American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Feb 2017
Severe maternal morbidity and comorbid risk in hospitals performing <1000 deliveries per year.
While research has demonstrated increasing risk for severe maternal morbidity in the United States, risk at lower volume hospitals remains poorly characterized. More than half of all obstetric units in the United States perform <1000 deliveries per year and improving care at these hospitals may be critical to reducing risk nationwide. ⋯ Our findings demonstrate increasing maternal risk at hospitals performing <1000 deliveries per year broadly distributed over the patient population. Rates of morbidity in centers with ≥1000 deliveries have also increased. These findings suggest that maternal safety improvements are necessary at all centers regardless of volume.
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Am. J. Obstet. Gynecol. · Feb 2017
Perinatal regionalization: a geospatial view of perinatal critical care, United States, 2010-2013.
Perinatal services exist today as a dyad of maternal and neonatal care. When perinatal care is fragmented or unavailable, excess morbidity and mortality may occur in pregnant women and newborns. ⋯ Gaps in access and discordance between the availability of level III or higher obstetric and neonatal care may affect the delivery of risk-appropriate care for high-risk maternal fetal dyads. Further study is needed to understand the importance of these gaps and discordance on maternal and neonatal outcomes.
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Am. J. Obstet. Gynecol. · Feb 2017
Observational StudyNonurgent and urgent emergency department use during pregnancy: an observational study.
Emergency department use is common among pregnant women. Nonurgent emergency department use may represent care that would be better provided by an established obstetric provider in an ambulatory setting. ⋯ Women frequently use the emergency department during pregnancy, including visits for nonurgent indications. Identifying risk factors for nonurgent emergency department use in pregnancy is important for identifying women likely to use the emergency department, including for nonurgent visits, and the development of strategies to decrease nonurgent emergency department utilization in pregnancy.
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Am. J. Obstet. Gynecol. · Jan 2017
Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death.
Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based on the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (ie, maternal deaths). In 2013, the Intensive Care National Audit and Research Center Case Mix Program reported the first statistically validated early warning scoring system for pregnant women. ⋯ Although there are opportunities for improvement, Obstetric Early Warning Score obtained upon admission to the intensive care unit can predict survival in conditions directly related to pregnancy and postpartum. The use of early warning scores in obstetrics may be a highly useful approach in the early identification of women at an increased risk of dying.
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Am. J. Obstet. Gynecol. · Jan 2017
Obstetrician call schedule and obstetric outcomes among women eligible for a trial of labor after cesarean.
Reducing cesarean deliveries is a major public health goal. The low rate of vaginal birth after cesarean has been attributed largely to a decrease in the likelihood of choosing a trial of labor after cesarean, despite evidence suggesting a majority of women with 1 prior low transverse cesarean are trial of labor after cesarean candidates. Although a number of reasons for this decrease have been explored, it remains unclear how systems issues such as physician call schedules influence delivery approach and mode in this context. ⋯ Although physicians working on a night float call system were significantly more likely to have patients with a prior cesarean undergo trial of labor after cesarean and achieve vaginal birth after cesarean, their patients also were more likely to experience maternal and neonatal morbidity. However, these differences did not persist when limiting analyses to women attempting a trial of labor after cesarean. Using a night float call schedule may be an effective measure to promote a trial of labor after cesarean and vaginal birth after cesarean.