Becker's Hospital Review

32 QUALITY IMPROVEMENT & MEASUREMENT Calculator predicting cesarean delivery risk reduces maternal deaths By Anuja Vaidya A calculator that predicts the likelihood of cesarean deliveries for women whose labor has been induced can reduce maternal deaths, according to a study published in the American Journal of Obstetrics and Gynecology. The calculator helps clinicians flag women who are at a higher risk for cesar- ean delivery, allowing them to make key clinical decisions earlier in labor. For the study, researchers assessed maternal deaths at a hospital one year before using the calculator and compared it to the number of deaths one year after. There were 1,610 women included in the study, with 788 in the pre-imple- mentation group and 822 in the post-implementation group. After using the calculator, maternal deaths decreased overall. In women with a calculated cesarean delivery risk of less than 20 percent, the cesarean delivery rate decreased from 12.8 percent pre-implementation to 6.4 percent post-implementation. Maternal death rates decreased from 12.8 percent to 6.8 percent, pre-and post-implementation respectively. Among women with a calculated cesarean delivery risk of 60 percent or higher, maternal death rates dropped from 27.8 percent pre-implementa- tion to 14 percent post-implementation. n More C-sections, induced labors likely causes of US birth weight decline By Anuja Vaidya I n the U.S., birth weights have dropped in the last few decades, and research points to the increase in cesarean deliveries and induced labor as the causes. A study published in the journal Demog- raphy shows that cesarean deliveries and inductions have shortened the average pregnancy. Fetuses can put on significant weight in the final weeks of pregnancy, which could explain why birth weights have been on the decline. Researchers analyzed more than 23 million single births from 1990 to 2013. They gathered data on birth weight, week during which the delivery occurred and method of delivery. ey found the incidence of cesarean deliv- eries grew from 25 percent in 1990 to 31.2 percent in 2013, with delivery rates rising fastest in weeks 37 to 39. Labor induction more than doubled from 12 percent of deliv- eries to 29 percent during the study period. Concurrently, the average length of preg- nancy decreased by about one week, from 40 weeks to 39 weeks. Increasingly, births became concentrated between 37 and 39 weeks. Between 1990 and 2013, the average birth weight of U.S.-born babies fell by about 67 grams or about 0.14 pounds. Researchers conducted a simulation and found that if the rates of cesarean delivery and induction hadn't increased, the average birth weight would have risen by 12 grams or 0.02 pounds. Researchers said that while cesarean deliver- ies and inductions are sometimes medically necessary, providers should keep an eye on how oen these interventions are used, since the consequences of low birth weights can be harmful. Low birth weight has been linked to negative effects on long-term health. n Mandatory surgical jackets, bouffant caps in OR don't cut infection risk, study finds By Anuja Vaidya T he use of surgical jackets and bouffant caps in the operating room do not lower the risk of patients developing surgical site infections, according to a study published in JAMA Surgery. Researchers conducted a study of 34,042 inpatient surgeries at the University of Alabama at Birmingham University Hospital between January 2017 and October 2018. They examined an eight-month period where surgical jackets and bouffant caps were not mandated by the hospital; a six-month period where surgical jackets were mandated; and an eight-month period where both surgical jackets and bouffants were mandated. Researchers found no significant difference in the risk of patients develop- ing surgical site infections in the three time periods. The rate of surgical site infections were: • 1.01 percent for patients when caps, jackets were not mandated • 0.99 percent for patients when jackets were mandated • 0.83 percent for patients when caps, jackets were mandated Researchers also found no significant difference in the risk of death, de- veloping postoperative sepsis or wound separation among patients in the three time periods. n

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