Publications by authors named "Jessica Illuzzi"
Persistent racial and ethnic disparities exist in severe maternal and neonatal morbidity, which may be due in part to differences in labor and delivery unit practices across hospitals. We used data collected from 184 hospitals in California (2015-2018) to assess whether nulliparous individuals with low-risk pregnancies differ by race and ethnicity in giving birth at hospitals that tend to use lower-interventional labor and delivery unit practices, and whether such differences contribute to disparities in severe maternal and neonatal morbidity. We classified labor and delivery units as higher- or lower-interventional based on a latent class analysis of survey responses about the frequency of using lower-interventional practices.
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- - The study assessed how well obstetric providers at an academic medical center followed labor arrest and failed induction of labor (IOL) criteria in cesarean deliveries involving first-time mothers and measured the effects of an educational initiative aimed at improving adherence to these criteria.
- - Using electronic health records, researchers compared cesarean deliveries before and after the educational intervention, revealing that adherence significantly improved after the initiative was implemented.
- - Results indicated that while Maternal-Fetal Medicine physicians initially adhered better to the criteria than generalist obstetricians, the educational intervention helped bridge that gap, leading to similar adherence rates post-intervention.
Introduction: The J9 Plus (J9) maternal-child accompaniment program is based on four pillars: group antenatal care (GANC), group pediatric care, psychosocial support, and community-based care. We aimed to evaluate the impact of the J9 model of care on perinatal outcomes.
Methodology: We conducted a convergent mixed methods study of maternal-newborn dyads born in 2019 at Hôpital Universitaire de Mirebalais.
Article Synopsis
- The 2023 update on neonatal resuscitation guidelines is informed by four extensive systematic reviews managed by the International Liaison Committee on Resuscitation Neonatal Life Support Task Force.
- The reviews focused on key topics such as umbilical cord management for different types of newborns and the best devices for providing ventilation during resuscitation.
- New recommendations include practices like umbilical cord milking and guidelines on selecting appropriate devices for effective positive-pressure ventilation.
Article Synopsis
- - This 2023 update to neonatal resuscitation guidelines is based on recent systematic reviews conducted by a specialized task force focused on newborn care.
- - The task force reviewed scientific literature regarding umbilical cord management for different types of newborns, as well as devices for providing positive-pressure ventilation during resuscitation.
- - New recommendations include guidance on milking intact umbilical cords, choosing the right devices for ventilation, and introducing an additional primary interface for resuscitation.
Background: The vaginal birth after cesarean delivery calculator by the Maternal-Fetal Medicine Units Network was created to help providers counsel patients on predicted success of trial of labor after cesarean delivery using individualized risk assessment. The inclusion of race and ethnicity as predictors of vaginal birth after cesarean delivery in the 2007 calculator was problematic and potentially exacerbated racial disparities in obstetrics. Thus, a modified calculator without race and ethnicity was published in June 2021.
View Article and Find Full Text PDFObjective: High-quality, respectful maternity care has been identified as an important birth process and outcome. However, there are very few studies about experiences of care during a pregnancy and birth after a prior cesarean in the U.S.
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- The study aimed to analyze how knowledge and awareness about reproductive health and fertility among women aged 18-40 in the U.S. vary by race and ethnicity.
- A survey conducted in 2013 revealed that Hispanic, African American, and Asian women show different levels of awareness regarding fertility risks and concerns, with Asian women being particularly affected by cultural perceptions around discussing fertility.
- The conclusion indicates that race/ethnicity plays a significant role in shaping women's understanding and perceptions of reproductive health and infertility issues.
Article Synopsis
- The study focuses on understanding the knowledge and practices of obstetric providers regarding penicillin allergy, which is often incorrectly reported, particularly in pregnant patients.
- An anonymous survey was conducted before and after an educational intervention to assess changes in antibiotic allergy knowledge and management practices among these providers.
- Results showed that many providers lacked accurate knowledge of penicillin allergies, but those who attended educational sessions demonstrated improved understanding of the issue after the intervention.
Article Synopsis
- The study investigates the impact of updated guidelines on labor arrest and failed induction on the rates of primary cesarean deliveries in a large academic medical center between 2010 and 2013.
- Results showed a decrease in overall primary cesarean delivery rates from 23.5% to 21.1%, with a significant drop in cesarean deliveries attributed to labor arrest and failed induction.
- Despite some improvements, 65.2% of cesarean deliveries at the end of the study still did not meet the updated guidelines for labor arrest, highlighting ongoing issues in adherence to these criteria.
Background: Previous studies show that obesity predisposes patients to higher risks of adverse pregnancy outcomes. Data on the relationship between increasing degrees of obesity and risks of severe maternal morbidity, including mortality, are limited.
Objective: We examined the association of increasing classes of obesity, especially super obesity, with the risk of severe maternal morbidity and mortality at the time of delivery hospitalization.
Article Synopsis
- * The plan included tools like an early labor triage guide and a labor walking path and showed a 16% decrease in early labor admissions while increasing team knowledge by 35%.
- * Patient satisfaction soared above 98%, demonstrating that adhering to evidence-based practices can lead to better outcomes and quality improvements in maternity care.
Objective: In recent decades, there has been a call to foster effective collaborative models of practice between midwives and obstetricians/gynecologists (OB/GYNs) in the United States in order to improve clinician satisfaction and outcomes for childbearing women. Currently, there is no existing validated scale that measures the collaboration between obstetricians and midwives on labor and birth units. We sought to develop and validate a Midwifery- Obstetrics Collaboration (MOC) Scale that measures obstetricians' attitudes towards collaboration between obstetricians and midwives on labor and birth units.
View Article and Find Full Text PDFBackground: Vaginal birth after cesarean (VBAC) is safe, cost-effective, and beneficial. Despite professional recommendations supporting VBAC and high success rates, VBAC rates in the United States (US) have remained below 15% since 2002. Very little has been written about access to VBAC in the United States from the perspectives of birthing people.
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- * Study Design: Researchers analyzed data from 276,489 newborns (2010-2012) in California, assessing how factors like hospital characteristics impacted NICU admissions using statistical methods.
- * Results: The study found significant variation in NICU admission rates, particularly for mild diagnoses, indicating that some hospitals may be admitting more babies than necessary, suggesting a possible issue of overuse.
Objective: Trial of labor after cesarean delivery has been mostly studied in the setting of one prior cesarean delivery; controversy remains regarding the risks and benefits of trial of labor for women with two prior cesarean deliveries. This study aimed to examine utilization, success rate, and maternal and neonatal outcomes of trial of labor in this population.
Methods: Using linked hospital discharge and birth certificate data, we retrospectively analyzed a cohort of mothers with nonanomalous, term, singleton live births in California between 2010-2012 and had two prior cesarean deliveries and no clear contraindications for trial of labor.
This study describes the prevalence of positive SARS-CoV-2 test results among asymptomatic pregnant women presenting for labor and delivery at Yale New Haven health system hospitals.
View Article and Find Full Text PDFObjective: To evaluate the association between temporary cessation in oxytocin infusion (oxytocin rest) and mode of delivery in women undergoing induction of labor with a protracted latent phase.
Methods: We conducted a retrospective cohort analysis of nulliparous women with term, vertex, singleton gestations who were undergoing induction of labor with continuous oxytocin infusion at a large academic medical center. Episodes of oxytocin rest were identified among patients who were exposed to 8 hours of continuous oxytocin yet remained in latent labor (ie, protracted latent labor).
Article Synopsis
- - A study evaluated the reliability of birth certificate data for analyzing NICU admission rates, comparing it with California Children's Services (CCS) data to see how well they matched across hospitals.
- - Birth certificate data generally reported lower NICU admission rates than CCS data, but in a specific group of hospitals, the two data sources showed strong agreement.
- - The results suggest that, for certain hospitals, birth certificate data could be a useful tool to examine variations in NICU admissions across different facilities.
Background: Hospitals across the country are investing millions of dollars to adopt new Health Insurance Portability and Accountability Act (HIPAA)-compliant secure text messaging systems. However, in nearly all cases, these implementations are occurring without evaluation of their impact on patient care.
Objective: To evaluate perceived impact on patient care and workflow of new text messaging system implemented in obstetrics at Yale-New Haven Hospital and to inform guidelines for future implementations in emergent settings.
Introduction: Despite evidence supporting the safety of low-interventional approaches to intrapartum care, defined by the American College of Obstetricians and Gynecologists as "practices that facilitate a physiologic labor process and minimize intervention," little is known about how frequently such practices are utilized. We examined hospital use of low-interventional practices, as well as variation in utilization across hospitals.
Methods: Data came from 185 California hospitals completing a survey of intrapartum care, including 9 questions indicating use of low- versus high-interventional practices (eg, use of intermittent auscultation, nonpharmacologic pain relief, and admission of women in latent labor).
Article Synopsis
- The study aimed to identify factors related to a decline in primary cesarean delivery rates at an academic medical center between 2009 and 2013, focusing on physician-documented indications for cesarean deliveries.
- The cesarean delivery rate decreased from 36.5% to 31.4%, with 74% of this decline due to fewer primary cesarean births, primarily influenced by reductions in cases of labor arrest, abnormal fetal heart rates, and preeclampsia.
- The findings suggest that changes in how labor arrest and fetal monitoring were defined and approached at the institution significantly impacted the rates of cesarean deliveries.
Background: Cardiovascular disease is the leading cause of pregnancy-related death in the United States. Identification of short-term indicators of cardiovascular morbidity has the potential to alter the course of this devastating disease among women. It has been established that hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease 10-30 years after delivery; however, little is known about the association of hypertensive disorders of pregnancy with cardiovascular morbidity during the delivery hospitalization.
View Article and Find Full Text PDFObjective: To examine whether women who varied from recommended gestational weight gain guidelines by the Institute of Medicine (IOM, now known as the National Academy of Medicine) were at increased risk of severe maternal morbidity during delivery hospitalization compared with those whose weight gain remained within guidelines.
Methods: We conducted a retrospective cohort study using linked 2008-2012 New York City discharge and birth certificate data sets. Cases of severe maternal morbidity were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes based on the Centers for Disease Control and Prevention criteria, which consists of 21 indicators of possible life-threatening diagnoses, life-saving procedures, or death.
Article Synopsis
- - Placenta accreta poses significant risks, especially since prenatal diagnosis methods are not fully reliable, leading to questions about how well clinical and sonographic indicators predict varying degrees of this condition.
- - A study analyzed 416 cases of women with placenta accreta, comparing demographic and diagnostic data across different levels of placental invasion (percreta, increta, accreta, and focal accreta) to understand risks and outcomes.
- - Findings showed that as the depth of placental invasion decreased, the reliability of clinical risk factors and sonographic evaluations also diminished, highlighting the need for better diagnostic tools to manage and predict this condition.