Mona T. Lydon-Rochelle
University of Washington
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Featured researches published by Mona T. Lydon-Rochelle.
The New England Journal of Medicine | 2001
Mona T. Lydon-Rochelle; Victoria L. Holt; Thomas R. Easterling; Diane P. Martin
Background Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication. Methods We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor. Results Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 ...
Obstetrics & Gynecology | 2001
Mona T. Lydon-Rochelle; Victoria L. Holt; Thomas R. Easterling; Diane P. Martin
Objective To assess the association between first-birth cesarean delivery and second-birth placental abruption and previa. Methods We conducted a population-based, retrospective cohort analysis using data from the Washington State Birth Events Record Database. The study cohort included all primiparas who gave birth to live singleton infants in nonfederal short-stay hospitals from January 1, 1987, through December 31, 1996, and who had second singleton births during the same period (n = 96,975). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for placental abruption or previa at second births associated with first-birth cesareans. Results Among our study cohort, abruptio placentae complicated 11.5 per 1000 and placenta previa 5.2 per 1000 singleton deliveries at second births. In logistic regression analyses adjusted for maternal age, women with first-birth cesareans had significantly increased risk of abruptio placentae (OR 1.3, 95% CI 1.1, 1.5), and placenta previa (OR 1.4, 95% CI 1.1, 1.6) at second births, compared with women with prior vaginal deliveries. Conclusion We found moderately increased risk of placental abruption and previa as a long-term effect of prior cesarean delivery on second births.
American Journal of Public Health | 2004
Mona T. Lydon-Rochelle; Paula Krakowiak; Philippe P. Hujoel; Riley Peters
OBJECTIVES We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy. METHODS We used data from the Washington State Department of Healths Pregnancy Risk Assessment Monitoring System. RESULTS Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems. CONCLUSIONS There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy.
Obstetrics & Gynecology | 2007
Mia A. Swartz; Mona T. Lydon-Rochelle; David Simon; Jonathan L. Wright; Michael P. Porter
OBJECTIVE: Nephrolithiasis occurring during pregnancy may be associated with an elevated risk of preterm delivery and other adverse birth outcomes. The goal of this study was to describe the association between these outcomes and admission for nephrolithiasis during pregnancy. METHODS: We performed a retrospective cohort study using birth certificate records linked to Washington State hospital discharge data from 1987–2003 to compare pregnant women admitted for nephrolithiasis and randomly selected pregnant women without nephrolithiasis. The main outcomes of interest were preterm delivery, premature rupture of membranes at term or before 37 weeks of gestation, low birth weight, and infant death. RESULTS: A total of 2,239 women were admitted for nephrolithiasis, yielding a cumulative incidence of 1.7 admissions per 1,000 deliveries. Women admitted for nephrolithiasis during pregnancy had nearly double the risk of preterm delivery compared with women without stones (adjusted odds ratio 1.8, 95% confidence interval 1.5–2.1). However, they were not at higher risk for the other outcomes investigated. A total of 471 (25.9%) women had one or more procedures for kidney stones during prenatal hospitalization. Undergoing a procedure and the trimester of admission did not affect the risk of preterm delivery. CONCLUSION: Although the incidence of nephrolithiasis requiring hospital admission during pregnancy is relatively low, these women have an increased risk of preterm delivery. This has potential implications for counseling of pregnant women with kidney stones requiring hospital admission. Additionally, it may prompt definitive treatment of small, asymptomatic stones in women during reproductive years. LEVEL OF EVIDENCE: II
American Journal of Public Health | 2005
Mona T. Lydon-Rochelle; Vicky Cárdenas; Jennifer L. Nelson; Kay M. Tomashek; Beth A. Mueller; Thomas R. Easterling
We sought to estimate the accuracy, relative to maternal medical records, of perinatal risk factors recorded on fetal death certificates. We conducted a validation study of fetal death certificates among women who experienced fetal deaths between 1996 and 2001. The number of previous births, established diabetes, chronic hypertension, maternal fever, performance of autopsy, anencephaly, and Down syndrome had very high accuracy, while placental cord conditions and other chromosomal abnormalities were reported inaccurately. Additional population-based studies are needed to identify strategies to improve fetal death certificate data.
Obstetrics & Gynecology | 2001
Mona T. Lydon-Rochelle; Victoria L. Holt; Thomas R. Easterling; Diane P. Martin
Objective To examine the association between delivery method and mortality within 6 months of delivery among primiparas. Methods We conducted a population-based, retrospective cohort analysis using statewide, maternally linked birth certificate, hospital discharge, and death certificate data. The present cohort was all primiparas who gave birth to live-born infants in civilian hospitals in Washington State from January 1, 1987 through December 31, 1996 (n = 265,471). Odd ratios (OR) and 95% confidence intervals (CI) were calculated for overall mortality, pregnancy-related mortality, and pregnancy-unrelated mortality associated with delivery method. Results Thirty-two women (12.1 per 100,000 singleton live births) died within 6 months of delivery of their first child. Eleven of 32 deaths were pregnancy related (4.1 per 100,000 singleton live births, 95% CI 1.6, 6.5), and 21 of the 32 deaths were not pregnancy related (7.9 per 100,000 singleton live births, 95% CI 4.5, 11.3). The pregnancy-related mortality rate was higher among women delivered by cesarean (10.3/100,000) than among women delivered vaginally (2.4/100,000). In logistic regression analyses, women who had cesarean delivery were not at significantly higher risk of death overall after adjustment for maternal age (OR 1.7, 95% CI 0.3, 3.6), pregnancy-related death after adjustment for maternal age and severe preeclampsia (OR 2.2, 95% CI 0.6, 7.9), or pregnancy-unrelated death after adjustment for maternal age and marital status (OR 0.9, 95% CI 0.3, 2.7), relative to women who had vaginal delivery. Conclusion Cesarean delivery might be a marker for serious preexisting morbidities associated with increased mortality risk rather than a risk factor for death in and of itself. Data from additional sources such as medical records and autopsy reports are necessary to disentangle preexisting mortality risk from risk associated solely with delivery method.
Medical Care | 2007
Mona T. Lydon-Rochelle; Vicky Cárdenas; Jennifer C. Nelson; Victoria L. Holt; Carolyn Gardella; Thomas R. Easterling
Background: Induction of labor is an increasingly common obstetrical procedure, with approximately 20–34% of women undergoing labor induction in the United States annually. Objective: To determine the extent of labor induction in the absence of standard medical indications and to assess possible associations with maternal and infant characteristics and hospital factors. Methods: We ascertained induction of labor and associated details as part of a medical record validation study of 4541 women with live, singleton births in 2000 in Washington State using medical record, birth certificate, and hospital discharge data. In this analysis, we report findings for the 1473 women (33% of original cohort) whose medical records indicated that their labors were induced. Results: Among women with induced labor, 7.9% had no clinical information providing an indication for the induction, and 6.4% had only “nonstandard” indications recorded. Compared with women delivering in moderate volume hospitals, women who delivered at lower volume (odds ratios [OR] 3.9; 95% confidence intervals [CI] 1.8–8.6) or higher volume hospitals (OR 4.2; 95% CI 2.4–7.2) had significantly increased risk for undocumented indication of labor. Women who had undocumented indication for induction were at significantly decreased risk of giving birth at a teaching hospital and a public nonfederally owned hospital, and were at greater risk to give birth at a private religious hospital. Factors that remained independently associated with nonstandard indication for induction of labor were primiparas (OR 2.4; 95% CI 1.3–4.2); multiparas (OR 4.3; 95% CI 2.5–7.4), pregnancy-induced hypertension (OR 0.2; 95% CI 0.1–0.4), hospital volume ≥2000 births annually (OR 19.9; 95% CI 6.7–58.6), primary (OR 11.7; 95% CI 4.1–33.6), and tertiary level hospital (OR 0.4; 95% CI 0.2–0.7). Conclusions: Our findings suggest that nearly 15% of inductions either were not clinically indicated according to standard protocols or indications were incompletely documented. At minimum, further studies are needed to explore how best to improve documentation of indications of labor because accurately describing, among other things, the process of labor induction, is a basic benchmark of care.
Obstetrics & Gynecology | 2004
Paula Krakowiak; Erin N. Smith; Guy de Bruyn; Mona T. Lydon-Rochelle
OBJECTIVE: To assess the relationship among maternal weight and cesarean delivery, cervical dilation rate, and labor duration. METHODS: We used a secondary analysis of 509 term women who were previously enrolled in a prospective observational study of a labor induction protocol in which standardized criteria were used for labor management. A variety of analyses were performed, both unadjusted and adjusted. P < .05 was considered significant. RESULTS: The mean ± standard deviation weight of women who underwent a cesarean (97 ± 29 kg) was significantly higher than that of women who were delivered vaginally (87 ± 22 kg, P < .001). In a logistic regression model of nulliparas who comprised 71% of the study population, after adjustment for the confounding effects of infant birth weight, maternal age, initial cervical dilation, and diabetes, for each 10-kg increase in maternal weight, the odds ratio for cesarean delivery was significantly increased (odds ratio 1.17; 95% confidence interval 1.04, 1.28). In a linear regression model also limited to nulliparas and after adjusting for the same confounders, the rate of cervical dilation was inversely associated with maternal weight: for each 10-kg increment, the rate of dilation was decreased by 0.04 cm/h (P = .05). Similarly, labor duration was positively associated with maternal weight: for each 10-kg increment, an increase in the oxytocin to delivery interval of 0.3 hours was observed in nulliparas (P = .02). Neither lower rates of oxytocin administration to heavier women nor diminished uterine responsiveness (as reflected in measured Montevideo units) accounted for the slower labor progress. CONCLUSION: In nulliparous women undergoing labor induction, maternal weight was associated with a higher cesarean risk and longer labor and was inversely proportional to the cervical dilation rate. LEVEL OF EVIDENCE: II-2OBJECTIVE To identify risk factors and outcomes associated with a short umbilical cord. METHODS We conducted a population-based case-control study using linked Washington State birth certificate-hospital discharge data for singleton live births from 1987 to 1998 to assess the association between maternal, pregnancy, delivery, and infant characteristics and short umbilical cord. Cases (n = 3565) were infants diagnosed with a short umbilical cord. Controls (n = 14260) were randomly selected from among births without a diagnosis of short umbilical cord. RESULTS Case mothers were less likely to be overweight (body mass index 25 or more, odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6, 0.8) and more likely to be primiparous (OR 1.4; 95% CI 1.3, 1.6). Case infants were more likely to be female (OR 1.3; 95% CI 1.2, 1.4), have a congenital malformation (OR 1.6; 95% CI 1.4, 1.8), and be small for their gestational age (risk ratio [RR] 1.6; 95% CI 1.4, 1.9). A short cord was associated with increased risk for maternal labor and delivery complications, including retained placenta (RR 1.6; 95% CI 1.2, 2.3) and operative vaginal delivery (RR 1.4; 95% CI 1.3, 1.5). Adverse fetal and infant outcomes in cases included fetal distress (RR 1.8; 95% CI 1.6, 2.1) and death within the first year of life among term infants (RR 2.4; 95% CI 1.2, 4.6). CONCLUSION Modifiable risk factors associated with the development of a short cord were not identified. Case mothers and infants are more likely to experience labor and delivery complications. Term case infants had a 2-fold increased risk of death, which suggests closer postpartum monitoring of these infants.
Journal of Nurse-midwifery | 1993
Kay D. Sedler; Mona T. Lydon-Rochelle; Yvonne M. Castillo; Ellen Craig; Nancy Clark; Leah L. Albers
The Nurse-Midwifery Division, with the full support of the Department of Obstetrics and Gynecology, and with committed partners in the College of Nursing, is proceeding forward with a three-part mission: nurse-midwifery practice, teaching, and research. Our practice sites are likely to remain varied but stable, with half of our clients being either Hispanic or Native American. Our commitment to nurse-midwifery education is solid, and our participation in the process will continue to take several forms, including the central one of clinical preceptorships. Our research agenda will grow. We hope our experience with GRAVI-DATA will contribute to the development of a national nurse-midwifery data base. Other future goals of our research program include collaboration in multisite clinical research projects, obtaining substantial external funding and recruiting doctorally prepared investigators.
Maternal and Child Health Journal | 2004
Mona T. Lydon-Rochelle; Victoria L. Holt
Numerous researchers have expressed concern over the impacts on medical records availability of the newly effective Medical Information Privacy rule, as authorized by the Health Insurance Portability and Accountability Act (HIPAA). The increased costs associated with compliance with the rule, and the increased potential for financial liability, raises the possibility that hospitals may be less likely to participate in such research, resulting in a decrease of the validity of multisite studies designed to represent an entire population. Our multisite medical record validation study, designed to assess the accuracy of maternally linked birth records, provides an overview of a number of HIPAA implementation challenges. We found that the new HIPAA rule presents new challenges for those who rely on the release of medical record information for epidemiologic research. At the very minimum, increased compliance costs associated with human subjects protection and increased administrative burden for researchers would seem to be inevitable as medical institutions address the requirements of the new HIPAA rule by instituting more complex and thus more cumbersome procedures. Researchers should anticipate increased costs and plan accordingly when budgeting for human subjects review processes.