ArticleAmerican journal of perinatology2016
Association between Hospital Birth Volume and Maternal Morbidity among Low-Risk Pregnancies in Rural, Urban, and Teaching Hospitals in the United States.
Article in American journal of perinatology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Impact of regionalisation and case-volume on neonatal and perinatal mortality: an umbrella review.BMJ open · 2020Pooled it
- Estimating the incidence and risk factors of postpartum hemorrhage from the national ENACT network.npj health systems · 2026Article
- Article
- Disparities in delivery hospital risk-adjusted outcomes for very low birthweight infants: the role of NICU volume and level of care.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Hospital birth volume and rurality: Associations with pregnancy outcomes among individuals with chronic hypertension.Pregnancy (Hoboken, N.J.) · 2025Article
- Unveiling the Challenges and Solutions: A Scoping Review of Maternal Healthcare Access in Rural Georgia.Cureus · 2025Review
- Virtual simulation training for postpartum hemorrhage in low-to-moderate-volume hospitals in the US.AJOG global reports · 2024Article
- Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region.International journal of environmental research and public health · 2024Article
- Hypertensive Disorders of Pregnancy: A Literature Review - Pathophysiology, Current Management, Future Perspectives, and Healthcare Disparities.US cardiology · 2024Review
- Understanding categories of postpartum care use among privately insured patients in the United States: a cluster-analytic approach.Health affairs scholar · 2023Article
- Racial and Rural-Urban Disparities in Maternal Cardiac Disease Care in North Carolina: A Call to Action.North Carolina medical journal · 2023Article
- Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals.JAMA health forum · 2023Article
- A Nationwide Study of the "July Effect" Concerning Postpartum Hemorrhage and Its Risk Factors at Teaching Hospitals across the United States.Healthcare (Basel, Switzerland) · 2023Article
- Epidemiological characteristics and risk factors of obstetric infection after the Universal Two-Child Policy in North China: a 5-year retrospective study based on 268,311 cases.BMC infectious diseases · 2022Article
- Association of hospital and community factors on the attainment of Baby-Friendly designation: A breastfeeding health promotion.Maternal & child nutrition · 2022Article
- The causal effect of delivery volume on severe maternal morbidity: an instrumental variable analysis in Sichuan, China.BMJ global health · 2022Article
- Labor and Delivery Unit Closures in Rural Georgia from 2012 to 2016 and the Impact on Black Women: A Mixed-Methods Investigation.Maternal and child health journal · 2022Article
- Birth Volume and Geographic Distribution of US Hospitals With Obstetric Services From 2010 to 2018.JAMA network open · 2021Article
- The Implementation of a Collaborative Pediatric Telesimulation Intervention in Rural Critical Access Hospitals.AEM education and training · 2021Article
- Geographic access to critical care obstetrics for women of reproductive age by race and ethnicity.American journal of obstetrics and gynecology · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
Objectives This study aims to examine the relationship between hospital birth volume and multiple maternal morbidities among low-risk pregnancies in rural hospitals, urban non-teaching hospitals, and urban teaching hospitals, using a representative sample of U.S. hospitals. Study Design Using the 2011 Nationwide Inpatient Sample from 607 hospitals, we identified 508,146 obstetric deliveries meeting low-risk criteria and compared outcomes across hospital volume categories. Outcomes include postpartum hemorrhage (PPH), chorioamnionitis, endometritis, blood transfusion, severe perineal laceration, and wound infection. Results Hospital birth volume was more consistently related to PPH than to other maternal outcomes. Lowest-volume rural (< 200 births) and non-teaching (< 650 births) hospitals had 80% higher odds (adjusted odds ratio [AOR] = 1.80; 95% CI = 1.56-2.08) and 39% higher odds (AOR = 1.39; 95% CI = 1.26-1.53) of PPH respectively, than those in corresponding high-volume hospitals. However, in urban teaching hospitals, delivering in a lower-volume hospital was associated with 14% lower odds of PPH (AOR = 0.86; 95% CI = 0.80-0.93). Deliveries in rural hospitals had 31% higher odds of PPH than urban teaching hospitals (AOR = 1.31; 95% CI = 1.13-1.53). Conclusions Low birth volume was a risk factor for PPH in both rural and urban non-teaching hospitals, but not in urban teaching hospitals, where higher volume was associated with greater odds of PPH.
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