Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact.

Objective: We examined the extent to which differences in hospital-level cesarean delivery rates in Massachusetts were attributable to hospital-level, rather than maternal, characteristics.

Methods: Birth certificate and maternal in-patient hospital discharge records for 2004-06 in Massachusetts were linked. The study population was nulliparous, term, singleton, and vertex births (NTSV) (n = 80,371) in 49 hospitals.

The impact of psoriasis on pregnancy outcomes.

Psoriasis is an inflammatory disease that affects women in their reproductive years. Other similar diseases have been associated with adverse pregnancy outcomes. We sought to assess whether pregnant women with psoriasis are at higher risk of developing complications, such as preterm birth (PTB) and low birth weight (LBW).

Hospital volume, provider volume, and complications after childbirth in U.S. hospitals.

Objective: To examine the relationship between both hospital and provider case volume and obstetric complication rates in U.S. hospitals.

Recent trends in continuing medical education among obstetrician-gynecologists.

Objective: To estimate current trends in continuing medical education among obstetrician-gynecologists in relation to the Maintenance of Certification program.

Methods: A validated questionnaire was mailed to 1,030 randomly selected physicians of the American College of Obstetricians and Gynecologists in the United States, Puerto Rico, and Canada. Participants were asked about current practices and opinions regarding continuing medical education activities.

Quality in obstetric care: measuring what matters.

Quality measures allow providers, payers, and patients to assess and compare the performance of medical teams. The ideal quality measure is easy to define and observe, important to patients and physicians, and identifies areas ripe for improvement. There are several challenges unique to obstetrics that complicate quality measurement.

Comparing the second stage in induced and spontaneous labor.

Objective: To compare the duration and complications of the second stage of labor between women in induced and spontaneous labor.

Methods: This was a retrospective cohort study of women with singleton term gestations who reached full dilation at a single institution from 2001 through 2009. Second-stage duration, mode of delivery, and complication rates were compared between women in induced and spontaneous labor using survival analysis, univariable analysis, and multivariable analyses to control for potential confounders.

The cost-effectiveness of prenatal screening for spinal muscular atrophy.

Objective: We sought to investigate the cost-effectiveness of prenatal screening for spinal muscular atrophy (SMA).

Study Design: A decision analytic model was created to compare a policy of universal SMA screening to that of no screening. The primary outcome was incremental cost per maternal quality-adjusted life year.

Association of cotinine levels and preeclampsia among African-American women.

Introduction: Although prior studies have shown that smoking reduces preeclampsia risk, the relationship between nicotine level and preeclampsia risk is not known. Our objective was to study the effects of smoking on the incidence of preeclampsia in African-American women using cotinine, a quantitative marker of nicotine.

Methods: We performed a secondary analysis of data collected prospectively in Project District of Columbia Healthy Outcomes of Pregnancy Education.

Listeriosis in pregnancy: diagnosis, treatment, and prevention.

Listeriosis is a rare disease that causes mild maternal illness, but can be devastating to the fetus. Listeria's rare microbiologic features make it a difficult infection to diagnose and treat: it is an intracellular organism that hides within host cells. Because of the potentially severe consequences, it is important that obstetricians are familiar with the diagnosis, treatment, and prevention of listerial infection.

Calcium supplements and bone resorption in pregnancy: a randomized crossover trial.

Background: Pregnancy is a time of increased need for calcium. The role of calcium supplements in altering maternal responses to fetal demand for calcium is not fully understood. This article describes the results of a randomized, crossover trial of calcium supplementation on bone resorption among pregnant women.