined from 14.7% in 1992 to 10.7% in 2006 for all deliveries; from 14.4% to 11.6% for VD; and from 15.7% to 8.5% for CD. During 1992 to 2006, the average number of comorbidities increased from 0.65 to 0.93 for patients overall, from 0.43 to 0.58 for VD patients, and 1.34 to 1.59 for CD patients.

Conclusion: As evidenced by New York and Florida, the US has seen large reductions in major maternal complications over the past 15 years. Concurrently, the average number of comorbidities increased. These results reflect substantial improvements in maternal delivery outcomes.

From the *Department of OB/GYN, University of Pennsylvania, Philadelphia, PA; †Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; ‡Yale University, New Haven, CT; §Cornell University, New York, NY; and ¶Center for Health Equity Research and Promotion, Philadelphia, PA.

Supported by the Stemmler Fund of the National Board of Medical Examiners. This research has been performed independent of the funding source.

Presented at the Society for Maternal Fetal Medicine Meeting as an abstract presentation, January 2009 (Abstract #155).

Reprints: Sindhu K. Srinivas, MD, MSCE, University of Pennsylvania, 421 Curie Boulevard, BRB II/III 1353, Philadelphia, PA 19104. E-mail: ssrinivas@obgyn.upenn.edu.

© 2010 Lippincott Williams & Wilkins, Inc.