Obstetric Quality and Safety
Poster Session 4
Adina R. Kern-Goldberger, MD, MPH, MSCE
Assistant Professor, Maternal-Fetal Medicine
Cleveland Clinic Lerner College of Medicine
Cleveland, OH, United States
Megan Ansbro, MD, PhD
Cleveland Clinic
Cleveland, OH, United States
Cara D. Dolin, MD, MPH
Assistant Professor of Obstetrics and Gynecology
Cleveland Clinic
Pepper Pike, OH, United States
Edward Chien, MD
Cleveland Clinic
Lakewood, OH, United States
Justin R. Lappen, MD
Division Director - Maternal Fetal Medicine
Associate Professor - Obstetrics/Gynecology and Reproductive Biology
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
Cleveland Clinic Foundation
Cleveland, OH, United States
With expertise in complex deliveries, maternal-fetal disease, and obstetric emergencies, MFM physicians can contribute meaningfully to labor and delivery (L&D) care. There is variability in the role of MFM physicians on delivery units. This study evaluated the impact on severe maternal morbidity (SMM) of a health system change to add an MFM physician to the L&D team.
Study Design:
This is a retrospective cohort study of all deliveries > 20 weeks from 1/1/2018-12/31/2022 at 2 academic hospitals in a large health system. Both hospitals previously had consultative-only MFM involvement on L&D, but added an MFM attending to the L&D team 4/2021. Patient-level clinical data were extracted from the medical record and compared pre/post. The only other systemic change during this time was adoption of a hypertension care bundle, so a planned sensitivity analysis excluding patients with chronic hypertension/preeclampsia was conducted. The primary outcome was SMM without transfusion (Table). Multivariable logistic regression was used to evaluate SMM pre- and post-MFM presence on L&D.
Results:
There were 31,680 deliveries in the pre-MFM period and 21,292 in the post-period with no differences in patient characteristics across period including race/ethnicity, insurance status, pregravid BMI, parity, plurality, gestational age at delivery, or mode of delivery – other than higher mean maternal age [31.9 (SD 5.3) v. 29.7 (5.6), p < 0.01] and higher OB-CMI in the post-period (Table). There were significantly decreased odds of SMM, hemorrhage, and maternal ICU admission in the post-period on adjusted analysis (Table), with similar findings excluding patients with hypertension/preeclampsia.
Conclusion:
Adding an MFM physician to L&D was associated with reduced SMM, despite increased maternal age and co-morbidities in the post-group. These findings suggest the impactful role that the perspective and knowledge of MFM physicians can have in reducing morbidity in real-time on L&D.