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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
51 to 75 of 106 Research Studies DisplayedAustin N, Kristensen-Cabrera A, Sherman J
Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design.
This study evaluated the effect of space and design on labor and deliver (L&D) hospital units. A quantitative analysis was done to see if it made an impact on the risk of deliveries. The researchers recommend standardization of the space based on number of deliveries and cesarean sections.
AHRQ-funded; HS023506.
Citation: Austin N, Kristensen-Cabrera A, Sherman J .
Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design.
PLoS One 2018 Dec 26;13(12):e0209339. doi: 10.1371/journal.pone.0209339..
Keywords: Labor and Delivery, Pregnancy, Women
Neal JL, Lowe NK, Caughey AB
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
The aims of this study were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. The authors suggest that adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Caughey AB .
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
Birth 2018 Dec;45(4):358-67. doi: 10.1111/birt.12358..
Keywords: Labor and Delivery, Pregnancy, Women
Neal JL, Lowe NK, Phillippi JC
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
The goals of this study were: Determine the proportions of women admitted to the hospital before or in active labor per the leading National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines; Compare associations of labor status at admission with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. Active labor diagnostic guidelines were applied retrospectively to cervical examination data. The authors conclude that many parous women with spontaneous labor onset are admitted to the hospital before active labor, and these women are more likely to receive oxytocin augmentation during labor and to have a cesarean birth. Implications for practice are discussed.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Phillippi JC .
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
Midwifery 2018 Dec;67:64-69. doi: 10.1016/j.midw.2018.09.007..
Keywords: Decision Making, Guidelines, Hospitalization, Labor and Delivery, Pregnancy, Women
Nelson DB, Moniz MH, Davis MM
Population-level factors associated with maternal mortality in the United States, 1997-2012.
This study analyzed state-level maternal mortality for the years 1997-2012 using multilevel mixed-effects regression grouped by state, using publicly available data. The study concluded that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.
AHRQ-funded; HS025465.
Citation: Nelson DB, Moniz MH, Davis MM .
Population-level factors associated with maternal mortality in the United States, 1997-2012.
BMC Public Health 2018 Aug 13;18(1):1007. doi: 10.1186/s12889-018-5935-2..
Keywords: Health Services Research (HSR), Labor and Delivery, Mortality, Pregnancy, Social Determinants of Health
Attanasio LB, Kozhimannil KB, Kjerulff KH
Factors influencing women's perceptions of shared decision making during labor and delivery: results from a large-scale cohort study of first childbirth.
The researchers examined correlates of shared decision making during labor and delivery. They found that women who were black and who did not have a college degree or private insurance were less likely to report high shared decision making, as well as women who underwent labor induction, instrumental vaginal or cesarean delivery.
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Kjerulff KH .
Factors influencing women's perceptions of shared decision making during labor and delivery: results from a large-scale cohort study of first childbirth.
Patient Educ Couns 2018 Jun;101(6):1130-36. doi: 10.1016/j.pec.2018.01.002.
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Keywords: Decision Making, Disparities, Labor and Delivery, Patient-Centered Healthcare, Social Determinants of Health
Xu X, Lee HC, Lin H
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
The purpose of this study was to examine hospital variation in cost of childbirth hospitalizations and identify factors that contribute to the variation. The study concluded that cost of childbirth hospitalizations varied widely among hospitals in California. Institutional characteristics significantly contributed to this variation. Higher-cost hospitals did not have better outcomes, suggesting potential opportunities to enhance value in care.
AHRQ-funded; HS023801.
Citation: Xu X, Lee HC, Lin H .
Hospital variation in cost of childbirth and contributing factors: a cross-sectional study.
BJOG 2018 Jun;125(7):829-39. doi: 10.1111/1471-0528.15007..
Keywords: Healthcare Costs, Health Services Research (HSR), Hospitals, Labor and Delivery, Pregnancy
White VanGompel E, Main EK, Tancredi D
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
The authors estimated the association between individual provider attitudes towards birth and their low-risk primary cesarean rate. Through surveys of California providers of intrapartum care in 2013, they found that provider attitudinal differences are associated with nulliparous, term, singleton, vertex cesarean rates. Those meeting the HP2020 goal hold attitudes more favorable towards vaginal birth, suggesting a modifiable target for quality improvement initiatives to decrease low risk primary cesareans.
AHRQ-funded; HS022236.
Citation: White VanGompel E, Main EK, Tancredi D .
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
BMC Pregnancy Childbirth 2018 May 29;18(1):184. doi: 10.1186/s12884-018-1756-7.
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Keywords: Provider: Health Personnel, Labor and Delivery, Pregnancy, Practice Patterns
Lyndon A, Malana J, Hedi LC
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
This study used an interdisciplinary team of five investigators to examine women’s birth experiences in the perspective of patient safety. Five investigators in the fields of nursing, medicine, product design, and journalism analyzed transcripts to see how women felt about their physical or emotional safety during birth, and to identify opportunities for improvement in care. Teams that were well-organized promoted feelings of safety as well as human connection.
AHRQ-funded; HS023506.
Citation: Lyndon A, Malana J, Hedi LC .
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
J Obstet Gynecol Neonatal Nurs 2018 May;47(3):324-32. doi: 10.1016/j.jogn.2018.02.008..
Keywords: Labor and Delivery, Pregnancy, Women, Patient Safety, Patient Experience
Hefele JG, Santos P, Ritter G
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
The purpose of this observational study was to examine shoulder dystocia risk factors by race and ethnicity using a 19,236 sample of pregnant women who presented for labor and delivery. Results found that, for White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation and use of epidural anesthesia during delivery. Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural and having gestational diabetes and controlling the condition with insulin. Additionally, among Hispanic mothers, having Spanish as the primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language. This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups.
AHRQ-funded; HS019608.
Citation: Hefele JG, Santos P, Ritter G .
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
J Racial Ethn Health Disparities 2018 Apr;5(2):333-41. doi: 10.1007/s40615-017-0374-9..
Keywords: Adverse Events, Labor and Delivery, Injuries and Wounds, Newborns/Infants, Pregnancy, Risk
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Santos P, Hefele JG, Ritter G
Population-based risk factors for shoulder dystocia.
This retrospective observational study examined population-based risk factors for infant shoulder dystocia during labor. Five hospitals in 5 states were used and over 19,000 births evaluated between April 2011 and July 2013. An increased risk for dystocia was found for women who were prescribed insulin, indicating gestational diabetes. However this was not true of women with gestational diabetes who were not prescribed insulin. Other risk factors included being Black, Hispanic, covered by Medicaid or no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes.
AHRQ-funded; HS019608.
Citation: Santos P, Hefele JG, Ritter G .
Population-based risk factors for shoulder dystocia.
J Obstet Gynecol Neonatal Nurs 2018 Jan;47(1):32-42. doi: 10.1016/j.jogn.2017.11.011..
Keywords: Labor and Delivery, Newborns/Infants, Risk, Pregnancy, Injuries and Wounds, Adverse Events
Phillippi JC, Danhausen K, Alliman J
Neonatal outcomes in the birth center setting: a systematic review.
This systematic review examined the effects of the birth center setting on neonatal mortality in economically developed countries. The criteria for inclusion included being in English, published after 1980 and in countries with similar guidelines to the American Association of Birth Centers Standards. The only measure used was neonatal mortality and results did not find any difference between using a birth center as opposed to a traditional hospital setting. The literature was not found to have many good quality studies, and further research is recommended.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Danhausen K, Alliman J .
Neonatal outcomes in the birth center setting: a systematic review.
J Midwifery Womens Health 2018 Jan;63(1):68-89. doi: 10.1111/jmwh.12701..
Keywords: Evidence-Based Practice, Labor and Delivery, Mortality, Newborns/Infants, Outcomes, Pregnancy, Women
Attanasio LB, Hardeman RR, Kozhimannil KB
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
This study examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. The study concluded that there are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Findings also suggested that white and high-socioeconomic status women may be more able to realize their preferences in childbirth.
AHRQ-funded; HS024215.
Citation: Attanasio LB, Hardeman RR, Kozhimannil KB .
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
Birth 2017 Dec;44(4):306-14. doi: 10.1111/birt.12305..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Racial and Ethnic Minorities, Social Determinants of Health
Markowitz S, Adams EK, Lewitt MJ
Competitive effects of scope of practice restrictions: public health or public harm?
This paper examined the case of scope of practice (SOP) restrictions for certified nurse midwives and evaluated the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. The authors found that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births.
AHRQ-funded; HS024530.
Citation: Markowitz S, Adams EK, Lewitt MJ .
Competitive effects of scope of practice restrictions: public health or public harm?
J Health Econ 2017 Sep;55:201-18. doi: 10.1016/j.jhealeco.2017.07.004..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Public Health, Policy
Lapcharoensap W, Lee HC
Tackling quality improvement in the delivery room.
Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room quality improvement (QI). Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Lee HC .
Tackling quality improvement in the delivery room.
Clin Perinatol 2017 Sep;44(3):663-81. doi: 10.1016/j.clp.2017.05.003.
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Keywords: Communication, Labor and Delivery, Newborns/Infants, Quality Improvement, Patient Safety
Metz TD, Gonzalez C, Allshouse AA
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
This study aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Odds of forceps versus vacuum were higher with induction, nulliparity, epidural, maternal indication, older maternal age, and longer second stage. Odds of cesarean versus operative vaginal delivery were higher with maternal indication, a perinatologist, longer second stage, older gestational age and longer labor.
AHRQ-funded; HS022143.
Citation: Metz TD, Gonzalez C, Allshouse AA .
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
Am J Perinatol 2017 Aug;34(10):974-81. doi: 10.1055/s-0037-1601441.
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Keywords: Adverse Events, Healthcare Delivery, Labor and Delivery, Pregnancy, Women
Jensen EA, Lorch SA
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
This study assessed the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment. It found that very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity.
AHRQ-funded; HS015696.
Citation: Jensen EA, Lorch SA .
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
J Pediatr 2017 Jul;186:41-48.e4. doi: 10.1016/j.jpeds.2017.02.007.
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Keywords: Labor and Delivery, Mortality, Newborns/Infants, Adverse Events
Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Researchers compared proportions of live birth, miscarriage, and abortion among women with basic action difficulties, women with complex activity limitations, and women without disabilities in a nationally representative sample. They found few differences between women with and without disabilities, and good likelihood of live birth among women with disabilities experiencing pregnancy.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG .
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Disabil Health J 2017 Jul;10(3):382-86. doi: 10.1016/j.dhjo.2017.02.006.
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Keywords: Disabilities, Labor and Delivery, Medical Expenditure Panel Survey (MEPS), Pregnancy
Masinter LM, Dina B, Kjerulff K
Short interpregnancy intervals: results from the first baby study.
Short interpregnancy interval (SIPI), defined as 18 months or fewer between delivery and subsequent conception, has become an independent marker of maternal and child health. The authors of this study performed a secondary analysis of 18 months of data from The First Baby Study, a prospective cohort of women followed from pregnancy through 3 years after their first birth.
AHRQ-funded; HS000078.
Citation: Masinter LM, Dina B, Kjerulff K .
Short interpregnancy intervals: results from the first baby study.
Womens Health Issues 2017 Jul - Aug;27(4):426-33. doi: 10.1016/j.whi.2017.02.011..
Keywords: Pregnancy, Labor and Delivery, Women
Horner-Johnson W, Biel FM, Darney BG
Time trends in births and cesarean deliveries among women with disabilities.
This study assessed time trends in births by any mode and in primary cesarean deliveries among women with physical, sensory, or intellectual/developmental disabilities. Among all women giving birth, the proportion with a disability increased from 0.27 percent in 2000 to 0.80 percent in 2010. Women with disabilities had significantly elevated odds of primary cesarean delivery in each year, but the magnitude of the odds ratio decreased over time.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Biel FM, Darney BG .
Time trends in births and cesarean deliveries among women with disabilities.
Disabil Health J 2017 Jul;10(3):376-81. doi: 10.1016/j.dhjo.2017.02.009.
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Keywords: Disabilities, Labor and Delivery, Pregnancy
Attanasio LB, Kozhimannil KB, Srinivas SK
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Researchers compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources. Ninety-one percent of women reported a reason for their cesarean that was present in the discharge data. Positive predictive value (PPV), the probability that women's self-reported reasons for cesarean varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1 percent), and lower PPV for malposition (81.7 percent).
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Srinivas SK .
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Womens Health Issues 2017 May - Jun;27(3):329-35. doi: 10.1016/j.whi.2016.12.006.
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Keywords: Hospital Discharge, Labor and Delivery, Pregnancy, Women
Sjaarda LA, Radin RG, Silver RM
AHRQ Author: Mitchell E
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
This study investigated the effect of preconception-initiated low dose aspirin (LDA) on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy. It concluded that in women attempting conception with elevated high sensitivity C-reactive protein (hsCRP) and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates to those of women without inflammation and reduce hsCRP elevation during pregnancy.
AHRQ-authored.
Citation: Sjaarda LA, Radin RG, Silver RM .
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
J Clin Endocrinol Metab 2017 May;102(5):1495-504. doi: 10.1210/jc.2016-2917.
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Keywords: Pregnancy, Medication, Outcomes, Labor and Delivery
Darney BG, Biel FM, Quigley BP
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. It found that women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type.
AHRQ-funded; HS022981.
Citation: Darney BG, Biel FM, Quigley BP .
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
Womens Health Issues 2017 May - Jun;27(3):336-44. doi: 10.1016/j.whi.2016.12.007.
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Keywords: Disabilities, Labor and Delivery, Patient-Centered Outcomes Research, Pregnancy, Women
Burstein PD, Zalenski DM, Edwards JL
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
The researchers established a multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol.
AHRQ-funded; HS019608.
Citation: Burstein PD, Zalenski DM, Edwards JL .
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
Health Serv Res 2016 Dec;51 Suppl 3:2472-86. doi: 10.1111/1475-6773.12589.
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Keywords: Labor and Delivery, Newborns/Infants, Adverse Events, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Outcomes, Guidelines, Evidence-Based Practice, Pregnancy, Teams
Sentell T, Chang A, Ahn HJ
Maternal language and adverse birth outcomes in a statewide analysis.
The study goal was to consider the relationship of maternal language to birth outcomes using Hawaii’s hospitalization data. It found that non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.
AHRQ-funded; HS019990; HS021903.
Citation: Sentell T, Chang A, Ahn HJ .
Maternal language and adverse birth outcomes in a statewide analysis.
Women Health 2016;56(3):257-80. doi: 10.1080/03630242.2015.1088114.
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Keywords: Adverse Events, Communication, Labor and Delivery, Outcomes