Reducing the recurrence of preterm delivery (RPD): aggressive MFM management versus consultation “as needed”

Abstract

GRESSIVE MFM MANAGEMENT VERSUS CONSULTATION ‘‘AS NEEDED’’ ROBERT D. EDEN, ANN PENKA, DAVID W. BRITT, ELLEN J. LANDSBERGER, MARK I. EVANS, St. Luke’s Roosevelt Hospital Center, Obstetrics & Gynecology, New York, NY Desert Perinatal Center, Palm Springs, CA Institute for Genetics & Fetal Medicine, St. Luke’s Roosevelt Hospital Center, New York, NY Columbia University, Institute for Human Nutrition, New York, NY Institute for Genetics & Fetal Medicine, St. Luke’s Roosevelt Hospital Center, Obstetrics and Gynecology, New York, NY OBJECTIVE: To assess RPD in patients managed entirely by MFM versus those ultimately transferred to MFM after consultation. STUDY DESIGN: Demographics, complications, and outcomes on 268 patients at risk for RPD in one community hospital over an 11-year period were compared by those managed by MFM exclusively to those for whom MFM assumed care mid-course or transferred late in pregnancy. RESULTS: RPD and related outcomes in MFM managed cases were highly significantly lower than in those managed by generalists. Demographics and other risk factors between the groups were not different (not shown). CONCLUSION: Preterm delivery results in enormous anguish and costs to society. Attempts to predict and prevent it have been generally unsuccessful. Our data suggest that regionalization of high-risk care to MFM subspecialists may be more successful than reliance upon generalists with MFM consultation only when it may be too late to impact outcome.