Clark T. Johnson

Examining the relationship between positive mid-gestational fetal fibronectin assays and histological evidence of acute placental inflammation

Abstract Aims: Both acute placental inflammation and positive mid-gestational cervico-vaginal fetal fibronectin assays have been independently correlated with preterm delivery. We conducted this study to examine the relationship between positive mid-gestational fetal fibronectin (fFN) assays and histological evidence of acute placental inflammation at delivery among women presenting with symptomatic preterm labor. Methods: This retrospective chart review included women who underwent cervico-vaginal fFN testing for preterm contractions between 24–34 weeks gestation and also had placental histological analysis after delivery. Women with a multiple gestation, cerclage, preterm premature rupture of membranes, intercourse or vaginal bleeding within 24 h before the assay were excluded. The primary outcome was histological evidence of acute placental inflammation defined as acute chorioamnionitis, acute deciduitis, funisitis, or microabscess formation. Results: Of 82 women who met all study inclusion criteria, 45% were fFN positive. Women with positive assays were no more likely to have histological evidence of acute inflammation noted at birth than women with negative assays (45% vs. 26%, P=0.07). The assay had a sensitivity of 58.6%, specificity of 62.3%, positive predictive value of 46.0%, and negative predictive value of 73.3% for predicting acute inflammation at delivery. Conclusions: No association exists between positive fetal fibronectin assays and acute histologic placental inflammation at birth.

Physiciansʼ Knowledge Regarding Tablet- and Handheld-Based Applications in Gynecology and Obstetrics [384]

INTRODUCTION: Mobile health is a newer concept that describes services supported by mobile communication devices such as wireless Smartphones and tablet computers. The purpose of this study is to assess the baseline knowledge held by training and practicing gynecologists and obstetricians on the availability and use of mobile applications (apps) in their field of practice. METHODS: We developed a multifaceted survey to assess knowledge and use of mobile apps as well as to illicit recommendations for development of future apps. The survey was administered electronically to training and practicing obstetricians and gynecologists at select academic institutions affiliated with residency programs. RESULTS: Responses from 29 health care providers from three institutions were analyzed. Greater than 80% of practitioners use Smartphone apps in their practice. The primary use is “physician and student reference.” The predominant apps used are those for cervical cytology guidelines and obstetric wheels. The majority of practitioners estimate that 10–30% of patients use apps for issues related to their health. Greater than 80% of health care providers would like to have more apps available for use. CONCLUSION AND IMPLICATION: Apps are currently used by both physicians and patients to gain knowledge and information in the field of obstetrics and gynecology. This is an expanding technology and regardless of whether a health care provider chooses to implement these new resources into clinical practice, promoting the importance of physician awareness of these new technologies may benefit advancement in gynecologic and obstetrics health care and medical education.

The Nationwide Relationship Between Malpractice Rates of Vaginal and Cesarean Delivery

INTRODUCTION: Malpractice rates vary widely by state. We sought to examine the relationship between malpractice rates and the rate of vaginal delivery compared with cesarean delivery at the state level. METHODS: Data were collected from the Centers for Disease Control and Prevention National Vital Statistics System for 2010 regarding mode of delivery: vaginal or cesarean. Malpractice rates for practicing obstetrics–gynecology providers for each state from the year 2010 were obtained from the 2011 Medical Liability Monitor Rate Survey (Karls CC. From crunchy candy to simmering frogs: waiting and hoping for a hardening market as the market trends slowly, steadily softer. Med Liabil Monit 2011;36:1–43.). Using SAS 9.3 statistical software, linear regression modeling was performed to evaluate the relationship between those medical malpractice rates and the rates of vaginal delivery and cesarean delivery rate by state. RESULTS: Data were collected from each of the 50 states and the District of Columbia regarding average malpractice rate per

Maternal deaths from suicide and overdose in Colorado, 2004-2012

1 million of insurance as well as the percentage of total deliveries that were delivered vaginally or by cesarean. Regression modeling demonstrated that states with lower malpractice rates have significantly higher rates of vaginal delivery (P<.01) with lower rates of cesarean delivery (Fig. 1). Fig 1. A comparison of and trend line between state vaginal delivery rates and malpractice rates (for mature claims-made policies with limits of

An Evaluation of the Relationship Between Out-of-Hospital Birth Characteristics and Malpractice Rates by State [16K]

1 million/

Wait Times for First Appointments: A Novel Method of Assessing Access to Obstetric Services [30N]

3 million). (Johnson, p. 119–20S) CONCLUSIONS: States with higher malpractice rates have lower vaginal delivery rates and higher cesarean delivery rates than states with lower malpractice rates. Efforts to reduce statewide malpractice rates may curb rising cesarean delivery rates.

The Cost-Effectiveness of Operative Delivery in the Management of Obstructed Labor [323]

I congratulate Metz et al1 on their recent publication regarding causes of maternal mortality in Colorado from 2004 to 2012, and I embrace their findings as representative of a major cause of maternal deaths in this country. In Maryland, our Maternal Mortality Review has noticed very similar pattern

The Johns Hopkins manual of gynecology and obstetrics

INTRODUCTION: In recent decades, there has been an increasing incidence of out-of-hospital births, while at the same time obstetric malpractice rates have increased significantly. We evaluated the relationship between malpractice rates and trends in the risk profile of home births nationally. METHODS: Data was collected from the CDC National Vital Statistics System for 2003 and 2013. For both years, data on rates of out-of-hospital births and characteristics of those births, including extremes of maternal age (<20 or >35) and prior caesarian section, was analyzed. Malpractice rates for practicing OB/GYN providers for each state from the year 2010 were obtained from the 2011 Medical Liability Monitor Rate Survey. STATA 13 software was used to perform linear regression analysis to evaluate the relationship between obstetric malpractice rates and the rates of various higher risk characteristics of out-of-hospital delivery. RESULTS: Data was available from 31 states included in our analysis, with other states limited by data collected on birth certificates. Linear regression demonstrated no significant relationship (P<.05) between state malpractice rate and the rate of out-of-hospital VBAC or extremes of maternal age (either <20 or >35), for 2003, 2013, or the difference in rates between 2003 and 2013. CONCLUSION: Our study showed no relationship between state obstetric malpractice premiums and higher risk out-of-hospital births across those states. This may suggest that current obstetric practice and defensive medicine may not be a primary driver of increased out-of-hospital birth rates of higher risk mothers, which may be evaluated in future studies.

THE CONTENT OF PRENATAL CARE Update 2005

INTRODUCTION: Assessing the population access to obstetric care can be challenging based on existing databases of obstetric providers. Applying a patient-centered perspective, access to care includes distance to nearest provider or hospital, and in the antepartum setting includes barriers to first obstetric visits. We sought to directly evaluate details regarding scheduling a first obstetric appointment at obstetric provider offices across the state of Maryland. METHODS: A hospital database of obstetric providers in the state that have the ability to refer patients was used to identify all clinics in the state. The study design was designated as IRB exempt by our institutional IRB. Each clinic site was contacted by phone to survey details regarding time until this next available appointment, interpreter services or accommodation, and financial requirements for patients without insurance. RESULTS: A wide variety of clinic practices were identified in our study. Wait times to first visit ranged from one day to one month, with some counties without available appointments for weeks. Most clinics accepted patients without insurance, although some required upfront payment of up to

Advanced research and data methods in women's health: Big data analytics, adaptive studies, and the road ahead

2,500 prior to being seen. Although many clinics would see patients who did not speak English, a number required the patient to provide interpreter services. CONCLUSION: Barriers exist to establishing obstetric care across the state of Maryland. Addressing barriers that delay patients first establishing prenatal care may help patients access timely prenatal care. Data collection assessing scheduling the first prenatal appointment can provide important information for efforts to improve patient accession of obstetric care.