Of the 4 million women who give birth annually in the United States, 13% experience a complication from the delivery. The lack of a national system for reporting these complications has left clinicians with little evidence to use in the hopes of preventing them or reducing their number-and has left patients with little information on the quality of care provided by hospitals or individual obstetricians.

To determine how maternal morbidity differs across U.S. hospitals, researchers embarked on a retrospective data review of 750,000 deliveries from the 2010 Healthcare Cost and Utilization's Nationwide Inpatient Sample, a large national database of representative patient and hospital information from a 20% sample of U.S. community hospitals. Hospitals' performance was categorized as low, average, or high based on the relative risk that a patient would experience a major complication.

Most of the hospitals in the study sample were private, nonprofit hospitals (64.7%); nonteaching facilities (76%); and located in urban areas (60.2%). White women made up 46% of the patient population, 20% were Hispanic, and 13.4% were black.

The rate of major complications in women undergoing vaginal deliveries (defined as a combination of hemorrhage, laceration, infection, or other) at low-performance hospitals was 22.5%, compared with 10.4% at high-performance hospitals. The rate of cesarean delivery complications (defined as hemorrhage, operative complications, infection, or other) reached 20.9% at low-performance hospitals, compared with 4.3% at high-performance facilities-a nearly fivefold difference.

Because of the lack of complete patient data, which could mask the role of significant clinical risk factors, the authors state that the study's results are preliminary. Yet the striking variability between complication rates suggests a large quality gap across U.S. hospitals.

The authors suggest this could be addressed by increased and standardized quality-metrics collection and public reporting of outcomes in maternal health. A regional model of maternal health networks may also help to properly organize patients according to risk.-AK

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