[Is it Reasonable to Establish an Independently Managed Obstetric Unit in a Small Hospital and Does it Result in Measurable Changes in Quality of Maternity Care?]

INTRODUCTION

An independently managed, specialty obstetric unit in a small hospital setting resulted in measurable changes in quality of maternity care.

MATERIAL AND METHODS

We present obstetric data from a level I (basic care) hospital in Frankfurt, Germany. We compare data from the mandatory state register collected in 2013, when the obstetric unit was under single management with the gynaecology department, with data collected in 2016 after the establishment of independent obstetric unit and a specialised service.

RESULTS

Between 2013 and 2016, the birth rate in our hospital increased by 46.4%, from 803 to 1176 births/year. CS rates decreased by 8.9%, from 34.9 to 26% (p<0.01). Operative vaginal delivery rates increased by 5.2 (p<0.01%). Transfer of neonates to NICU decreased from 5.6% to 3.1% (p<0.01). Other obstetric interventions also decreased, including induction of labour (10.1 to 9.4%, p=0.632) and rate of episiotomy (13.4 to 1.1%, p<0.01). Rates of severe fetal acidosis (p<0.05) increased from no events in 2013 to 2 events in 2016. There were non-significant reductions in planned caesarean section for primiparous women and repeat caesarean section.

CONCLUSION

An independently managed, specialised obstetric unit separate from an Obstetric & Gynaecology Department previously under single management can lead to measurable changes and quality improvement in a short period of time.