The Relationship between Various Measures of Perinatal Quality

Objective: To examine the correlations between pairs of maternal, infant, and maternal-infant dyad quality measures to provide a comprehensive assessment of perinatal care. Study Design: In a retrospective cohort study using birth and fetal death certificates linked to hospital discharge data from Michigan, Oregon, Pennsylvania, and South Carolina (2016-2018), we examined correlations between pairs of maternal, infant, and maternal-infant dyad quality measures. Maternal quality measures included nulliparous term singleton vertex (NTSV) cesarean birth, non-transfusion severe maternal morbidity (SMM), and a composite maternal outcome. Infant quality was assessed with a composite outcome measure, while the dyad measure combined maternal and infant outcomes. Results: Among 955,904 dyads across 266 hospitals, 25.9% had NTSV, 0.7% had non-transfusion SMM, 12.3% had the composite infant measure, and 19.3% had the dyad measure. The correlation between non-transfusion SMM and the dyad measure was 0.12 while the correlation between the composite infant measure and the dyad measure was 0.86 which was higher than the correlation between the composite maternal measure and the dyad measure (0.47). Conclusion: We observed minimal correlations among these perinatal quality measures, especially when aggregated beyond individual outcomes.