Potential Effects of Regionalized Maternity Care on U.S. Hospitals.


OBJECTIVE:To examine the current patterns of care for women at high risk for delivery-related morbidity to inform discussions about the feasibility of this regionalized approach. METHODS:We performed a cross-sectional study and linked 2014 American Hospital Association survey and State Inpatient Database data from seven representative states. We used American Hospital Association-reported hospital characteristics and State Inpatient Database procedure codes to assign a level of maternal care to each hospital. We then assigned each patient to a minimum required level of maternal care (I-IV) based on maternal comorbidities captured in the State Inpatient Database. Our outcome was delivery at a hospital with an inappropriately low level of maternal care. Comorbidities associated with delivery at an inappropriate hospital were assessed using descriptive statistics. RESULTS:The analysis included 845,545 deliveries occurring at 556 hospitals. The majority of women had risk factors appropriate for delivery at level I or II hospitals (85.1% and 12.6%, respectively). A small fraction (2.4%) of women at high risk for maternal morbidity warranted delivery in level III or IV hospitals. The majority (97.6%) of women delivered at a hospital with an appropriate level of maternal care, with only 2.4% of women delivering at a hospital with an inappropriate level of maternal care. However, 43.4% of the 19,988 high-risk patients warranting delivery at level III or IV hospitals delivered at level I or II hospitals. Women with comorbidities likely to benefit from specialized care (eg, maternal cardiac disease, placenta previa with prior uterine surgery) had high rates of delivery at hospitals with an inappropriate level of maternal care (68.2% and 37.7%, respectively). CONCLUSION:Though only 2.41% of deliveries occurred at hospitals with an inappropriate level of maternal care, a substantial fraction of women at risk for maternal morbidity delivered at hospitals potentially unequipped with resources to manage their needs. Promoting triage of high-risk patients to hospitals optimized to provide risk-appropriate care may improve maternal outcomes with minimal effect on most deliveries.


Obstet Gynecol


Easter SR,Robinson JN,Menard MK,Creanga AA,Xu X,Little SE,Bateman BT




Has Abstract


2019-09-01 00:00:00














  • Treatment of stress urinary incontinence due to paravaginal fascial defect.

    abstract::This study supports the thesis that the physical findings of pelvic relaxation, such as cystourethrocele, are the results of isolated defects in the pelvic fascia rather than the results of generalized stretching or attenuation of the supporting structures. The most frequently encountered defect resulting in cystouret...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Richardson AC,Edmonds PB,Williams NL

    更新日期:1981-03-01 00:00:00

  • Experimental hyperprolactinemia and hypoprolactinemia and human chorionic gonadotropin during early pregnancy.

    abstract::The effect of experimental hyperprolactinemia and hypoprolactinemia on human chorionic gonadotropin (hCG) concentration was studied in 34 healthy volunteers between weeks 6 and 11 of normal pregnancy. Hyperprolactinemia was induced in 12 women with 150 mg of sulpiride daily for 2 weeks; treatment led to a mean plasma ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Viinikka L,Kivinen S,Rönnberg L,Ylikorkala O

    更新日期:1981-04-01 00:00:00

  • Sterilization.

    abstract::Worldwide, sterilization (tubal sterilization and vasectomy) is used by more people than any other method of contraception. All techniques of tubal sterilization in widespread use in the United States have low risks of surgical complications. Although tubal sterilization is highly effective, the risk of pregnancy vari...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审


    authors: Peterson HB

    更新日期:2008-01-01 00:00:00

  • Amniotic fluid alpha-fetoprotein as a marker in prenatal diagnosis of neural tube defects.

    abstract::The prenatal diagnosis of anencephaly and spina bifida (neural tube defect, NTD) through amniotic fluid analysis for alpha-fetoprotein (AFP) is gradually gaining clinical recognition. AFP concentrations were determined in 237 amniotic fluids from normal pregnancies ranging between 7 and 42 weeks of gestation. A steady...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Weiss RR,Macri JN,Elligers K,Princler GL,McIntire R,Waldman TA

    更新日期:1976-02-01 00:00:00

  • Repeat measurement of cervical length after successful tocolysis.

    abstract:OBJECTIVE:To measure the ultrasonographic cervical length in undelivered women after successful tocolysis for preterm labor, and to determine whether this could improve the predictive value of cervical length measured before initiation of tocolysis on the risk of preterm delivery. METHODS:This was a prospective study ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Rozenberg P,Rudant J,Chevret S,Boulogne AI,Ville Y

    更新日期:2004-11-01 00:00:00

  • Antenatal treatment of alloimmune thrombocytopenia.

    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


    authors: Lynch L,Bussel JB,McFarland JG,Chitkara U,Berkowitz RL

    更新日期:1992-07-01 00:00:00

  • Prenatal Testing in the Genomic Age: Clinical Outcomes, Quality of Life, and Costs.

    abstract:OBJECTIVE:To use a decision-analytic model to assess a comprehensive set of outcomes of prenatal genetic testing strategies among women of varying ages. METHODS:We assessed outcomes of six testing strategies incorporating diagnostic testing with chromosomal microarray, multiple marker screening, cell-free DNA screenin...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Kaimal AJ,Norton ME,Kuppermann M

    更新日期:2015-10-01 00:00:00

  • Antepartum Testing for the Prevention of Stillbirth: Where Do We Go From Here?

    abstract::Unexpected antepartum fetal demise remains one of the most tragic complications of pregnancy. Various approaches to antepartum fetal assessment have been developed as a means of either reassuring the clinician of fetal well-being or identifying potential fetal jeopardy and the need for delivery. As additional high-ris...

    journal_title:Obstetrics and gynecology

    pub_type: 社论


    authors: Johnson GJ,Clark SL,Turrentine MA

    更新日期:2018-12-01 00:00:00

  • Bilateral metastatic inflammatory carcinoma in the breast from primary ovarian cancer.

    abstract::A case of ovarian carcinoma with bilateral metastases to the breasts is presented. This is the first report of simultaneous involvement of both breasts presenting as an inflammatory tumor. Axillary lymph node enlargement preceded breast involvement. The related literature is reviewed briefly, and the unpredictable inv...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Krishnan EU,Phillips AK,Randell A,Taylor B,Garg SK

    更新日期:1980-03-01 00:00:00

  • The effect of angiotensin II and indomethacin on uterine artery blood flow in pregnant monkeys.

    abstract::In experiments performed in anesthetized monkeys in the third trimester of pregnancy, mean maternal arterial blood pressure was continuously monitored, the uterine artery blood flow was measured with an electromagnetic flow probe, and prostaglandin levels were assayed in the uterine venous effluent. After inhibition o...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Speroff L,Haning RV Jr,Levin RM

    更新日期:1977-11-01 00:00:00

  • Clear cell adenocarcinoma arising in endometriosis of a previous episiotomy site.

    abstract:BACKGROUND:Malignant transformation of endometriosis in an episiotomy site is rare. CASE:A 42-year-old woman presented with a palpable mass, 2.5 cm in size, just inside the posterior commissure of the vagina, at the site of a previous episiotomy for a vaginal delivery. Three years previously, an endometriotic cyst had...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Kwon YS,Nam JH,Choi G

    更新日期:2008-08-01 00:00:00

  • Gestational age-dependent reference values for pH in umbilical cord arterial blood at term.

    abstract:OBJECTIVE:Despite a change of fetal physiologic and biochemical functions with gestational age, stationary umbilical cord acid-base reference values are used as measures of obstetric care quality. The aim of this study was to assess the risk of low Apgar score relative to low pH when using stationary versus gestational...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Kitlinski ML,Källén K,Marsál K,Olofsson P

    更新日期:2003-08-01 00:00:00

  • Effects of the thromboxane-receptor antagonists AH 23848 and BM 13.177 on human uteroplacental arteries.

    abstract:OBJECTIVE:We studied the effects of the thromboxane (Tx)A2-receptor antagonists AH 23848 and BM 13.177 in small isolated human uteroplacental arteries. METHODS:Fetal stem villous arteries and maternal intramyometrial arteries were dissected from placental specimens and from myometrial biopsies obtained at cesarean or ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Svane D,Skajaa K,Andersson KE,Forman A

    更新日期:1992-08-01 00:00:00

  • Lack of patient preparation for the postpartum period and patients' satisfaction with their obstetric clinicians.

    abstract:OBJECTIVE:To assess whether lack of patient preparation for common physical and emotional postpartum symptoms is associated with patient satisfaction with obstetric clinicians. METHODS:We conducted a telephone survey of 724 postpartum women. Women were interviewed 2 weeks postpartum to assess self-perceived preparatio...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Howell EA

    更新日期:2010-02-01 00:00:00

  • Using middle cerebral artery peak systolic velocity to time in utero transfusions in fetomaternal hemorrhage.

    abstract:BACKGROUND:Fetomaternal hemorrhage is a rare cause of fetal anemia and hydrops fetalis. Early and severe fetomaternal hemorrhage may benefit from in utero transfusion(s); however, hemorrhage rate is unpredictable, and reliable criteria are needed to identify recurrent anemia. CASE:Fetal hydrops due to massive fetomate...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Friszer S,Cortey A,Pierre F,Carbonne B

    更新日期:2010-05-01 00:00:00

  • Delayed hemorrhage of a persistent ectopic pregnancy following laparoscopic salpingostomy and methotrexate therapy.

    abstract::This report describes the first known case of delayed hemorrhage of a persistent ectopic pregnancy following surgical and medical therapy. A 2.5-cm ampullary pregnancy without cardiac activity was removed by laparoscopic salpingostomy. The serum beta-hCG level before laparoscopy was 1542 mIU/mL, increasing to 3163 mIU...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Dumesic DA,Hafez GR

    更新日期:1991-11-01 00:00:00

  • Fertility sparing treatment for in situ and early invasive adenocarcinoma of the cervix.

    abstract:OBJECTIVE:To explore the outcome and long-term follow-up of fertility sparing surgery for cervical adenocarcinoma in situ and early invasive adenocarcinoma. METHODS:Between 1985 and 1996, all women with adenocarcinoma in situ (AIS) and stage I adenocarcinoma were identified. Data were abstracted from clinical records ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: McHale MT,Le TD,Burger RA,Gu M,Rutgers JL,Monk BJ

    更新日期:2001-11-01 00:00:00

  • The natural history of theca lutein cysts.

    abstract::The histories of 386 patients with untreated hydatidiform mole were reviewed to define the clinical aspects of accompanying theca lutein cysts. These cysts occurred in 102 patients (26.4%), with three patients experiencing cyst-related complications. Mean cyst size at diagnosis was 7.3 cm (3-20 cm), and did not correl...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Montz FJ,Schlaerth JB,Morrow CP

    更新日期:1988-08-01 00:00:00

  • Alternating weekly chemotherapy with etoposide-methotrexate-dactinomycin/cyclophosphamide-vincristine for high-risk gestational trophoblastic disease.

    abstract:OBJECTIVE:To evaluate the response rate and toxicity of alternating weekly therapy with etoposide-methotrexate-dactinomycin/cyclophosphamide-vincristine for women with high-risk gestational trophoblastic disease. METHODS:Twenty-two women with gestational trophoblastic disease received 126 cycles of the study regimen. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Soper JT,Evans AC,Clarke-Pearson DL,Berchuck A,Rodriguez G,Hammond CB

    更新日期:1994-01-01 00:00:00

  • Transurethral bladder eversion concurrent with uterovaginal prolapse.

    abstract:BACKGROUND:Transurethral bladder eversion is rare. A case of transurethral bladder eversion with concurrent uterovaginal prolapse is presented. CASE:The patient was postmenopausal, had a long history of uterovaginal prolapse, and developed bladder eversion. Examination under anesthesia revealed full-thickness transure...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Mastropietro MA,Clark MH,Hale DS

    更新日期:2002-05-01 00:00:00

  • The mechanism of reduced antithrombin III activity in women with preeclampsia.

    abstract::The cause(s) of the low plasma antithrombin III activity in women with preeclampsia is unknown. The purpose of this study was to evaluate the relationship between plasma antithrombin III activity and both clotting parameters (platelet count and fibrinopeptide A) and renal parameters (serum creatinine and uric acid con...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Weiner CP

    更新日期:1988-12-01 00:00:00

  • Extent of surgery for pelvic inflammatory disease in relation to duration of intrauterine device use.

    abstract::The risk of a first episode of pelvic inflammatory disease resulting in extensive surgery was examined in relation to duration of intrauterine device (IUD) use in a case-control study. Extensive surgery for pelvic inflammatory disease was defined as hysterectomy or bilateral adenexal surgery, with pelvic inflammatory ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Stadel BV,Schlesselman S

    更新日期:1984-02-01 00:00:00

  • Chronic pelvic pain and previous sexual abuse.

    abstract:OBJECTIVE:To determine whether there is an association between history of sexual abuse and development of chronic pelvic pain. METHODS:We studied 36 women with chronic pelvic pain, 23 with chronic low back pain, and 20 healthy women with reference to experience of sexual abuse, physical violence, and emotional neglect...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Lampe A,Sölder E,Ennemoser A,Schubert C,Rumpold G,Söllner W

    更新日期:2000-12-01 00:00:00

  • Spontaneous pneumothorax in pregnancy: a case report and review of the literature.

    abstract::A 19-year-old primigravida at term presented with bilateral, spontaneous pneumothorax. The maternal and infant outcomes were successful. The impact on pregnancy is discussed, and suggestions are made for obstetric management. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Farrell SJ

    更新日期:1983-09-01 00:00:00

  • The reliability and predictive value of an amniotic fluid scoring system in severe second-trimester oligohydramnios.

    abstract::Sixty-two cases of oligohydramnios diagnosed by ultrasound between 13-28 weeks' gestation were reviewed. Three experienced ultrasonographers used a subjective scale to rate the oligohydramnios as mild, moderate, severe, or anhydramniotic. Interobserver reliability was excellent (intraclass correlation coefficient 0.81...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Moore TR,Longo J,Leopold GR,Casola G,Gosink BB

    更新日期:1989-05-01 00:00:00

  • Placental insufficiency is characterized by platelet activation in the fetus.

    abstract:OBJECTIVE:To investigate whether activation of circulating platelets was present in the fetal and maternal circulation in cases with vascular disease in the fetal-umbilical-placental circulation as identified by umbilical artery Doppler study. METHODS:We studied 20 mother-fetus pairs with an abnormal umbilical artery ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Trudinger B,Song JZ,Wu ZH,Wang J

    更新日期:2003-05-01 00:00:00

  • Efficacy, safety, and tolerability of a monophasic oral contraceptive containing nomegestrol acetate and 17β-estradiol: a randomized controlled trial.

    abstract:OBJECTIVE:To estimate the efficacy, cycle control, tolerability, and safety of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-estradiol (E2) in comparison with drospirenone and ethinyl E2. METHODS:In a randomized, open-label, comparative multicenter trial, healthy women (n=2,281; age 1...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Westhoff C,Kaunitz AM,Korver T,Sommer W,Bahamondes L,Darney P,Verhoeven C

    更新日期:2012-05-01 00:00:00

  • Ectopic pregnancy risk with assisted reproductive technology procedures.

    abstract:OBJECTIVE:To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. METHODS:The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient an...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Clayton HB,Schieve LA,Peterson HB,Jamieson DJ,Reynolds MA,Wright VC

    更新日期:2006-03-01 00:00:00

  • Computed tomographic pelvimetry in the evaluation of breech presentation.

    abstract::The purpose of this investigation was to assess computed tomographic (CT) pelvimetry in the evaluation of breech presentation for trial of labor. Thirty-two patients with singleton term breech deliveries formed the study group. Seventeen of the 32 (53.1%) patients fulfilled the criteria for attempted vaginal delivery....

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Kopelman JN,Duff P,Karl RT,Schipul AH,Read JA

    更新日期:1986-10-01 00:00:00

  • Death from pseudomembranous enterocolitis.

    abstract::During the past 2 years at the Los Angeles County-University of Southern California Medical Center (LAC-USC), there have been 2 deaths from pseudomembranous enterocolitis. Each of these deaths occurred postoperatively in previously healthy women who received pronlonged antibiotic prophylasix. The implications of these...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Ledger WJ,Puttler OL

    更新日期:1975-06-01 00:00:00