Abstract：
OBJECTIVES:This study was undertaken to examine the national and regional rates of operative delivery among almost one quarter million births in a single year in the nation's largest healthcare delivery system, using variation as an arbiter of the quality of decision making. STUDY DESIGN:We compared the variation in rates of primary cesarean and operative vaginal delivery in facilities of the Hospital Corporation of America during the year 2004. RESULTS:In 124 facilities representing almost 220,000 births during a 1-year period, the primary cesarean and operative vaginal delivery rates were 19% +/- 5% (range 9-37) and 7% +/- 4% (range 1-23). Within individual geographic regions, we consistently found variations of 200-300% in rates of primary cesarean delivery and variations approximating an order of magnitude for operative vaginal delivery. CONCLUSION:Within broad upper and lower limits, rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making. This reflects a lack of sufficient reliable, outcomes-based data to guide clinical decision making.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Clark SL,Belfort MA,Hankins GD,Meyers JA,Houser FMdoi
10.1016/j.ajog.2007.01.024subject
Has Abstractpub_date
2007-06-01 00:00:00pages
526.e1-5issue
6eissn
0002-9378issn
1097-6868pii
S0002-9378(07)00095-6journal_volume
196pub_type
杂志文章abstract：:There are two major approaches to the prophylaxis for adhesions: chemical methods (e.g., dextran) and barrier methods. Theoretically, dextran prevents the formation of adhesions by a surface-coating or hydroflotation effect, whereas the barrier methods either prevent the formation of or mask adhesions by covering and ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(82)90018-7
更新日期：1982-08-01 00:00:00
abstract：OBJECTIVES:Our purpose was to develop a method to induce premature delivery in rats and to use this method to identify biochemical changes that are critical to cervical dilatation by comparison to changes that occur during term delivery. STUDY DESIGN:Rats were treated with antiprogestational agents onapristone or lilo...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1053/ob.1996.v175.a74254
更新日期：1996-09-01 00:00:00
abstract：OBJECTIVE:Our purpose was to assess the adequacy of currently accepted criteria for the diagnosis of twin-to-twin transfusion syndrome. STUDY DESIGN:Between April 1991 and February 1992 nine consecutive women with twin gestations and ultrasonographic findings of marked growth discordance, coexistent oligohydramnios-po...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(93)90028-h
更新日期：1993-10-01 00:00:00
abstract：:The effects of maternal hyperexcitability on the fetus were studied in 17 baboons. In the period of agitation, induced by stressful stimulus such as exposure to bright light or by clamping of the toe, the mother exhibited an increase in arterial blood pressure and, in some instances, arrhythmia. These changes were acc...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(16)33032-0
更新日期：1979-06-01 00:00:00
abstract：:Peripheral blood mononuclear cells from patients with preeclampsia were enumerated by means of monoclonal anti-T-cell antibodies. The percentage of total T cells was significantly decreased in this group of patients, as compared with normal term pregnant women. The low proportion of T cells was due to a proportional r...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(83)90018-2
更新日期：1983-11-01 00:00:00
abstract：OBJECTIVE:Iron supplementation in pregnancy seems beneficial for neonatal/maternal outcomes, but it was associated with diabetes and hypertension in the general population. STUDY DESIGN:We investigated the association between iron supplementation during midpregnancy and metabolic/hypertensive abnormalities in 500 cons...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2009.04.049
更新日期：2009-08-01 00:00:00
abstract：OBJECTIVE:We undertook this investigation to explore the effects of ethanol exposure on nitric oxide synthase levels and nitric oxide release. Our hypothesis was that ethanol exposure modifies nitric oxide activity within the placenta as a result of oxidative stress. STUDY DESIGN:Four 10-g samples of term normal human...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1067/mob.2000.104201
更新日期：2000-03-01 00:00:00
abstract：OBJECTIVE:A paucity of data exists concerning the normal glycemic profile in nondiabetic pregnancies. Using a novel approach that provides continuous measurement of blood glucose, we sought to evaluate the ambulatory daily glycemic profile in the second half of pregnancy in nondiabetic women. STUDY DESIGN:Fifty-seven ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2004.06.059
更新日期：2004-09-01 00:00:00
abstract：OBJECTIVE:An Rh-negative woman with preexisting anti-D antibodies may affect some or all subsequent fetuses, depending on the genotype of her Rh-positive partner. Currently, a reliable technique for an absolute determination of RhD genotype is not available. This study was initiated to develop an accurate method for Rh...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(96)70675-0
更新日期：1996-04-01 00:00:00
abstract：:To stimulate first-trimester human cytomegalovirus infection, pregnant guinea pigs were inoculated with a low dose of guinea pig cytomegalovirus during the first trimester of pregnancy. Maternal viremia, which was cleared by 2 weeks after inoculation, was found to reappear near the time of delivery in one third of the...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(87)90159-1
更新日期：1987-05-01 00:00:00
abstract：:This document builds upon recommendations from peer organizations and outlines a process for identifying maternal cases that should be reviewed. Severe maternal morbidity is associated with a high rate of preventability, similar to that of maternal mortality. It also can be considered a near miss for maternal mortalit...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2016.07.050
更新日期：2016-09-01 00:00:00
abstract：OBJECTIVE:We examined trends in overall and preoperative urodynamics utilization among women with stress urinary incontinence (SUI) to determine if practice patterns changed following publication of a 2012 randomized trial questioning the value of preoperative urodynamics in patients with uncomplicated SUI. STUDY DESI...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2015.06.062
更新日期：2015-11-01 00:00:00
abstract：:Molluscum contagiosum in a venereal distribution (MCV) was identified as an incidental finding in 14 patients in a women's outpatient clinic at a general hospital. The lesions were frequently overlooked both by patients and physicians. The lesions of MCV are frequently asymptomatic. The sexual history of the patients ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(77)90037-0
更新日期：1977-07-01 00:00:00
abstract：BACKGROUND:Although it is uncommon, the incidence of endometrial cancer and atypical hyperplasia among reproductive-aged women is increasing. The fertility outcomes in this population are not well described. OBJECTIVE:We aim to describe the patterns of care and fertility outcomes of reproductive-aged women with endome...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2019.05.029
更新日期：2019-11-01 00:00:00
abstract：OBJECTIVE:Our purpose was to examine the cellular localization of inhibin subunits and messenger ribonucleic acid expressions for the inhibin subunits and the serum levels of inhibin A and inhibin B in human ovarian sex cord stromal tumors. STUDY DESIGN:We examined the immunohistochemical localization of the inhibin s...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(97)70090-5
更新日期：1997-12-01 00:00:00
abstract：OBJECTIVE:The purpose of this study was to identify differences in antepartum uterine contraction frequency (UCF) in twin pregnancies with and without preterm labor (PTL). STUDY DESIGN:Twin gestations enrolled for outpatient surveillance with twice daily electronic uterine activity monitoring and telephonic nursing as...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2007.10.781
更新日期：2008-05-01 00:00:00
abstract：OBJECTIVES:This article derives new mathematic formulas to calculate the probability that the husband of a D-negative woman is heterozygous for the D antigen. STUDY DESIGN:Current published formulas and tables that estimate this probability are biased in that they incorrectly assume that the father is randomly selecte...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(92)91830-4
更新日期：1992-01-01 00:00:00
abstract：:A technique to assist in the atraumatic delivery of the very low birth weight fetus in cases of malpresentation at cesarean section is described; the technique minimizes potential trauma associated with version and/or extraction techniques. Use of uterine relaxing anesthetic agents and subsequent risk of hemorrhage ar...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(86)90492-8
更新日期：1986-04-01 00:00:00
abstract：:Motrin (ibuprofen), a potent inhibitor of prostaglandin synthetase, was tested in women and men for treatment of recurrences of genital herpes. In a double-blind trial, no statistically significant differences were observed between treated and placebo groups in any of the measured parameters. ...
journal_title：American journal of obstetrics and gynecology
pub_type： 临床试验,杂志文章
doi：10.1016/0002-9378(86)90842-2
更新日期：1986-08-01 00:00:00
abstract：:In order to study the hormonal characteristics of human prolactin-secreting pituitary adenomas, in vitro monolayer and suspension cultures from human pituitary glands were established. Optimal conditions for cultures included enzymatic dispersion into viable single-cell suspensions with the use of 1% collagenase in ph...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(80)90084-8
更新日期：1980-11-15 00:00:00
abstract：OBJECTIVE:The molecular mechanisms underlying ectopic implantation have not been well characterized. Here we investigate HOXA10 gene expression at the site of ectopic implantation as compared with the endometrium and with the normal fallopian tube. STUDY DESIGN:Northern blot analysis was used to evaluate HOXA10 gene m...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2004.01.066
更新日期：2004-05-01 00:00:00
abstract：OBJECTIVE:The purpose of this study was to investigate the potential efficacy of high-intensity focused ultrasound for the treatment of uterine fibroid tumors in a nude mouse model. STUDY DESIGN:A total of 60 female athymic nude mice were inoculated subcutaneously with 3 to 5 x 10(6) ELT-3 cells, a uterine fibroid tum...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1067/mob.2000.105347
更新日期：2000-07-01 00:00:00
abstract：:It is demonstrated that for rats N,N'-bis(dischloroacetyl)-1,8-octamethylenediamine (Win 18,446) is a highly efficient embryocidal N,N'-bis(dichloroacetyl)-1,8-octamethylenediamine It was previously used to supress spermatogenesis in man and other mammals. In the initial rat studies, a fixed dosage of Win 18,446 was...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(74)90117-3
更新日期：1974-07-01 00:00:00
abstract：:Although genital condylomata worsen with pregnancy, we are unaware of any reports of fatal maternal laryngeal papillomatosis. A maternal death at 20 weeks' gestation of a patient with chronic laryngeal papillomatosis is described. Pregnant patients with a history of this disorder who have symptoms should be considered...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(92)91662-t
更新日期：1992-02-01 00:00:00
abstract：OBJECTIVE:To summarize the evidence on short-, mid-, and long-term results up to 5 years of uterine artery embolization in comparison to surgery. STUDY DESIGN:We searched the CENTRAL, MEDLINE and EMBASE databases for randomized clinical trials comparing uterine artery embolization with hysterectomy/myomectomy in preme...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章,meta分析,评审
doi：10.1016/j.ajog.2011.03.016
更新日期：2011-10-01 00:00:00
abstract：OBJECTIVE:Estrogen receptor-positive cancers that initially respond to hormone therapy often progress to a resistant state. The breast cancer cell line T47Dco is a model for such resistance. It is a polymorphic line, composed of multiple cell populations that demonstrate the presence of mutant estrogen receptors by clo...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(11)90590-0
更新日期：1992-04-01 00:00:00
abstract：:Invasive cervical squamous cell carcinoma was diagnosed in 45 patients less than 35 years old from 1980 to 1985. Thirty-two cases were Stage IB; 10, Stage IIB; and three, Stage IIIB. Twenty-two patients developed persistent or recurrent disease. Only one of these is now alive with no evidence of tumor. The mean interv...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(88)90144-5
更新日期：1988-02-01 00:00:00
abstract：:Healthy pregnant women underwent a mild exercise study to evaluate the effects of this amount of work on their fetuses. The results indicated that there were no direct correlations between exercise and fetal body or breathing movements at this particular work intensity (2.33 m). We found a relationship between the mat...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(83)90003-0
更新日期：1983-11-01 00:00:00
abstract：OBJECTIVE:This study was to evaluate the predictive value of the uterine cervix tissue with the use of quantitative ultrasound gray level analysis for preterm delivery. STUDY DESIGN:Sixty-eight patients with preterm labor between 20 and 35 weeks of gestation were included. When two-dimensional transvaginal ultrasound ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1067/s0002-9378(03)00488-5
更新日期：2003-08-01 00:00:00
abstract：:Two studies were conducted to investigate the effect of a progesterone-releasing intrauterine contraceptive device (IUD) on uterine secretion of prostaglandin (PG) F2alpha associated with IUD-induced luteolysis in sheep. In bilaterally ovulating ewes receiving an IUD on day 3 (estrus = day 0) intrauterine release of p...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(78)90803-7
更新日期：1978-09-01 00:00:00
