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PubMedDate not supplied

Prolonged bedrest during pregnancy: does the risk of deep vein thrombosis warrant the use of routine heparin prophylaxis?

This is the first study to assess the risk of clinically apparent DVT in pregnant women placed in the hospital at prolonged bedrest. The outcome is discussed with reference to the risks associated with heparin. Information, including delivery data, length of hospital stay, and discharge diagnoses were extracted from a prospectively collected computerized data bank of all deliveries that occurred over a 5.5-year period at Long Beach Memorial Women's Hospital in Long Beach, California, and at St. Joseph's Hospital in Milwaukee, Wisconsin. One group consisted of all pregnant women who had been hospitalized at prolonged antepartum bedrest, as defined by 3 weeks or more. The other group consisted of the remaining population of women whose deliveries occurred during the same time period. There were 48,525 deliveries during the study period, and 266 (0.5%) women were hospitalized at prolonged antepartum bedrest. The mean number of days in the hospital for these women was 34.6 +/- 14 (range 21-82 days). Of these women, one received prophylactic heparin for a prior history of DVT. There were no cases of DVT in the 265 women who did not receive heparin, risk = 0.0 (CI = 0.00-0.99). Of these 265 women, 234 were hospitalized up to the day of delivery. Of these 234 women, 154 (65.8%) underwent cesarean section and no case of DVT occurred in the postoperative period, risk = 0.0 (CI = 0.0-1.7). Out of the remaining 48,259 women who were not hospitalized at prolonged bedrest, there were 18 cases of clinically apparent DVT, and the longest antepartum hospitalization was 4 days. A conservative risk of complications with prophylactic heparin therapy is 1.0% or greater. Although the risk of DVT in pregnant women hospitalized at prolonged bedrest is not zero, our study indicates that it is very low (< 1.0%). Whereas a risk of DVT of at least 1.0% could warrant heparin prophylaxis, even with 265 patients at prolonged bedrest and 48,525 controls, this risk could not be demonstrated. Using a power analysis with an alpha of 0.05 and a power of 80% to demonstrate this risk, one would need 247 cases and approximately 49,000 controls, which were clearly achieved in this study. In view of the risks associated with heparin, routine antenatal prophylaxis is not recommended unless other risk factors for DVT are present.

Bed Rest↗
PubMed1991

The relationship of maternal exercise on labor, delivery and health of the newborn.

Thirty women were interviewed and divided into active and sedentary groups. Pre-delivery data, information regarding labor and delivery, Apgar scores of the newborn and perceived exertion during labor were recorded and statistically analyzed. Neonates of active women showed slightly higher one-minute Apgars and no difference in fetal weight or five-minute Apgars. Active women indicated lower perceived exertion during labor, longer delivery times and no differences in gestational length, maternal weight gain and time during the first stage of labor. Maternal weight gain in both groups correlated positively with fetal weight. A higher fetal weight indicated a slightly higher five-minute Apgar. Primaparas showed no difference in the first stage of labor although longer delivery time was noted. No differences in levels of medication during labor were revealed although the youngest and oldest subjects required cesarean delivery. Obese women labored longer, indicated higher perceived exertion and higher fetal weights.

Adolescent↗
PubMedDate not supplied

New global communication process in thermodynamics: impact on quality of published experimental data.

Thermodynamic data are a key resource in the search for new relationships between properties of chemical systems that constitutes the basis of the scientific discovery process. In addition, thermodynamic information is critical for development and improvement of all chemical process technologies. Historically, peer-reviewed journals are the major source of this information obtained by experimental measurement or prediction. Technological advances in measurement science have propelled enormous growth in the scale of published thermodynamic data (almost doubling every 10 years). This expansion has created new challenges in data validation at all stages of the data delivery process. Despite the peer-review process, problems in data validation have led, in many instances, to publication of data that are grossly erroneous and, at times, inconsistent with the fundamental laws of nature. This article describes a new global data communication process in thermodynamics and its impact in addressing these challenges as well as in streamlining the delivery of the thermodynamic data from "data producers" to "data users". We believe that the prolific growth of scientific data in numerous and diverse fields outside thermodynamics, together with the demonstrated effectiveness and versatility of the process described in this article, will foster development of such processes in other scientific fields.

Chemistry↗
PubMed2004

Elective primary caesarean delivery: accuracy of administrative data.

The caesarean delivery rate has become a commonly used measure intended to reflect the quality of obstetric care. At least 25% of all primary caesarean deliveries occur electively, i.e. to women who are not in labour. This study is intended to validate a previously published model designed to use ICD-9-CM codes to identify and categorise cases of elective primary caesarean delivery by their indication. ICD-9-CM codes were compared with diagnoses written in the medical record for all women without a prior caesarean who delivered in the same month in a single hospital to examine the accuracy of the codes for 12 potential elective primary caesarean indications derived by the published model: malpresentation; bleeding; genital herpes; severe hypertension; uterine scar; multiple gestation; macrosomia; unengaged fetus; maternal soft tissue conditions; other hypertensive conditions; prematurity; and chromosomal anomalies. Of 440 eligible women, a total of 26 (5.9%) had an elective primary caesarean by medical record review vs. [27] (6.1%) by administrative data. Using medical record data as the gold standard, the sensitivity, specificity, and accuracy of administrative data for the identification of elective primary caesarean delivery were 73.1%, 98.1%, and 96.6%, respectively. Administrative coding for all of the 12 conditions was highly specific, although wide variability existed in its sensitivity; its accuracy ranged between 83.9% and 100%. These results suggest that, despite widespread use of caesarean delivery rates obtained through administrative data, more experience is needed to determine which obstetric codes may be sufficiently specific, sensitive, or prevalent to serve a monitoring or surveillance function reflecting the quality of obstetrical care. The results support continued efforts to use administrative data to monitor elective primary caesarean delivery.

Adult↗
PubMed1999

A comprehensive approach to clustering of expressed human gene sequence: the sequence tag alignment and consensus knowledge base.

The expressed human genome is being sequenced and analyzed by disparate groups producing disparate data. The majority of the identified coding portion is in the form of expressed sequence tags (ESTs). The need to discover exonic representation and expression forms of full-length cDNAs for each human gene is frustrated by the partial and variable quality nature of this data delivery. A highly redundant human EST data set has been processed into integrated and unified expressed transcript indices that consist of hierarchically organized human transcript consensi reflecting gene expression forms and genetic polymorphism within an index class. The expression index and its intermediate outputs include cleaned transcript sequence, expression, and alignment information and a higher fidelity subset, SANIGENE. The STACK_PACK clustering system has been applied to dbEST release 121598 (GenBank version 110). Sixty-four percent of 1,313, 103 Homo sapiens ESTs are condensed into 143,885 tissue level multiple sequence clusters; linking through clone-ID annotations produces 68,701 total assemblies, such that 81% of the original input set is captured in a STACK multiple sequence or linked cluster. Indexing of alignments by substituent EST accession allows browsing of the data structure and its cross-links to UniGene. STACK metaclusters consolidate a greater number of ESTs by a factor of 1. 86 with respect to the corresponding UniGene build. Fidelity comparison with genome reference sequence AC004106 demonstrates consensus expression clusters that reflect significantly lower spurious repeat sequence content and capture alternate splicing within a whole body index cluster and three STACK v.2.3 tissue-level clusters. Statistics of a staggered release whole body index build of STACK v.2.0 are presented.

Algorithms↗
PubMed2003

The reciprocal effects of program evaluation on service delivery for the SPNS adolescent HIV outreach and treatment programs.

PURPOSE: To describe the contexts within which the Special Projects of National Significance (SPNS) Adolescent HIV Outreach and Treatment programs were evaluated, the effects their evaluations had on their respective programs and, in turn, the effects the program delivery had on the evaluations. METHODS: The full range of process evaluation heuristics were used to analyze the bi-directional effects of conducting field-based, service delivery data collection. Although data collection efforts sometimes interfered with service delivery, and vice versa, several notable positive effects were disclosed. CONCLUSIONS: Specific guidance and recommendations were provided to program designers, behavioral researchers and institutional funding decision makers. Primary amongst them was a call for research evaluation designs that allow for maximum flexibility.

Adolescent↗
PubMed1982

High risk antenatal hospitalization.

High risk, antenatal units have been established to provide highly sophisticated obstetric care for women with complications of pregnancy. In an effort to more precisely define the patients requiring this care, and to begin to document the benefits of antenatal hospitalization, a 2-year prospective evaluation of the Antenatal Unit (AU) at the Brigham and Women's Hospital was performed. Between July 1, 1978 and June 30, 1980, 1488 consecutive patients were admitted to the AU. Demographic data, antenatal hospitalization time, hospitalization outcome, and delivery data were determined for these patients. Diabetes mellitus, premature labor, hypertensive disorders, premature rupture of the membranes, and late pregnancy bleeding disorders resulted in over 60% of the admissions. Follow-up data demonstrated that among these 1488 patients admitted to the AU, there occurred 32 stillbirths (21.5/1000), 50 neonatal deaths (33.6/1000), and no maternal deaths. This study demonstrated that a broad spectrum of medical, surgical, and obstetric complications necessitate antenatal hospitalization, resulting in an overall perinatal survival rate of 95%.

Boston↗
PubMed2001

Perinatal outcome following fetal single umbilical artery diagnosis.

OBJECTIVE: We report the frequency of associated congenital abnormalities in fetuses with a single umbilical artery as well as the sensitivity, specificity, positive predictive value and negative predictive value of ultrasound for detecting these abnormalities. We also report the pregnancy outcome of fetuses complicated by single umbilical artery, both isolated and with other congenital anomalies. METHODS: All pregnancies complicated by fetal single umbilical artery from 1995 to 1999 were identified. A retrospective chart review was performed on both the prenatal records and the ultrasound records of these pregnancies, determining the nature and incidence of other congenital abnormalities. Delivery data were collected to include gestational age at delivery, Apgar score, birth weight, mode of delivery, fetal gender and any complications. RESULTS: Ninety-two pregnancies were identified with a fetal single umbilical artery, of which outcome data were available for 65. Forty-eight (74%) cases were identified as isolated single umbilical artery. Seventeen (26%) cases had other congenital abnormalities. High-resolution ultrasound had 100% sensitivity and specificity for identifying single umbilical artery and an 85% sensitivity and 98% specificity for detecting other congenital abnormalities. Compared to isolated single umbilical artery, pregnancies complicated by single umbilical artery with other abnormalities had a statistically significantly increased rate of fetal aneuploidy, lower birth weight, preterm delivery and Cesarean delivery. CONCLUSION: Pregnancies complicated by fetal single umbilical artery, especially when associated with other congenital abnormalities, are at increased risk for adverse pregnancy outcome.

Adult↗
PubMedDate not supplied

Shoulder dystocia and operative vaginal delivery.

Our objective was to determine the factors involved in the development of shoulder dystocia in association with operative vaginal delivery. In this prospective study, patients who were candidates for operative vaginal delivery were randomized either to forceps (N = 315) or vacuum with M-cup (N = 322) and timed from initial placement of instrument to final delivery. Data were gathered prior to and after instrumental delivery. Statistics used were Pearson chi square, Fisher's exact, analysis of variance, and multiple logistic regression. There were a total of 21 patients with shoulder dystocia in both groups (3.3% incidence). Discriminant factors that did nor meet significance included use of epidural analgesia (P = .12), station (P = .99), previous vaginal delivery (P = .99), fetal gender (P = .54), indication for operative vaginal delivery (P = .63), > 45 degrees rotation (P = .68), use of episiotomy (P = .62), maternal weight (P = .26), and maternal diabetes (P = .08). Nearly attaining significance in univariate analysis was randomization to vacuum (P = .052). Significant factors included gestational age (P = .03), time required to effect delivery (P = .007), and birthweight (P = .0001). When these factors were subjected to stepwise multiple logistic regression, three factors remained as significant associations with shoulder dystocia: randomization to vacuum (P = .04), time for delivery (P = .03), and birthweight (P = .0001). In this operative vaginal delivery trial, shoulder dystocia was strongly associated with large fetal size, longer time to delivery, and the use of vacuum for delivery.

Birth Injuries↗
PubMed1994

Vaginal birth after cesarean: a 10-year experience.

OBJECTIVE: To report the changing incidence of previous cesarean delivery, and the increasing use and success of a trial of labor and its effect on the repeat cesarean rate. METHODS: Between 1983-1992, there were 164,815 deliveries at Los Angeles County+University of Southern California Women's Hospital, of which 17,322 (10.5%) were to women with at least one previous cesarean delivery. Data were gathered on an ongoing basis from delivery logs and patient charts. RESULTS: Women with at least one previous cesarean accounted for 8.1% of all deliveries in 1983, increasing to 14.1% by 1992. Trial of labor was used in 80% of women with one previous cesarean, in 54% with two, and in 30% with three or more. The success rate was significantly higher with one previous cesarean (83%) than with two or more (75.3%). Furthermore, uterine rupture was three times more common with two or more previous cesareans. Compared to a policy of routine repeat cesarean, trial of labor yielded a 6.4% lower cesarean delivery rate. The majority of this benefit (5.5%) was derived by women with one previous cesarean. Among women undergoing a trial of labor, there were three rupture-related perinatal deaths and a single rupture-related maternal death. CONCLUSION: Substantial reduction in the cesarean rate is achieved safely and efficiently by encouraging a trial of labor in women with a single previous cesarean delivery.

Cesarean Section↗
PubMed2002

Epidural analgesia does not prolong the third stage of labour.

PURPOSE: To investigate whether there is an association between epidural analgesia and duration of third stage of labour, and between epidural analgesia and type of placental delivery (spontaneous vs expressed vs manual). METHODS: We examined, retrospectively, the computerized labour and delivery data of all 7,468 parturients who had vaginal deliveries from 1996 to 1999 at the Civic Campus of the Ottawa Hospital. RESULTS: There was no difference in duration of third stage of labour between women with and without epidural pain relief who had spontaneous or expressed (fundal pressure/gentle cord traction) placental delivery. Duration of third stage of labour was shorter in women with epidural analgesia requiring manual removal of placenta. (25.3 min vs 40.1 min, P < 0.0001). The incidence of expressed placental delivery or manual removal of placenta was not different between the groups. CONCLUSIONS: We conclude that there is no clinically important difference in duration of third stage of labour between women with or without epidural analgesia who have spontaneous placental delivery or placental expulsion with fundal pressure/gentle cord traction. However, duration of third stage of labour was shorter in women who received epidural analgesia and required manual removal of the placenta.

Adult↗
PubMed2000

[Assisted labor among non European community pregnant women at the Gynecology and Obstetrics Clinic of the Verona University].

BACKGROUND: The aim of this paper is to evaluate the role and the prevalence of the non-European Community pregnant women in our Institute during the period 1992-1998. The peculiarity of the female immigration in the world and particularly in Italy is stressed from the point of view of the different cultural, ethnic and religious problems of these women. METHODS: During the observed period 8972 women delivered; 434 of them came from non-European Community countries and their individual (age, country) and obstetric (parity, physiological or pathological evaluation of pregnancy, mode of delivery) data were observed. On the basis of the different countries of provenance these women have been subdivided into five groups (East Europe, North Africa and Middle East, Central Africa, Far East and Latin America). RESULTS: The percentages of preterm births (24.2% vs 23.1%), of < or = 1500 g newborns (6.9% vs 5.3%) and of caesarean sections (34.3% vs 27.7%) are higher in the non-European Community women that delivered in our Institute. In 222 (51.1%) cases the women delivered without induction of labour; while in 14.5% of cases it was induced. The length of labour and the genital conditions (episiotomy, tearing) were considered in all ethnic groups of women. CONCLUSIONS: On the basis of the literature and of the analysis of our data, some suggestions about the management of labour and delivery of non-European Community women in Italy are proposed. In particular, the problems of linguistic communication and of the hospital staff preparation in the assistance to labour and delivery are stressed.

Adult↗
PubMed1995

The role and scope of data management in a changing health services delivery environment.

Data and information are essential to rational decision making and the good management of the health services delivery systems in any country. The restructuring of health systems world-wide is impacted by these concepts. The information systems necessary to provide data and information can be characterized by a number of interdependent domains. Data Management is central because data provides the binding principle: Applications are processing Data, Technology is transferring data, Methodology is identifying how data is captured and where it is used in order to minimize the cost of data as a resource. The whole purpose is to serve the Business of Health Services Delivery. Each domain is interdependent with the others at an intersection between the domains.

Database Management Systems↗