Interprofessional collaborative practice in obstetrics and midwifery.

As the health care system transforms to accommodate an increased need for primary care services and more patients, new models of health care delivery are needed that can provide quality health care services efficiently. An integrated collaborative practice of certified nurse-midwives, obstetrician-gynecologists, and perinatologists is best suited to meet the rapidly changing needs of the maternity health care delivery system. This article reviews the literature on interprofessional collaborative practice and describes the structure, function, and essential elements of successful collaboration in health care.

Magnetic resonance imaging of cervical ectopic pregnancy in the second trimester.

Objective: To describe the magnetic resonance imaging findings of cervical ectopic pregnancy in the second trimester.

Conclusions: Magnetic resonance imaging findings of cervical ectopic pregnancy in the second trimester include intracervical location of the fetus, endometrial hyperplasia within an otherwise empty endometrial cavity, and irregular placentation in the cervix. Correct recognition of the condition is critical because of the potential for catastrophic and life-threatening maternal bleeding.

Cost-effectiveness of private umbilical cord blood banking.

Objective: To investigate the cost-effectiveness of private umbilical cord blood banking.

Methods: A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.

Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation.

There has been a substantial increase in the use of computed tomography (CT) and magnetic resonance imaging (MRI) in pregnancy and lactation. Among some physicians and patients, however, there are misperceptions regarding risks, safety, and appropriate use of these modalities in pregnancy. We have developed a set of evidence-based guidelines for the use of CT, MRI, and contrast media during pregnancy for selected indications including suspected acute appendicitis, pulmonary embolism, renal colic, trauma, and cephalopelvic disproportion.

Time of delivery and neonatal morbidity and mortality.

Objective: The objective of the study was to examine the association between time of delivery and neonatal outcomes in term deliveries.

Study Design: We conducted a retrospective cohort study of all term pregnancies delivered at an academic institution with 24-hour in-house obstetric and anesthesia coverage. Time of delivery was categorized as day (7 am to 6 pm), evening (6 pm to 12 midnight), and late night (12 midnight to 7 am).

Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes.

Objective: This study was undertaken to examine perinatal outcomes associated with the second stage of labor in multiparous women.

Study Design: This is a retrospective cohort study of all term, cephalic, singleton births delivered by multiparous women between 1991 and 2001. Duration of the second stage of labor was stratified into hourly intervals: 0-1 hour, 1-2 hours, 2-3 hours, and 3 hours or longer.

Presence of the sickle cell trait and preterm delivery in African-American women.

Objective: To estimate the association between presence of the sickle cell trait and preterm delivery among African-American women.

Methods: A retrospective cohort study was conducted to study all deliveries by African-American women at one institution between 1976 and 2001. The primary predictor of interest was the presence of the sickle cell trait, and the primary outcome was preterm delivery.

Manual rotation of the fetal occiput: predictors of success and delivery.

Objective: The purpose of the study was to define predictors of successful rotation and rate of cesarean delivery after manual rotation of the fetal occiput from occiput posterior or transverse position.

Study Design: A retrospective cohort study comprised patients who underwent a trial of manual rotation of the fetal occiput from occiput posterior or occiput transverse position. Successful rotation was defined as delivery in the occiput anterior position.

Face presentation: predictors and delivery route.

Objective: We sought to identify associated characteristics of face presentation and to examine factors that were associated with mode of delivery in the setting of face presentation.

Study Design: This was a retrospective cohort study of women who were diagnosed with face presentation during labor. We examined maternal, fetal, and labor characteristics to determine the associations and predictors of cesarean delivery.

Forceps compared with vacuum: rates of neonatal and maternal morbidity.

Objective: To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations.

Methods: This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution.

Racial/ethnic differences in perineal, vaginal and cervical lacerations.

Objective: To determine if variation exists between ethnicities for risk of perineal, vaginal, and cervical laceration at vaginal delivery.

Study Design: Retrospective cohort study of nulliparous women who underwent vaginal delivery of a vertex presentation. Predictor variable was ethnicity with outcome variables cervical, vaginal, and second-, third-, or fourth-degree perineal laceration.

Presidential address: medical-legal issues in obstetrics and gynecology.

Patients, physicians, insurance companies, and legislators are expressing mounting concern in the area of malpractice insurance costs and its effect on the availability of health care. In 1986, the highest award in the history of medical-legal claims, 1,200,000 US dollars, was paid. By 2001, the average award had increased to 3,500,000 US dollars.

Neonatal complications of term pregnancy: rates by gestational age increase in a continuous, not threshold, fashion.

Objective: The purpose of this study was to determine whether, when, and how rates of short-term neonatal complications increase beyond 37 weeks of gestation.

Study Design: A retrospective cohort study was conducted of all low-risk, term, cephalic, and singleton births that were delivered at the University of California, San Francisco, between 1976 and 2001. Primary outcomes included neonatal umbilical artery pH, umbilical artery base excess, the presence of meconium, macrosomia, 5-minute Apgar scores, and admission to the intensive care nursery.

Obstetric attending physician characteristics and their impact on vacuum and forceps delivery rates: University of California at San Francisco experience from 1977 to 1999.

Objective: The objective of our study was to determine the impact of obstetric attending physician characteristics (eg, region of previous residency training, sex, year of graduation from residency) on the rates of vacuum and forceps delivery at our institution.

Study Design: The analysis was based on 19,897 vaginal deliveries that were performed by 171 attending physicians and 160 resident physicians between 1977 and 1999 at the University of California at San Francisco Medical Center. Z -tests and multivariate logistic regression were performed on a perinatal database that contained standard obstetric variables.