Society for Maternal-Fetal Medicine Special Statement: Best-practice recommendations for ultrasound network connectivity.

Prenatal ultrasound is an indispensable tool used by obstetrical care providers to assist in the everyday care of their pregnant patients. Alongside advancements in imaging, the electronic systems that support this technology have become more advanced. However, it is currently difficult for these individual systems to communicate with each other "out of the box.

Hospital-Level Variation in the Frequency of Cesarean Delivery Among Nulliparous Women Who Undergo Labor Induction.

Objective: To evaluate the use of administrative data for identification of labor induction and to estimate the variation in cesarean delivery rates among low-risk women who underwent labor induction.

Methods: A cross-sectional study was performed examining live births in California hospitals during 2016 and 2017 using birth certificate data linked with maternal patient discharge records. Initially, eight hospitals performed medical record reviews by using reVITALize definitions on 46,916 deliveries to assess the validity of induction identification by birth certificate or discharge diagnosis records or both.

National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births-Supporting Intended Vaginal Births.

Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit.

National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births- Supporting Intended Vaginal Births.

Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit.

National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births-Supporting Intended Vaginal Births.

Cesarean births and associated morbidity and mortality have reached near epidemic proportions. The National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care responded by developing a patient safety bundle to reduce the number of primary cesarean births. Safety bundles outline critical practices to implement in every maternity unit.

Accuracy of Blood Loss Measurement during Cesarean Delivery.

 This study aims to compare the accuracy of visual, quantitative gravimetric, and colorimetric methods used to determine blood loss during cesarean delivery procedures employing a hemoglobin extraction assay as the reference standard.  In 50 patients having cesarean deliveries blood loss determined by assays of hemoglobin content on surgical sponges and in suction canisters was compared with obstetricians' visual estimates, a quantitative gravimetric method, and the blood loss determined by a novel colorimetric system. Agreement between the reference assay and other measures was evaluated by the Bland-Altman method.

Standardizing Maternity Care Data to Improve Coordination of Care.

The amount of data generated by health information technology systems is staggering, and using those data to make meaningful care decisions that improve patient outcomes is difficult. The purpose of this article is to describe the Maternal Health Information Initiative, a multidisciplinary group of maternity care stakeholders charged with standardizing maternity care data. Complementary strategies that practicing clinicians can use to support this initiative and improve the usability of maternity care data are provided.

Cost comparison of robotic-assisted laparoscopic hysterectomy versus standard laparoscopic hysterectomy.

The aim of the study was to assess if the cost of robotic-assisted total laparoscopic hysterectomy is similar to the cost of standard laparoscopic hysterectomy when performed by surgeons past their initial learning curve. A retrospective chart review of all hysterectomies was performed for benign indications without concomitant major procedures at Orange Coast Memorial Medical Center (OCMMC) and Saddleback Memorial Medical Center between January 1, 2013 and September 30, 2013. Robotic-assisted total laparoscopic hysterectomies (RTLH) and standard laparoscopic hysterectomies (LAVH and TLH) were compared.

National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage.

Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care.

National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage.

Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care.

National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage.

Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care.

Postpartum hemorrhage: state and national response.

Purpose Of Review: The rise in maternal mortality has raised a significant concern for epidemiologists and providers. One of the most preventable and frequent causes of maternal death is hemorrhage-related events. Most providers of obstetrical care see such complications on a frequent basis, and the costs in maternal lives and blood usage have become a universal concern.

The future of obstetrics/gynecology in 2020: a clearer vision. Transformational forces and thriving in the new system.

Revamping the delivery of women's health care to meet future demands will require a number of changes. In the first 2 articles of this series, we introduced the reasons for change, suggested the use of the 'Triple Aim' concept to (1) improve the health of a population, (2) enhance the patient experience, and (3) control costs as a guide post for changes, and reviewed the transformational forces of payment and care system reform. In the final article, we discuss the valuable use of information technology and disruptive clinical technologies.

The future of obstetrics/gynecology in 2020: a clearer vision. Why is change needed?

External and internal pressures are causing rapid changes to the delivery of health care that markedly will influence the practice of obstetrics and gynecology. These changes can be divided into broad categories: (1) Burden of the high cost of current health care on society; (2) demographic changes in women that include aging, obesity, diversity, and chronic medical conditions; and (3) workforce changes that include growing provider shortages, inexperience, and desires for improved lifestyles. The combination of these factors has brought health care to a strategic inflection point where current practice methods will lead to an inability to meet the demand for health care because of increasing volume while simultaneously controlling costs and improving quality.

The future of obstetrics/gynecology in 2020: a clearer vision: finding true north and the forces of change.

The pressure to transform health care has been building for many years, and many frameworks have been proposed for this transformation. The 'Triple Aim' concept of improving the health of the population, improving the experience of the patient, and controlling cost can be used as a guide post for the adoption of the necessary changes to thrive in a new construct of women's health care. Following these guiding principles should lead to improved clinical outcomes at affordable costs with high patient and provider satisfaction.

The relationship between previous treatment for cervical dysplasia and preterm delivery in twin gestations.

Objective: To describe the impact of previous cervical surgery on preterm birth prior to 34 weeks in twins.

Methods: A retrospective review of twin pregnancies delivered between January 1998 and December 2005 at two institutions was performed. Women with a prior cold knife cone (CKC), loop electrosurgical excision procedure (LEEP), or ablative procedure were compared to a control group of women who had not undergone a previous treatment for cervical dysplasia.

Gestational age at cervical length measurement and preterm birth in twins.

Objectives: To estimate the risk of preterm delivery of twin pregnancies based upon sonographic cervical length measurement and gestational age at measurement.

Methods: Twin pregnancies that delivered between 1999 and 2005 and that underwent sonographic measurement of cervical length between 13 and 34 + 6 weeks' gestation were identified and a retrospective review performed. Women with anomalous pregnancies, multifetal reduction, cerclage placement or medically indicated deliveries before 35 weeks were excluded.

Persistent pulmonary hypertension of the newborn following elective cesarean delivery at term.

Objective: To evaluate the frequency of persistent pulmonary hypertension of the newborn (PPHN) following elective cesarean at greater than 34 weeks' gestation in an academically affiliated community hospital.

Methods: Retrospective cohort study involving chart review of 300 newborns with PPHN between 1999 and 2006. Infants less than 34 weeks' or with congenital anomalies were excluded.

A state-wide obstetric hemorrhage quality improvement initiative.

Purpose: The mission of the California Maternal Quality Care Collaborative is to eliminate preventable maternal death and injury and to promote equitable maternity care in California. This article describes California Maternal Quality Care Collaborative's (CMQCC's) statewide multistakeholder quality improvement initiative to improve readiness, recognition, response, and reporting of maternal hemorrhage at birth and details the essential role of nurses in its success.

Project Design And Approach: In partnership with the State Department of Maternal, Child, and Adolescent Health, CMQCC identified maternal hemorrhage as a significant quality improvement opportunity.

Twin versus singleton pregnancies complicated by preterm premature rupture of membranes.

Objective: To compare latency period, infectious morbidity, neonatal morbidity and neonatal mortality in twin versus singleton pregnancies complicated by preterm premature rupture of membranes (PPROM) remote from term.

Methods: A retrospective, matched cohort study comparing 41 twin and 82 singleton pregnancies complicated by PPROM between 24-0/7 and 31-6/7 weeks' gestation. The data were obtained by reviewing maternal and neonatal charts.

The use of ultrasound to detect small-for-gestational-age infants in patients with elevated human chorionic gonadotropin on maternal serum screening.

We evaluated serial sonography for the antenatal detection of small-for-gestational-age (SGA) infants in pregnancies with elevated human chorionic gonadotropin (hCG) levels on midtrimester triple-marker screen. A retrospective cohort study was performed at Saddleback Memorial Medical Center where serial ultrasounds from 26 weeks to delivery are generally recommended for patients with hCG levels >2.0 Multiple of the Median (MoM).

Previous cesarean section and the risk of postpartum maternal complications and adverse neonatal outcomes in future pregnancies.

Objective: To assess maternal postpartum and neonatal outcomes associated with previous method of delivery.

Study Design: We analyzed prospectively collected maternal and neonatal data from July 2002 to December 2003. Data were collected from dedicated perinatal database and neonatal database from discharge and procedure codes.