Infertility case management: improving both short-term and long-term outcomes while reducing costs.

Purpose/objectives: Infertility is a growing medical condition as more women are desirous of having children at an older age. It is estimated to be a $3 billion business, and, while infertility treatment is a for-profit commercial endeavor, the product is noncommercial (baby or babies). The treatment process may be complicated with overutilization, drug wastage, and adverse outcomes.

Fetal deaths in the United States. Influence of high-risk conditions and implications for management.

Objective: To estimate the effect of specific maternal-fetal high-risk conditions on the risk and timing of fetal death.

Methods: This study examined 10,614,679 non-anomalous singleton pregnancies delivering at or beyond 24 weeks' gestation, derived from the U.S.

The impact of prenatal care on postneonatal deaths in the presence and absence of antenatal high-risk conditions.

Objective: This study was undertaken to determine the association, if any, between prenatal care and postneonatal death in the presence and absence of high-risk pregnancy conditions.

Study Design: Data were derived from the national linked birth/infant death data set for the years 1995 to 1997 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred after 23 completed weeks of gestation.

The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions.

Objective: This study was undertaken to determine the association between prenatal care in the United States and preterm birth rate in the presence, as well as absence, of high-risk pregnancy conditions for African American and white women.

Study Design: Data were derived from the natality data set for the years 1995 to 1998 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred at >/=20 weeks' gestation.

Down syndrome risk estimation after normal genetic sonography.

Objective: The objective of this study was to determine whether there are any indication-specific variations in risk reduction for fetal Down syndrome after a normal genetic sonogram.

Study Design: A second-trimester genetic sonogram was offered to all pregnant women who were at increased risk for fetal Down syndrome (>/=1:274) because of either advanced maternal age (>/=35 years), an abnormal triple screen, or both. Outcome information included the results of genetic amniocentesis (if performed), the results of pediatric assessment, and follow-up after birth.

Second-trimester genetic sonography in patients with advanced maternal age and normal triple screen.

Objective: To estimate the value of second-trimester genetic sonography in detecting fetal Down syndrome in patients with advanced maternal age (at least 35 years) and normal triple screen.

Methods: Since July 1999, a prospective collection and recording of all individual triple screen risks for fetal Down syndrome was initiated for all patients with advanced maternal age presenting in our ultrasound unit for second-trimester genetic sonography. Genetic sonography evaluated the presence or absence of multiple aneuploidy markers.

The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions.

Objective: The purpose of this study was to determine the association between prenatal care in the United States and the neonatal death rate in the presence and absence of antenatal high-risk conditions.

Study Design: Data were derived from the national perinatal mortality data sets for the years 1995 through 1997, which were provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred after 23 completed weeks of gestation.

Prenatal care and black-white fetal death disparity in the United States: heterogeneity by high-risk conditions.

Objective: To determine the impact of prenatal care in the United States on the fetal death rate in the presence and absence of obstetric and medical high-risk conditions, and to explore the role of these high risk conditions in contributing to the black-white disparity.

Methods: This is a population-based, retrospective cohort study using the national perinatal mortality data for 1995-1997 assembled by the National Center for Health Statistics. Fetal death rate (per 1000 births) and adjusted relative risks were derived from multivariable logistic regression models.