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American Journal of Medical Quality
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*Childbirth
*High Risk Pregnancy
*Safety
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Factors Contributing to Maternal Birth-Related Trauma

Lance L. Roberts, MS

Department of Health Management and Policy, University of Iowa, Iowa City, lance-l-roberts{at}uiowa.edu

John W. Ely, MD

Department of Family Medicine, University of Iowa, Iowa City

Marcia M. Ward, PhD

Department of Health Management and Policy, University of Iowa, Iowa City

The Agency for Healthcare Research and Quality Quality Indicator tools were used to identify risk factors for maternal birth-related trauma rates in the 2003 Nationwide Inpatient Sample and the 2002-2004 Iowa State Inpatient Database. Risk-adjusted analyses of these datasets isolated salient risk factors for maternal trauma. The rates of Iowa's risk factors for the most serious types of trauma—third/fourth-degree lacerations—were compared with national rates. The comparisons suggest that episiotomy, artificial rupture of membranes, obstructed labor, and late pregnancies are the most salient risk factors for third/fourth-degree lacerations within Iowa. Thus, this research suggested that a combination of maternal, baby, and episiotomy factors contributed to the high prevalence of third/fourth-degree lacerations in vaginal deliveries in Iowa. Finally, our risk-adjustment methodology could be used in a similar manner to analyze other discharge datasets for opportunities to improve maternal outcomes. (Am J Med Qual 2007;22:334-343)

Key Words: maternal birth-related trauma • obstetric trauma • patient safety indicators (PSIs) • quality indicators • patient safety

American Journal of Medical Quality, Vol. 22, No. 5, 334-343 (2007)
DOI: 10.1177/1062860607303315
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