Regional variation in obstetrical intervention for hospital birth in the Republic of Ireland, 2005-2009.

Background: Obstetrical interventions during childbirth vary widely across European and North American countries. Regional differences in intrapartum care may reflect an inpatient-based, clinician-oriented, interventional practice style.

Methods: Using nationally representative hospital discharge data, a retrospective cohort study was conducted to explore regional variation in obstetric intervention across four major regions (Dublin Mid Leinster; Dublin Northeast; South; West) within the Republic of Ireland.

Maternal morbidity during hospitalization for delivery.

Objective: To estimate nationally representative incidence rates of maternal morbidities and to examine if the incidence of maternal morbidity increased during a 4-year study period.

Methods: We conducted a population-based retrospective cohort study of women delivering in hospitals in Ireland between 2005 and 2008 using nationally representative hospital discharge data from the Hospital In-Patient Enquiry data set. Using singleton deliveries, we categorized International Classification of Diseases 10, Australian Modification diagnostic codes into 38 clinically relevant maternal morbidity groups and assessed the incidence of morbidities potentially affecting labor, delivery, and the puerperium.

Birth after previous cesarean delivery: short-term maternal outcomes.

An estimated 40% of the 1.3 million cesarean deliveries performed each year in the United States are repeat procedures. The appropriate clinical management approach for women with previous cesarean delivery remains challenging because options are limited.

Certified nurse midwife-attended births: trends in Washington State, 1995-2004.

Nationwide, the proportion of certified nurse-midwife (CNM)-attended births has increased steadily. We examined trends in CNM-attended singleton spontaneous vaginal births between 1995 and 2004 in Washington State by site of birth, payer source, and hospital birth volume. CNMs were more likely than other providers to care for women at risk for adverse outcomes based on several sociodemographic indicators.

Induction of labor in the absence of standard medical indications: incidence and correlates.

Background: Induction of labor is an increasingly common obstetrical procedure, with approximately 20-34% of women undergoing labor induction in the United States annually.

Objective: To determine the extent of labor induction in the absence of standard medical indications and to assess possible associations with maternal and infant characteristics and hospital factors.

Methods: We ascertained induction of labor and associated details as part of a medical record validation study of 4541 women with live, singleton births in 2000 in Washington State using medical record, birth certificate, and hospital discharge data.

Admission for nephrolithiasis in pregnancy and risk of adverse birth outcomes.

Objective: Nephrolithiasis occurring during pregnancy may be associated with an elevated risk of preterm delivery and other adverse birth outcomes. The goal of this study was to describe the association between these outcomes and admission for nephrolithiasis during pregnancy.

Methods: We performed a retrospective cohort study using birth certificate records linked to Washington State hospital discharge data from 1987-2003 to compare pregnant women admitted for nephrolithiasis and randomly selected pregnant women without nephrolithiasis.

Accuracy of birth certificate and hospital discharge data: a certified nurse-midwife and physician comparison.

Objectives: Birth certificate and hospital discharge data are relied upon heavily for national surveillance and research on maternal health. Despite the great importance of these data sources, the recording accuracy in these datasets, comparing birth attendant type, has not been evaluated. The study objective was to assess the variation in chart documentation accuracy between certified nurse-midwives (CNMs) and physicians (MDs) for selected maternal variables using birth certificate and hospital discharge data.

Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review.

Background: Safe and effective management of the second stage of labor presents a clinical challenge for laboring women and practitioners of obstetric care. This systematic review was conducted to evaluate evidence for the influence of prolonged second stage of labor on the risk of selected adverse maternal and neonatal outcomes.

Methods: Articles were searched using PubMed, Cochrane Library, and CINAHL from 1980 until 2005.

Repeat cesarean delivery: what indications are recorded in the medical chart?

Background: National surveillance estimates reported a troubling 63 percent decline in the rate of vaginal birth after cesarean delivery (VBAC) from 1996 (28.3%) to 2003 (10.6%), with subsequent rising rates of repeat cesarean delivery.

Cessation of periodontal care during pregnancy: effect on infant birthweight.

The goal of this study was to assess whether interruption of care for chronic periodontitis during pregnancy increased the risk of low-birthweight infants. A population-based case-control study was designed with 793 cases (infants < 2,500 g) and a random sample of 3,172 controls (infants >or= 2,500 g). Generalized estimating equation models were used to relate periodontal treatment history to low birthweight risk and to common risk factors.

Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records.

While the impact of maternal morbidities and intrapartum procedures is a common topic in perinatal outcomes research, the accuracy of the reporting of these variables in the large administrative databases (birth certificates, hospital discharges) often utilised for such research is largely unknown. We conducted this study to compare maternal diagnoses and procedures listed on birth certificates, hospital discharge data, and birth certificate and hospital discharge data combined, with those documented in a stratified random sample of hospital medical records of 4541 women delivering liveborn infants in Washington State in 2000. We found that birth certificate and hospital discharge data combined had substantially higher true positive fractions (TPF, proportion of women with a positive medical record assessment who were positive using the administrative databases) than did birth certificate data alone for labour induction (86% vs.

Validity of maternal and perinatal risk factors reported on fetal death certificates.

We sought to estimate the accuracy, relative to maternal medical records, of perinatal risk factors recorded on fetal death certificates. We conducted a validation study of fetal death certificates among women who experienced fetal deaths between 1996 and 2001. The number of previous births, established diabetes, chronic hypertension, maternal fever, performance of autopsy, anencephaly, and Down syndrome had very high accuracy, while placental cord conditions and other chromosomal abnormalities were reported inaccurately.

The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data.

Objective: The purpose of this study was to determine the accuracy of live-birth certificates and hospital discharge data that reported of pre-existing maternal medical conditions and complications of pregnancy.

Study Design: We conducted a population-based validation study in 19 non-federal short-stay hospitals in Washington state with a stratified random sample of 4541 women who had live births between January 1, 2000, and December 31, 2000. True- and false-positive fractions were calculated.

Postpartum sexual functioning and method of delivery: summary of the evidence.

Short-term postpartum sexual problems are highly prevalent, ranging from 22% to 86%; however, there are few studies that address how mode of delivery affects sexual functioning after childbirth. The objective of this study was to perform a systematic review of the literature on selected postpartum sexual function outcomes as affected by cesarean, assisted vaginal, and spontaneous vaginal delivery. We searched PubMed, CINAHL, and Cochrane databases from January 1990 to September 2003 and focused on mode of delivery and the most commonly reported sexual health outcomes, which included perineal pain, dyspareunia, resumption of intercourse, and self-reported perception of sexual health/sexual problems.

HIPAA transition: challenges of a multisite medical records validation study of maternally linked birth records.

Numerous researchers have expressed concern over the impacts on medical records availability of the newly effective Medical Information Privacy rule, as authorized by the Health Insurance Portability and Accountability Act (HIPAA). The increased costs associated with compliance with the rule, and the increased potential for financial liability, raises the possibility that hospitals may be less likely to participate in such research, resulting in a decrease of the validity of multisite studies designed to represent an entire population. Our multisite medical record validation study, designed to assess the accuracy of maternally linked birth records, provides an overview of a number of HIPAA implementation challenges.

Dental care use and self-reported dental problems in relation to pregnancy.

Objectives: We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy.

Methods: We used data from the Washington State Department of Health's Pregnancy Risk Assessment Monitoring System.

Results: Of the women surveyed, 58% reported no dental care during their pregnancy.

Risk factors and outcomes associated with a short umbilical cord.

Objective: To identify risk factors and outcomes associated with a short umbilical cord.

Methods: We conducted a population-based case-control study using linked Washington State birth certificate-hospital discharge data for singleton live births from 1987 to 1998 to assess the association between maternal, pregnancy, delivery, and infant characteristics and short umbilical cord. Cases (n = 3565) were infants diagnosed with a short umbilical cord.

A systematic approach for midwifery students: how to consider evidence-based research findings.

The midwifery profession is increasingly applying the results of evidence-based research findings. Several researchers were asked if they would answer questions regarding the essential research skills necessary for midwives, the relevance of applying valid evidence to practice, and concerns regarding evidence-based practice overall. The objectives were to share expert researchers' responses that could be used by educators to help introductory midwifery students understand the importance of developing skills in assessing "the best evidence" and to stimulate interactive discussion in the classroom.

Midwifery education roundtable discussion: transitions to the workplace.

A snapshot of four graduates' views on their educational experience at a research institution as well as their perspective on how it prepared them for the challenges they faced in entering the workplace is presented. Discussants stated that research knowledge is a critical aspect to clinical practice. Their educational experience provided them with the ability to understand information technology applications, identify and access relevant scientific research, evaluate the integrity and comparability of research findings, and apply research findings to clinical practice.