Labor and delivery unit practices and racial and ethnic disparities in severe maternal and neonatal morbidity among nulliparous individuals with low-risk pregnancies - Scorecard - MDSpire
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Labor and delivery unit practices and racial and ethnic disparities in severe maternal and neonatal morbidity among nulliparous individuals with low-risk pregnancies
Clinical Scorecard: Examining Racial and Ethnic Disparities in Severe Maternal and Neonatal Morbidity Among Low-Risk Nulliparous Patients: The Role of Labor and Delivery Unit Practices
At a Glance
Category
Detail
Condition
Severe maternal and neonatal morbidity disparities among low-risk nulliparous patients
Key Mechanisms
Differences in labor and delivery unit interventional practices across hospitals influenced by structural racism and healthcare inequities
Target Population
Low-risk, nulliparous individuals giving birth in California hospitals
Care Setting
Labor and delivery units in hospitals across California
Key Highlights
Racial and ethnic disparities exist in severe maternal and neonatal morbidity, with Black and Latino individuals less likely to deliver at lower-interventional hospitals.
Lower-interventional labor and delivery practices are recommended by ACOG for low-risk patients to improve outcomes.
If all births occurred at lower-interventional hospitals, disparities in severe maternal and neonatal morbidity would modestly increase except for severe neonatal morbidity among AI/AN individuals.
Guideline-Based Recommendations
Diagnosis
Use ICD-CM diagnosis and procedure codes from birth hospitalization to identify severe maternal and neonatal morbidity.
Management
Adopt lower-interventional labor and delivery practices for low-risk patients as recommended by ACOG.
Avoid hospital admission of low-risk patients in latent labor to reduce labor arrest, cesarean birth, and prolonged labor.
Provide continuous support during labor to lower risks of cesarean birth and low 5-minute Apgar scores.
Monitoring & Follow-up
Monitor severe maternal and neonatal morbidity rates using linked birth certificate and hospitalization data.
Assess hospital labor and delivery unit practices via surveys to classify interventional levels.
Risks
Higher-interventional labor and delivery practices may contribute to increased severe maternal and neonatal morbidity.
Structural racism and inequities in healthcare policies contribute to disparities in hospital quality and outcomes.
Patient & Prescribing Data
Low-risk, nulliparous individuals across racial and ethnic groups in California hospitals
Black and Latino patients are less likely to deliver at hospitals with lower-interventional practices, potentially contributing to disparities in morbidity outcomes.
Clinical Best Practices
Implement lower-interventional labor and delivery practices for low-risk nulliparous patients to improve maternal and neonatal outcomes.
Provide continuous labor support to reduce cesarean rates and improve newborn health.
Avoid early hospital admission during latent labor to prevent labor arrest and unnecessary interventions.
Address structural and organizational factors in hospitals that contribute to racial and ethnic disparities in care quality.
by Stephanie A Leonard, Xiao Xu, Shantay Davies-Balch, Elliott K Main, Brian T Bateman, David H Rehkopf, Henry C Lee, Jessica Illuzzi, Irogue Igbinosa, Ijeoma Iwekaogwu, Deirdre J Lyell
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