Abstract:
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.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Easter SR,Robinson JN,Menard MK,Creanga AA,Xu X,Little SE,Bateman BTdoi
10.1097/AOG.0000000000003397subject
Has Abstractpub_date
2019-09-01 00:00:00pages
545-552issue
3eissn
0029-7844issn
1873-233Xpii
00006250-201909000-00016journal_volume
134pub_type
杂志文章abstract::Newborn screening is the largest genetic screening program in the United States, with approximately 4 million infants screened annually. Newborn screening is a mandatory state-based public health program that provides all newborns in the United States with testing and necessary follow-up health care for a variety of m...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1097/AOG.0000000000003246
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To examine whether there are: 1) regional differences in three perinatal interventions that reflect active treatment among periviable gestations and 2) racial-ethnic differences in the receipt of these perinatal interventions after accounting for hospital region. METHODS:We conducted a retrospective study on...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003747
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:To identify potential predictors for treatment success in medical management with misoprostol for early pregnancy failure. METHODS:We conducted a planned secondary analysis of data from a multicenter trial that compared medical and surgical management of early pregnancy failure. Medical management consisted ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/01.AOG.0000206737.68709.3e
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND:The effect of gonadotropin-releasing hormone agonist (GnRHa) on uterine arteriovenous malformations (AVM) is not well known. CASE:A 37-year-old woman with a previous cesarean was diagnosed as having a uterine AVM after a spontaneous abortion with massive vaginal bleeding. The AVM decreased in size from 5.1 ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000191584.28717.2c
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVE:To examine cigarette smoking as a risk factor for different types of epithelial ovarian cancer. METHODS:We used data from the Cancer and Steroid Hormone Study, a multicenter, population-based, case control investigation. Cases were 447 women aged 20-54 years with diagnoses of epithelial ovarian cancer. Contr...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/s0029-7844(99)00531-1
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:Patient-prosthesis mismatch is a known and severe complication after aortic valve repair in the general population. There is a paucity of literature regarding this condition in pregnancy. CASE:We present the clinical course of a pregnant woman with severe patient-prosthesis mismatch after aortic valve repla...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000074
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVES:To compare patient satisfaction and exclusive breastfeeding rates for patients discharged from the hospital on postcesarean day 1 (next day) or day 2. METHODS:Healthy women admitted for planned cesarean delivery were randomized to day 1 or day 2 discharge. Postoperative assessment for suitability for discha...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1097/aog.0b013e3182723a95
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:Our objective was to estimate whether a transvaginal endometrial stripe of less than 5 mm in premenopausal women would exclude endometrial polyps and intracavitary leiomyomata, thereby eliminating the need for sonohysterography. METHODS:Data from 206 consecutive sonohysterograms performed in premenopausal wo...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000130065.49187.c8
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals. METHODS:Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multiv...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182a91e0f
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To assess the risk of adverse obstetric, perinatal, and fetal outcomes for pregnant women participating in prenatal sequential integrated screening through the California Prenatal Screening Program who had a false-positive screening result. METHODS:Women who underwent first- and second-trimester prenatal int...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000145
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:Erythrasma is an uncommon vulvar infection, best diagnosed by its fluorescence under the Wood lamp. This report shows that despite a negative Wood lamp examination, the diagnosis can be made histologically. CASE:A 42-year-old woman was referred to our clinic with a persistent candidal infection. Evaluation ...
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 measure the serum levels of interleukin (IL)-8, prostaglandin (PG) F2alpha, and beta-endorphin in parturients with acupuncture treatment and in controls to clarify the effect of acupuncture and duration of labor on the serum levels of substances active in cervical ripening and dilatation. METHODS:A matche...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/s0029-7844(98)00200-2
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:To describe the relations between body mass index (BMI; kg/m(2)), weight gain, and incident urinary incontinence in middle-aged women. METHODS:This was a prospective study in the Nurses' Health Study II. Participants reported their weight at age 18 years, and current weight and height in 1989; weight was upd...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000270121.15510.57
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:To determine whether gravidas with prior low vertical uterine incision(s) are at a higher risk for uterine rupture during a trial of labor after cesarean delivery than women with prior low transverse uterine incision(s). METHODS:The medical records of women undergoing a trial of labor after prior cesarean de...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(99)00398-1
更新日期:1999-11-01 00:00:00
abstract::Endometriotic ureteral obstruction is a serious event commonly diagnosed late and therefore associated with a major risk of hydronephrotic renal atrophy. The standard therapy is surgical. However, medical treatment has been reported using danazol, progestins, and estrogen-progestin combinations, although solid documen...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of hysteroscopic sterilization reversal by assessing pregnancy rates and identifying surgical complications. METHODS:All patients at a single center undergoing elective reversal of hysteroscopic sterilization for fertility were followed from January 2009 to May 2014. Eligible pa...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000543
更新日期:2014-12-01 00:00:00
abstract::Reported are 172 patients considered for external cephalic version at gestational age greater than 37 weeks. Their outcome was compared with 40 similar patients in whom external version was not attempted. One hundred fifty-eight patients had attempted version, and success was achieved in 122 (77%). Intrapartum vertex ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::A case of human fetal renal maldevelopment following the administration of nitrogen mustard, vincristine, procarbazine, and prednisone in early pregnancy for therapy of Hodgkin's disease is reported. While these agents have been shown to be teratogenic in animal experiments, adverse fetal effects following their use d...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1975-08-01 00:00:00
abstract:OBJECTIVE:To assess the value of the fetal nonstress test (NST) in predicting neonatal transfusion in pregnancies complicated by red cell isoimmunization. METHODS:We retrospectively reviewed the records of all patients evaluated for isoimmunization in pregnancy for the period January 1992 to December 1994. In addition...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(96)00180-9
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of orally administered nifedipine and intravenously administered labetalol for acute blood pressure control in hypertensive emergency of pregnancy. METHODS:In this double-blind, randomized, controlled trial, pregnant women with sustained increase in systolic blood pressure of 160...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1097/AOG.0b013e3182a9ea68
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To describe obstetric health care providers' responses and counseling approaches to patients' disclosures of marijuana use during first prenatal visits. METHODS:We performed a content analysis of audio-recorded patient-health care provider first prenatal visits for obstetrics health care providers' responses...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001343
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:To characterize the use of cervical cerclage on a population basis. METHODS:This population-based study of U.S. natality records from 2005 to 2012 evaluated use of cerclage in singleton and multiple gestation live births. Obstetric, medical, and demographic characteristics were evaluated. A multivariable log...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000930
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:To compare the patterns of perioperative blood transfusion in patients undergoing radical hysterectomy in time periods before and after the discovery of transfusion-related human immunodeficiency virus (HIV) infection. METHODS:We reviewed the medical records of all patients who underwent radical hysterectomy...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
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. Exclus...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003521
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Monoamniotic twin pregnancies are frequently associated with cord entanglement, but such entanglement rarely involves the co-twin's trunk, extremities, or neck. CASE:We report a set of monoamniotic twins in which color Doppler imaging revealed that the cord of twin B was wrapped around the neck of its dead ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-10-01 00:00:00
abstract::The early detection of preterm labor and the prevention of preterm birth require special attention to early subtle signs and symptoms of preterm labor. The concept of "Braxton Hicks contractions" may negate these early signs and symptoms by falsely reassuring patients, thus encouraging them not to seek medical care pr...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVE:To determine the safety, tolerability, and efficacy of combination gefitinib and methotrexate to treat ectopic pregnancy. METHODS:We performed a phase I, single-arm (nonrandomized), open-label study. Twelve women with ectopic pregnancies were administered methotrexate (50 mg/m, intramuscular) and 250 mg oral...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182a14cfb
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To quantify the risk of residual invasion when cervical conization reveals microinvasive squamous carcinoma and to determine whether any factors affect this risk. METHODS:We reviewed the charts and histopathology slides of 87 women who underwent a conization that contained microinvasive squamous carcinoma, f...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(97)00414-6
更新日期:1997-11-01 00:00:00
abstract::Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debrie...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1097/01.AOG.0000444442.04111.c6
更新日期:2014-03-01 00:00:00
abstract::Both herpes simplex virus (HSV) type I and HSV type 2 can cause genital herpes. Because the infection is chronic, genital herpes has become the most common sexually transmitted disease among women. The prevalence of the HSV-2 antibody among women in the United States is 26%, although genital herpes has been diagnosed ...
journal_title:Obstetrics and gynecology
pub_type: 指南,杂志文章,实务指引
doi:
更新日期:2004-11-01 00:00:00