Pre-existing clinical
|
Heart disease: including CHF,a,b CHD,a,c pulmonary hypertension,a ischemic heart disease,a valvular heart disease,a conduction disorders
|
43 (53.1%)
|
10
|
0
|
33
|
Sickle cell diseasea
|
11 (13.6%)
|
1
|
0
|
10
|
Collagen vascular disease: including SLEa,d and rare autoimmune, rheumatoid arthritis and other collagen vascular
|
27 (33.3%)
|
5
|
0
|
22
|
HIVa
|
21 (25.9%)
|
3
|
0
|
18
|
Chronic renal diseasea
|
37 (45.7%)
|
7
|
0
|
30
|
Chronic hypertensiona
|
68 (84.0%)
|
20
|
0
|
48
|
Chronic diabetesa
|
67 (82.7%)
|
15
|
1
|
51
|
Chronic lung disease, including asthmaa
|
31 (38.3%)
|
5
|
1
|
25
|
Thyroid disease, hypothyroidism
|
8 (9.9%)
|
0
|
0
|
8
|
Maternal soft tissue condition: includes other uterine surgery, fibroids, cervical conditions
|
5 (6.2%)
|
0
|
0
|
5
|
Pelvis abnormal
|
1 (1.2%)
|
0
|
0
|
1
|
Gynecological conditions: e.g., endometriosis, PCOS,e peritoneal adhesions
|
3 (3.7%)
|
0
|
0
|
3
|
Skin and subcutaneous tissues
|
1 (1.2%)
|
0
|
0
|
1
|
Hospitalization in prior 5 years or during pregnancy
|
4 (4.9%)
|
1
|
0
|
3
|
Drug abuse:a including amphetamine, opioid, other; one vs multiple substance, cocaine, combination with alcohol or smoking or mental health conditions
|
27 (33.3%)
|
4
|
1
|
22
|
Alcohol abusea
|
16 (19.8%)
|
1
|
1
|
14
|
Smoking
|
34 (42.0%)
|
6
|
7
|
21
|
Mental health, including depression
|
16 (19.8%)
|
4
|
0
|
12
|
Obesity class, BMI,f weight gain during pregnancy
|
40 (49.4%)
|
15
|
5
|
20
|
Height
|
2 (2.5%)
|
0
|
0
|
2
|
Weight gain
|
3 (3.7%)
|
2
|
1
|
0
|
Liver disorders, including failure, hepatitis B or C
|
11 (13.6%)
|
2
|
0
|
9
|
Digestive diseases, including IBDg
|
9 (11.1%)
|
1
|
2
|
6
|
Seizures and other CNSh conditions, e.g., stroke, MSi
|
12 (14.8%)
|
2
|
0
|
10
|
Blood diseases: including thrombocytopenia, coagulopathy, or anaemia
|
16 (19.8%)
|
3
|
0
|
13
|
Fluid electrolyte disorders
|
2 (2.5%)
|
0
|
0
|
2
|
Paralysis
|
2 (2.5%)
|
0
|
0
|
2
|
Peripheral vascular disorders
|
4 (4.9%)
|
0
|
0
|
4
|
Weight loss
|
2 (2.5%)
|
0
|
0
|
2
|
Musculoskeletal conditions
|
5 (6.2%)
|
0
|
2
|
3
|
Malignancy
|
4 (4.9%)
|
0
|
0
|
4
|
History of organ transplant
|
1 (1.2%)
|
0
|
0
|
1
|
High risk summary measure
|
28 (34.6%)
|
14
|
0
|
14
|
VTE,j anticoagulant use (now or in past)
|
4 (4.9%)
|
1
|
0
|
3
|
Hyperlipidemia
|
1 (1.2%)
|
0
|
0
|
1
|
Disorders of the adrenal gland
|
1 (1.2%)
|
0
|
0
|
1
|
Obstructive sleep apnea
|
1 (1.2%)
|
1
|
0
|
0
|
Genital herpes
|
4 (4.9%)
|
0
|
0
|
4
|
Cystic fibrosis
|
2 (2.5%)
|
0
|
1
|
1
|
Maternal agea
|
79 (97.5%)
|
31
|
2
|
46
|
Maternal race/ethnicity
|
44 (54.3%)
|
24
|
0
|
20
|
N = 41 pre-existing clinical covariates
|
Obstetrical Antepartum
|
Parity (nulliparous vs grand multipara) and combinations with prior cesarean birth
|
48 (59.3%)
|
16
|
0
|
32
|
Prior cesarean delivery,a number of prior cesareans
|
48 (59.3%)
|
13
|
2
|
33
|
Prior preterm birth
|
4 (4.9%)
|
0
|
0
|
4
|
Multiple gestationa
|
69 (85.2%)
|
15
|
2
|
52
|
Preeclampsia:a including severe, mild, gestational, eclampsia
|
47 (58.0%)
|
13
|
1
|
33
|
Placental conditions
|
25 (30.9%)
|
6
|
0
|
26
|
Gestational diabetes
|
29 (35.8%)
|
4
|
5
|
20
|
Assisted conception: invasive vs. non-invasive, IUI,k ovulation induction, IVF, ICSI,l diagnosed infertility, infertility treatment
|
13 (16.0%)
|
7
|
0
|
6
|
Neonatal congenital anomalies or cancer
|
14 (17.3%)
|
0
|
0
|
14
|
Fetal presentation
|
14 (17.3%)
|
2
|
2
|
10
|
LGAm or SGAn fetus
|
14 (17.3%)
|
3
|
1
|
10
|
Oligohydramnios/polyhydramnios
|
6 (7.4%)
|
1
|
0
|
5
|
Male fetus
|
5 (6.2%)
|
0
|
0
|
5
|
First trimester prenatal care, adequate prenatal care
|
17 (21.0%)
|
8
|
0
|
9
|
Provider type (at PNC,o delivery)
|
4 (4.9%)
|
1
|
0
|
2
|
Isoimmunization
|
4 (4.9%)
|
0
|
0
|
4
|
Number of previous livebirths, number of previous miscarriages/previous miscarriage, ectopic, termination
|
4 (4.9%)
|
1
|
0
|
3
|
Prior D&Cp
|
1 (1.2%)
|
0
|
0
|
1
|
History of hemorrhage previous pregnancy
|
2 (2.5%)
|
2
|
0
|
0
|
History of hypertensive disorder in a previous pregnancy
|
1 (1.2%)
|
1
|
0
|
0
|
History of SGA
|
1 (1.2%)
|
0
|
0
|
1
|
Group B streptococcus screen positive
|
1 (1.2%)
|
0
|
0
|
1
|
N = 22 obstetrical antepartum covariates
|
Intrapartum or postpartum
|
Bishop score < 6
|
1 (1.2%)
|
1
|
0
|
0
|
Unengaged fetal head
|
3 (3.7%)
|
0
|
0
|
3
|
Uterine rupture, prolapsed cord
|
2 (2.5%)
|
0
|
0
|
3
|
Hemorrhage
|
4 (4.9%)
|
1
|
0
|
3
|
Prior stillbirth or infant death
|
4 (4.9%)
|
0
|
0
|
4
|
Stillbirth
|
9 (11.1%)
|
0
|
0
|
9
|
Route of delivery: includes labor y/n, operative VD,q cesarean
|
35 (43.2%)
|
12
|
3
|
20
|
Maternal indication for cesarean
|
1 (1.2%)
|
0
|
0
|
1
|
Cesarean incision type
|
1 (1.2%)
|
0
|
1
|
0
|
Induction
|
12 (14.8%)
|
5
|
0
|
7
|
Cervical ripening
|
1 (1.2%)
|
1
|
0
|
0
|
Epidural use
|
3 (3.7%)
|
0
|
0
|
3
|
PROM,r PPROMs
|
8 (9.9%)
|
0
|
0
|
8
|
Chorioamnionitis or maternal infection
|
4 (4.9%)
|
1
|
0
|
3
|
Birth day: weekend, night
|
6 (7.4%)
|
3
|
2
|
1
|
Gestational age at delivery, preterm birth, type of preterm birth
|
33 (40.7%)
|
6
|
0
|
27
|
Preterm birth spontaneous vs indicated
|
2 (2.5%)
|
0
|
0
|
2
|
Labor anomalies: prolonged second stage, oxytocin
|
5 (6.2%)
|
1
|
0
|
4
|
General vs neuraxial anesthesia
|
3 (3.7%)
|
2
|
0
|
1
|
Perineal trauma
|
1 (1.2%)
|
0
|
0
|
1
|
Elective delivery
|
6 (7.4%)
|
0
|
0
|
6
|
Fetal distress not in labor (separate from elective)
|
1 (1.2%)
|
0
|
0
|
1
|
N = 22 intrapartum/postpartum covariates
|
Other patient-level covariates
|
Year of childbirth
|
29 (35.8%)
|
13
|
2
|
14
|
Income
|
2 (2.5%)
|
1
|
0
|
1
|
Rural
|
4 (4.9%)
|
2
|
0
|
2
|
Insurance
|
39 (48.1%)
|
16
|
4
|
19
|
Education
|
21 (25.9%)
|
7
|
0
|
14
|
SESt
|
5 (6.2%)
|
1
|
0
|
4
|
Foreign born
|
16 (19.8%)
|
7
|
1
|
8
|
Language spoken
|
1 (1.2%)
|
0
|
0
|
1
|
Refugee status
|
1 (1.2%)
|
0
|
0
|
1
|
Duration of residence
|
1 (1.2%)
|
0
|
0
|
1
|
Working
|
2 (2.5%)
|
0
|
2
|
0
|
Married
|
13 (16.0%)
|
3
|
2
|
8
|
Profession
|
1 (1.2%)
|
0
|
0
|
1
|
Home birth
|
1 (1.2%)
|
0
|
0
|
1
|
Transfer in from other hospital
|
3 (3.7%)
|
0
|
0
|
3
|
N = 15 other patient-level covariates
|
Hospital-level covariates
|
Hospital level of maternal care
|
2 (2.5%)
|
1
|
1
|
0
|
Hospital size or delivery volume
|
17 (21.0%)
|
6
|
3
|
8
|
Hospitalist
|
1 (1.2%)
|
0
|
1
|
0
|
Hospital ownership
|
11 (13.6%)
|
4
|
2
|
5
|
Hospital teaching
|
15 (18.5%)
|
5
|
2
|
8
|
Hospital urban/rural
|
9 (11.1%)
|
2
|
2
|
5
|
Hospital percent high-risk
|
1 (1.2%)
|
1
|
0
|
0
|
Hospital percent non-White
|
1 (1.2%)
|
1
|
0
|
0
|
Hospital black-serving
|
1 (1.2%)
|
1
|
0
|
0
|
Hospital percent Medicaid
|
3 (3.7%)
|
1
|
0
|
2
|
Hospital coding intensity
|
1 (1.2%)
|
1
|
0
|
0
|
Hospital percent midwife births
|
1 (1.2%)
|
0
|
1
|
0
|
NICUu level
|
4 (4.9%)
|
2
|
1
|
1
|
Hospital cesarean rate general endotracheal anesthesia
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital epidural rate
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital induction rate
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital percent NTSVv
|
2 (2.5%)
|
0
|
0
|
2
|
Hospital percent early elective deliveries
|
2 (2.5%)
|
0
|
0
|
2
|
Hospital Clinical Processes of Care quintiles
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital Patient Perspectives of Care quintiles
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital number triaged per day
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital number triaged per delivery
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital > 4 hospitals within 20 miles of residence
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital excellent doctor:nurse relationship
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital doctors/1000 deliveries
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital MFMw on staff
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital midwives available
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital anesthesia available 24/7
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital anesthesia staff have no other responsibilities
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital equivalent staffing day and night
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital cesarean in main hospital operating room
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital radiology available 24/7
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital blood bank available24/7
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital massive transfusion protocol in place
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital pharmacist dedicated to L&Dx
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital Bakri Balloon available
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital epidural easy to get
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital adult critical care 24/7
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital subspecialty intensive care units available
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital difficult to get consults
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital has NICU
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital central FHRy monitoring
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital emergency response team available to L&D
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital allow TOLACz
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital 100% of cesareans begun within 30 min
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital intermittent FHR monitoring < 50% of patients
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital doctors sign out to each other
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital formal rounds are conducted on L&D
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital drills and simulations required
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital FHR monitoring course required of doctors
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital tracking of haemorrhage occurs
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital tracking of infection occurs
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital tracking of 3rd & 4th degree lacerations occurs
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital has cesarean evaluation team
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital allows maternal transfers in
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital has a protocol for induction of labor
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital has a protocol for cesarean delivery
|
1 (1.2%)
|
0
|
0
|
1
|
Hospital gives education regarding induction of labor
|
1 (1.2%)
|
0
|
0
|
1
|
N = 58 hospital-level covariates
|
Community-level covariates
|
Region
|
21 (25.9%)
|
6
|
1
|
14
|
Neighborhood poverty
|
3 (3.7%)
|
0
|
2
|
1
|
Miles from zip code to hospital
|
1 (1.2%)
|
0
|
1
|
0
|
Geographic designation of area urban/rural
|
8 (9.9%)
|
2
|
0
|
6
|
County frequency of obstetricians/anesthesiologists
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of births to teens
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of unmarried women
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of divorced females
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of female family heads
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of females with no insurance
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of foreign-born persons
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of persons with less than high school education
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of non-White persons
|
1 (1.2%)
|
0
|
1
|
0
|
County household income measure
|
18 (22.2%)
|
4
|
2
|
12
|
County frequency of unemployed persons
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of food stamp beneficiaries
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of persons with no phone
|
1 (1.2%)
|
0
|
1
|
0
|
County frequency of households with > 1 person/room
|
1 (1.2%)
|
0
|
1
|
0
|
County number of days with good air
|
1 (1.2%)
|
0
|
1
|
0
|
County number of deaths due to AIDSaa
|
1 (1.2%)
|
0
|
1
|
0
|
County number of deaths due to MVAbb
|
1 (1.2%)
|
0
|
1
|
0
|
County death suicide
|
1 (1.2%)
|
0
|
1
|
0
|
N = 22 community-level covariates
|
TOTAL: N = 180 covariates
|