Venous Thromboembolism Prophylaxis Should Be Recommended for Antepartum Admissions and Cesarean Delivery if Age and Body Mass Index Are Greater Than 35.

Objective:  Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality. Current expanded treatment recommendations result in the inclusion of a large percentage of the obstetric population, which has limited their adoption. The purpose of this study was to identify a population at high risk for VTE, with minimal impact on the number of patients that would qualify for expanded treatment.

Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.

Objective: The objective of the study was to describe the resources and activities associated with childbirth services.

Study Design: We adapted models for assessing the quality of healthcare to generate a conceptual framework hypothesizing that childbirth hospital resources and activities contributed to maternal and neonatal outcomes. We used this framework to guide development of a survey, which we administered by telephone to hospital labor and delivery nurse managers in California.

Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.

Objective: Measures of maternal mortality and severe maternal morbidity have risen in the United States, sparking national interest regarding hospitals' ability to provide maternal risk-appropriate care. We examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care.

Study Design: We performed a cross-sectional survey to identify hospital-specific resources and classify hospitals by criteria for basic, intermediate, and regional maternal levels of care in all nonmilitary childbirth hospitals in California.

Do laborists improve delivery outcomes for laboring women in California community hospitals?

Objective: We sought to determine the impact of the laborist staffing model on cesarean rates and maternal morbidity in California community hospitals.

Study Design: This is a cross-sectional study comparing cesarean rates, vaginal birth after cesarean rates, composite maternal morbidity, and severe maternal morbidity for laboring women in California community hospitals with and without laborists. We conducted interviews with nurse managers to obtain data regarding hospital policies, practices, and the presence of laborists, and linked this information with patient-level hospital discharge data for all deliveries in 2012.

First-trimester aneuploidy screening: is there a maternal age at which it loses effectiveness?

Objective: To determine the maternal age at which the likelihood of a "screen-positive" result justifies diagnostic testing.

Study Design: A retrospective review of women who presented for first-trimester screening using nuchal translucency (NT) measurements with or without serum biochemistry between January 2000-December 2011. Using cutoffs of 1:300, 1:270, and 1:200, the Trisomy 21 (T21) screen-positive rates were stratified by maternal age.