National Perinatal Information Center

As an Ob & Gyn, member of National Breast Cancer Foundation and a woman I find it very important to raise awareness about the importance of early detection of Breast Cancer. Make a difference! Spread the word about mammograms and encourage communities, organisations, your friends and family memebrs to get involved! Your help matters.

To use propensity score methods to control for confounding by indication in the association between labour induction and caesarean delivery. Cross-sectional analysis of administrative hospital discharge data supplemented by medical record information. Fourteen US member hospitals of the National Perinatal Information Center. A cohort of 166559 singleton liveborn deliveries in the period 2007-2012. We used propensity scores (PSs) to balance 83 covariates between induced and non-induced women, and compared estimates with traditional covariate adjustment. We estimated PSs for labour induction versus expectant management of pregnancy each week from 34 to 42weeks of gestation. We estimated risk ratios (RRs) for the association between labour induction and primary caesarean delivery from models with no adjustment, traditional adjustment of five covariates, matched PS, and adjustment for continuous PS. Caesarean delivery in current or subsequent week of gestation. In crude models labour induction increased the risk of caesarean delivery in all weeks (RR1.06-1.52), excepting 39weeks of gestation (RR0.89). After matching on PS, the analysis showed a significantly decreased risk of caesarean delivery with labour induction during weeks35-39 (RR0.77-0.92), and a significantly elevated risk at weeks40 (RR1.22) and 41 (RR1.39). Traditional covariate and PS adjustment resulted in RRs between those from crude and PS-matched models. There is evidence of considerable confounding by indication in the association of labour induction and caesarean delivery, particularly for preterm deliveries. Using PS methods, we found a reduced risk of caesarean delivery with labour induction before 40weeks of gestation, and an elevated risk for weeks40-42. With confounding adjustment, labour induction does not increase the risk of caesarean at 34-39weeks of gestation.

Streptococcal A infections are reemerging as a dangerous clinical problem. This particular infection is usually a problem for the postpartum mother and not usually associated with fetal or neonatal infections. Maternal morbidity and mortality are overwhelming when compared with other maternal infections. Historically, group A streptococcus was the cause of epidemic postpartum sepsis prior to the advent of proper hand-washing techniques. Currently, transmission can occur directly from a colonized healthcare provider, other patients, or a community-acquired source. The Joint Commission and the International Surviving Sepsis Campaign have placed patient safety and early recognition and treatment of sepsis as major initiatives to improving patient outcomes.

This report explores the availability of neonatal special care services in the US and examines the variation in those services from both the staffing and service perspectives. The American Hospital Association survey of hospitals and a special national survey of hospitals with special care services were used as data sources to describe changes in the status of high-risk care between 1983 and 1997. The latter survey had a 69% response rate and was a collaborative effort among the March of Dimes, the Maternal and Child Health Bureau, the American Hospital Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, Ross Labs, and the National Perinatal Information Center (NPIC). The study found that across all regions of the US, the special care supply has expanded. However, the study shows wide variation in medical staffing even among those hospitals offering the most intensive services; 25% had no physician in-house coverage 24 hr/d. There is wide availability of high-risk newborn care which is a possible oversupply; however, differential physician staffing raises issues regarding the need for more standardized care.

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.

Australias infant mortality rate fell below 10/1000 live births for the 1st time in 1983 (9.6/1000). Internationally Australia ranks 12th in infant mortality among countries with populations over 2.5 million. Contributing to this relatively poor international standing has been the high incidence of low birthweight infants high postneonatal mortality in disadvantaged population groups such as the Aborigines and the completeness of registration of infant mortality in Australia. There is a legal requirement that perinatal deaths from at least 20 weeks gestation or 400 gm birthweight be registered. In 1983 the national perinatal mortality rate was 12.2/1000 births. The greatest reduction in neonatal mortality has been among infants weighing 1000-2499 gms. Most of the recent improvement in the low birthweight component of the neonatal death rate is attributable to the better survival of these infants not a major reduction in the incidence of low birthweight. Several proposals are made for improving the data on perinatal and infant mortality in Australia. These deaths should be routinely linked to the maternal and fetal or neonatal data in the perinatal morbidity data collections to facilitate identification of risk factors. Also pregnancies terminated after diagnosis of fetal abnormalities should be included in these perinatal data collections. Steps such as educating the community about the adverse effects of alcohol and smoking in pregnancy increased planning of pregnancy better detection of high risk pregnancies and regionalization of the care of pregnant women at high risk of complications could contribute to further reductions in infant and perinatal mortality in Australia.