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. Hospital-level variation in cesarean delivery rates was then assessed among all California hospitals for women with low-obstetric-risk first births before and after further risk adjustment and after the exclusion of potential medical and obstetric indications for induction. Variation in physician-level cesarean delivery rates after induction at four large hospitals also was examined. The relationships between cesarean delivery rates among women with induced labors compared with noninduced labors and with the hospital rate of induction also were explored.
Results: Identifying induction by a combination of discharge diagnosis codes and birth certificate data had the highest accuracy (92.9%, 95% CI 92.7-93.2). Among 917,225 births at 238 birthing hospitals, there were 99,441 nulliparous women with term, singleton, vertex pregnancies who were induced. The median cesarean delivery rate after labor induction for nulliparous women with term, singleton, vertex pregnancies was 32.2%, with a range of 18.5-84.6%. This wide variation was not reduced after risk adjustment or after exclusion of all women with induction indications. A similar wide variation was noted within geographic regions, neonatal intensive care levels, and among individual physicians in the same facility. Only very weak associations were found for the cesarean delivery rate after labor induction and either the rate after noninduced labor (R<0.08) or the rate of nulliparous labor induction (R<0.12).
Conclusion: The large variation of cesarean delivery rates after induction of labor suggests that clinical management plays an important role in achieving induction success.
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http://dx.doi.org/10.1097/AOG.0000000000004139 | DOI Listing |
JAMA Netw Open
December 2024
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Importance: Access to appropriate postpartum care is essential for improving maternal health outcomes and promoting maternal health equity.
Objective: To analyze the impact of the Nurse-Family Partnership (NFP) home visiting program on use of routine and emergency postpartum care.
Design, Setting, And Participants: This study was a secondary analysis of a randomized clinical trial that enrolled eligible participants between 2016 and 2020 to receive NFP or usual care from a South Carolina Medicaid program.
Cureus
November 2024
Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA.
Background: Atrial fibrillation (AF) is rare during pregnancy and current data on the impact of AF during delivery is scarce. In this study, we aim to analyze the impact of AF in patients who underwent delivery via cesarean section (CS), natural spontaneous delivery (NSD), or instrumental delivery (ID).
Methods: This study analyzed discharge data from the National Inpatient Sample (NIS) from 2016 to 2020.
Proc (Bayl Univ Med Cent)
October 2024
Department of Anesthesiology, Baylor Scott & White Medical Center - Temple, Temple, Texas, USA.
Background: We hypothesized that patients who received a lower dose of intrathecal morphine (ITM) would have higher postoperative opioid consumption following cesarean delivery.
Methods: Patients who had cesarean deliveries from February 15, 2022, through February 14, 2024 at Baylor Scott & White Medical Center - Temple with single injection spinal or combined spinal epidural anesthesia who did not have labor epidural anesthesia were included. Morphine milligram equivalent (MME) opioid consumption in the first 24 postoperative hours was recorded along with patient demographic, physical, and clinical characteristics.
Proc (Bayl Univ Med Cent)
November 2024
Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Int J Gynaecol Obstet
December 2024
Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Objective: To compare adverse neonatal outcomes between trial of vaginal delivery and upfront cesarean delivery for singleton infants born at 24 to 28 weeks of gestation.
Methods: This is a retrospective cohort study that was conducted at a university-affiliated tertiary medical center between 2011 and 2022, involving singleton pregnancies delivered between 24 and 27 weeks of gestation. Participants were divided into two groups based on their intended mode of delivery: a trial of labor (TOL) group and an upfront cesarean delivery (CD) group.
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