Society For Maternal-Fetal Medicine Research Articles

Society for Maternal Fetal Medicine 2016 Annual Pregnancy Meeting Round-up: Part 3 (Podcast)

Society for Maternal Fetal Medicine 2016 Annual Pregnancy Meeting Round-up: Part 3 (Podcast)

Society for Maternal Fetal Medicine 2016 Annual Pregnancy Meeting Round-up: Part 2 (Podcast)

Society for Maternal Fetal Medicine 2016 Annual Pregnancy Meeting Round-up: Part 2 (Podcast)

Society for Maternal Fetal Medicine 2016 Annual Pregnancy Meeting Round-up: Part 1 (Podcast)

Society for Maternal Fetal Medicine 2016 Annual Pregnancy Meeting Round-up: Part 1 (Podcast)

Looking forward to The Pregnancy Meeting 2016: A Guide to Atlanta (Podcast)

Dr. Chris Robinson talks to Dr. Iris Krishna from the Emory University School of Medicine in Atlanta to discuss the upcoming Society for Maternal Fetal Medicine 2016 Annual Pregnancy Meeting. Dr. Krishna has been a long-time resident of Atlanta and shares her perspective on Atlanta as a city and backdrop for the Annual Meeting.

88: Nifedipine versus placebo in the treatment of preterm premature rupture of membranes. Assessment of perinatal outcome by use of tocolysis in early labor - APOSTEL IV study

36th Annual Meeting of the Society for Maternal Fetal Medicine: The Pregnancy Meeting 01 February 2016 - 06 February 2016

Location of childbirth for rural women: implications for maternal levels of care

A recent American Congress of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (MFM) consensus statement on levels of maternity care lays out designations that correspond to specific capacities available in facilities that provide obstetric care. Pregnant women in rural and remote areas receive particular attention in discussions of regionalization and levels of care, owing to the challenges in assuring local access to high-acuity services when necessary. Currently, approximately half a million rural women give birth each year in US hospitals, and whether and which of these women give birth locally is crucial for successfully operationalizing maternal levels of care. We sought to characterize rural women who give birth in nonlocal hospitals and measure local hospital characteristics and maternal diagnoses present at childbirth that are associated with nonlocal childbirth. This was a repeat cross-sectional analysis of administrative hospital discharge data for all births to rural women in 9 states in 2010 and 2012. Multivariate logistic regression models were used to predict the odds of childbirth in a nonlocal hospital (at least 30 road miles from the patient's residence). We examined patient age, race/ethnicity, payer, rurality, clinical diagnoses (diabetes, hypertension, hemorrhage during pregnancy, placental abnormalities, malpresentation, multiple gestation, preterm delivery, prior cesarean delivery, and a composite of diagnoses that may require MFM consultation), as well as local hospital characteristics (birth volume, neonatal care level, ownership, accreditation, and system affiliation). The rate of nonlocal childbirth among 216,076 rural women was 25.4%. It varied significantly by primary payer (adjusted odds ratio [AOR], 0.76; 95% confidence interval [CI], 0.68-0.86 for Medicaid vs private insurance) and by clinical conditions including multiple gestation (AOR, 1.82; 95% CI, 1.58-2.1), preterm deliveries (AOR, 2.41; 95% CI, 2.17-2.67), and conditions that may require MFM services or consultation (AOR, 1.28; 95% CI, 1.22-1.35). Rural women whose local hospital did not have a neonatal intensive or intermediate care unit had nearly double the odds of giving birth at a nonlocal hospital (AOR, 1.94; 95% CI, 1.64-2.31). Approximately 75% of rural women gave birth at local hospitals; rural women with preterm births and clinical complications, as well as those without local access to higher-acuity neonatal care, were more likely to give birth in nonlocal hospitals. However, after controlling for clinical complications, rural Medicaid beneficiaries were less likely to give birth at nonlocal hospitals, implying a potential access challenge for this population.

Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures

This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use.

SMFM Statement: clarification of recommendations regarding cell-free DNA aneuploidy screening

The purpose of this statement is to clarify that the Society for Maternal-Fetal Medicine (SMFM) does not recommend that cell-free DNA aneuploidy screening be offered to all pregnant women, nor does it suggest a requirement for insurance coverage for cell-free DNA screening in women at low risk of aneuploidy. However, SMFM believes, due to the ethics of patient autonomy, that the option should be available to women who request additional testing beyond what is currently recommended by professional societies.

Current Resources for Evidence-Based Practice, September/October 2015.

Standardizing Evidence-Based Perinatal Practice Amid the Medical Malpractice Threat I recently had a conversation with a fellow midwife in which she discussed a frustrating encounter she had with a collaborating physician regarding her care of a woman receiving labor augmentation for premature rupture of membranes. The physician was concerned about the woman’s rate of cervical dilation and expressed his opinion that she should have a cesarean if she did not give birth vaginally in the next few hours. The midwife cited a recent obstetric care consensus (American College of Obstetricians and Gynecologists & Society for Maternal-Fetal Medicine, 2014) as evidence to support her recommendation that the woman have more time to complete latent-phase labor in the presence of normal maternal and fetal monitoring results. The physician was dismissive of this evidence and told the midwife, “No new study or guideline is going to save us if anything goes wrong with this baby. I’m not risking a medical malpractice case over this.” Later, the midwife was pessimistic about evidence-based practice as she discussed the conversation with me, “Does it even matter if we have scientific evidence about clinical practice, when the only thing guiding our decision making is the fear of a medical malpractice claim?”

Role of the Hospitalist and Maternal Fetal Medicine Physician in Obstetrical Inpatient Care

The objective of this study was to evaluate the role of hospitalists and Maternal Fetal Medicine (MFM) subspecialists in obstetrical inpatient care. This electronic survey study was offered to members of the American College of Obstetrics & Gynecology (ACOG; n = 1,039) and the Society for Maternal-Fetal Medicine (SMFM; n = 1,813). Overall, 607 (21%) respondents completed the survey. Overall, 35% reported that hospitalists provided care in at least one of their hospitals. Compared with ACOG respondents, a higher frequency of SMFM respondents reported comfort with hospitalists providing care for all women on labor and delivery (74.4 vs. 43.5%, p = 0.005) and women with complex issues (56.4 vs. 43.5%, p = 0.004). The majority of ACOG respondents somewhat/completely agreed that hospitalists were associated with decreased adverse events (69%) and improved safety/safety culture (70%). Overall, 35% of ACOG respondents have MFM consultation available with 53% having inpatient coverage. Of these, 85% were satisfied with MFM availability. Over one-third of respondents work in units staffed with hospitalists and more than half have inpatient MFM coverage. It is important to evaluate if and how hospitalists can improve maternal and perinatal outcomes, and the types of hospitals that are best served by them.

Morris, T.Cut it Out: The C‐Section Epidemic in America. New York: New York University Press. 2013. 256pp £18.99 (hbk) ISBN 978‐0‐8147‐6411‐4

Morris, T.Cut it Out: The C‐Section Epidemic in America. New York: New York University Press. 2013. 256pp £18.99 (hbk) ISBN 978‐0‐8147‐6411‐4

Conversion of Society for Maternal-Fetal Medicine abstract presentations to manuscript publications

We sought to evaluate the rate of conversion of Society for Maternal-Fetal Medicine (SMFM) annual meeting abstract presentations to full manuscript publications over time. Full manuscript publications corresponding to all SMFM oral abstracts 2003 through 2010 inclusive, and SMFM poster abstracts in 2003, 2005, 2007, and 2009 were manually searched in PubMed. An abstract was considered to "match" a full publication if the abstract and publication titles as well as main methods and results were similar and the abstract first author was a publication author. In cases of uncertainty, the abstract-publication match was reviewed by a second physician researcher. Time to publication, publication rates over time, and publication rates among US vs non-US authors were examined. PubMed identification numbers were also collected to determine if >1 abstract contributed to a manuscript. Data were analyzed using Wilcoxon rank sum, analysis of variance, t test, and logistic regression. In all, 3281 abstracts presented at SMFM over the study period, including 629 orals (63 main plenary, 64 fellows plenary, 502 concurrent), were reviewed. Of 3281, 1780 (54.3%) were published, generating 1582 unique publications. Oral abstracts had a consistently higher rate of conversion to publications vs posters (77.1% vs 48.8%, P < .001). The median time to publication was 19 (interquartile range, 9-36) months, and was significantly shorter for orals vs posters (11 vs 21 months, P < .001). Over the study period, rates of publication of orals remained constant, but rates of publication of posters were lower in 2007 and 2009 compared to 2003 and 2005. Publications related to SMFM abstracts were published in 194 different journals, most commonly American Journal of Obstetrics and Gynecology (39.8%), Obstetrics and Gynecology (9.7%), and Journal of Maternal-Fetal and Neonatal Medicine (6.5%). Publication rates were higher if the abstract's first author was affiliated with a non-US institution (64.8% vs 51.1%, P < .001) and if the abstract received an award (82.7% vs 53.3%, P < .001). In regression models, oral presentation at SMFM, first author affiliation with a non-US institution, submission for American Journal of Obstetrics and Gynecology SMFM special issue, and year of abstract presentation at SMFM were associated with full manuscript publication. From 2003 through 2010, full manuscript publication rates of SMFM abstracts were high and consistent, and time to publication decreased/improved across the study period for oral presentations.

Misguided guidelines for managing labor

In a recent review we expressed concerns about new guidelines for the assessment and management of labor recommended jointly by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). These guidelines are based heavily on a new concept of how cervical dilatation and fetal descent progress, derived from the work of Zhang etal. In their Viewpoint article they have addressed, but not allayed, the concerns we described in our review. We assert that the dilatation curve promulgated by Zhang etal cannot be reconciled with direct clinical observation. Even if they were correct, however, it still does not follow that the ACOG/SMFM guidelines should recommend replacing the coherent system of identifying and managing labor aberrations described by Friedman. That system is grounded in well-established clinical principles based on decades of use and the objectively documented association of some labor abnormalities with poor fetal and maternal outcomes. Recommendations for new clinical management protocols should require the demonstration of superior outcomes through extensive, preferably prospective, assessment. Using untested guidelines for the management of labor may adversely affect women and children. Even if those guidelines were to reduce the currently excessive cesarean delivery rate, the price of that benefit is likely to be a trade-off in harm to parturients and their offspring. The nature and degree of that harm needs to be documented before considering adoption of the guidelines.

REACT: An Interprofessional Education and Safety Program to Recognize and Manage the Compromised Obstetric Patient.

In recent years, there has been an increase in the number of pregnancies complicated by preexisting medical conditions as well as an increase in maternal morbidity and mortality in the United States. The goal of the REACT quality and safety initiative was to reduce maternal morbidity and mortality by providing an interprofessional education program for recognizing and managing the woman who becomes compromised during pregnancy, childbirth, or the puerperium. REACT is an acronym for Recognize, Educate, Activate, Communicate, and Treat early signs and symptoms of maternal compromise. Early signs and symptoms of maternal compromise outlined in the REACT program are similar to recently published recommendations by the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, the Society for Maternal-Fetal Medicine, the Health Resources and Services Administration, the Association of Women's Health, Obstetric and Neonatal Nurses, and the American College of Nurse-Midwives.

Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The fetus at risk for anemia–diagnosis and management

We sought to provide evidence-based guidelines for the diagnosis and management of fetal anemia. A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through May 2014. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology was used for defining the strength of recommendations and rating the quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. We recommend the following: (1) middle cerebralartery peak systolic velocity (MCA-PSV) measured by ultrasound Doppler interrogation be used as the primary technique to detect fetal anemia; (2) amniotic fluiddelta OD450not be used to diagnosis fetal anemia; (3) MCA-PSV assessment bereserved for those patients who are at risk of having an anemic fetus (proper techniquefor MCA-PSV evaluation includes assessment of the middle cerebral artery close to its origin, ideally at a zero degree angle without angle correction); (4) if a fetus isdeemed at significant risk for severe fetal anemia (MCA greater than 1.5 multiples of the median or hydropic), fetal blood sampling be performed with preparation for an intrauterine transfusion, unless the pregnancy is at a gestational age when the risks associated with delivery are considered to be less than those associated with the procedure; (5) if a fetus is deemed at significant risk for severe fetal anemia, the patient be referred to a center with expertise in invasive fetal therapy; (6) MCA-PSV be considered to determine the timing of a second transfusion in fetuses with anemia, and, alternatively, a predicted decline in fetal hemoglobin may be used for timing thesecond procedure; and (7) pregnancies with a fetus at significant risk for fetal anemia be delivered at 37-38 weeks of gestation unless indications develop prior to this time.

Expanded carrier screening in reproductive medicine-points to consider: a joint statement of the American College of Medical Genetics and Genomics, American College of Obstetricians and Gynecologists, National Society of Genetic Counselors, Perinatal Quality Foundation, and Society for Maternal-Fetal Medicine.

The Perinatal Quality Foundation and the American College of Medical Genetics and Genomics, in association with the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and the National Society of Genetic Counselors, have collaborated to provide education for clinicians and laboratories regarding the use of expanded genetic carrier screening in reproductive medicine. This statement does not replace current screening guidelines, which are published by individual organizations to direct the practice of their constituents. As organizations develop practice guidelines for expanded carrier screening, further direction is likely. The current statement demonstrates an approach for health care providers and laboratories who wish to or who are currently offering expanded carrier screening to their patients.

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 5: Post-Meeting Round-Up (Part 1 of 3)

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 5: Post-Meeting Round-Up (Part 1 of 3)

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 6: Post-Meeting Round-Up (Part 2 of 3)

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 6: Post-Meeting Round-Up (Part 2 of 3)

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 7: Post-Meeting Round-Up (Part 3 of 3)

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 7: Post-Meeting Round-Up (Part 3 of 3)

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 2: Looking Ahead to the Scientific Program

Society for Maternal Fetal Medicine 2015 Annual Pregnancy Meeting supplemental episode 2: Looking Ahead to the Scientific Program