Analysis of Adverse Outcome Index, Weighted Adverse Outcome Score, and Severity Index as Novel Quality Indicators of Obstetric Care in a Tertiary Care Hospital

Abstract

Objective: To analyze the adverse outcome index, weighted adverse outcome score and Severity index calculated from routinely collected obstetric data as indicators of quality of obstetric care.

Methodology A descriptive cross-sectional study was carried out at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, from January to December 2020. Using non-probability consecutive sampling approach, all pregnant women who were admitted for obstetric care and experienced any of ten prespecified adverse maternal and neonatal outcomes( neonatal death> 2500g,and > 37 weeks, in-hospital maternal death, uterine rupture, maternal admission to intensive care unit, delivery birth trauma, return to the operating room, intensive neonatal unit admission with >2500g and > 37 weeks for more than one day, Apgar <7 at 5 minutes, blood transfusion> 4 units and fourth-degree perineal laceration) were included in the study and the data was used to calculate previously standardized quality indicators like adverse outcome index, Weighted adverse outcome scores and Severity Index. Data was analyzed using SPSS 23.

Results: Our obstetrics unit witnessed 4975 deliveries during the research period. Mean age, parity and gestation were 25.20±4.32,2.7±2.34 and 36.35±2.50 respectively. On admission, 98.6% of pregnant women were un-booked. The average adverse outcome index was 14.8/1000, the weighted adverse outcome score was 0.96 and severity index 65%. In our study population, the adverse outcomes contributing most to the AOI were neonates born with low APGAR score (40.5%), Maternal ICU admission (21.6%) and Blood transfusion (17.6%).

Conclusions: Adverse outcomes contributing most to the AOI in our setup were neonates born with low APGAR score, unplanned maternal ICU admission and Blood transfusion. With the help of these novel quality indicators, policy makers can plan concerted efforts in improving access, utilization of antenatal care and use of evidence-based guidelines to impart care and evaluation of services provided by individual maternity hospitals.