Making North Carolina the best place to give birth and be born!
The Golden Circle: AIM-RPC Edition
Why
There are risks to Cesarean birth
beyond the surgical risks of the
initial surgery
There is unexplained variation in
primary cesarean rates across the
state and within communities
indicating an opportunity for
improvement
How
AIM partners across the state will
work together to assure that any
women who has a primary
Cesarean for arrest of dilation,
arrest of descent or failed induction
met the ACOG/SMFM criteria for
those diagnoses
What
Teams at each hospital in the state
will identify ways to support labor
and allow a safe vaginal birth using
resources such as the AIM bundle
or the CMQCC toolkit
 NTSV CS Rate
total number of NTSV CS

total number of NTSV deliveries

Total Cesarean Delivery Rate

total number of cesarean deliveries

total number of mothers who deliver

(includes repeat CS)
NTSV CS Not Meeting ACOG/SMFM CS
Criteria

37%
35%

28% 27% 28%

26% 26%
24% 24%
21%
19%

FEB MARCH APRI L MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
NTSV CS and NTSV CS Not Meeting CS Criteria

40%
37%
35%
35%

30% 28% 28%

27%
26% 26%
25% 24% 24%
26%
22%
24% 21% 24%
23% 23% 23% 23% 23%
20% 22%
21%
19%
15%
FEBRUARY MARCH APRI L MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER

NTSV CS NTSV CS Not Meeting CS Criteria

 Failed Induction
10%

NTSV CS Fetal
Concern

Audit Data 37%

Labor
Dystocia
by the 37%

Numbers
No labor
12%
 Less than 6 cm dilation
at time of delivery

Bishop score greater than

Failed Induction 6 prior to elective
induction

Oxytocin for at least 12

hours after membrane
rupture
Failed Induction
Percentage Audited NTSV CS Meeting Criteria
93% 95% 94%
88%

67%

55%
48%

35%

25%
20%
12% 13%

Q1 2019 Q2 2019 Q3 2019 Q4 2019

Less than 6 cm dilation Bishop score greater than 6 prior to induction Oxytocin for at least 12 hours after membrane rupture
 Greater than 6 cm
at time of delivery

Labor Dystocia Membranes ruptured

No cervical change after 4

hours of adequate uterine
activity
Labor Dystocia
Percentage Audited NTSV CS Meeting Criteria

96% 95% 94%

90%

91% 90% 88%

86%

67% 66%
61%
55%

Q1 2019 Q2 2019 Q3 2019 Q4 2019

Greater than 6cm dilation Membranes ruptured No cervical changes x4h with adequate uterine activity
 Category II tracing with clinically significant
variable decelerations and/or minimally absent
fetal heart rate variability without significant
decelerations

Category III tracing

Maternal position change

Fetal Concern Maternal fluid bolus

Administration of oxygen

Reduced or stopped uterine stimulant

Amnioinfusion

Stimulation with minimal or absent

fetal heart rate variability
Category of Fetal Tracing of Audited NTSV CS

75% 75% 76% 76%

19%
12% 12% 12%

Q1 2019 Q2 2019 Q3 2019 Q4 2019

Cat II Cat III

Fetal Concern
Resuscitative Interventions Performed
94%
91%
88% 90% 86% 85%
80% 81%
74% 75%
70% 71% 71% 72% 69% 72%

14%
11% 13% 11% 10% 11% 12% 11%

Mat position change Mat fluid bolus Administration of oxygen Reduce or stop uterine Amnioinfusion Stimulation
stimulant
Q1 2019 Q2 2019 Q3 2019 Q4 2019
NTSV CS with 5 min Apgar less than 7

3%
3%
2% 2% 2%
2% 2% 2%
2%
2%
1%

FEBRUARY MARCH APRI L MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
NTSV CS NICU Admissions

7% 7%

6% 6% 6% 6%
6% 6%
5% 5%
5%

FEBRUARY MARCH APRI L MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER