1025 The incidence and predictability of high-risk maternal conditions

Abstract

The Levels of Maternal Care were established to facilitate regionalization and risk appropriate care of maternal conditions. The objective of this study was to understand the incidence and “predictability” of high-risk conditions among women delivering in diverse hospital settings within a single health system. This retrospective cohort study examined women delivering over a 3-year time period from 7 hospitals within a single health system. Conditions considered to be appropriate for Level III and IV hospitals, per the Levels of Maternal Care guidelines, were identified using ICD-10 codes from the delivery admission (listed in Figure 1). All those identified at the Level I-III centers and a random 33% sample from the two Level IV centers were reviewed. Chart review was performed to confirm the accuracy of the ICD-10 code and to determine when the high-risk condition was diagnosed and if consultations or referrals preceded the delivery admission. During the study period, there were 46,138 deliveries. The annual hospital delivery volume ranged from 128 to 6,114. 457 women (99.1 per 10,000) had a diagnosis code for conditions appropriate for a Level III center, and 41 (8.9 per 10,000) for a Level IV center. Nearly all women with a high-risk condition delivered at a corresponding Level III or IV center (94.6%). Conditions were confirmed in 91.6% of the 237 chart-reviewed cases, of which 85.7% were diagnosed prior to the delivery admission. Of those diagnosed before delivery, 96.7% (178/186) delivered at a Level III/IV center or had a prenatal MFM consultation. Of those not diagnosed before delivery, 58% (18/31) were placenta accreta spectrum disorders (Figure 2). Maternal conditions requiring Level III or IV maternal care occur rarely, and the vast majority with our health system are diagnosed before delivery and deliver at a hospital with the level of services recommended based on the Levels of Maternal Care. These findings can help inform hospitals and health systems in understanding and implementing regionalization plans to optimize risk appropriate maternal care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)