Using Electronic Health Record and Administrative Data to Analyze Maternal and Neonatal Delivery Complications

Obstetric quality of care measures have largely focused on severe maternal morbidity (SMM), with little consensus about measures of less severe but more prevalent delivery and neonatal complications. This study analyzes risk-adjusted maternal and neonatal outcomes using both ICD-10 coding and electronic health record (EHR) data.

Complication rates at seven health system hospitals from January 2016 to August 2019 were analyzed. EHR data and ICD-10 codes were used to identify the incidence of SMM as well as other route-specific maternal and neonatal complications. Researchers tested the association of maternal sociodemographic and clinical risk markers with the likelihood of maternal and neonatal complications using multiple logistic and Poisson regression.

Among 42,681 deliveries, the SMM rate was 1.3%, and other complication rates were 12.9% for vaginal and 19.7% for cesarean deliveries. The neonatal complication rate was 20.2%. Risk factors for all complications included multiple gestation and hypertensive disorders of pregnancy. Risk factors for SMM included nulliparity, cesarean delivery, and preexisting conditions; risks for neonatal complications included academic medical center admission, cesarean delivery, higher maternal body mass index, and preterm birth. There were significant racial disparities in maternal and neonatal outcomes.

This study is among the first to combine EHR and administrative discharge data to describe a wide range of maternal and neonatal birth outcomes, including associations with established risk factors. Although SMM was rare, route-specific and neonatal complications were much more common and may offer a better focus for obstetric quality improvement efforts.