Cesarean Section, Obstetric Labor Complications
Conditions
Brief summary
This study is an evaluation of a Quality Improvement (QI) project addressing delivery of the impacted fetal head being conducted at Regions Hospital. This study aims to determine the morbidity of second stage cesarean deliveries before and after implementation of simulation protocols that address delivery of the impacted fetal head for Ob/gyn surgeons, nursing staff, and surgical technicians at Regions Hospital.
Detailed description
Cesarean deliveries performed during the second stage of labor can be difficult due to impaction of the fetal head deep in the maternal pelvis and is associated with increased risk of both maternal and perinatal complications. There is little existing data to inform management of deeply impacted fetal heads, therefore these situations can be difficult for surgeons and other healthcare staff when they arise. Team simulations for obstetric emergencies have been shown to assist with provider comfort, improved clarity of thinking, and quicker action during emergency situations resulting in improved outcomes. This study aims to show that a simulation education project for the entire obstetric team can decrease morbidity of difficult fetal head extraction associated with second stage cesarean deliveries and improve provider and nursing staff confidence regarding anticipation and management of this emergency. The simulation education project is not being conducted for the purpose of research, but is a department-wide educational activity and Quality Improvement project.
Interventions
OTHERQuality Improvement Project
Simulation education conducted at Regions Hospital for a Quality Improvement project on delivery of impacted fetal head at cesarean section. This is a department-wide, simulation-based educational training required for all Regions Hospital Birth Center staff physicians, residents, nursing staff, and surgical techs.
Sponsors
Regions Hospital
HealthPartners Institute
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Inclusion criteria
Patient: The patient study population includes all patients age 18-45 who underwent cesarean section during the second stage of labor (during the time period July 2016-June 2019 at Regions Hospital and Methodist Hospital) and their infants. Second stage is defined as the time between complete cervical dilation and delivery of the infant. Medical staff: All staff members (staff physicians, residents, nurses, surgical technicians) at Regions Hospital who practice in the Birth Center who underwent required simulation education regarding delivery of impacted fetal heads during second stage cesarean section and completed the surveys as part of the QI project. Note: Medical staff were not enrolled in the research study; rather, staff survey data from the QI project was a data source for the study.
Exclusion criteria
Patient:
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite Variable of Maternal Morbidity of Second Stage Cesarean Section | During the procedure through 6 weeks following the procedure | For each eligible procedure during the study timeframe, data retrospective programmatic and manual chart reviews was used to flag the presence of any of the following events: a) extension of uterine incision (yes/no), b) operative blood loss \>1000 mL (yes/no), c) requirement of any blood transfusion during cesarean section (yes/no), d) wound infection within 6 weeks of cesarean section (yes/no), e) endometritis within 6 weeks of cesarean section (yes/no). These individual endpoints were used to compose a composite variable reflecting maternal morbidity associated with each second stage cesarean section procedure (unit of analysis). The primary outcome variable was coded as 1 if any of the above events were recorded (Yes, maternal morbidity/complication occurred) or 0 if none. |
| Composite Variable of Infant Morbidity of Second Stage Cesarean Section | During the procedure through 6 weeks following the procedure | For each eligible procedure during the study timeframe, data retrospective programmatic and manual chart reviews was used to flag the presence of any of the following events: a) 5 minute APGAR score \<7 (yes/no), b) NICU admission (yes/no), c) umbilical cord arterial pH \<7.1 ph units (yes/no), d) fetal injury of cesarean delivery during the second stage of labor (yes/no). These individual endpoints were used to compose a composite variable reflecting infant morbidity associated with each second stage cesarean section procedure (unit of analysis). The primary outcome variable was coded as 1 if any of the above events were recorded (Yes, infant morbidity/complication occurred) or 0 if none. \*\*APGAR score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth. A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time From Uterine Incision to Delivery | During the procedure | Time from Uterine Incision to Delivery measured in minutes - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
| UTI During Maternal Admission | During the procedure through 6 weeks following the procedure | UTI during Maternal Admission (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
| Urethral Injury | During the procedure through 6 weeks following the procedure | Urethral Injury (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
| APGAR Score at 1 Minute | During the procedure | APGAR score at 1 minute \< 7 (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training. \*\*APGAR score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth. A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. |
| Operative Time | During the procedure | Operative Time measured in minutes defined as skin incision to delivery - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
| Fetal Hyperbilirubinemia | During the procedure through 6 weeks following the procedure | Fetal Hyperbilirubinemia (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
| Head Pushed up From Below Prior to Cesarean Section | During the procedure | Head pushed up from below (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
| Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Surveys distributed directly before, directly after, and 6 months after simulation training. | Response on Likert Scale - * Not at all confident * Slightly confident * Moderately confident * Very confident Reported as % who responded they were very or moderately confident on each item - Only assessed in providers at the Intervention hospital that received quality improvement educational training. |
| Fetal Death | During the procedure through 6 weeks following the procedure | Fetal Death (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
| Length of Stay | During the procedure through 6 weeks following the procedure | Length of Stay for delivery - Only compared between time periods at Intervention hospital that received quality improvement educational training. |
Countries
United States
Participant flow
Recruitment details
Note: Medical staff were not enrolled in the research study; rather, staff survey data from the QI project was a data source for the study.
Pre-assignment details
Study start date 1/1/2018, the first date in which a patient received care at the intervention hospital after staff received simulation training. The first 205 patients included in this study (7/1/2016-12/31/2017) were identified retrospectively and received care before the intervention. The next 204 patients (1/1/2018-6/30/2019) were included prospectively, post-implementation of the intervention. Only 73 of the 204 were exposed to providers that partook in the simulation.
Participants by arm
| Arm | Count |
|---|---|
| Quality Improvement Project (Pre-Period) Quality Improvement Project: Pre-Period (7/1/2016 to 12/31/2017)
Patients received care at the intervention hospital in the 18 months before providers participated in the department-wide, simulation-based educational training. | 99 |
| No Quality Improvement Project (Pre-Period) No Quality Improvement Project: Pre-Period (7/1/2016 to 12/31/2017)
Patients received care at the comparison hospital where no quality improvement educational training had occurred. | 106 |
| Quality Improvement Project (Post-Period) Quality Improvement Project: Post-Period (1/1/2018 to 3/20/2019)
Patients received care at the intervention hospital in the 18 months after providers participated in the department-wide, simulation-based educational training. | 73 |
| No Quality Improvement Project (Post-Period) No Quality Improvement Project: Post-Period (1/1/2018 to 3/20/2019)
Patients received care at the comparison hospital where no quality improvement educational training had occurred. | 131 |
| Total | 409 |
Baseline characteristics
| Characteristic | Quality Improvement Project (Pre-Period) | No Quality Improvement Project (Pre-Period) | Quality Improvement Project (Post-Period) | No Quality Improvement Project (Post-Period) | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 99 Participants | 106 Participants | 73 Participants | 131 Participants | 409 Participants |
| Cesarean Indication Fetal | 24 Participants | 22 Participants | 28 Participants | 40 Participants | 114 Participants |
| Cesarean Indication Maternal | 73 Participants | 81 Participants | 44 Participants | 90 Participants | 288 Participants |
| Cesarean Indication Missing | 2 Participants | 3 Participants | 1 Participants | 1 Participants | 7 Participants |
| Delivery Method Pull | 2 Participants | 1 Participants | 2 Participants | 1 Participants | 6 Participants |
| Delivery Method Push | 20 Participants | 9 Participants | 8 Participants | 13 Participants | 50 Participants |
| Delivery Method Standard | 77 Participants | 96 Participants | 63 Participants | 117 Participants | 353 Participants |
| Fetal Station 0 to +1 | 64 Participants | 57 Participants | 50 Participants | 89 Participants | 260 Participants |
| Fetal Station -2 to -1 | 7 Participants | 11 Participants | 6 Participants | 13 Participants | 37 Participants |
| Fetal Station +2 to +3 | 27 Participants | 37 Participants | 17 Participants | 29 Participants | 110 Participants |
| Fetal Station Missing | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 2 Participants |
| Fetal Weight | 3619 grams STANDARD_DEVIATION 468 | 3609 grams STANDARD_DEVIATION 460 | 3534 grams STANDARD_DEVIATION 436 | 3526 grams STANDARD_DEVIATION 460 | 3571 grams STANDARD_DEVIATION 458 |
| Gestational Age at Time of C-Section | 39.9 Weeks STANDARD_DEVIATION 1.2 | 40.3 Weeks STANDARD_DEVIATION 1 | 39.8 Weeks STANDARD_DEVIATION 1.3 | 40.1 Weeks STANDARD_DEVIATION 1 | 40.0 Weeks STANDARD_DEVIATION 1.1 |
| Length of Second Stage 0-2 hours | 20 Participants | 17 Participants | 11 Participants | 20 Participants | 68 Participants |
| Length of Second Stage 2-4 Hours | 37 Participants | 32 Participants | 22 Participants | 46 Participants | 137 Participants |
| Length of Second Stage 4+ Hours | 41 Participants | 57 Participants | 40 Participants | 64 Participants | 202 Participants |
| Length of Second Stage Missing | 1 Participants | 0 Participants | 0 Participants | 1 Participants | 2 Participants |
| Maternal BMI | 33.5 kg/m^2 STANDARD_DEVIATION 5.9 | 33.5 kg/m^2 STANDARD_DEVIATION 6.6 | 31.5 kg/m^2 STANDARD_DEVIATION 6.7 | 32.7 kg/m^2 STANDARD_DEVIATION 6.1 | 32.9 kg/m^2 STANDARD_DEVIATION 6.3 |
| Parity 0 | 72 Participants | 87 Participants | 54 Participants | 105 Participants | 318 Participants |
| Parity 1 | 15 Participants | 14 Participants | 12 Participants | 20 Participants | 61 Participants |
| Parity 2 | 9 Participants | 5 Participants | 0 Participants | 5 Participants | 19 Participants |
| Parity 3 | 2 Participants | 0 Participants | 3 Participants | 1 Participants | 6 Participants |
| Parity 4 | 0 Participants | 0 Participants | 3 Participants | 0 Participants | 3 Participants |
| Parity 5+ | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 2 Participants |
| Previous C-Section (% yes) | 17 Participants | 10 Participants | 7 Participants | 21 Participants | 55 Participants |
| Race and Ethnicity Not Collected | — | — | — | — | 0 Participants |
| Sex: Female, Male Female | 99 Participants | 106 Participants | 73 Participants | 131 Participants | 409 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Type of Uterine Incision Classical | 1 Participants | 0 Participants | 0 Participants | 13 Participants | 14 Participants |
| Type of Uterine Incision Lower Lower Uterine Segment | 97 Participants | 106 Participants | 70 Participants | 29 Participants | 302 Participants |
| Type of Uterine Incision Upper Lower Uterine Segment | 1 Participants | 0 Participants | 2 Participants | 89 Participants | 92 Participants |
| Type of Uterine Incision Vertical Lower Uterine Segment | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Use of Instrumentation Missing | 0 Participants | 1 Participants | 1 Participants | 0 Participants | 2 Participants |
| Use of Instrumentation None | 92 Participants | 88 Participants | 68 Participants | 118 Participants | 366 Participants |
| Use of Instrumentation Tool (Vacuum or Forceps) | 7 Participants | 17 Participants | 4 Participants | 13 Participants | 41 Participants |
| Use of Tocolytics (% yes) | 1 Participants | 0 Participants | 3 Participants | 4 Participants | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 99 | 0 / 106 | 0 / 73 | 1 / 131 |
| other Total, other adverse events | 0 / 99 | 0 / 106 | 0 / 73 | 0 / 131 |
| serious Total, serious adverse events | 0 / 99 | 0 / 106 | 0 / 73 | 0 / 131 |
Outcome results
Primary
Composite Variable of Infant Morbidity of Second Stage Cesarean Section
For each eligible procedure during the study timeframe, data retrospective programmatic and manual chart reviews was used to flag the presence of any of the following events: a) 5 minute APGAR score \<7 (yes/no), b) NICU admission (yes/no), c) umbilical cord arterial pH \<7.1 ph units (yes/no), d) fetal injury of cesarean delivery during the second stage of labor (yes/no). These individual endpoints were used to compose a composite variable reflecting infant morbidity associated with each second stage cesarean section procedure (unit of analysis). The primary outcome variable was coded as 1 if any of the above events were recorded (Yes, infant morbidity/complication occurred) or 0 if none. \*\*APGAR score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth. A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health.
Time frame: During the procedure through 6 weeks following the procedure
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | Composite Variable of Infant Morbidity of Second Stage Cesarean Section | 64 Participants |
| Quality Improvement Project (Post-Period) | Composite Variable of Infant Morbidity of Second Stage Cesarean Section | 39 Participants |
| No Quality Improvement Project (Pre-Period) | Composite Variable of Infant Morbidity of Second Stage Cesarean Section | 38 Participants |
| No Quality Improvement Project (Post-Period) | Composite Variable of Infant Morbidity of Second Stage Cesarean Section | 59 Participants |
p-value: 0.46595% CI: [0.53, 4.03]Regression, Logistic
Primary
Composite Variable of Maternal Morbidity of Second Stage Cesarean Section
For each eligible procedure during the study timeframe, data retrospective programmatic and manual chart reviews was used to flag the presence of any of the following events: a) extension of uterine incision (yes/no), b) operative blood loss \>1000 mL (yes/no), c) requirement of any blood transfusion during cesarean section (yes/no), d) wound infection within 6 weeks of cesarean section (yes/no), e) endometritis within 6 weeks of cesarean section (yes/no). These individual endpoints were used to compose a composite variable reflecting maternal morbidity associated with each second stage cesarean section procedure (unit of analysis). The primary outcome variable was coded as 1 if any of the above events were recorded (Yes, maternal morbidity/complication occurred) or 0 if none.
Time frame: During the procedure through 6 weeks following the procedure
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | Composite Variable of Maternal Morbidity of Second Stage Cesarean Section | 64 Participants |
| Quality Improvement Project (Post-Period) | Composite Variable of Maternal Morbidity of Second Stage Cesarean Section | 39 Participants |
| No Quality Improvement Project (Pre-Period) | Composite Variable of Maternal Morbidity of Second Stage Cesarean Section | 38 Participants |
| No Quality Improvement Project (Post-Period) | Composite Variable of Maternal Morbidity of Second Stage Cesarean Section | 59 Participants |
p-value: 0.03195% CI: [0.17, 0.91]Regression, Logistic
Secondary
APGAR Score at 1 Minute
APGAR score at 1 minute \< 7 (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training. \*\*APGAR score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth. A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health.
Time frame: During the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | APGAR Score at 1 Minute | 17 Participants |
| Quality Improvement Project (Post-Period) | APGAR Score at 1 Minute | 21 Participants |
p-value: 0.195% CI: [-0.01, 0.24]Fisher Exact
Secondary
Fetal Death
Fetal Death (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure through 6 weeks following the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | Fetal Death | 0 Participants |
| Quality Improvement Project (Post-Period) | Fetal Death | 0 Participants |
Secondary
Fetal Hyperbilirubinemia
Fetal Hyperbilirubinemia (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure through 6 weeks following the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | Fetal Hyperbilirubinemia | 27 Participants |
| Quality Improvement Project (Post-Period) | Fetal Hyperbilirubinemia | 22 Participants |
p-value: 0.8195% CI: [-0.12, 17.8]Fisher Exact
Secondary
Head Pushed up From Below Prior to Cesarean Section
Head pushed up from below (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | Head Pushed up From Below Prior to Cesarean Section | 14 Participants |
| Quality Improvement Project (Post-Period) | Head Pushed up From Below Prior to Cesarean Section | 11 Participants |
p-value: 195% CI: [-0.11, 0.13]Fisher Exact
Secondary
Length of Stay
Length of Stay for delivery - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure through 6 weeks following the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Quality Improvement Project (Pre-Period) | Length of Stay | 76.1 Hours | Standard Deviation 23 |
| Quality Improvement Project (Post-Period) | Length of Stay | 75.1 Hours | Standard Deviation 19 |
p-value: 0.7595% CI: [-76, 5.5]t-test, 2 sided
Secondary
Operative Time
Operative Time measured in minutes defined as skin incision to delivery - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Quality Improvement Project (Pre-Period) | Operative Time | 74.6 Minutes | Standard Deviation 33 |
| Quality Improvement Project (Post-Period) | Operative Time | 63.2 Minutes | Standard Deviation 22 |
p-value: 0.0195% CI: [-20.4, -2.5]t-test, 2 sided
Secondary
Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures
Response on Likert Scale - * Not at all confident * Slightly confident * Moderately confident * Very confident Reported as % who responded they were very or moderately confident on each item - Only assessed in providers at the Intervention hospital that received quality improvement educational training.
Time frame: Surveys distributed directly before, directly after, and 6 months after simulation training.
Population: The number of participants analyzed reflects a different denominator than other outcomes. This outcome was measured in medical staff at the intervention hospital who participated in the simulation training. We collected survey responses at three timepoints - Directly before participating in the simulation training, directly after participating in the simulation training, and six-months after completing the simulation training. The count of participants reflects the number of survey respondents.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Understand your role during obstetric emergency? | 57 Participants |
| Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Understand role of others during emergency? | 50 Participants |
| Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Performing your role during extraction? | 43 Participants |
| Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Anticipating difficult extraction? | 56 Participants |
| Quality Improvement Project (Post-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Anticipating difficult extraction? | 90 Participants |
| Quality Improvement Project (Post-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Performing your role during extraction? | 80 Participants |
| Quality Improvement Project (Post-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Understand role of others during emergency? | 100 Participants |
| Quality Improvement Project (Post-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Understand your role during obstetric emergency? | 98 Participants |
| No Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Understand role of others during emergency? | 65 Participants |
| No Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Anticipating difficult extraction? | 62 Participants |
| No Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Performing your role during extraction? | 55 Participants |
| No Quality Improvement Project (Pre-Period) | Provider and Nurse Confidence Associated With Participation in Quality Improvement Training for Second Stage Cesarean Procedures | Understand your role during obstetric emergency? | 68 Participants |
Secondary
Time From Uterine Incision to Delivery
Time from Uterine Incision to Delivery measured in minutes - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Quality Improvement Project (Pre-Period) | Time From Uterine Incision to Delivery | 1.7 Minutes | Standard Deviation 2 |
| Quality Improvement Project (Post-Period) | Time From Uterine Incision to Delivery | 1.2 Minutes | Standard Deviation 1 |
p-value: 0.0295% CI: [-1, -0.1]t-test, 2 sided
Secondary
Urethral Injury
Urethral Injury (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure through 6 weeks following the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | Urethral Injury | 0 Participants |
| Quality Improvement Project (Post-Period) | Urethral Injury | 1 Participants |
Secondary
UTI During Maternal Admission
UTI during Maternal Admission (% yes) - Only compared between time periods at Intervention hospital that received quality improvement educational training.
Time frame: During the procedure through 6 weeks following the procedure
Population: As was pre-specified in the Study Protocol, only the participants who received care at the intervention hospital were assessed for this measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quality Improvement Project (Pre-Period) | UTI During Maternal Admission | 0 Participants |
| Quality Improvement Project (Post-Period) | UTI During Maternal Admission | 0 Participants |