PQCNC Support for Birth Initiative

Aggregate baseline data

“JCAHO rate” = C/S rate for all NTSV admissions (includes scheduled C/S)
All Facilities November 2010 "Joint Commission" Rate

Joint Commission Joint Commission

Facility Facility
Rate Rate
110 27.03% 400 16.00%
120 25.00% 420 34.51%
200 10.53% 430 33.75%
210 18.42% 500 24.00%
270 28.21% 510 21.43%
300 19.51% 530 30.23%
320 37.14% 540 34.21%
330 14.29% 550 6.25%
350 24.00% 640 21.74%
380 54.55% 650 35.90%
390 23.08% 660 24.68%
392 34.78% 680 39.39%
 NTSV vaginal birth rate
Aggregate: 75.23% overall, 80.23% no risk factors, 61.69% with risk

Facility VBR VBR no 1+ risk Facility VBR VBR no 1+ risk

overall risk factors overall risk factors
factors factors
110 79.22% 80.60% 70.00% 420 74.23% 80.45% 60.66%
200 81.82% 82.50% 80.00% 430 73.29% 78.95% 53.13%
210 77.50% 73.30% 80.00% 490 91.30% 94.12% 83.33%
270 76.92% 83.08% 46.15% 500 80.95% 78.82% 90.00%
300 68.24% 79.03% 39.13% 510 86.36% 88.24% 80.00%
320 73.08% 81.82% 45.16% 530 74.39% 80.65% 55.00%
330 86.71% 91.67% 50.00% 540 69.62% 70.83% 67.74%
350 66.67% 72.09% 50.00% 550 93.75% 93.33% 100%
390 82.00% 87.18% 63.64% 640 70.83% 71.05% 70.00%
391 80.00% 85.00% 70.00% 650 73.42% 80.70% 54.55%
392 74.07% 78.18% 56.00% 660 78.23% 85.53% 66.67%
400 75.56% 81.08% 50.00% 680 76.81% 81.63% 65.00%
 Frequency of maternal risk factors
Diabetes IUGR Maternal Hypertensive Macrosomia Obesity
age >35 disease (EFW >4000g)

100 46 74 231 18 184

5.0% 2.3% 3.7% 11.6% 0.9% 9.2%

n=1998
 Baseline Data: Vaginal Birth Rate by Cervical Dilation and
Labor Status at Admission

Number Number Number

of of of
patients Percent patients Percent patients Percent
Total Total who
Type of with no who admitted who admitted who
number of delivered
Labor cervical delivered with a delivered with a delivered
patients vaginally
exam at vaginally cervical vaginally cervical vaginally
admission dilation of dilation of
provided 0-3cm 4+cm

Induction
7 42.86% 927 64.83% 47 70.21% 981 64.93%
of labor

Spontane
1 100.00% 469 82.73% 487 88.71% 957 85.79%
ous labor
 Aggregate Frequency of Cervical Dilation
< 4cm among Patients “in labor”at Admission
60.0%

50.0%

40.0%
%age of pts in labor at 0cm
30.0% %age of pts in labor at 1cm

20.0%
%age of pts in labor at 2cm
%age of pts in labor at 3cm
10.0%

0.0%
1

Labor patients
Dilation at admission 0cm 1cm 2cm 3cm
Number 14 88 140 231
Percent of labor 1.5% 9.2% 14.6% 24.0%
patients
 Aggregate frequency of cervical dilations admitted
NOT in labor and with intact membranes
70.0%

60.0%

50.0%

40.0%

30.0%
Cesarean Deliveries
20.0% Vaginal Deliveries
10.0%

0.0%

Of pts not in labor, not Of pts not in labor, not Of pts not in labor, not
ruptured, number and ruptured, number and ruptured, number and
percent that were 0-1cm percent that were 2-3cm percent that were 4-5cm

# pts not in labor with intact Not in labor, intact Not in labor, intact Not in labor, intact
membranes at admission membranes, cervical membranes, cervical membranes, cervical
dilation at admission dilation at admission dilation at admission
0-1cm 2-3cm 4-5cm

766 491 233 37

64.1% 30.4% 4.8%
 Aggregate Mode of Delivery By Use of Cervical Ripening Among Patients Admitted for Induction of Labor
01/01/2010 - 12/31/2010
Cesarean Section Cesarean Section Vaginal Delivery Vaginal Delivery
Cervical Ripening Total
Count Rate Count Rate
Cervical Ripening
551 171 31.03% 380 68.97%
Not Used
Cervical Ripening
430 173 40.23% 257 59.77%
Used
 Aggregate Mode of Delivery by Top 5 Cervical Ripening Methods
01/01/2010 - 12/31/2010
Frequency of Vaginal Birth Rate for this
Method Cesarean Section Vaginal Delivery
Usage Method
Cervidil 16.52% 26.02% 42.53% 61.17%
Cytotec 9.95% 15.16% 25.11% 60.36%
Foley Bulb 7.47% 9.95% 17.42% 57.14%
Foley Bulb+Cervidil 0.68% 1.81% 2.49% 72.73%
Foley Bulb+Cytotec 1.81% 3.17% 4.98% 63.64%
Aggregate Primary Indication for C-section
01/01/2010 - 12/31/2010

Indication
Chorioamnionitis 0.42%
Malpresentation 1.04%
(No indication) 1.67%
Failed operative vaginal delivery 1.67%

Presumed cephalopelvic disproportion 4.38%

Other 5.00%
Failure to descend (2nd stage C/S) 14.38%
Nonreassuring fetal status 31.46%
Failure to progress (1st stage C/S) 40.00%
Aggregate IUPC Use Among Failure to Progress Cesareans
01/01/2010 - 12/31/2010
IUPC Used IUPC Count IUPC Rate
(No answer) 10 5.21%
No 68 35.42%
Yes 114 59.38%
 Aggregate Frequency of Adequate Uterine Contractions
Prior to FTP C-section (primary indication)

# MVUs reached
200 ≥2hrs
# MVUs DID NOT
reach 200 ≥2hrs
No answer

# MVUs reached 200 # MVUs DID NOT reach 200 No answer

≥2hrs ≥2hrs
42 64 9
36.5% 55.7% 7.8%
 Aggregate Cervical Dilation at Time of Failure To Progress Diagnosis
01/01/2010 - 12/31/2010
Dilation Count Percent
(No answer) 11 5.73%
0-3 54 28.13%
4-6 79 41.15%
7-9 48 25.00%
 How many women in NC go into spontaneous labor?
Data from PQCNC 39 Weeks Project
Hospital Induction rate Scheduled C/S rate Total Scheduled
June 2010 June 2010 June 2010
A* 22.2% 12.1% 34.2%
B 45.5% 27.3% 72.8%
C 30.2% 13.9% 44.1%
D 21.3% 16.9% 38.2%
E 29.9% 22.4% 52.3%
F 54.5% 9.1% 63.6%
G 22.7% 16.5% 39.2%
H* 12.6% 21.2% 33.8%
I 35.5% 34.0% 69.5%
J* 18.0% 10.3% 28.3%
 Understanding your data
• If something doesn’t look “right”, consider
your sample size – was it too small?
• Sample should be a minimum of 40 NTSV
patients admitted for intended vaginal birth
• Sample should be consecutive patients