Abstract:
OBJECTIVE:To compare midwife and obstetrician labor practices and birth outcomes in women with low-risk pregnancies delivered in the hospital. METHODS:We conducted a retrospective cohort study of singleton births of 37 0/7-42 6/7 weeks of gestation at 11 hospitals between January 1, 2014, and December 31, 2018. Exclusions included intrapartum transfer from home-birth center, antepartum stillbirth, previous cesarean delivery, practitioner other than midwife or obstetrician, prelabor cesarean, prepregnancy maternal disease, and pregnancy complications or risk factors. Interventions (induction, artificial rupture of membranes, epidural, oxytocin, and episiotomy), mode of delivery, maternal outcomes (third- or fourth-degree laceration, postpartum hemorrhage, blood transfusion, and severe maternal morbidity), and newborn outcomes (shoulder dystocia, 5-minute Apgar score less than 7, resuscitation at delivery, birth trauma, and neonatal intensive care unit admission) were examined by practitioner type. We used modified Poisson regression models adjusted for individual confounders to assess risk ratios, stratified by parity, for health care provider type and perinatal outcomes. RESULTS:The study cohort comprised 23,100 births (3,816 midwife and 19,284 obstetrician). Compared with obstetricians, midwifery patients had significantly lower intervention rates, an approximately 30% lower risk of cesarean delivery in nulliparous patients (adjusted relative risk [aRR] 0.68; 95th% CI 0.57-0.82), and an approximately 40% lower risk of cesarean in multiparous patients (aRR 0.57; 95th% CI 0.36-0.89). Operative vaginal birth was also less common in nulliparous patients (aRR 0.73; 95th% CI 0.57-0.93) and multiparous patients (aRR 0.30; 95th% CI 0.14-0.63). Shoulder dystocia was more common in multiparous patients receiving midwifery care (aRR 1.42; 95th% CI 1.04-1.92). CONCLUSIONS:In low-risk pregnancies, midwifery care in labor was associated with decreased intervention, decreased cesarean and operative vaginal births, and, in multiparous women, an increased risk for shoulder dystocia. Greater integration of midwifery care into maternity services in the United States may reduce intervention in labor and potentially even cesarean delivery, in low-risk pregnancies. Larger research studies are needed to evaluate uncommon but important maternal and newborn outcomes.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Souter V,Nethery E,Kopas ML,Wurz H,Sitcov K,Caughey ABdoi
10.1097/AOG.0000000000003521subject
Has Abstractpub_date
2019-11-01 00:00:00pages
1056-1065issue
5eissn
0029-7844issn
1873-233Xjournal_volume
134pub_type
杂志文章abstract:OBJECTIVE:To evaluate whether peptides given to adult mice with Down syndrome prevent learning deficits, and to delineate the mechanisms behind the protective effect. METHODS:Ts65Dn mice were treated for 9 days with peptides D-NAPVSIPQ (NAP)+D-SALLRSIPA (SAL) or placebo, and wild-type animals were treated with placebo...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182051ca5
更新日期:2011-02-01 00:00:00
abstract::The healing of a midfibular fracture was studied in mature rats. The strength of the healing fracture was determined by a constant speed-driven tensiometer which measured the force required to separate the healing callus. The breaking strength of the healing experimental fracture was ascertained in control, estrogen-t...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1976-09-01 00:00:00
abstract:OBJECTIVE:Neonatal alloimmune thrombocytopenia is caused by platelet antigen incompatibility between the mother and fetus. Affected fetuses may have severe thrombocytopenia leading to intracranial hemorrhage before or at birth. We sought to treat this condition in utero to prevent these hemorrhages. METHODS:Eighteen w...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVE:To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the United States. METHODS:We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,0...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001982
更新日期:2017-05-01 00:00:00
abstract::This month, we focus on current research in preterm birth prevention. Dr. Andrews discusses recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts. ...
journal_title:Obstetrics and gynecology
pub_type: 评论,杂志文章
doi:10.1097/AOG.0b013e31829e41fc
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To characterize the use of venous thromboembolism prophylaxis during antepartum and postpartum hospitalizations in the United States. METHODS:A retrospective cohort study using the Perspective database was performed to analyze temporal trends of mechanical and pharmacologic venous thromboembolism prophylaxis...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002099
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:Preeclampsia often complicates pregnancies after maternal kidney transplantation. We aimed to assess whether preeclampsia is associated with kidney function decline either during the pregnancy or in the long term. METHODS:We performed an international multicenter retrospective cohort study. Renal function at...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1097/AOG.0000000000002404
更新日期:2018-01-01 00:00:00
abstract::Reviewed are 37 patients with the diagnosis of uterine papillary serous carcinoma. Clinically, 19 patients presented as stage I, 9 as stage II, 1 as stage III, and 8 as stage IV. Four of 18 patients with clinical stage I disease who underwent surgery had pelvic metastases and five had disease spread beyond the pelvis....
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
abstract::Insulin-dependent diabetic women without adequate glucose control have a higher spontaneous abortion rate when compared with the general population. The present study examined whether the increased rate of spontaneous abortions in insulin-dependent diabetic women was associated with poor glycemic control in the early ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198609000-00015
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:To compare the efficacy and acceptability of same-day misoprostol and overnight laminaria for cervical ripening before early second-trimester surgical abortion. METHODS:We performed a randomized, double-blinded, controlled trial comparing 400 microg of vaginal misoprostol, given 3-4 hours preoperatively, wit...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.AOG.0000168629.17326.00
更新日期:2005-08-01 00:00:00
abstract::A pregnant patient with Eisenmenger's syndrome is reported. The hemodynamic data gathered during this pregnancy suggest that decreased peripheral vascular resistance and reflex bradycardia secondary to postural changes could be of extreme importance in contributing to the extremely high maternal mortality. Suggestions...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1977-07-01 00:00:00
abstract:OBJECTIVE:To determine trends in the clinicopathology of vulvar squamous cell carcinoma over the past 2 decades, with particular reference to the possible effects of the increasing incidence of vulvar intraepithelial neoplasia (VIN) during this time. METHODS:Two cohorts of 56 and 57 women with squamous cell carcinoma ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(97)00298-6
更新日期:1997-09-01 00:00:00
abstract::We report the first known case of Chediak-Higashi syndrome in human pregnancy. This rare autosomal recessive disorder is characterized by partial oculocutaneous albinism, decreased leukocyte chemotaxis, susceptibility to infection, and death in childhood. Pathognomonic giant cytoplasmic granules are postulated to be d...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-05-01 00:00:00
abstract::A randomized prospective study compared the efficacy of a three-dose perioperative course of intravenously administered cefuroxime and metronidazole versus suction drainage of the vaginal vault for preventing postoperative infection in abdominal and vaginal hysterectomies. In vaginally operated patients, a significant...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1987-09-01 00:00:00
abstract::Sacral nerve stimulation delivers nonpainful electrical pulses to the sacral nerves that modulate the reflexes that control the bladder, bowels, and pelvic floor musculature. This relatively simple procedure was generated to improve and restore function in patients with a variety of pelvic floor disorders. Currently t...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0000000000002968
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To examine the effect of prenatal care with and without drug rehabilitation on perinatal outcome in cocaine-using women. METHODS:Cocaine-exposed pregnancies of 905 human immunodeficiency virus (HIV)-negative women were frequency matched (ratio 6:1) and compared with 150 nonusers. Cocaine subgroups consisted ...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/s0029-7844(98)00202-6
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the usefulness of routine screening for other associated autoimmune endocrine disorders in patients with karyotypically normal spontaneous premature ovarian failure. METHODS:One hundred nineteen women with karyotypically normal spontaneous premature ovarian failure (FSH exceeding 40 mIU/mL) who d...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(97)00077-x
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To determine whether the risk for uterine rupture is increased in women attempting vaginal birth after multiple cesarean deliveries. METHODS:We conducted a prospective multicenter observational study of women with prior cesarean delivery undergoing trial of labor and elective repeat operation. Maternal and p...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1097/01.AOG.0000224694.32531.f3
更新日期:2006-07-01 00:00:00
abstract::Ten cases of malignant tumors arising in foci of gonadal and extragonadal endometriosis are reported and added to 195 previously reported cases from the English literature. The ovary was the primary site in 165 (78.7%) of the cases, whereas extragonadal sites represented 44 (21.3%). Endometrioid adenocarcinomas accoun...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:
更新日期:1990-06-01 00:00:00
abstract:OBJECTIVE:To describe the prevalence of urinary incontinence during exercise in women, estimate whether exercise intensity is related to leakage severity, and report women's assessments of incontinence as a barrier to exercise. METHODS:Questionnaires were mailed to 5,130 women aged 18-60 years drawn from National Fami...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000168455.39156.0f
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Although most patients with a surgical stage I endometrial cancer have an excellent prognosis, some patients will experience a recurrence. Endometrial cancer typically recurs at the vaginal cuff or in the pelvis; however, it can recur distantly in the abdomen or lung. Although recurrences have been reported ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000123268.57857.0d
更新日期:2004-11-01 00:00:00
abstract::The analgesic properties and motor effect of epidural 0.25% bupivacaine (8 mL) were compared with those of epidural morphine (2 mg in 10 mL saline) followed by 8 mL of 0.25% bupivacaine. The study was performed on two groups of parturients (30 in each group) in active labor. Pain relief in the morphine-bupivacaine gro...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198602000-00009
更新日期:1986-02-01 00:00:00
abstract::Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive th...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1097/AOG.0000000000002019
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:To investigate whether prepregnancy obesity is associated with adverse pregnancy outcomes among women without chronic disease. METHODS:Singleton deliveries (N=112,309) among mothers without chronic diseases in the Consortium on Safe Labor, a retrospective U.S. cohort, were analyzed using Poisson regression w...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001465
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:Goodpasture syndrome, an immunologic disorder characterized by glomerulonephritis and pulmonary hemorrhage, rarely presents in pregnancy. CASE:We describe a patient who was diagnosed with Goodpasture syndrome in her second trimester. She required daily hemodialysis, intermittent plasmapheresis, and immunosu...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000161061.35611.98
更新日期:2005-11-01 00:00:00
abstract::This study reviews 27 patients with positive OCTs who were subsequently allowed a trial of directly monitored labor. Of these, 19 patients (70%) developed FHR signs of fetal distress and 8 (30%) tolerated labor without late decelerations. These patients were evaluated for signs of fetal reactivity (acceleration of the...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1977-12-01 00:00:00
abstract:OBJECTIVE:Case reports of suspected adverse pregnancy outcomes associated with prenatal exposure to angiotensin-converting enzyme inhibitors, particularly oligohydramnios, prolonged neonatal anuria, and defects of ossification of the skull dome, prompted us to examine pregnancy outcome in a large cohort of pregnant wom...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-09-01 00:00:00
abstract:BACKGROUND:A spontaneous fall in the radioimmunoassay for the beta subunit of hCG to less than 2 mIU/mL documents regression of hydatidiform mole following evacuation of a molar pregnancy. Continued negative hCG levels for the year after evacuation indicates the absence of risk for persistent gestational trophoblastic ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVE:To assess outcomes and costs associated with around-the-clock point-of-care intrapartum group B streptococcus (GBS) polymerase chain reaction (PCR) screening. METHODS:Intrapartum PCR screening was implemented in 2010. Intrapartum PCR was compared with antenatal culture screening in an uncontrolled, single in...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1097/AOG.0000000000003057
更新日期:2019-02-01 00:00:00
abstract::The hospital-based alternative birth room has become a popular alternative to the conventional labor and delivery room setting. Responses to a mailed questionnaire from 78 of 82 (95%) Washington State hospitals with obstetric services were used to relate available birth options to alternative birth room status and obs...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-11-01 00:00:00