The rates of major obstetrical complications differ fivefold among hospitals in the United States, according to researchers.

“Despite the substantial morbidity associated with childbirth in the United States, there is currently no national system for reporting maternal complications,” wrote Laurent G. Glance, MD, of the University of Rochester in Health Affairs.

To examine the variation in obstetrical complication outcomes across hospitals in the United States, the investigators used multivariable regression models on a large, nationally representative sample of more than 750,000 obstetrical deliveries in 2010.

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Nearly 23% of female patients who deliver vaginally at low-performing hospitals experienced major complications, compared with 10% of patients at high-performance hospitals, found the researchers.

Patients undergoing a cesarean delivery at low-performing hospitals had nearly five times the rate of major complications compared with patients undergoing the same procedure at high-performing hospitals (20.9% compared to 4.4%).

“Our finding that the rate of major obstetrical complications varies markedly across US hospitals should prompt clinicians and policy makers to develop comprehensive quality metrics for obstetrical care and focus on improving obstetrical outcomes,” concluded the researchers. “If this performance gap could be narrowed, it could lead to substantial improvements in obstetrical outcomes for large numbers of women.”


  1. Glance L et al. Health Affairs. 2014; doi: 10.1377/hlthaff.2013.1359