Abstract：
:This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Armstrong JC,Kozhimannil KB,McDermott P,Saade GR,Srinivas SK,Society for Maternal-Fetal Medicine Health Policy Committee.doi
10.1016/j.ajog.2015.10.935subject
Has Abstractpub_date
2016-02-01 00:00:00pages
153-163issue
2eissn
0002-9378issn
1097-6868pii
S0002-9378(15)02292-9journal_volume
214pub_type
杂志文章abstract：:Although the importance of sonography in modern obstetrics is undisputed, its role in the evaluation of the patient with gynecologic disease is less clear. We evaluated the role of pelvic sonography in the initial assessment of gynecologic patients. Standardized pelvic sonography was performed on patients scheduled to...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(84)90241-2
更新日期：1984-07-15 00:00:00
abstract：OBJECTIVE:The objective of the study was to evaluate the risk for bacterial vaginosis (BV) in a douching cessation trial. STUDY DESIGN:Thirty-nine reproductive-age women who reported use of douche products were enrolled into a 20-week study consisting of a 4 week douching observation (phase I) followed by 12-weeks of ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2007.11.043
更新日期：2008-06-01 00:00:00
abstract：:If protective immunity were to develop following an episode of gonococcal pelvic inflammatory disease (salpingitis), PID should recur with organisms bearing antigens that do not react with these immune mechanisms. To test this hypothesis, gonococci from 15 women with gonococcal PID, who experienced 19 subsequent episo...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(80)91091-1
更新日期：1980-12-01 00:00:00
abstract：OBJECTIVE:The objective of the study was to compare time to first bowel movement (BM) after surgery in subjects randomized to placebo or senna with docusate. STUDY DESIGN:Ninety-six subjects completed a baseline 7-day bowel diary before and after surgery. After pelvic reconstructive surgery, the subjects were randomiz...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ajog.2010.01.003
更新日期：2010-05-01 00:00:00
abstract：BACKGROUND:Pelvic organ prolapse is common, but the underlying etiologies are poorly understood, which limits our current prevention and treatment options. OBJECTIVE:Our primary objective was to compare the uterosacral ligament histologic features in women with and without prolapse using the novel pelvic organ prolaps...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2020.10.040
更新日期：2021-01-01 00:00:00
abstract：:A case of herpes gestationis recurring in each pregnancy, with a postpartum flare-up in the last pregnancy, is described. The diagnosis was confirmed by skin biopsy. The first pregnancy ended in a term stillbirth, but there were favorable outcomes in four subsequent pregnancies. Histopathologic examination of the plac...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(91)90514-r
更新日期：1991-03-01 00:00:00
abstract：:Characteristics of cervical dilation produced by the new osmotic dilator, laminaria, and rigid (metal or plastic) dilators were compared. The osmotic dilator (Lamicel) is an open-porosity polyvinyl alcohol sponge loaded with magnesium sulfate and compressed into a rod. Pressures exerted by the Lamicel and laminaria te...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(83)90997-3
更新日期：1983-07-15 00:00:00
abstract：:To determine the genetic origin of the complete hydatidiform mole, 20 abnormal pregnancies were studied with restriction fragment length polymorphism with five genomic probes: EJ 6.6, beta-globin gene, 3'alpha-hypervariable region, J-Bir, and St14. In the 12 cases of molar pregnancy, pure paternal origin was proved in...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(91)90537-2
更新日期：1991-03-01 00:00:00
abstract：BACKGROUND:Routine cesarean delivery has been shown to decrease mother-to-child-transmission of HIV in women with high viral load greater than 1000 copies/mL; however, women presenting late in pregnancy may not have viral load results before delivery. OBJECTIVE:Our study investigated the costs and outcomes of using a ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2019.06.021
更新日期：2019-09-01 00:00:00
abstract：OBJECTIVES:Fascia lata allografts are commonly used in urogynecologic procedures. Functional failure of several grafts has occurred, and such failure has been recognized as a materials problem in 12 patients. STUDY DESIGN:Twelve patients with failure of an initial urogynecologic procedure performed with irradiated and...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(99)70374-1
更新日期：1999-12-01 00:00:00
abstract：:To investigate whether immune system activation may contribute to the tissue damage observed in salpingitis, we isolated peripheral blood mononuclear cells and quantitated production of the monocyte activation products tumor necrosis factor-alpha, interleukin-1, and interleukin-6. Unstimulated cells from 7 of 20 women...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(91)90316-j
更新日期：1991-09-01 00:00:00
abstract：:To determine whether hormone analysis could be used for accurate determination of fetal sex, we measured testosterone (T) and follicle-stimulating hormone (FSH) in 130 amniotic fluid samples at midgestation. The mean unconjugated T in amniotic fluid of 73 patients carrying male fetuses was 202 pg. per milliliter (95 p...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(77)90034-5
更新日期：1977-07-01 00:00:00
abstract：OBJECTIVE:After strong evidence and major organizations recommending salpingectomy over tubal ligation, we sought to perform a systematic review and meta-analysis comparing the intraoperative attributes and complication rates associated with these 2 procedures. DATA SOURCES:We searched PubMed, the Cochrane Library, Em...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章,评审
doi：10.1016/j.ajog.2020.09.011
更新日期：2020-09-14 00:00:00
abstract：OBJECTIVE:Our purpose was to evaluate which factors regulate insulin-like growth factor-I and insulin-like growth factor binding protein-1 concentrations in preterm fetuses. STUDY DESIGN:We studied 76 singleton births between 25 and 36 weeks of gestation. Forty-nine pregnancies were complicated by hypertensive disease...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1067/mob.2003.26
更新日期：2003-02-01 00:00:00
abstract：OBJECTIVE:The objective of the study was to assess whether herpes simplex virus antibody avidity is associated with risk of transmission of herpes simplex virus to the neonate. STUDY DESIGN:We developed a novel herpes simplex virus type 1 avidity test based on the commercially available Focus HerpeSelect-1 enzyme-link...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2006.02.013
更新日期：2006-07-01 00:00:00
abstract：:Oral contraceptives (OCs) raise the plasma levels of some clotting factors, especially factor VII. Until recently, however, there has been no evidence for a relationship between high levels of clotting factor and the onset of clinically manifest vascular disease. It has not been established, on a preliminary basis, th...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(16)32484-x
更新日期：1982-03-15 00:00:00
abstract：OBJECTIVE:This study was undertaken to evaluate the occurrence and management of mesh erosions in patients undergoing abdominal sacrocolpopexy. STUDY DESIGN:A retrospective chart review of the abdominal sacrocolpopexy procedure (n = 92) between 1997 and 2003 was performed. Patients with mesh erosion were identified. I...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2005.02.062
更新日期：2005-06-01 00:00:00
abstract：OBJECTIVES:We sought to investigate the fetal hemodynamic response to the acute stress of invasive procedures. STUDY DESIGN:The middle cerebral artery pulsatility index was measured by Doppler ultrasonography before and after 136 invasive procedures (fetal blood sampling, transfusion, shunt insertion, tissue biopsy, a...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(99)70340-6
更新日期：1999-10-01 00:00:00
abstract：OBJECTIVE:This survey was conducted to determine the practice patterns of gynecologists in Canada regarding the discontinuation of oral contraceptives before gynecologic surgical procedures. STUDY DESIGN:In May and June of 1997, surveys were sent to all obstetricians and gynecologists on the mailing list of the Societ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1067/mob.2002.127372
更新日期：2002-12-01 00:00:00
abstract：:A protein that is immunochemically indistinguishable from the major basic protein of the eosinophil granule is present at elevated concentrations in the plasma of pregnant women. Major basic protein has been localized to placental trophoblasts known as X cells. Because X cells are located in placental septa and septal...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(91)90107-3
更新日期：1991-08-01 00:00:00
abstract：BACKGROUND:There are limited data on how maternal age is related to twin pregnancy outcomes. OBJECTIVE:The purpose of this study was to assess the relationship between maternal age and risk for preterm birth, fetal death, and neonatal death in the setting of twin pregnancy. STUDY DESIGN:This population-based study of...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2017.03.002
更新日期：2017-07-01 00:00:00
abstract：:A computer program for pattern recognition of fetal electroencephalogram has been used to analyze the records of nine fetuses, known to be neurologically abnormal at 1 year of age. In 4,913 10 second epochs of adequate FEEG, Low Voltage Irregular (LVI) accounted for 17.8 per cent, Mixed activity (MIX) for 30.5 per cen...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1976-06-15 00:00:00
abstract：OBJECTIVE:We sought to determine whether sacrospinous uterosacral ligament fixation restores the uterus to its normal anatomic position, preserving uterine function and allowing future childbearing. STUDY DESIGN:This study was undertaken at two separate medical centers. Women with symptomatic uterovaginal prolapse who...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(93)90689-g
更新日期：1993-06-01 00:00:00
abstract：OBJECTIVE:Our purpose was to evaluate the need for frequent amniotic fluid volume assessments in our antepartum testing unit. STUDY DESIGN:In a retrospective analysis of data accumulated over 1 year in our antepartum testing unit amniotic fluid index values performed at 3- to 4-day intervals were compared with follow-...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(96)70369-1
更新日期：1996-01-01 00:00:00
abstract：:The known effect of progesterone on carbohydrate metabolism prompted a study of some of the hepatic "lipogenic" and "gluconeogenic" enzymes in rats treated with progesterone. Several enzymes providing lipid precursors (phosphofructokinase, malic enzyme, glucose-6-phosphate dehydrogenase, and citrate cleavage enzyme) s...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0002-9378(77)90732-3
更新日期：1977-09-15 00:00:00
abstract：:To characterize the effects of aminophylline and nifedipine on pregnant human myometrium, in vitro contractility studies were performed on myometrial strips obtained at cesarean section. The strips were stimulated with oxytocin (800 mU/L) to simulate labor and then were exposed to increasing concentrations of aminophy...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(87)80373-3
更新日期：1987-07-01 00:00:00
abstract：:We report 2 cases of 47,XXX that were diagnosed prenatally and were screened positive for trisomy 21 by biochemical and ultrasound markers. These cases underline the importance of discussing the sex chromosome abnormalities during the genetic counseling after an abnormal triple screen test or ultrasound examination. ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/j.ajog.2004.12.037
更新日期：2005-05-01 00:00:00
abstract：OBJECTIVES:Smoking is associated with a reduced risk of preeclampsia, but what is the outcome of pregnancy when preeclampsia develops in women who smoke? STUDY DESIGN:Single births in Sweden from 1987 through 1993 to nulliparous women aged 15 to 34 years (N = 317,652) were included. Poisson regression analyses were us...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/s0002-9378(97)70455-1
更新日期：1997-07-01 00:00:00
abstract：OBJECTIVE:Our goal was to evaluate an antibiotic protocol for treatment of postcesarean endometritis. STUDY DESIGN:Endometritis was diagnosed as a persistent fever > or =100.4 degrees F beyond 24 hours after cesarean delivery and one or more of the following: uterine tenderness, tachycardia, foul lochia, or leukocytos...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章
doi：10.1067/mob.2000.103249
更新日期：2000-05-01 00:00:00
abstract：:Perimenopause represents a transition period lasting about 5 years before the permanent cessation of spontaneous menses. During this transition, the emphasis of clinical care changes. Although women still need effective contraception during perimenopause, issues including loss of bone mineral density, menstrual cycle ...
journal_title：American journal of obstetrics and gynecology
pub_type： 杂志文章,评审
doi：10.1067/mob.2001.116525
更新日期：2001-08-01 00:00:00
