National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 54 Research Studies DisplayedPineles BL, Harris AD, Goodman KE
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
This study compared adverse maternal and delivery outcomes of pregnant 10- to 13-year-olds vs 14- to 17-year-olds and 18- to 19-year-olds. This cross-sectional study looked at all patients aged 10 to 19 years who delivered at hospitals in the Premier Healthcare Database from January 2019 through May 2021. The study included 90,876 deliveries across 655 US hospitals. Controlling for patient race and ethnicity, insurance type, and obesity status: 10- to 13-year-olds had significantly higher risks of preterm delivery and cesarean delivery compared with 14- to 17-year-olds. The risk of preeclampsia was not higher for 10- to 13-year-olds compared to 14- to 17-year-olds. There was a higher risk of preterm delivery for 10- to 13-year-olds compared to 18- to 19-year-olds, but not significantly different for cesarean delivery and preeclampsia.
AHRQ-funded; HS028363.
Citation: Pineles BL, Harris AD, Goodman KE .
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
JAMA 2022 Nov 1;328(17):1766-68. doi: 10.1001/jama.2022.18340..
Keywords: Children/Adolescents, Pregnancy, Labor and Delivery, Women, Outcomes, Adverse Events, Maternal Care
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Associations between state-level severe maternal morbidity and other perinatal indicators.
This study used the HCUP State Inpatient Databases (HCUP-SID) to determine the correlation between state-level severe maternal morbidity (SMM) rates and perinatal indicators. HCUP-SID was analyzed from 2017 to 2019 using revised code sets for 20 indicators excluding blood transfusions. Perinatal indicators used included prepregnancy hypertension, prepregnancy diabetes, prepregnancy obesity, low-risk cesarean delivery, preterm birth, infant mortality, and maternal mortality. HCUP-SID data for 10,542,942 maternal deliveries and 11,394,752 live births from the National Vital Statistics System (NVSS) were aggregated for state-level analysis. SMM rates were significantly correlated with 2 of the 7 perinatal indicators: prepregnancy hypertension and low-risk cesarean deliveries. All other perinatal indicators were significantly associated with at least 4 of 7 other indicators, and most correlations were higher in magnitude. Maternity mortality rates were highest in the southeast.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Associations between state-level severe maternal morbidity and other perinatal indicators.
JAMA Netw Open 2022 Jul;5(7):e2224621. doi: 10.1001/jamanetworkopen.2022.24621..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
Smith AJB, Zhou RA, Sites E
Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years.
This study’s objectives were to compare place of birth between 2020 and years before the COVID-19 pandemic and to investigate whether changes in place of birth differed between system-owned and independent hospitals and urban and rural regions in Oregon. Findings showed that, in Oregon, in-hospital births declined significantly during the first year of COVID-19 and affected system-owned hospitals more than independent ones. Further, shifts toward out-of-hospital births occurred in both urban and rural areas.
AHRQ-funded; HS024072.
Citation: Smith AJB, Zhou RA, Sites E .
Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years.
Am J Obstet Gynecol 2022 Jul;227(1):108-11. doi: 10.1016/j.ajog.2022.03.027..
Keywords: Labor and Delivery, Pregnancy, Women, COVID-19
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
This study evaluated national and state trends in severe maternal morbidity (SMM) rates from 2012 to 2019, and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. This repeated cross-sectional analysis examined delivery hospitalizations in the HCUP’s National Inpatient Sample and State Inpatient Databases. There were almost 6 million delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean maternal age of 28.6 years. SMM rates increased from 69.5 per 10,000 deliveries to 79.7 per 10,000 in 2019 without a significant change across the ICD-10-CM/PCS transition. OF 20 SMM indicators, rates for 10 indicators increased while 3 significantly decreased with 5 of those changes associated with the ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10,000 delivery hospitalizations, with no change associated with ICD transition. Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10,000, with a significant drop associated with ICD transition. State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and with varying associations with ICD transition.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
JAMA Netw Open 2022 Jul;5(7):e2222966. doi: 10.1001/jamanetworkopen.2022.22966..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
Dude AM, Schueler K, Schumm LP
Preconception care and severe maternal morbidity in the United States.
This study’s objective was to measure the association between preconception care and the odds of severe maternal morbidity among women with Medicaid using a secondary analysis of Medicaid claims using Medicaid Analytic Extract files. Findings showed that contraceptive services in the year before conception and routine exams for women with chronic disease were associated with decreased odds of severe maternal morbidity or death for Medicaid enrollees.
AHRQ-funded; HS027027.
Citation: Dude AM, Schueler K, Schumm LP .
Preconception care and severe maternal morbidity in the United States.
Am J Obstet Gynecol MFM 2022 Mar;4(2):100549. doi: 10.1016/j.ajogmf.2021.100549..
Keywords: Maternal Care, Pregnancy, Women, Labor and Delivery, Sexual Health
Lyndon A, Simpson KR, Spetz J
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
The purpose of this study was to confirm reliability and validity of the Perinatal Missed Care Survey in a large sample of nurses and hospitals, test construct validity with confirmatory factor analysis, and describe the prevalence of missed nursing care during labor and birth. The study found the survey to be a valid and reliable adaptation of the original MISSCARE instrument. This survey could potentially be used to measure nursing care quality and to assess the effectiveness of structural interventions to improve quality and safety.
AHRQ-funded; HS025715.
Citation: Lyndon A, Simpson KR, Spetz J .
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
Appl Nurs Res 2022 Feb;63:151516. doi: 10.1016/j.apnr.2021.151516..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women
Williams D, Stout MJ, Rosenbloom JI
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established. The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia. The investigators concluded that preeclampsia/eclampsia was an independent risk factor for future hospitalizations for HFpEF.
AHRQ-funded; HS019455.
Citation: Williams D, Stout MJ, Rosenbloom JI .
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
J Am Coll Cardiol 2021 Dec 7;78(23):2281-90. doi: 10.1016/j.jacc.2021.09.1360..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk, Labor and Delivery, Pregnancy, Women
Zochowski MK, Kolenic GE, Zivin K
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17.
AHRQ-funded; HS027640.
Citation: Zochowski MK, Kolenic GE, Zivin K .
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Health Aff 2021 Oct;40(10):1585-91. doi: 10.1377/hlthaff.2021.00780..
Keywords: Labor and Delivery, Pregnancy, Women, Anxiety
Calthorpe LM, Baer RJ, Chambers BD
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
This study’s objective was to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. The study sample was taken from a database of live-born neonates delivered in California, 2011-2017, and included all births to singleton infants between the gestational ages of 20 and 44 weeks. The findings indicate found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. These findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
AHRQ-funded; HS026383.
Citation: Calthorpe LM, Baer RJ, Chambers BD .
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
Am J Obstet Gynecol MFM 2021 Jul;3(4):100380. doi: 10.1016/j.ajogmf.2021.100380..
Keywords: Behavioral Health, Pregnancy, Women, Labor and Delivery, Risk
Wilson BL, Butler RJ
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. In this study the investigators examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing.
AHRQ-funded; HS024607.
Citation: Wilson BL, Butler RJ .
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Nurs Outlook 2021 Jan-Feb;69(1):84-95. doi: 10.1016/j.outlook.2020.07.003..
Keywords: Provider: Nurse, Provider, Workforce, Labor and Delivery, Pregnancy, Quality of Care, Risk, Women
Henke RM, Karaca Z, Gibson TB
Medicaid Accountable Care Organizations and childbirth outcomes.
This study examined the impact of Accountable Care Organizations (ACOs) to childbirth outcomes. States that use Medicaid ACOs were compared with states that had not adopted ACO. Using HCUP data, the relationship between Medicaid ACO adoption and neonatal and maternal outcomes, and cost per birth was examined. Medicaid ACO implementation was associated with a moderate reduction in hospital costs per birth and decreased cesarean section rates with results varying by state. There was no association with other birth outcomes, including infant inpatient mortality, low birthweight, neonatal intensive care unit utilization and severe maternal morbidity.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicaid Accountable Care Organizations and childbirth outcomes.
Med Care Res Rev 2020 Dec;77(6):559-73. doi: 10.1177/1077558718823132..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Health Insurance, Healthcare Costs, Labor and Delivery, Pregnancy, Women, Outcomes
Tilden EL, Phillippi JC, Carlson N
The association between longer durations of the latent phase of labor and subsequent perinatal processes and outcomes among midwifery patients.
The purpose of this study was to evaluate the association between the duration of the latent phase of labor and subsequent processes and outcomes. The investigators concluded that longer duration of the spontaneous latent phase of labor among women with low-risk pregnancies may signal longer total labor processes, leading to an increase in diagnosis of dystocia, interventions to manage dystocia, and epidural use. Apart from multiparous neonatal NICU admission, no other maternal or child morbidity outcomes were elevated with longer duration of the latent phase of labor.
AHRQ-funded; HS024733.
Citation: Tilden EL, Phillippi JC, Carlson N .
The association between longer durations of the latent phase of labor and subsequent perinatal processes and outcomes among midwifery patients.
Birth 2020 Dec;47(4):418-29. doi: 10.1111/birt.12494..
Keywords: Labor and Delivery, Pregnancy, Women, Outcomes
Leifheit KM, Schwartz GL, Pollack CE
Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.
This study measured the association of severe housing insecurity with adverse birth and infant outcomes. Data was analyzed from 3248 mother-infant dyads enrolled in the Fragile Families and Child Wellbeing Study. This prospective cohort study represented births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness. Adverse outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. There were statistically significant associations found between severe housing insecurity during pregnancy and low birth weight and/or preterm births. Housing insecurity and infant fair or poor health and poor temperament were not found to have statistically significant associations. Population attributable fraction (PAF) estimates suggested that up to 3% of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women.
AHRQ-funded; HS000046.
Citation: Leifheit KM, Schwartz GL, Pollack CE .
Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.
Int J Environ Res Public Health 2020 Nov 21;17(22):8659. doi: 10.3390/ijerph17228659..
Keywords: Pregnancy, Labor and Delivery, Vulnerable Populations, Outcomes, Adverse Events, Women, Low-Income, Newborns/Infants
Guglielminotti J, Li G
Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization.
This retrospective cohort study evaluated the risk of general anesthesia use in cesarean delivery versus neuraxial anesthesia on maternal mental health. Cesarean deliveries performed in New York State hospitals between 2006 and 2013 were included. Exclusion criteria included having more than 1 cesarean delivery during the study period, residing outside of New York State, and having a general anesthetic for other surgery or delivery in the year before or after the index case. The primary outcome looked at was severe postpartum depression (PPD), and secondary outcomes were suicidal ideation, anxiety disorders, and posttraumatic stress disorder (PTSD). The majority of cesareans used neuraxial anesthesia and only 8% (34,356) had general anesthesia. Severe PPD requiring hospitalization occurred in 1158 women with 60% identified during readmission. General anesthesia was found to be associated with a 54% increased odds of PPD, and a 91% increased odds of suicidal ideation or self-inflicted injury. There was insufficient evidence for increased risk of anxiety orders.
AHRQ-funded; HS025787.
Citation: Guglielminotti J, Li G .
Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization.
Anesth Analg 2020 Nov;131(5):1421-29. doi: 10.1213/ane.0000000000004663..
Keywords: Labor and Delivery, Pregnancy, Women, Depression, Behavioral Health, Surgery, Risk, Hospitalization, Medication, Adverse Drug Events (ADE), Adverse Events
Biel F, Darney B, Caughey A
Medical indications for primary cesarean delivery in women with and without disabilities.
The purpose of this study was to examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries. Findings showed that women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.
AHRQ-funded; HS022981.
Citation: Biel F, Darney B, Caughey A .
Medical indications for primary cesarean delivery in women with and without disabilities.
J Matern Fetal Neonatal Med 2020 Oct;33(20):3391-98. doi: 10.1080/14767058.2019.1572740..
Keywords: Labor and Delivery, Pregnancy, Disabilities, Women, Maternal Care
Simpson KR, Lyndon A, Spetz J
Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth.
The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. The investigators indicate that the results support exclusive breast milk feeding as a nurse-sensitive quality indicator.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Missed nursing care during labor and birth and exclusive breast milk feeding during hospitalization for childbirth.
MCN Am J Matern Child Nurs 2020 Sep/Oct;45(5):280-88. doi: 10.1097/nmc.0000000000000644..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Breast Feeding, Inpatient Care, Nursing, Women
Malhamé I, Mehta N, Raker CA
Identifying cardiovascular severe maternal morbidity in epidemiologic studies.
This study’s goal was to identify cases of cardiovascular severe maternal morbidity (CSMM) for use in epidemiologic studies. CSMM has become the leading cause of maternal mortality. The authors analyzed delivery hospitalizations at an obstetric teaching hospital from 2007 to 2017. A subset of indicators developed by the CDC based on ICD codes were utilized to form the composite variable for CSMM. Two expert clinicians manually reviewed all qualifying events using a standardized tool to determine if they were true CSMM events. They also estimated the number of CSMM cases among delivery hospitalizations without qualifying ICD codes by manually reviewing all severe preeclampsia cases and a random sample of 1000 hospitalizations without severe preeclampsia. Among 91,355 delivery admissions, they captured 113 potential CSMM cases. Of those 65 (57.5%) were true CSMM cases. Indicators for acute myocardial infarction, cardiac arrest, and cardioversion had 100% true-positive rates. An additional 70 CSMM cases in the 2102 admissions with severe preeclampsia were found.
AHRQ-funded; HS025013.
Citation: Malhamé I, Mehta N, Raker CA .
Identifying cardiovascular severe maternal morbidity in epidemiologic studies.
Paediatr Perinat Epidemiol 2020 Jul;34(4):452-59. doi: 10.1111/ppe.12571..
Keywords: Cardiovascular Conditions, Pregnancy, Women, Maternal Care, Labor and Delivery
Dombrowski M, Illuzzi JL, Reddy UM
Trial of labor after two prior cesarean deliveries: patient and hospital characteristics and birth outcomes.
This study’s goal was to examine utilization, success rate, and maternal and neonatal outcomes of trial of labor among women with two prior cesarean deliveries. Linked hospital discharge and birth certificate data were used for a retrospective analyses of a cohort of women in California with nonanomalous, term, singleton live births, two prior cesarean deliveries, and no clear contraindications for trial of labor. Findings showed that, among women with two prior cesarean deliveries, trial of labor was rarely attempted and was successful in 39.4% of attempts. Trial of labor in this population was associated with a modest increase in severe neonatal morbidity.
AHRQ-funded; HS023801.
Citation: Dombrowski M, Illuzzi JL, Reddy UM .
Trial of labor after two prior cesarean deliveries: patient and hospital characteristics and birth outcomes.
Obstet Gynecol 2020 Jul;136(1):109-17. doi: 10.1097/aog.0000000000003845.
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Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Outcomes
Danilack VA, Hutcheon Triche, EW EW
Development and validation of a risk prediction model for cesarean delivery after labor induction.
The goal of this study was to develop and validate a prediction model for cesarean delivery after labor induction that included factors known before the start of induction. The model contained eight variables, was well calibrated with good risk stratification at the extremes of predicted probability, and performed well on internal validation. The authors concluded that their prediction model can help providers estimate a woman's risk of cesarean delivery when planning a labor induction.
AHRQ-funded; HS025013.
Citation: Danilack VA, Hutcheon Triche, EW EW .
Development and validation of a risk prediction model for cesarean delivery after labor induction.
J Womens Health 2020 May;29(5):656-69. doi: 10.1089/jwh.2019.7822.
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Keywords: Labor and Delivery, Pregnancy, Women, Risk
Sherman JP, Hedli LC, Kristensen-Cabrera AI
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. In this study, the investigators employed design thinking methodology to understand how the design of labor and delivery units impacted safety and identified spaces and systems where improvements are needed.
AHRQ-funded; HS023506.
Citation: Sherman JP, Hedli LC, Kristensen-Cabrera AI .
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
Am J Perinatol 2020 May;37(6):638-46. doi: 10.1055/s-0039-1685494..
Keywords: Labor and Delivery, Pregnancy, Patient Safety, Maternal Care, Women, Newborns/Infants
Glazer KB, Danilack VA, Werner EF
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
This study’s goal was to quantify the extent to which overweight and obesity explain cesarean delivery rates among women of different racial and ethnic backgrounds. Administrative records were used from New York City for 216,481 singleton, nulliparous births from 2008 to 2013. Risk ratios, risk differences, and population attributable fractions for associations between body mass index and cesarean, stratified by race and ethnicity was calculated. Black and Hispanic women had the highest cesarean rates attributable to obesity and overweight (17.4% and 14.6%) respectively.
AHRQ-funded; HS025013.
Citation: Glazer KB, Danilack VA, Werner EF .
Elucidating the role of overweight and obesity in racial and ethnic disparities in cesarean delivery risk.
Ann Epidemiol 2020 Feb;42:4-11.e4. doi: 10.1016/j.annepidem.2019.12.012.
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Keywords: Disparities, Racial and Ethnic Minorities, Pregnancy, Labor and Delivery, Risk, Obesity, Women
Guglielminotti J, Rosenberg H, Li G
Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014.
The goal of this study was to assess the prevalence of malignant hyperthermia (MH) diagnosis and associated factors in obstetric patients. Using data from the Nationwide Inpatient Sample, results showed that the prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified.
AHRQ-funded; HS025787.
Citation: Guglielminotti J, Rosenberg H, Li G .
Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014.
BMC Anesthesiol 2020 Jan 20;20(1):19. doi: 10.1186/s12871-020-0934-0..
Keywords: Healthcare Cost and Utilization Project (HCUP), Pregnancy, Maternal Care, Women, Diagnostic Safety and Quality, Labor and Delivery
Rosenbloom JI, Lewkowitz AK, Lindley KJ
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
The purpose of this study was to test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery. The investigators concluded that prolonged expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiac disease in the ensuing years.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Lewkowitz AK, Lindley KJ .
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
Obstet Gynecol 2020 Jan;135(1):27-35. doi: 10.1097/aog.0000000000003567..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Labor and Delivery, Risk, Women
Lundsberg LS, Main EK, Lee HC
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
This study compared hospitals in California with low and high-interventional practices for labor and delivery. A total of 185 California hospitals completed a survey of intrapartum care, including questions on low- versus high-interventional practices. They identified 2 distinct groups of hospitals that tended to use low- or high-interventional practices. Hospitals that used low-interventional practices tended to have midwife-led or physician-midwife collaborative labor management or were in rural locations. High-interventional practice hospitals had a higher proportion of women covered by Medicaid or other safety-net programs as well as hospitals located in counties with higher liability insurance premiums. Both sets of hospitals had comparable morbidity rates but low-intervention hospitals had lower rates of cesarean birth and episiotomies. Only one-quarter of hospitals were found to use low-interventional practices.
AHRQ-funded; HS023801.
Citation: Lundsberg LS, Main EK, Lee HC .
Low-interventional approaches to intrapartum care: hospital variation in practice and associated factors.
J Midwifery Womens Health 2020 Jan;65(1):33-44. doi: 10.1111/jmwh.13017..
Keywords: Labor and Delivery, Pregnancy, Women, Maternal Care, Hospitals, Quality of Care
Carlson NS, Breman R, Neal JL
Preventing cesarean birth in women with obesity: influence of unit-level midwifery presence on use of cesarean among women in the Consortium on Safe Labor data set.
The primary goal of this study was to examine associations between midwifery unit-level presence and unplanned cesarean birth in women with different body mass index (BMI) ranges. Data from the Consortium on Safe Labor was used to analyze information on low-risk, healthy women who labored and gave birth in medical centers with or without the unit-level presence of midwives. Results indicate that the odds of unplanned cesarean birth among women who gave birth in centers with midwives were 16% lower than the odds of cesarean birth among similar women who gave birth at centers without midwives. However, women whose BMI was above 35.00 kg/m at labor admission had similar odds of cesarean birth, regardless of unit-level midwifery presence. Although integration of midwives into the caregiving environment of medical centers in the United States was associated with overall decrease in the incidence of cesarean birth, increased maternal BMI nevertheless remained positively associated with these outcomes.
AHRQ-funded; HS024733
Citation: Carlson NS, Breman R, Neal JL .
Preventing cesarean birth in women with obesity: influence of unit-level midwifery presence on use of cesarean among women in the Consortium on Safe Labor data set.
J Midwifery Womens Health 2020 Jan;65(1):22-32. doi: 10.1111/jmwh.13022..
Keywords: Labor and Delivery, Pregnancy, Obesity, Women, Prevention, Maternal Care