Obstetrics

Obstetrics

Obstetric outcomes are reported for births attended by both staff and private physicians and midwives at Cleveland Clinic health system regional hospitals and main campus. In 2018, 76.8% of births in the system were attended by Cleveland Clinic staff physicians or midwives.

2018 Data includes Akron General Hospital.

NTSVᵇ Cesarean Delivery Rate

2015 - 2018

Source: Joint Commission National Quality Measures Perinatal Care-02

ᵃCleveland Clinic Target: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Reduce cesarean births among low-risk (full-term, singleton, and vertex presentation) women. Healthy People 2020. Washington, DC: 2010

ᵇNumber of low-risk, first-birth women (ie, nulliparous, term, singleton, vertex presentation)

Labor Induction Rate

2014 - 2017

Induction of labor is an intervention designed to artificially initiate uterine contractions, leading to progressive dilation and effacement of the cervix and birth of the baby.

ᵃ All deliveries

Vaginal Birth After Cesarean Delivery

2014 - 2017

Source: Vaginal Birth After Cesarean (VBAC) Rate, All Inpatient Quality Indicators #34 Area-Level Indicator, Procedure Utilization Indicator, AHRQ Quality Indicators, Version 4.3, August 2011. qualityindicators.ahrq.gov/Downloads/Modules/IQI/V43/TechSpecs/IQI%2034%20Vaginal%20Birth%20After%20Cesarean%20(VBAC)%20Rate%20All.pdf

ᵃCleveland Clinic target: derived from review of peer organization members of Vizient. Data from the Vizient
Clinical Data Base/Resource Manager™ used by permission of Vizient. All rights reserved.

ᵇNumber of patients with prior cesarean delivery

Successful Trial of Labor After Cesarean Delivery

2014 - 2017

ACOG = American Congress of Obstetricians and Gynecologists

ᵃCleveland Clinic target: ACOG practice bulletin. Vaginal birth after previous cesarean delivery. Number 5, July 1999 (replaces
practice bulletin number 2, October 1998). Clinical management guidelines for obstetrician-gynecologists. American College of
Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1999 Aug;66(2):197-204.

ᵇPatients with prior cesarean delivery who underwent trial of labor

Episiotomy Rate

2015 – 2018

ACNM = American College of Nurse-Midwives

Source: National Perinatal Information Center

ᵃAmerican College of Nurse-Midwives (ACNM) Benchmarking Project 2010: Practices with > 500 deliveries per year.
www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000001539/ACNM_BenchmarkingProject_1012.pdf

ᵇNumber of vaginal deliveries

Third- and Fourth-Degree Lacerations in Vaginal Deliveries With Instrument Assistance

2015 – 2018

Source: Obstetric Trauma Rate — Vaginal Delivery With Instrument, Patient Safety Indicator #18, Provider-Level Indicator,
AHRQ Quality Indicators, Version 4.3, August 2011. qualityindicators.ahrq.gov/Downloads/Modules/PSI/V2018/TechSpecs/PSI_18_Obstetric_Trauma_Rate%E2%80%93Vaginal_Delivery_With_Instrument.pdf

ᵃCleveland Clinic target: derived from review of peer organization members of Vizient. Data from the Vizient Clinical Data Base/Resource Manager™ used by permission of Vizient. All rights reserved.

ᵇTotal number of instrument-assisted vaginal deliveries

Third- and Fourth-Degree Lacerations in Vaginal Deliveries Without Instrument Assistance

2015 – 2018

Source: Obstetric Trauma Rate — Vaginal Delivery With Instrument, Patient Safety Indicator #18, Provider-Level Indicator,
AHRQ Quality Indicators, Version 4.3, August 2011. qualityindicators.ahrq.gov/Downloads/Modules/PSI/V2018/TechSpecs/PSI_18_Obstetric_Trauma_Rate%E2%80%93Vaginal_Delivery_With_Instrument.pdf

ᵃCleveland Clinic target: derived from review of peer organization members of Vizient. Data from the Vizient Clinical Data Base/Resource Manager™ used by permission of Vizient. All rights reserved.

ᵇTotal number of spontaneous vaginal deliveries

Postpartum Depression Screening

2015 – 2018

The Ob/Gyn & Women's Health Institute screened more than 87% of postpartum patients for depression in 2017. This was accomplished by incorporating screening for postpartum depression into an electronic questionnaire that was developed within the electronic medical record for all 6 week postpartum encounters. A two-item patient health questionnaire is used to evaluate all postpartum patients. If either question is answered yes, a complete Edinburgh Postnatal Depression Scale is administered.

With this screening and provider education, patients with symptoms of depression are identified, and opportunities for treatment and intervention are maximized.

Appropriate Use of Antenatal Steroids

2016 – 2018

All patients between 24 and 32 weeks of gestation who were at risk for preterm delivery received antenatal steroids to enhance fetal lung maturity prior to delivery, in keeping with national guidelines. ¹⁻²

References

  1. The Joint Commission. 2012. Specifications Manual for Joint Commission National Quality Measures (v2013A1), PC-03 Antenatal Steroids.

  2. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Statement. 1994 Feb 28-Mar 2; 12(2):1-24

Exclusive Breast Milk Feeding During Newborn’s Entire Hospitalization

2016 – 2018

Exclusive breast milk feeding for the first 6 months of life is associated with improved health and neonatal survival. Initiation of breastfeeding in the hospital soon after birth increases the rate of its continuation after hospital discharge.

Source: Obstetric Joint Commission National Quality Measures Perinatal Care PC-05

ᵃCleveland Clinic target: derived from review of peer organization members of Vizient. Data from the Vizient Clinical
Data Base/Resource ManagerTM used by permission of Vizient. All rights reserved.