SC Birth Outcomes Initiative

Key Terms

Age: Maternal age on the day of delivery as identified on the hospital UB-04 record and categorized as ages <20, 20-24, 25-29, 30-34, and 35+.

Birthweight: Newborn birthweight designated on the birth record and categorized as very low (<1,500 grams), moderately low (1,500-2,499 grams), and not low birthweight (2,500+ grams).

C-Sections: Final route identified on the birth record as cesarean or vaginal and cesarean was used as the primary source of information for this measure. If mode of delivery was missing from the birth record, the following codes from the patient's hospital UB-04 delivery record were used to identify cesareans: APR-DRG code (540), MS-DRG codes (765, 766, 783, 784, 785, 786, 787, 788), or ICD-10-PCS codes (10D00Z0, 10D00Z1, 10D00Z2).

Deliveries: Obstetric deliveries were flagged if one of the below billing codes existed on the patient's hospital UB-04 record:
- ICD-10-CM: Z37.0, Z37.1, Z37.2, Z37.3, Z37.4, Z37.50, Z37.51, Z37.52, Z37.53, Z37.54, Z37.59, Z37.60, Z37.61, Z37.62, Z37.63, Z37.64, Z37.69, Z37.7, Z37.9, O75.82, O80, O82;
- ICD-10-PCS: 10D00Z0, 10D00Z1, 10D00Z2, 10D07Z3, 10D07Z4, 10D07Z5, 10D07Z6, 10D07Z7, 10D07Z8, 10E0XZZ;
- MS-DRG: 765, 766, 767, 768, 774, 775, 783, 784, 785, 786, 787, 788, 796, 797, 798, 805, 806, 807;
The delivery hospitalization included the patient's UB-04 record with the delivery flag and any hospitalization records within 0-1 day.

Delivery Exclusions: Records with delivery codes were excluded if they had any of the following ICD-10 codes indicating ectopic pregnancies, miscarriage, or abortion:
- ICD-10-CM: O00, O01, O02, O03, O04, O07, O08
- ICD-10-PCS: 10A0
They were also not flagged as the unique delivery record if occurring less than 7 months away from the previous delivery record or having the below DRGs identifying false labor, threatened abortion, antepartum admission, or postpartum admission:
- MS-DRG: 778, 780, 781, 782, 817,818, 819, 831, 832, 833, 769, 776
- APR-DRG: 563, 565, 566, 561

First-Time Delivery: Identified when previous live births (now living or dead) from the birth record were zero.

Gestational Age: Identified by the gestation on the birth record as Preterm: <37 weeks, Early-Term: 37-38 weeks, Term: 39 weeks, or Term+: 40+ weeks. When gestation was missing, this field was populated using the Z3A codes from the maternal hospital UB-04 record

Maternal: Represents all deliveries and not unique delivery patients.

Maternal Diabetes: Inclusive of any chronic or gestational diabetes identified during the 12 months prior to or at the time of delivery using ICD-10 codes or DRG codes from emergency department and/or inpatient hospital records or information provided from birth records.
- Chronic diabetes was identified by diagnosis or DRG codes if having any type 1 (O24.0 & E10), type 2 (O24.1, E11 & Z79.4), or other/unspecified diabetes (ICD10 - O24.3, O24.8, O24.9, E08, E09, E13; APRDRG -199, MSDRG-304,305) or by birth record if having any pre-pregnancy diabetes flag.
- Gestational diabetes was identified by the diagnosis code O244 or by birth record (flag).

Maternal Hypertension: Inclusive of any chronic or gestational hypertension identified during the 12 months prior to or at the time of delivery using ICD-10 codes or DRG codes from emergency department and/or inpatient hospital records or information provided from birth records.
- Chronic hypertension was identified by any ICD-CM-10 codes for hypertensive diseases (I10-I16), postprocedural hypertension (I97.3), pre-existing hypertension complicating pregnancy, childbirth, and the puerperium (O10), or any APR-DRG & MS-DRG codes for hypertension (APR-DRG: 199; MS-DRG: 304, 305) or by birth record if having any pre-pregnancy hypertension flag.
- Gestational hypertension was identified by any ICD-CM-10 codes for hypertension in pregnancy (O13, O16) or preeclampsia (O11, O14, O15) or by birth record (flag).

Number of Babies (Births): Represents all newborn birth records.

Parity: Number of previous live births (now living or dead) as designated on the birth record and categorized as Nulliparous (zero), One, Two, or Three+.

Payment Source: Payor detailed on the hospital UB-04 record and categorized as Private Insurance (Commercial Insurance or Health Maintenance Organization); Medicaid, and Other (Self-pay, Indigent/Charitable Organization, Medicare, Worker’s Compensation, Other Government, Not verified Medicaid, and Not Stated on hospital record). Medicaid delivery payment was verified through linkage with Medicaid recipient records.

Perinatal Level: SCDPH hospital designation as of May 2024. Hospitals with recent perinatal level changes may still be compared to hospitals with their prior perinatal level to allow time for transition. The level corresponds with the level of services provided: Level I (basic care for normal uncomplicated pregnancies), Level II (specialty care for both normal and selected high risk obstetrical and neonatal patients), Level III (subspecialty care for mothers and infants at less than 32 weeks gestation, estimated fetal weight less than 1,500 grams, and anticipated complex medical or surgical conditions regardless of gestation age), and Level IV (complex care for the most complex and critically ill newborn infants and have pediatric medical and surgical specialty consultants available 24 hours a day). It may vary from the level submitted with the hospital record, and for the protection of hospital-level data, Levels III and IV are presented as III+.

Perinatal Region: SCDPH perinatal region designation based on maternal county of residence. Each region has a regional perinatal center (RPC), and all other perinatal hospitals in a respective region maintain a relationship with its designated RPC for consultation, transport, transfer when appropriate, and continuing education. The five regions are Regions I/II (Upstate), Region III (Midlands), Region IV (Pee Dee), and Region V (Lowcountry).

Prenatal Care: The APNCU index developed by Kotelchuck determines the adequacy of prenatal care utilization based on two parts: the month in which prenatal care was initiated and the number of visits from initiation of care until delivery. The level of adequacy is then grouped into four categories reported on the birth certificate: Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), and Adequate Plus (110% or more). Adequate prenatal care is defined as a score of 80% or greater on the Kotelchuck Index, or the sum of the Adequate and Adequate Plus categories. More detailed specifications may be reviewed here.

Plurality: Obtained using the birth month, birth year, and delivery patient's identification number from the birth records as Singleton (1 newborn) and Multiples (> 1 newborn).

Race: Maternal race as identified on the birth record as non-Hispanic Black, non-Hispanic White, Hispanic, and non-Hispanic Other (which includes Multiple Race and Unknown). Maternal race was also extracted from the delivery patients' hospitalization data when the delivery was not linked to a birth record, or the birth record was missing race.

Residence: Rural or urban status identified by a crosswalk using the zip code provided on the delivery patient's hospital UB-04 record. The crosswalk is based on the US Census Bureau 2010 Decennial Census (Summary File 1: Table P2, Urban and Rural). Non-SC zip codes were classified into an Out-of-state/Unknown group. Please note: Rural and urban boundaries are subject to change as new federal crosswalks using the 2020 Census become available.

State: Represents all deliveries occurring in SC birthing facilities. This excludes out-of-hospital births such as home births and those occurring in freestanding birthing facilities. It includes births for some out-of-state residents.

Year, Quarter – All data reflects post-ICD-10 time periods and is reported using calendar years and quarters (Q2, 2021 – Q1, 2024).

Outcomes

Labor & Delivery

Total C-Section: Percent of total deliveries identified as cesarean on the birth record or via APR-DRG, MS-DRG, or ICD-10-PCS codes.

Total Primary C-Section: Percent of deliveries without a prior cesarean identified as cesarean on the birth record or via APR-DRG, MS-DRG, or ICD-10-PCS codes.

Primary C-Section (TJC PC-02, NTSV): This Joint Commission PC-02 Cesarean Birth Measure reflects cesareans identified by ICD-10-PCS codes (Appendix A, Table 11.06, v2024A1) among deliveries limited to gestation at least 37 weeks, first-time delivery (nulliparous), singleton, ages 10 to 64, and excluding multiple gestations and other presentations (Appendix A, Table 11.09, v2024A1).

Primary C-Section (TJC PC-02, NTSV) among patients with Cardiac Conditions in Obstetric Care : The rate of PC-02 Cesarean births among people with cardiac conditions at time of delivery. Such cardiac conditions may include congenital heart disease, cardiac valve disorders, cardiomyopathies, arrhythmias, coronary artery disease, pulmonary hypertension, and aortic dissection.

Births

Birthweight

Not Low Birthweight – 2,500+ grams
Moderately Low Birthweight – 1,500 to 2,499 grams
Very Low Birthweight – <1,500 grams

Gestational Age

Preterm (<37 weeks)
Preterm (<37 weeks) - Preterm among people with Cardiac Conditions at Delivery (as defined in Maternal Safety).
Early-term (37-38 weeks)
Term (39 weeks)
Term+ (40 weeks)

Unexpected Complications in Term Newborns (TJC PC-06, v2024A1) - Overall Rate

This measure reflects adverse outcomes in full-term newborns without pre-existing conditions. The Joint Commission uses PC-06 as a quality metric for obstetric care. The overall PC-06 rate consists of severe complications like neonatal death, birth injuries, neurological damage, and transfers to higher levels of care, as well as moderate complications or infections with longer stays. The measure is helpful to examine when interpreting rates of potentially avoidable primary cesarean (TJC PC-02).

Maternal Safety

Severe maternal morbidity (SMM) refers to life-threatening outcomes of labor and delivery. UB-04 all-payer billing data were used to calculate delivery-related SMM using ICD-10 codes associated with 20 SMM conditions, such as heart failure, renal failure, sepsis, shock, embolism, and respiratory ventilation.

This measure is then calculated for four delivery subpopulations:

Maternal hemorrhage was identified if any of the following were present at the time of delivery:

Presence of an Abruption, Previa, or Antepartum hemorrhage diagnosis code;
Presence of transfusion procedure code without a sickle cell crisis diagnosis code;
Presence of a Postpartum hemorrhage diagnosis code

Severe Hypertension/Preeclampsia accounts for obstetric patients with a diagnosis code for:

Severe Preeclampsia
Eclampsia
Preeclampsia superimposed on pre-existing hypertension

Cardiac Conditions in Obstetric Care (CCOC) were identified if any of the following diagnosis codes were present at the time of delivery:

Congenital Heart Disease
Cardiac Valve Disorders
Cardiomyopathies
Arrhythmias
Coronary Artery Disease
Pulmonary Hypertension
Other/not specified cardiac conditions

Perinatal Mental Health Conditions (PMHC) refer to mood, anxiety, and anxiety-related disorders and may be inclusive of mental health conditions with onset that predates pregnancy. Note: For the dashboard, PMHC diagnoses were captured from emergency department visits or inpatient stays from one year prior to through one year after delivery, which varies from other AIM measures captured only at the time of inpatient delivery. Excluded from the AIM definition were diagnoses for substance use disorder, suicidal ideation, disruptive and conduct disorders, personality disorders, or general mental health.

The 03/27/2024 AIM Data Collection Plan and 05/14/2024 AIM SMM Codes List were used to calculate these outcomes.

Note: Given inconsistent coding of transfusions at the hospital level after the implementation of ICD-10 and less risk of maternal mortality for transfusion-only patients, as of October 1, 2022, these measures are no longer reported for patients whose only indicant of SMM was a transfusion. This will result in a decrease of SMM rates statewide.

More information about the AIM initiative can be found here: What is AIM?

Sources

Mother with toddler and newborn in her lap.

Maternal and newborn data were inclusive of hospitalizations from April 1, 2021, to March 31, 2024. SCRFA pulled all data records as of October 7, 2024. These data were restricted to only deliveries and births occurring in SC birthing facilities (i.e., data for births and deliveries among SC residents occurring outside the state of SC, at home, or in a freestanding birthing center were not included).

The maternal and newborn data were derived from three sources:

South Carolina Revenue and Fiscal Affairs Office, Health and Demographics, all-payer uniform billing data for inpatient discharges (UB-04)

Used as the base for maternal age and residence and measures of maternal quality as defined by billing codes submitted on the hospital record.

South Carolina Department of Public Health, Division of Biostatistics, Vital Statistics

Used to establish maternal race, gestation, birthweight, singleton, parity, and mode of delivery.
Based on birth records submitted to SCDPH by delivering hospitals in South Carolina.

South Carolina Department of Health and Human Services, Medicaid recipient records

Used to verify Medicaid as the payer.

To maximize information, this report links birth and pregnancy data from birth records to UB-04 delivery and newborn hospitalization records.

The Joint Commission PC-02 measure does not require this linkage of obstetric hospital events with vital statistics, as some states are not set up for this level of data sharing. Linking newborn and delivery patient's UB-04 hospital data with birth records allows maximum use of the available data for newborn and maternal measures with improved accuracy of results.

BOI Data Processing Flowchart, Events from April 1, 2021 — March 31, 2024, Inclusive and also available in About the Data PDF.

Download Complete Data Information

Caveats (FAQs)

What do these SCBOI data represent?

The data reflect point-in-time UB-04 data provided by individual hospitals to the SC Revenue and Fiscal Affairs Office (SCRFA) as of October 7, 2024. They may differ from a review of internal hospital medical records.

Notes: All data presented for Q1 2024 are preliminary. Outcomes presented from Q2 2021 to Q2 2023 occurred during the COVID-19 pandemic emergency; caution should be taken when comparing these rates to other quarters. Due to missing data linkages, the percentage of Medicaid may be higher than reported.

What accounts for differences in denominators?

The number of births and maternal deliveries used to calculate each maternal and newborn measure or characteristic may vary due to missing data and/or measure restrictions. Newborn measures were per neonate live birth from birth records with or without linkage to a UB-04 newborn hospitalization. The maternal delivery characteristics and labor and delivery measures were per UB-04 deliveries with linkage to a live birth from birth records. For the maternal safety measures, linkage to live birth from birth records was not required. One delivery was counted regardless of plurality.

How were demographic data determined?

Maternal demographics, such as maternal age and residence, were as of the day of delivery.

What does it mean when there is no data for a measure?

A value of zero percent (0.00%) may indicate zero births in the quarter matching the measure criteria, or an actual value of zero for a specific table result. For additional interpretation, refer to the numerators and denominators.

What measure and hospital definitions were used in this report?

The most recent definitions for newborn and maternal measures were used and applied across all time periods. Hospital data in this report reflect naming, perinatal levels, mergers, and closures identified by SCDPH as of May 2024.

How are unknown and missing data treated?

For purposes of visual presentation, Unknown and Missing values are not presented in the portal. These data are, however, included in statewide and hospital totals. Therefore, subtotals in charts may not add to 100%.