The total cesarean section rate in the United States. Effect of Peer Review and Trial of Labor on Lowering Cesarean Section Rates.

Size: px
Start display at page:

Download "The total cesarean section rate in the United States. Effect of Peer Review and Trial of Labor on Lowering Cesarean Section Rates."

Transcription

1 Original Article J Chin Med Assoc 2004;67: Wei-Hsing Liang Chiou-Chung Yuan Jeng-Hsiu Hung Man-Li Yang Ming-Jie Yang Yi-Jen Chen Tzay-Shing Yang Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and National Yang-Ming University, School of Medicine, Taipei, Taiwan, R.O.C. Key Words cesarean section; peer review; trial of labor Effect of Peer Review and Trial of Labor on Lowering Cesarean Section Rates Background. In an attempt to lower cesarean section rates, a cesarean surveillance system and a selective trial of labor were introduced in a tertiary hospital in Taiwan. Methods. From 1997 to 2000, 2 physicians were appointed as consultants for the pre-cesarean surveillance, and a trial of labor after a cesarean section was employed concurrently. We organized a weekly departmental Cesarean Indication Conference on Mondays. Comparisons of the cesarean rates between and were made using the chi-square test. Comparisons of the proportion of overall cesarean sections contributed by each indication for both 1993 and 2000 were also made by chi-square test. Results. A comparison of the 4-year periods before and after 1997 showed that the total cesarean rate had decreased from 37.0 to 30.7% (p < 0.001), primary cesarean rate from 21.3 to 17.8% (p < 0.001), and repeat cesarean rate from 15.7 to 12.9% (p < 0.001). No uterine rupture occurred. Among the 54 indications for primary cesareans, compared between 1993 and 2000, the proportion rates for dystocia, fetal distress, preeclampsia, induction failure, gestational diabetes, and elderly primigravidahad decreased substantially. Conclusions. The efficient way to lower the repeat cesarean rate is trial of labor, and the way to reduce the number of primary cesareans is in practicing of the guidelines for various indications. The cesarean surveillance system can solidify these guidelines, leading to a lower cesarean rate and an avoidance of inappropriate indications. The total cesarean section rate in the United States increased steadily during the period of the 1960s-1980s, reaching in 1988 a peak rate of 24.7%; at the same time, the rates in the European countries were below 14%, and as high as 34% was reached in Taiwan (Fig. 1). 1,2 There was a growing consensus in the 1980s that the risks of cesarean section had probably exceeded the benefits of improving perinatal mortality, and that a reduction in the rate could be achieved without compromising the improved mortality statistics for neonates. 3,4 Besides, there were strong economic arguments for the reduction of the cesarean rate. 5 At least 13 strategies have been employed or proposed to reduce cesarean section use, including: vaginal birth after prior cesarean (VBAC), peer review, external audit, active management of labor, operative vaginal delivery, supportive companion (doula), changing hospital reimbursement, etc. 2,6-9 In January, 1997, Taipei Veterans General Hospital (TVGH) instituted some remodeling efforts to lower the cesarean rate, including: a cesarean Fig. 1. Annual cesarean section rates for Taipei Veterans General Hospital, Taiwan, the United States, Norway, and England. The Taiwan data consists of the hospitals enrolled each year in the Health and Vital Statistics Annual Report, Department of Health, Republic of China. No formal data were available before Received: September 26, Accepted: May 12, Correspondence to: Tzay-Shing Yang, MD, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan. Tel: ; Fax: ; 281

2 Wei-Hsing Liang et al. Journal of the Chinese Medical Association Vol. 67, No. 6 surveillance system, trial of labor after one cesarean section, encouraging instrumental delivery in VBAC trials, staff education, calculation of the physician s cesarean section rate, press conferences, and calling for an increased national health insurance reimbursement for VBAC. MATERIALS AND METHODS The peer review included pre-cesarean consultation and post-cesarean surveillance. We organized a weekly departmental Cesarean Indication Conference on Mondays. Two board-certified obstetricians were appointed consultants. A second opinion by a consultant was required for all cesarean sections. The guidelines for dystocia, fetal distress, and breech remained unchanged from 1993 through The diagnosis of dystocia was accepted after no labor progress had been observed in more than 2 hours of appropriate uterine contractions, which was defined as more than 200 Montevideo units in a 10-minute period in the active phase of labor. The diagnosis of fetal distress was based on the following results of a monitoring of the fetal heart rate: persistent bradycardia < 120 or tachycardia > 180 beats/min; any baseline heart rate with late decelerations; and meconium with severe variable decelerations. Every cesarean case were supposed to be presented in the departmental conference by the chief resident on the following Monday. The tracing records of the tocodynamometry and fetal heart rate, and other related information, e.g., the ph values of the umbilical vessels, or the operative findings, would be discussed and defended by the patient s attending physician. All physicians cesarean section rates were presented at the conference, but not disseminated to the press or on the Internet. The selection criteria for a selective trial of labor were: (1) one low transverse uterine scar; (2) a singleton pregnancy without suspected macrosomia (> 4,000 gm); (3) a vertex presentation; (4) no medical or surgical illness; and (5) patient consent. For pregnancies of more than 37 weeks, an assessment of the thickness of the uterine scar and an estimation of the fetal weight by ultrasound were performed routinely. Induction of labor was not recommended. Continuous electronic fetal monitoring was set-up after intravenous fluid had been started with a transfusion catheter emplaced when the patient came to delivery room. No food or drink was allowed until the baby was born. Only one indication was recorded for each cesarean section in the analysis of the distribution and attribution of the cesarean section rate based on cesarean causes. The decision rules for assigning multiple-diagnosis deliveries to a single clinically reasonable diagnostic class were modified from the method described previously by Anderson and Lomas. 10 A total of 1,112 records in 1993 and 665 records in 2000 were classified. The data were analyzed in 2 stages. First, the overall cesarean birth rate, regardless of diagnosis, was calculated for each year. Comparisons of the cesarean rates between and were made using chi-square test. Secondly, the data were analyzed for each indication for both 1993 and Comparisons of the proportion of overall cesarean sections contributed by each indication were also made by chi-square test. RESULTS Fig. 1 depicts the annual cesarean section rates at TVGH paralleled with those of the United States from 1975 through The rate at TVGH exceeded the latter in 1989, and that of Taiwan in The cesarean section rate declined from 36.7 (1996) to 30.2% (1997), which was lower than the rate for Taiwan as a whole (32.7%) in The cesarean section rates of Norway and England shown in the figure served as good references for the 1980s. Table 1 shows the numbers and percentages of women who received selective VBAC from 1997 through Totally, among 1,169 women with prior cesareans, 188 (16.1%) elected a trial of labor and 145 (12.4%) achieved a vaginal delivery. The VBAC success rate was 77.1%. No uterine rupture occurred; however, 2 women received a hysterectomy due to a postpartum hemorrhage caused by placenta accreta, and one abruptio placentae occurred. No maternal or perinatal mortality ever occurred in 188 episodes of trial of labor. Only 2 neonates were born with a low Apgar score (< 7) at the 5-minute 282

3 June 2004 Peer Review and Trial of Labor stage: one was scored as 7/4/9 at 1-, 5-, and 10-minute periods after a low-forceps delivery; the other was delivered by emergency cesarean section due to abruptio placentae. The babies were followed-up by pediatricians, and are in fair condition. Thirty-two vacuum-assisted and 5 low-forceps deliveries were performed in 145 successful VBAC cases, with an operative vaginal birth rate of 25.5%. The reasons for the 43 failed trials of labor were: 19 (44.2%) dystocia, 13 (30.2%) intrapartum laboring pain, 10 (23.2%) fetal distress, and 1 (2.3%) abruptio placentae. As shown in Table 2, a comparison of the 4-year periods before and after 1997 at TVGH showed a significant reduction in all 3 categories, rated: p < for total cesareans; p < for primary cesareans; and p < for repeat cesareans. At the same time in Taiwan, conversely, significant increases occurred in the total cesarean section rate during the periods and (p < 0.001). Stage 2 of this study was designed to detect the effectiveness of VGH-T sremodeling efforts by revealing the proportional changes in the overall cesarean birth Table 1. Vaginal birth after prior cesarean (VBAC) rate, VBAC success rate, and the major complications of VBAC at Taipei Veterans General Hospital Year VBAC Prior cesarean VBAC rate* VBAC trial VBAC success rate Major complications n n % n % hysterectomies nil nil abruptio * VBAC rate = number of VBAC/ number of women with prior cesarean section. VBAC success rate = number of VBAC/number of VBAC trials. Pathology-proved placenta accreta. Table 2. Summary of cesarean section data from Taipei Veterans General Hospital and in Taiwan, 1993 through 2000 Taipei Veterans General Hospital Taiwan Year Total deliveries Cesarean sections Total deliveries Total cesarean sections Total Primary Repeat n n(%) n n(%) (40.7) 711 (26.0) 401 (14.7) (32.2) (36.4) 507 (20.5) 394 (15.9) (33.1) (33.8) 449 (17.5) 416 (16.3) (33.7) (36.7) 432 (20.6) 337 (16.1) (32.7) (37.0)* 2099 (21.3) 1548 (15.7) (32.9) (30.2) 344 (16.5) 285 (13.7) (32.7) (32.5) 334 (18.8) 244 (13.7) (33.1) (29.2) 326 (16.9) 238 (12.3) (34.0) (30.9) 408 (18.9) 257 (11.9) (34.5) (30.7)* 1412 (17.8) 1024 (12.9) (33.5) * Reduction of total cesarean section rate at VGH-T, comparing the periods of and using chi-square test, p < 0.001; 95% Confidence Interval (CI) for 37.0%: ; 30.7%: Reduction of primary cesarean section rate at VGH-T, comparing the periods of and , p < 0.001; 95% CI: 21.3%: ; 17.8%: Reduction of repeat cesarean section rate at VGH-T, comparing the periods of and , p < 0.001; 95% CI: 15.7%: ; 12.9%: Increase of total cesarean rate in Taiwan, comparing the periods of and , p < 0.001; 95% CI: 32.9%: ; 33.5%:

4 Wei-Hsing Liang et al. Journal of the Chinese Medical Association Vol. 67, No. 6 rate attributed to each indication. In 1993, 43 indications were employed as reasons for cesarean sections, whereas 35 indications were used in 2000 (Table 3). Table 4 shows the comparison of the proportions attributed to 15 leading indications in 1993 and 2000: 9 indications declined, 5 inclined, and 1 remained unchanged. The reductions were substantial in the major indications, including prior cesarean (-25.2%), dystocia (-38.4%), and fetal distress (-48.4%). Comparing the proportions attributed to 5 indications in 1993 and 2000, there were significant reductions in prior cesareans (p < 0.001), dystocia (p < 0.001), and fetal distress (p = 0.001), but no significant differences were found in breech (p = 0.621) and other (p = 0.360). The contribution of each major indication to the decline of the total cesarean rate can be estimated: 36.7% by reduced prior cesarean use, 37.8% by dystocia; 3.1% by breech presentation, 15.3% by fetal distress, and 8.2% by other. Table 3. Distribution of conditions employed as the indications for cesarean deliveries at Taipei Veterans General Hospital in 1993 and 2000 Characteristic Total cesarean deliveries in 1993 Total cesarean deliveries in 2000 n (%) n (%) Prior cesarean* 391 (35.2) 231 (34.7) Dystocia 270 (24.3) 132 (19.9) Nonvertex 114 (10.3) 84 (12.6) Fetal distress 84 (7.6) 35 (5.3) Other 253 (22.8) 183 (27.5) Total 1112 (100.0) 665 (100.0) * There were 401 and 257 prior cesareans in 1993 and 2000, respectively; the reductions in number were attributed to various conditions, including antepartum hemorrhages, VBAC failure due to dystocia or fetal distress, maternal medical conditions, or fetal disorders. Breech: 111 cases in 1993, 79 in 2000; transverse lie: 2 in 1993, 4 in 2000; compound presentation: 1 in 1993, 1 in minor indications in 1993, 31 minor indications in With a rounding error of 0.2 in the total. Table 4. The proportions of 15 leading indications for cesarean section in 1993 and 2000 Characteristic 1993 (%) 2000 (%) Change* (%) p Prior cesarean < Dystocia < Nonvertex Fetal distress Other Multifetal pregnancy PIH and Preeclampsia Induction failure Placenta previa Abruptio placentae Prior myomectomy Elderly primigravida GDM Macrosomia Myoma Elective primary cesarean Total * Change = (percent in percent in 1993)/ percent in Consists of 51 indications, accounting for 22.8% of the overall cesarean section rate in 1993 and 27.5% in The top 11 indications appear in this table. PIH, pregnancy-induced hypertension; GDM, gestational diabetes mellitus. 284

5 June 2004 Peer Review and Trial of Labor DISCUSSION This study was the first trial to employ VBAC systematically in Taiwan. The authors chose almost perfect candidates for trial of labor. Labor induction or augmentation by oxytocin or prostaglandins was not recommended. 11 The VBAC rate at TVGH has been 12.4% in the most recent 4 years. We plan a 37 percent VBAC rate in the next 5 years, the same percentage as recommended by the American College of Obstetricians and Gynecologists (ACOG) Task Force on Cesarean Delivery Rate for the United States for the year 2010 a gradual increase starting from the 27.4% of 1997 and the 26.3% of VBAC was accepted and encouraged during the 1980s. 13 Accumulated experience showed that trial of labor might be associated with higher maternal morbidity and perinatal complications, but most of these adverse effects were attributable to uterine rupture. 14 The rate of cesarean delivery in the United States increased after 1996, and the rate of VBAC decreased at the same time. Nonetheless, more recent reports dealing with the detailed mechanisms of VBAC are optimistic. 15,16 Although VBAC does pose a lower level of fetal risk, and probably had higher major maternal complications according to the definition of McMahon et al, significant neonatal morbidity could be avoided if prompt delivery, within 17 minutes, is undertaken for women with severe, repetitive late decelerations. 14,17 Active management of labor and external audit were ineffective in reducing cesarean section use. 18 However, the combined efforts of review committees, operative vaginal delivery, and 24-hour physician staffing in hospitals could lead to reduced numbers of convenience cesarean sections occurring during evening hours. 7,8 The contribution of dystocia to the overall cesarean rate per 100 total deliveries in Norway, Scotland, and Sweden was 1.7% to 4.0% in We have lowered the dystocia percentage of the total births from 9.9% (1993) to 6.2% (2000). The potential contribution of breech to the decline in the cesarean rate at our hospital is small because a liberal approach to breech delivery was agreed upon. Nevertheless, the external cephalic version was able to effectively decrease both the breech delivery and cesarean rates. 19 Vaginal delivery for multiparous breeches and external cephalic versions would be a feasible way to lower the breech portion of the cesarean rate. The introduction of electronic fetal monitoring contributed to an increased cesarean section rate in the 1970s. A better understanding and interpretation of fetal heart rate tracings led to a reduction in cesarean section use compared with an initial rise at the beginning of the routine use of monitors. 4,8 At TVGH, the cesarean surveillance system worked well in this category by reducing the fetal distress proportion rate from 3.1% in 1993 to 1.6% in The authors hope to reduce it to 1.1%, a percentage recommended by Myers and Gleicher. 8 It is obviously not sufficient to analyze the four leading indications, which accounted for 85% in Western industrialized countries and 75% at TVGH, in terms of their contribution to all cesarean deliveries. 12 Comparing dozens of minor indications at TVGH for 1993 and 2000, several findings are worth noting: (1) the incidence of multifetal pregnancy with malpresentation exceeded that of fetal distress; (2) the indications for placenta previa and abruptio increased; (3) a new indication referred to as elective primary cesarean (self-pay) appeared a kind of socioeconomic factor influencing the physician s decision-making; (4) inappropriate indications employed in 1993, such as Gestational diabetes mellitus (GDM), induction failure, gum bleeding, or elderly primigravida, were reduced or abandoned in use; (5) the number of conditions inevitably leading to a cesarean section, e.g., total placenta previa, spine/pelvis disorders, gynecological cancers, diaphragmatic hernia, and fetal congenital heart disorders, was high at TVGH as a tertiary center, contributing an approximately 3 percent proportion to the total cesarean rate; and (6) more advanced guidelines for the category other, which accounts for 25% of total cesarean deliveries, is crucial, and this shall be an area of attack for lowering the high cesarean delivery rate at this hospital. In 1990, there were 4 articles published concerning ways to reduce the cesarean rate. One which employed the educational approach alone failed to lower the cesarean rate over a short period. 20 The other three, employing stringent guidelines for prior cesarean, dystocia, fetal distress, and/or breech presentation, lowered the cesarean rate. 12,21 Up to now, the most efficient way to lower the repeat cesarean rate is VBAC, and an efficient way to 285

6 Wei-Hsing Liang et al. Journal of the Chinese Medical Association Vol. 67, No. 6 reduce the primary cesarean rate would be the practice of stringent guidelines for dystocia, fetal distress, and other indications. In this study, we found that the cesarean surveillance system, together with some supportive procedures, could solidify these guidelines. Trial of labor after cesarean section is an issue of medical, economic, and ethical concern. 22,23 Nevertheless, primary cesareans are the origin of this dispute, offering a continuous resource for the debate. Thus, the prevention of primary cesareans is fundamental. In this article, strategies for each category of lowering cesarean section rate have been analyzed, and based on this, the cesarean surveillance system would be a feasible way to double-check the indications before and after a cesarean delivery. REFERENCES 1. Notzon FC, Cnattingius S, Bergsjo P, Cole S, Taffel S, Irgens L, et al. Cesarean section delivery in the 1980s: international comparison by indication. Am J Obstet Gynecol 1994;170: Macfarlane A. At last - maternity statistics for England. BMJ 1998;316: Evrard JR, Gold EM. Cesarean section and maternal mortality in Rhode Island: incidence and risk factors, Obstet Gynecol 1977;50: Gilstrap LC III, Hauth JC, Toussaint S. Cesarean section: changing incidence and indications. Obstet Gynecol 1984;63: Shy KK, LoGerfo JP, Karp LE. Evaluation of elective repeat cesarean section as a standard of care: an application of decision analysis. Am J Obstet Gynecol 1981;139: Douglas RG, Birnbaum SJ, MacDonald FA. Pregnancy and labor following cesarean section. Am J Obstet Gynecol 1963;86: Sachs BP, Kobelin C, Castro MA, Frigoletto F. The risks of lowering the cesarean delivery rate. N Engl J Med 1999; 340: Myers SA, Gleicher N. A successful program to lower cesarean section rates. N Engl J Med 1988; 319: Stafford RS. Alternative strategies for controlling rising cesarean section rates. JAMA 1990;263: Anderson GM, Lomas J. Determinants of the increasing cesarean birth rate. N Engl J Med 1984;311: Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 2001;345: Cesarean delivery and postpartum hysterectomy. In: Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD, eds. Williams obstetrics. 21 st edition. New York: McGraw-Hill, 2001; Martin JN, Harris BA, Huddleston JF, Huddleston JF, Morrison JC, Propst MG, et al. Vaginal delivery following previous cesarean birth. Am J Obstet Gynecol 1983;146: McMahon MJ, Luther ER, Bowes WA, Olshan AF. Comparison of a trial of labor with an elective second cesarean section. N Engl J Med 1996;335: Zelop CM, Shipp TD, Repke JT, Cohen A, Lieberman E. Effect of previous vaginal delivery on the risk of uterine rupture during a subsequent trial of labor. Am J Obstet Gynecol 2000;183: Bretelle F, Cravello L, Shojai R, Roger V, D ercole C, Blanc B. Vaginal birth following two previous cesarean sections. Eur J Obstet Gynecol Reprod Biol 2001;94: Leung AS, Leung E, Paul RH. Uterine rupture after previous cesarean delivery: maternal and fetal consequences. Am J Obstet Gynecol 1993;169: Frigoletto FD Jr, Lieberman E, Lang JM, Cohen A, Barss V, Ringer S, et al. A clinical trial of active management of labor. N Engl J Med 1995;333: Zhang J, Bowes WA Jr, Fortney JA. Efficiency of external cephalic version: a review. Obstet Gynecol 1993;82: Porreco RP. Meeting the challenge of the rising cesarean birth rate. Obstet Gynecol 1990;75: Sanchez-Ramos L, Kaunitz AM, Peterson HB, Martinez-Schnell B, Thompson RJ. Reducing cesarean sections at a teaching hospital. Am J Obstet Gynecol 1990;163: Clark SL, Scott JR, Porter TF, Schlappy DA, McClellan V, Burton DA. Is vaginal birth after cesarean less expensive than repeat cesarean delivery? Am J Obstet Gynecol 2000;182: Greene MF. Vaginal delivery after cesarean section: Is the risk acceptable? N Engl J Med 2001;345:

Rural Health Advisory Committee s Rural Obstetric Services Work Group

Rural Health Advisory Committee s Rural Obstetric Services Work Group Rural Health Advisory Committee s Rural Obstetric Services Work Group March 15 th webinar topic: Rural Obstetric Patient and Community Issues Audio: 888-742-5095, conference code 6054760826 Rural Obstetric

More information

MANA Home Birth Data 2004-2009: Consumer Considerations

MANA Home Birth Data 2004-2009: Consumer Considerations MANA Home Birth Data 2004-2009: Consumer Considerations By: Lauren Korfine, PhD U.S. maternity care costs continue to rise without evidence of improving outcomes for women or babies. The cesarean section

More information

Newborn outcomes after cesarean section for fetal distress in BC

Newborn outcomes after cesarean section for fetal distress in BC Newborn outcomes after cesarean section for fetal distress in BC Patricia Janssen, PhD, UBC School of Population and Public Health Scientist, Child and Family Research Institute Kevin Jenniskens, MSc,

More information

Maternity Care Primary C-Section Rate Specifications 2014 (07/01/2013 to 06/30/2014 Dates of Service)

Maternity Care Primary C-Section Rate Specifications 2014 (07/01/2013 to 06/30/2014 Dates of Service) Summary of Changes Denominator Changes: Two additions were made to the denominator criteria. The denominator was changed to include patients who had: a vertex position delivery AND a term pregnancy of

More information

ABSTRACT LABOR AND DELIVERY

ABSTRACT LABOR AND DELIVERY ABSTRACT POLICY Prior to fetal viability, intentionally undertaking delivery of a fetus is the equivalent of abortion and is not permissible. After fetal viability has been reached, intentionally undertaking

More information

Epidemiology, trends in use of Cesarean section

Epidemiology, trends in use of Cesarean section February, 2010 Source Michelangelo Epidemiology, trends in use of Cesarean section Siri Vangen National Resource Centre for Women s Health, Department of Obstetric and Gynaecology, Oslo University Hospital

More information

C. P. Noel McCarthy, MD 1936 1936--2009 2009 Risk Reduction Strategies in Risk Obstetrics & Gynecology

C. P. Noel McCarthy, MD 1936 1936--2009 2009 Risk Reduction Strategies in Risk Obstetrics & Gynecology C. P. Noel McCarthy, MD 1936-2009 Risk Reduction Strategies in Obstetrics & Gynecology John F. Rodis, MD Professor of Clinical Obstetrics & Gynecology Columbia University College of Physicians & Surgeons

More information

Umbilical Arterial Blood Gas and Perinatal Outcome in the Second Twin according to the Planned Mode of Delivery

Umbilical Arterial Blood Gas and Perinatal Outcome in the Second Twin according to the Planned Mode of Delivery 643 Ivyspring International Publisher Research Paper International Journal of Medical Sciences 2011; 8(8):643-648 Umbilical Arterial Blood Gas and Perinatal Outcome in the Second Twin according to the

More information

Certified Professional Midwives Caring for Mothers and Babies in Virginia

Certified Professional Midwives Caring for Mothers and Babies in Virginia Certified Professional Midwives Caring for Mothers and Babies in Virginia Commonwealth Midwives Alliance Certified Professional Midwives in VA Licensed by the BOM since January 2006 5 member Midwifery

More information

Obstetric Guideline 6B ELECTRONIC FETAL MONITORING IN LABOUR, SCALP SAMPLING, & CORD BLOOD GASES

Obstetric Guideline 6B ELECTRONIC FETAL MONITORING IN LABOUR, SCALP SAMPLING, & CORD BLOOD GASES British Columbia Reproductive Care Program Obstetric Guideline 6B ELECTRONIC FETAL MONITORING IN LABOUR, SCALP SAMPLING, & CORD BLOOD GASES 1. PREAMBLE Meta-analysis of randomized clinical trials 1,2 indicate

More information

The New England. Copyright 2001 by the Massachusetts Medical Society THE CONTINUING VALUE OF THE APGAR SCORE FOR THE ASSESSMENT OF NEWBORN INFANTS

The New England. Copyright 2001 by the Massachusetts Medical Society THE CONTINUING VALUE OF THE APGAR SCORE FOR THE ASSESSMENT OF NEWBORN INFANTS The New England Journal of Medicine Copyright 21 by the Massachusetts Medical Society VOLUME 344 F EBRUARY, 21 NUMBER 7 THE CONTINUING VALUE OF THE APGAR SCORE FOR THE ASSESSMENT OF NEWBORN INFANTS BRIAN

More information

Guidelines for Vaginal Birth After Previous Caesarean Birth

Guidelines for Vaginal Birth After Previous Caesarean Birth SOGC CLINICAL PRACTICE GUIDELINES No 155 (Replaces guideline No 147), February 2005 Guidelines for Vaginal Birth After Previous Caesarean Birth This guideline has been prepared and reviewed by the Clinical

More information

Renown Regional Medical Center Department Of Obstetrics and Gynecology. Policies and Procedures Certified Nurse Midwives ( CNM S)

Renown Regional Medical Center Department Of Obstetrics and Gynecology. Policies and Procedures Certified Nurse Midwives ( CNM S) 1. Overview: Department Of Obstetrics and Gynecology Policies and Procedures Certified Nurse Midwives ( CNM S) supports the practice of Nurse Midwifery and will participate with Certified Nurse Midwives

More information

Oregon Birth Outcomes, by Planned Birth Place and Attendant Pursuant to: HB 2380 (2011)

Oregon Birth Outcomes, by Planned Birth Place and Attendant Pursuant to: HB 2380 (2011) Oregon Birth Outcomes, by Birth Place and Attendant Pursuant to: HB 2380 (2011) In 2011, the Oregon Legislature passed House Bill 2380, which required the Oregon Public Health Division to add two questions

More information

Section 3. Innovative Models

Section 3. Innovative Models Section 3. Innovative Models 3. Innovative Models This section outlines the processes, methods and outcomes from five different hospitals and systems as they have worked to improve maternal and infant

More information

Provider Notification Obstetrical Billing

Provider Notification Obstetrical Billing Provider Notification Obstetrical Billing Date of Notification September 1, 20 Revision Date September 17, 2015 Plans Affected Mercy Care Plan and Mercy Care Long Term Care Plan Referrals As outlined in

More information

Evaluation of cardiotocographic and cord blood changes in induced labor with dinoprostone and misoprostol

Evaluation of cardiotocographic and cord blood changes in induced labor with dinoprostone and misoprostol International Journal of Reproduction, Contraception, Obstetrics and Gynecology Pandey K et al. Int J Reprod Contracept Obstet Gynecol. 2014 Mar;3(1):199-203 www.ijrcog.org pissn 2320-1770 eissn 2320-1789

More information

Second stage fetal heart rate patterns and neonatal acid-base status Faridah Hanim Zam Zam 1, Nazimah Idris 2, Tham Seng Woh 1

Second stage fetal heart rate patterns and neonatal acid-base status Faridah Hanim Zam Zam 1, Nazimah Idris 2, Tham Seng Woh 1 Original Article IeJSME 2012 6(2): 18-23 Second stage fetal heart rate patterns and neonatal acid-base status Faridah Hanim Zam Zam 1, Nazimah Idris 2, Tham Seng Woh 1 Background: Fetal surveillance in

More information

CLINICAL GUIDELINE FOR VAGINAL BIRTH AFTER CAESAREAN SECTION (VBAC)

CLINICAL GUIDELINE FOR VAGINAL BIRTH AFTER CAESAREAN SECTION (VBAC) CLINICAL GUIDELINE FOR VAGINAL BIRTH AFTER CAESAREAN SECTION (VBAC) 1. Aim/Purpose of this Guideline 1.1. Due to a rise in the caesarean section rate there are increasing numbers of pregnant women who

More information

Simultaneous Uterine and Urinary Bladder Rupture in an Otherwise Successful Vaginal Birth After Cesarean Delivery

Simultaneous Uterine and Urinary Bladder Rupture in an Otherwise Successful Vaginal Birth After Cesarean Delivery CASE REPORT Simultaneous Uterine and Urinary Bladder Rupture in an Otherwise Successful Vaginal Birth After Cesarean Delivery Szu-Ying Ho 1, Shuenn-Dhy Chang 2,3, Ching-Chung Liang 2,3 * 1 Department of

More information

Chapter 14. Board of Certified Direct-Entry Midwives.

Chapter 14. Board of Certified Direct-Entry Midwives. Chapter 14. Board of Certified Direct-Entry Midwives. (Words in boldface and underlined indicate language being added; words [CAPITALIZED AND BRACKETED] indicate language being deleted. Complete new sections

More information

Managing the Risk of Uterine Rupture During a Trial of Labor After Cesarean Section

Managing the Risk of Uterine Rupture During a Trial of Labor After Cesarean Section Managing the Risk of Uterine Rupture During a Trial of Labor After Cesarean Section By NORCAL Mutual Insurance Company Introduction While a successful vaginal birth after cesarean section (VBAC) is associated

More information

Implementing Maternity Bundled Payment To Reduce Low-risk First-birth Cesarean Births: A Multi-Stakeholder Initiative

Implementing Maternity Bundled Payment To Reduce Low-risk First-birth Cesarean Births: A Multi-Stakeholder Initiative Implementing Maternity Bundled Payment To Reduce Low-risk First-birth Cesarean Births: A Multi-Stakeholder Initiative Elliott Main MD, CMQCC Brynn Rubinstein, PBGH Agenda 1. Pilot Overview (Brynn) 2. Quality

More information

Maternity billing codes

Maternity billing codes Maternity Billing The Maternity Period - For billing purposes, the obstetrical period begins on the date of the initial visit in which pregnancy was confirmed and extends through the end of the postpartum

More information

Private health insurance uptake and the impact on normal birth and costs: a hypothetical model

Private health insurance uptake and the impact on normal birth and costs: a hypothetical model 1 Homer CSE. Increasing private health insurance uptake and the impact on the rate of normal birth and costs of maternity care: a hypothetical model. Australian Health Review. 2002 25 (2).: 32-36. Private

More information

Obstetrical units should develop a procedure for archiving the fetal monitoring tracings within their own institution.

Obstetrical units should develop a procedure for archiving the fetal monitoring tracings within their own institution. The following guidelines are intended only as a general educational resource for hospitals and clinicians, and are not intended to reflect or establish a standard of care or to replace individual clinician

More information

Prince Edward Island Reproductive Care Program Perinatal Database Report 2011

Prince Edward Island Reproductive Care Program Perinatal Database Report 2011 Prince Edward Island Reproductive Care Program Perinatal Database Report 2011 Acknowledgements The PEI Reproductive Care Program is a joint initiative that operates under the direction of a multidisciplinary

More information

Fetal (FBS) / paired cord blood sampling guideline (GL839)

Fetal (FBS) / paired cord blood sampling guideline (GL839) Fetal (FBS) / paired cord blood sampling guideline (GL839) Approval Approval Group Job Title, Chair of Committee Date Maternity & Children s Services Clinical Governance Committee Mr Mark Selinger, Consultant

More information

Vaginal Birth After Cesarean: New Insights

Vaginal Birth After Cesarean: New Insights Evidence Report/Technology Assessment Number 191 Vaginal Birth After Cesarean: New Insights Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither

More information

Registered Midwife Clinical Privileges REAPPOINTMENT 2015-2016 Effective from July 1, 2015 to June 30, 2016

Registered Midwife Clinical Privileges REAPPOINTMENT 2015-2016 Effective from July 1, 2015 to June 30, 2016 Name: Initial privileges (initial appointment) Renewal of privileges (reappointment) All new applicants must meet the following requirements as approved by the governing body, effective: 04/Jun/2013. Applicant:

More information

Caesarean section and quality of obstetric care

Caesarean section and quality of obstetric care Caesarean section and quality of obstetric care Gjennombruddsprosjekt for keisersnitt September 2014 Michael Robson The National Maternity Hospital Dublin, Ireland Mrobson@nmh.ie Gjennombruddsprosjekt

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy Guidelines for Global Maternity Reimbursement File Name: Origination: Last Review: Next Review: guidelines_for_global_maternity_reimbursement 10/2003 7/2016 7/2017 Description

More information

SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY

SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: ADMISSION/DISCHARGE/ TRANSFER : EFFECTIVE DATE: REVISED DATE: POLICY TYPE: (Maternal) 11/84 7/15 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING

More information

Birth after Caesarean Choices for delivery

Birth after Caesarean Choices for delivery Birth after Caesarean Choices for delivery page 2 What are my choices for birth after a Caesarean? Currently, approximately 1 in 4 women (25%) in England give birth by Caesarean delivery. Some women have

More information

Bladder Injury during Cesarean Section: A Case Control Study for 10 Years

Bladder Injury during Cesarean Section: A Case Control Study for 10 Years Bahrain Medical Bulletin, Vol., No., September Bladder Injury during Cesarean Section: A Case Control Study for Years Mesfer Al-Shahrani, MD, FRCSC* Objective: To determine the incidence, risk factors

More information

Inpatient Obstetric Nursing

Inpatient Obstetric Nursing NCC believes the individual certified nurse is the best person to determine the specialty code for their CE, as they have the specific content of the CE program. Inpatient Obstetric Nursing NCC Maintenance

More information

OBSTETRICAL POLICY. Page

OBSTETRICAL POLICY. Page OBSTETRICAL POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 200.14 T0 Effective Date: April 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

Advanced Fetal Assessment and Monitoring: Online Program. Advanced Practice Strategies, LLC

Advanced Fetal Assessment and Monitoring: Online Program. Advanced Practice Strategies, LLC Advanced Fetal Assessment and Monitoring: Online Program Advanced Fetal Assessment and Monitoring: Online Program Comments from the Authors As a physician who does a great deal of medical legal expert

More information

SAMPLE. UK Obstetric Surveillance System. Management of Pregnancy following Laparoscopic Adjustable Gastric Band Surgery.

SAMPLE. UK Obstetric Surveillance System. Management of Pregnancy following Laparoscopic Adjustable Gastric Band Surgery. ID Number: UK Obstetric Surveillance System Management of Pregnancy following Laparoscopic Adjustable Gastric Band Surgery Case Definition: Study 04/11 Data Collection Form - Please report any woman delivering

More information

Guideline for the Use of Oxytocin December 2012

Guideline for the Use of Oxytocin December 2012 The following guidelines are intended only as a general educational resource for hospitals and clinicians, and are not intended to reflect or establish a standard of care or to replace individual clinician

More information

South Dakota Task Force to Study Abortion Pierre, South Dakota September 21, 2005

South Dakota Task Force to Study Abortion Pierre, South Dakota September 21, 2005 South Dakota Task Force to Study Abortion Pierre, South Dakota September 21, 2005 Section III. : The review and exposition of the body of medical, psychological, and sociological knowledge that has accumulated

More information

Clinical Policy Title: Home uterine activity monitoring

Clinical Policy Title: Home uterine activity monitoring Clinical Policy Title: Home uterine activity monitoring Clinical Policy Number: 12.01.01 Effective Date: August 19, 2015 Initial Review Date: July 17, 2013 Most Recent Review Date: July 15, 2015 Next Review

More information

POLICIES AND PROCEDURES

POLICIES AND PROCEDURES Purpose: To establish guidelines for the clinical practice of Nurse Midwives. Policy: The Central California Alliance for Health (the Alliance) requires all Nurse Midwives to meet the Alliance s guidelines

More information

LECTURE OBJECTIVES & OUTLINES

LECTURE OBJECTIVES & OUTLINES LECTURE OBJECTIVES & OUTLINES 74 I. OVERVIEW OF MATERNITY NURSING OBJECTIVES At the completion of this class the student will be able to: 1. Compare and contrast expanded nursing roles in this specialty.

More information

Delayed Cord Clamping

Delayed Cord Clamping ICEA Position Paper Delayed Cord Clamping Position The International Childbirth Education Association recognizes that the first minutes after birth are crucial to both mother and newborn. Optimal care

More information

Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin

Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin J Korean Med Sci 2007; 22: 248-53 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second

More information

Birth after previous caesarean. What are my choices for birth after a caesarean delivery?

Birth after previous caesarean. What are my choices for birth after a caesarean delivery? Birth after previous caesarean Information for you Published September 2008 What are my choices for birth after a caesarean delivery? More than one in five women (20%) in the UK currently give birth by

More information

8/13/2014. Blood, Sweat (and Tears): Delayed Cord Clamping and Delivery Room Temperature. Delayed Cord Clamping

8/13/2014. Blood, Sweat (and Tears): Delayed Cord Clamping and Delivery Room Temperature. Delayed Cord Clamping 8/13/2014 Blood, Sweat (and Tears): Delayed Cord Clamping and Delivery Room Temperature James F. Smith, Jr., MD Professor and Chair Obstetrics and Gynecology Creighton University School of Medicine The

More information

Priya Rajan, MD Northwestern University September 13, 2013

Priya Rajan, MD Northwestern University September 13, 2013 Priya Rajan, MD Northwestern University September 13, 2013 o Study Finds Benefits in Delaying Severing of Umbilical Cord nytimes.com, 7/10/13 o Delay cord clamping for baby health, say experts bbc.com.uk,

More information

SWISS SOCIETY OF NEONATOLOGY. Umbilical cord complications in two subsequent pregnancies

SWISS SOCIETY OF NEONATOLOGY. Umbilical cord complications in two subsequent pregnancies SWISS SOCIETY OF NEONATOLOGY Umbilical cord complications in two subsequent pregnancies June 2006 2 Hetzel PG, Godi E, Bührer C, Department of Neonatology (HPG, BC), University Children s Hospital, Basel,

More information

Hospital Response no paragraph citations. Dear Dr. Soffici,

Hospital Response no paragraph citations. Dear Dr. Soffici, Hospital Response no paragraph citations Dear Dr. Soffici, Thank you for your in depth reply to my letter requesting that Cottage Hospital reexamine its VBAC ban policy. I have spent some time over the

More information

ST Segment Analysis (STAN) as an Adjunct to Electronic Fetal Monitoring, Part II: Clinical Studies and Future Directions

ST Segment Analysis (STAN) as an Adjunct to Electronic Fetal Monitoring, Part II: Clinical Studies and Future Directions ST Segment Analysis (STAN) as an Adjunct to Electronic Fetal Monitoring, Part II: Clinical Studies and Future Directions Michael A. Belfort, MBBCH, MD, PhD*, George R. Saade, MD KEYWORDS ST segment analysis

More information

Fetal Acid Base Status and Umbilical Cord Sampling. David Acker, MD

Fetal Acid Base Status and Umbilical Cord Sampling. David Acker, MD Fetal Acid Base Status and Umbilical Cord Sampling David Acker, MD Part I: Some Background Intra-uterine Event as Causative of CP Cord ph < 7.00 and base excess of > 12 Early onset neonatal encephalopathy

More information

Associated Factors in 1611 Cases of Brachial Plexus Injury

Associated Factors in 1611 Cases of Brachial Plexus Injury Associated Factors in 1611 Cases of Brachial Plexus Injury WILLIAM M. GILBERT, MD, THOMAS S. NESBITT, MD, MPH, AND BEATE DANIELSEN, PhD Objective: To identify risk factors associated with brachial plexus

More information

Cesarean delivery rates in California and the United

Cesarean delivery rates in California and the United Current Commentary Creating a Public Agenda for Maternity Safety and Quality in Cesarean Delivery Elliott K. Main, MD, Christine H. Morton, PhD, Kathryn Melsop, MS, David Hopkins, PhD, Giovanna Giuliani,

More information

International Journal of Allied Medical Sciences and Clinical Research (IJAMSCR)

International Journal of Allied Medical Sciences and Clinical Research (IJAMSCR) International Journal of Allied Medical Sciences and Clinical Research (IJAMSCR) IJAMSCR Volume 2 Issue 4 Oct-Dec- 2014 Review article Nursing Research To assess level of knowledge of staff nurses on emergency

More information

A8b. Resuscitation of a Term Infant with Meconium Staining. Session Summary. Session Objectives. References

A8b. Resuscitation of a Term Infant with Meconium Staining. Session Summary. Session Objectives. References A8b Resuscitation of a Term Infant with Meconium Staining Karen Wright, PhD, NNP-BC Assistant Professor and Coordinator, Neonatal Nurse Practitioner Program Dept. of Women, Children, and Family Nursing,

More information

Diagnosis Codes for Pregnancy and Complications of Pregnancy

Diagnosis Codes for Pregnancy and Complications of Pregnancy This list is for informational purposes only and is not a binding or definitive list of covered conditions. It is not a guarantee of coverage; coverage depends on the available benefits and eligibility

More information

The relationship between maternal age and uterine dysfunction: A continuous effect throughout reproductive life

The relationship between maternal age and uterine dysfunction: A continuous effect throughout reproductive life The relationship between maternal age and uterine dysfunction: A continuous effect throughout reproductive life Denise M. Main, MD, a, b Elliott K. Main, MD, a, b and Dan H. Moore II, PhD b San Francisco,

More information

Exceptional People. Exceptional Care. Antenatal Appointment Schedule for Normal Healthy Women with Singleton Pregnancies

Exceptional People. Exceptional Care. Antenatal Appointment Schedule for Normal Healthy Women with Singleton Pregnancies Exceptional People. Exceptional Care. Antenatal Appointment Schedule for Normal Healthy Women with Singleton Pregnancies First Antenatal Contact with the GP Obtain medical and obstetric history. Measure

More information

PEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL)

PEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL) PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)

More information

Cardiovascular Disease and Maternal Mortality what do we know and what are the key questions?

Cardiovascular Disease and Maternal Mortality what do we know and what are the key questions? Cardiovascular Disease and Maternal Mortality what do we know and what are the key questions? AFSHAN HAMEED, MD, FACOG, FACC Associate Clinical Professor Maternal Fetal Medicine and Cardiology University

More information

Baltimore, MD 21225 * The Corporation Trust Inc 351 West Camden Street * Baltimore, MD 21201. KATHLEEN WARD, M.D. 3001 South Hanover Street *

Baltimore, MD 21225 * The Corporation Trust Inc 351 West Camden Street * Baltimore, MD 21201. KATHLEEN WARD, M.D. 3001 South Hanover Street * JAYLAN NORFLEET, a minor, by and through his Parents and Next Friends, SHANTIAH MOORE-NORFLEET and IN THE JOEL NORFLEET 5337 4 th Street CIRCUIT COURT Brooklyn, MD 21225 BALTIMORE CITY SHANTIAH MOORE-NORFLEET,

More information

SMFM Papers. The intrauterine device (IUD) is the. Pregnancy outcome in women with. with an intrauterine contraceptive device.

SMFM Papers. The intrauterine device (IUD) is the. Pregnancy outcome in women with. with an intrauterine contraceptive device. Pregnancy outcome in women with an intrauterine contraceptive device Hadas Ganer, BA; Amalia Levy, PhD; Iris Ohel, MD; Eyal Sheiner, MD, PhD OBJECTIVE: To investigate pregnancy outcome in patients who

More information

CONFIDENT CODING FOR OB/GYN CONFIDENT CODING FOR OB/GYN

CONFIDENT CODING FOR OB/GYN CONFIDENT CODING FOR OB/GYN Arlene J. Smith, CPC AAPC National Advisory Board 2007-2009 1 So when exactly does the global period start? Unraveling the confusion in antepartum care coding Correct coding for multiple gestations! Vaginal

More information

Maj Alison Baum. R3, Nellis FMR

Maj Alison Baum. R3, Nellis FMR Maj Alison Baum R3, Nellis FMR What are some of your thoughts about birth plans? http://www.youtube.com/watch?v=hh62v0c xf04 Labor: Pain management wishes Doulas Episiotomy Intermittent fetal monitoring

More information

Int.J.Curr.Microbiol.App.Sci (2014) 3(6):

Int.J.Curr.Microbiol.App.Sci (2014) 3(6): ISSN: 2319-7706 Volume 3 Number 6 (2014) pp. 865-875 http://www.ijcmas.com Original Research Article Perinatal Outcome and Associated maternal Co-morbid conditions in late Preterm Births - A Prospective

More information

My Birth Experience at Mercy

My Birth Experience at Mercy My Birth Experience at Mercy This booklet provides information about labor and birth practices at Mercy and includes an optional birth plan that you can complete prior to your baby s birth. Discuss your

More information

Maternal complications associated with type of delivery in a university hospital

Maternal complications associated with type of delivery in a university hospital Revista de Saúde Pública ISSN 0034-8910 versão impressa Rev Saúde Pública 2004; 38(1) Maternal complications associated with type of delivery in a university hospital Roseli Mieko Yamamoto Nomura, Eliane

More information

ANMC Certified-Nurse Midwife Practice Guideline

ANMC Certified-Nurse Midwife Practice Guideline Approved by the ANMC MCH CCBG April 2013 Reviewed Nov. 16, 2015 1. Intent of Certified Nurse-Midwife Practice Guideline 1.1. The intent of this practice guideline is to provide guidance for midwifery practice

More information

Placenta Accreta: Clinical Risk Factors, Accuracy of Antenatal Diagnosis and Effect on Pregnancy Outcome

Placenta Accreta: Clinical Risk Factors, Accuracy of Antenatal Diagnosis and Effect on Pregnancy Outcome ORIGINAL ARTICLE Placenta Accreta: Clinical Risk Factors, Accuracy of Antenatal Diagnosis and Effect on Pregnancy Outcome S Sofiah, MMed*, Late Y C Fung, FRCOG** *Department of O & G, Medical Faculty,

More information

Obstetric Emergencies for Every Provider

Obstetric Emergencies for Every Provider Obstetric Emergencies for Every Provider James Bates, PhD, MD Associate Professor Director of the division of OB anesthesia Clinical coordinator MOR Department of Anesthesia University of Iowa College

More information

Registered Nurse Initiated Activities Decision Support Tool No. 8A: Obstetrical Emergencies Cord Prolapse

Registered Nurse Initiated Activities Decision Support Tool No. 8A: Obstetrical Emergencies Cord Prolapse Registered Nurse Initiated Activities Decision Support Tool No. 8A: Obstetrical Emergencies Cord Prolapse Decision support tools are evidenced-based documents used to guide the assessment, diagnosis and

More information

Certified Nurse-Midwife and Women s Health Care Nurse Practitioner

Certified Nurse-Midwife and Women s Health Care Nurse Practitioner Certified Nurse-Midwife and Women s Health Care Nurse Practitioner Practice Agreements at Chicago Revised March 2007 TABLE OF CONTENTS SIGNATURES OF AGREEMENT 3 ORGANIZATION RELATIONSHIPS AND MEMBERSHIP

More information

OXYTOCIN: THE NEW HIGH ALERT MEDICATION. A. Oxytocin Becomes a High Alert Drug

OXYTOCIN: THE NEW HIGH ALERT MEDICATION. A. Oxytocin Becomes a High Alert Drug OXYTOCIN: THE NEW HIGH ALERT MEDICATION A. Oxytocin Becomes a High Alert Drug On August 9, 2007, the Institute for Safe Medication Practices named oxytocin to its list of High-Alert Medications. 1 Institute

More information

What is ACLS Maternal Focus?

What is ACLS Maternal Focus? Carla Rider, MBA, BSN, RNC-LRN, Administrative Director Women s Services Meredith Green, MSN Candidate, BSN, RN, Clinical Educator Women s Services What is? ACLS Component 1 American Heart Association

More information

Fairview Health Services CERTIFIED NURSE MIDWIFE Delineation of Privileges CROSSWALK FOR REQUESTING FAIRVIEW PRIVILEGES

Fairview Health Services CERTIFIED NURSE MIDWIFE Delineation of Privileges CROSSWALK FOR REQUESTING FAIRVIEW PRIVILEGES PAGE 1 OF 4 Fairview Health Services CERTIFIED NURSE MIDWIFE Delineation of Privileges Applicant s Name (please print): CROSSWALK FOR REQUESTING FAIRVIEW PRIVILEGES I Want to Work at the Following Fairview

More information

EmONC Training Curricula Comparison

EmONC Training Curricula Comparison EmONC Training Curricula Comparison The purpose of this guide is to provide a quick resource for trainers and course administrators to decide which EmONC curriculum is most applicable to their training

More information

New York Science Journal 2010;3(6) Cesarean Section Scar Depiction By Transvaginal Ultrasound in Non Pregnant State

New York Science Journal 2010;3(6) Cesarean Section Scar Depiction By Transvaginal Ultrasound in Non Pregnant State Cesarean Section Scar Depiction By Transvaginal Ultrasound in n Pregnant State Ghada M. Mansour, MD, Sherif F. El -Mekkawy, MD, Yasser G.M. Albahaie, MD, Asmaa H. Ali, MsC. Department of Obstetrics and

More information

Who Is Involved in Your Care?

Who Is Involved in Your Care? Patient Education Page 3 Pregnancy and Giving Birth Who Is Involved in Your Care? Our goal is to surround you and your family with a safe environment for the birth of your baby. We look forward to providing

More information

The debate about the safety of home births continues

The debate about the safety of home births continues CMAJ Research Outcomes of planned home birth with registered midwife versus planned hospital birth or physician Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD, Robert M.

More information

1 NCC Monograph, Volume 3, No. 1, 2010

1 NCC Monograph, Volume 3, No. 1, 2010 NICHD Definitions and Classifications: Application to Electronic Fetal Monitoring Interpretation Purpose of this Monograph Safe care for mothers and babies during labor and birth is the goal of all health

More information

Maternity - Clinical Risk Management Program

Maternity - Clinical Risk Management Program Maternity - Clinical Risk Management Document Number PD2009_003 Publication date 15-Jan-2009 Ministry of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone

More information

Correlation between Umbilical Cord ph and Apgar Score in High Risk Pregnancy

Correlation between Umbilical Cord ph and Apgar Score in High Risk Pregnancy Original Article Iran J Pediatr Dec 2010; Vol 20 (No 4), Pp:401-406 Correlation between Umbilical Cord ph and Apgar Score in High Risk Pregnancy Mousa Ahmadpour Kacho* 1, MD; Nesa Asnafi 2, MD; Maryam

More information

Gestational Diabetes Mellitus AADE Practice Synopsis Issued December 19, 2013

Gestational Diabetes Mellitus AADE Practice Synopsis Issued December 19, 2013 Gestational Diabetes Mellitus AADE Practice Synopsis Issued December 19, 2013 Gestational diabetes mellitus (GDM), a condition characterized by glucose intolerance during pregnancy, is associated with

More information

Post-Qualification Education in Ultrasound in Obstetrics and Gynecology for Advanced Midwives

Post-Qualification Education in Ultrasound in Obstetrics and Gynecology for Advanced Midwives Post-Qualification Education in Ultrasound in Obstetrics and Gynecology for Advanced Midwives FOLLOW-UP REPORT 2008 REACHING OUT TO RURAL SOUTH AFRICA Nelson R. Mandela School of Medicine University of

More information

What Every Pregnant Woman Needs to Know About Cesarean Section. Be informed. Know your rights. Protect yourself. Protect your baby.

What Every Pregnant Woman Needs to Know About Cesarean Section. Be informed. Know your rights. Protect yourself. Protect your baby. Be informed. Know your rights. Protect yourself. Protect your baby. What Every Pregnant Woman Needs to Know About Cesarean Section 2012 Childbirth Connection If you re expecting a baby, there s a good

More information

Risk Management in Obstetric Care for Family Physicians: Results of a 10-Year Project

Risk Management in Obstetric Care for Family Physicians: Results of a 10-Year Project ORIGINAL ARTICLES Risk Management in Obstetric Care for Family Physicians: Results of a 10-Year Project Thomas S. Nesbitt, MD, MPH, Allen Hixon, MD, Jeffrey L. Tanji, MD, Joseph E. Scherger, MD, MPH, and

More information

To provide safe and standardized nursing care for the patient requiring induction or augmentation of labor.

To provide safe and standardized nursing care for the patient requiring induction or augmentation of labor. Policy: Guidelines for the Management of Patients Undergoing Induction or Labor & Delivery Effective Date May 2012 Approval Date May 2012 Supersedes September 2011 Applicable to VUH Children s Hospital

More information

Births in. Licensed MictwlfemAttended, Outmof-Hospital. Patricia A. Janssen, BSN, MPH, Victoria 1. Holt RN, MPH, PhD, and Susan J.

Births in. Licensed MictwlfemAttended, Outmof-Hospital. Patricia A. Janssen, BSN, MPH, Victoria 1. Holt RN, MPH, PhD, and Susan J. BIRTH 21:3 September 1994 141 Licensed MictwlfemAttended, Outmof-Hospital Washington State: Are They Safe? Births in Patricia A. Janssen, BSN, MPH, Victoria 1. Holt RN, MPH, PhD, and Susan J. Myets, UM,

More information

A CLINICAL STUDY OF GESTATIONAL DIABETES MELLITUS IN A TEACHING HOSPITAL IN KERALA Baiju Sam Jacob 1, Girija Devi K 2, V.

A CLINICAL STUDY OF GESTATIONAL DIABETES MELLITUS IN A TEACHING HOSPITAL IN KERALA Baiju Sam Jacob 1, Girija Devi K 2, V. A CLINICAL STUDY OF GESTATIONAL DIABETES MELLITUS IN A TEACHING HOSPITAL IN KERALA Baiju Sam Jacob 1, Girija Devi K 2, V. Baby Paul 3 HOW TO CITE THIS ARTICLE: Baiju Sam Jacob, Girija Devi K, V. Baby Paul.

More information

North Carolina Medicaid Special Bulletin

North Carolina Medicaid Special Bulletin North Carolina Medicaid Special Bulletin An Information Service of the Division of Medical Assistance Visit DMA on the web at http://www.ncdhhs.gov/dma Number 1 (Revised 8/23/11) July 2011 Pregnancy Medical

More information

No. 125 April 2001. Enhanced Surveillance of Maternal Mortality in North Carolina

No. 125 April 2001. Enhanced Surveillance of Maternal Mortality in North Carolina CHIS Studies North Carolina Public Health A Special Report Series by the 1908 Mail Service Center, Raleigh, N.C. 27699-1908 www.schs.state.nc.us/schs/ No. 125 April 2001 Enhanced Surveillance of Maternal

More information

First-Trimester Cesarean Scar Pregnancy Evolving Into Placenta Previa/Accreta at Term

First-Trimester Cesarean Scar Pregnancy Evolving Into Placenta Previa/Accreta at Term Case Report First-Trimester Cesarean Scar Pregnancy Evolving Into Placenta Previa/Accreta at Term Jara Ben Nagi, MD, Dede Ofili-Yebovi, MD, Mike Marsh, MD, Davor Jurkovic, MD Placenta accreta is a rare

More information

THE LABOUR ADMISSION CTG An assessment of the test s predictive values, reliability and effect How the test is perceived by practicing midwives

THE LABOUR ADMISSION CTG An assessment of the test s predictive values, reliability and effect How the test is perceived by practicing midwives THE LABOUR ADMISSION CTG An assessment of the test s predictive values, reliability and effect How the test is perceived by practicing midwives Ellen Blix Doctoral thesis at the Nordic School of Public

More information

Disclosure Information. What You Need to Know: Changes in OB/GYN Coding. Invalid Codes. Revised Diagnosis Codes. New Diagnosis Codes

Disclosure Information. What You Need to Know: Changes in OB/GYN Coding. Invalid Codes. Revised Diagnosis Codes. New Diagnosis Codes Disclosure Information What You Need to Know: Changes in OB/GYN Coding Joan Slager, DNP, CNM, CPC, FACNM slagerj@bronsonhg.org I have the following financial relationship to disclose: Speaker s Bureau:

More information

Informed Consent Form for Hospital Transfer. Please carefully read this form, sign it and return it to us.

Informed Consent Form for Hospital Transfer. Please carefully read this form, sign it and return it to us. Dear Expectant Parent: Welcome! We look forward to your stay at the Puget Sound Birth Center in Kirkland. Enclosed is some information that will assist you in pre-registering and will prepare you for your

More information

BABY PHASES... Whether You Are Pregnant Now Or Just Thinking About It.

BABY PHASES... Whether You Are Pregnant Now Or Just Thinking About It. BABY PHASES... Whether You Are Pregnant Now Or Just Thinking About It. Healthchoice and the Winnie Palmer Hospital for Women & Babies Maternal Education and Breastfeeding Education Center offer an exceptional

More information

Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery

Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery Article Sonographic Evaluation of the Lower Uterine Segment in Patients With Previous Cesarean Delivery Vincent Y. T. Cheung, MBBS, FRCOG, FRCSC, RDMS, Oana C. Constantinescu, MD, RDMS, Birinder S. Ahluwalia,

More information

Obstetrical Services Policy

Obstetrical Services Policy Policy Number 2016R0064A Annual Approval Date Obstetrical Services Policy 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for

More information