Racial Disparities in the Rates of and Indications for Cesarean Delivery in California: Are They Changing Over Time?

2021 ◽  
Author(s):  
E. Nicole Teal ◽  
Kelechi Anudokem ◽  
Rebecca J. Baer ◽  
Laura Jelliffe-Pawlowski ◽  
Biftu Mengesha
Keyword(s):  
Racial Disparities ◽  
Cesarean Delivery ◽  
Placenta Previa ◽  
Birth Certificate ◽  
Active Phase ◽  
International Classification Of Diseases ◽  
Birth Certificates ◽  
Obstetric Outcomes ◽  
Adjusted Relative Risk ◽  
Black And White

Objective: The aim of this study was to assess whether racial disparities in rates of and indications for cesarean delivery (CD) between non-Hispanic Black and non-Hispanic White birthing people in California changed from 2011 to 2017. Methods: This was a retrospective cohort study using a database of birth certificates linked to discharge records. Singleton term live births in nulliparous Black and White birthing people in California between 2011 and 2017 were included. Those with noncephalic presentation, placenta previa, and placenta accreta were excluded. CD rate and indication were obtained from birth certificate variables and International Classification of Diseases codes. Differences in CD rate and indication were calculated for Black versus White individuals using univariable and multivariable logistic regression and adjusted for potential confounders. Results: A total of 348,144 birthing people were included, 46,361 Black and 301,783 White. Overall, 30.9% of Black birthing people underwent CD compared with 25.3% of White (adjusted relative risk [aRR]: 1.2, 95% confidence interval [CI]: 1.2–1.3). From 2011 to 2017, the CD rate fell 11% (26.4–23.7%, p < 0.0001) for White birthing people and 1% for Black birthing people (30.4–30.1%, p = 0.037). Over the study period, Black birthing people had a persistent 1.2- to 1.3-fold higher risk of CD and were persistently more likely to undergo CD for fetal intolerance (aRR: 1.1, 95% CI: 1.1–1.2) and less likely for active phase arrest or arrest of descent (aRRs: 0.9 and 0.4; 95% CIs: 0.9–0.9 and 0.3–0.5). Conclusion: The CD rate decreased substantially for White birthing people and minimally for Black birthing people in our cohort over the study period. Meanwhile, disparities in CD rate and indications between the two groups persisted, despite controlling for confounders. Although care bundles for reducing CD may be effective among White birthing people, they are not associated with reduction in CD rates among Black birthing people nor improvements in racial disparities between Black and White birthing people. Precis: Despite increasing attention to racial inequities in obstetric outcomes, there were no changes in disparities in CD rates or indications in California from 2011 to 2017. Key Points

Obstetric Outcomes Associated with Fetal Cyanotic Congenital Heart Disease

2018 ◽  
Vol 36 (07) ◽  
pp. 701-708
Author(s):  
Robert M. Rossi ◽  
Allison Divanovic ◽  
Emily A. DeFranco
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cesarean Delivery ◽  
Congenital Heart ◽  
Population Based ◽  
Primary Objective ◽  
Cyanotic Congenital Heart Disease ◽  
Obstetric Outcomes ◽  
Adjusted Relative Risk ◽  
Trial Of Labor

Objective To characterize obstetric outcomes associated with cyanotic congenital heart disease (CCHD) in a contemporary population. Study Design We conducted a population-based retrospective cohort study of all livebirths in Ohio (2006–2015). Obstetric characteristics of pregnancies complicated by fetal CCHD were compared with those without CCHD, excluding those with other anomalies and aneuploidy. The primary objective was to determine the risk of cesarean delivery among CCHD affected pregnancies. Multivariate logistic regression estimated the influence of CCHD on these obstetric outcomes. Results Among 1,463,506 live births in Ohio, there were 863 (0.06%) CCHD affected births. The overall cesarean rate was 45.9 versus 31.0% (p< 0.001) in CCHD compared with non-CCHD pregnancies. After adjusting for various confounders, CCHD affected pregnancies were associated with a higher risk for cesarean delivery (adjusted relative risk [aRR]: 2.0, 95% confidence interval [CI]: 1.6–2.4), preterm birth (PTB) (aRR: 1.5, 95% CI: 1.1–2.0), induction of labor (aRR: 1.2, 95% CI: 1.04–1.4), small for gestational age (SGA) birthweight (aRR: 2.4, 95% CI: 2.0–2.9), and fetal intolerance of labor (FIOL; aRR: 2.0, 95% CI: 1.6–2.4). Women with CCHD affected pregnancies were also less likely to undergo a trial of labor (aRR: 0.4, 95% CI: 0.3–0.5) prior to cesarean delivery. Conclusion Obstetric outcomes associated with CCHD include higher risk for cesarean delivery, PTB, SGA, and FIOL.

Adherence to Consensus Guidelines for the Management of Labor Arrest Disorders in a Single Academic Tertiary Care Medical Center

2018 ◽  
Vol 36 (09) ◽  
pp. 911-917 ◽  
Author(s):  
Mesk A. Alrais ◽  
Nana-Ama E. Ankumah ◽  
Farah H. Amro ◽  
Tyisha Barrett ◽  
Kendra Folh ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Medical Center ◽  
Tertiary Care ◽  
Night Shift ◽  
Perinatal Outcomes ◽  
Active Phase ◽  
Adherence Rate ◽  
Adjusted Relative Risk ◽  
Tertiary Care Medical Center ◽  
Primary Cesarean Delivery

Objective To evaluate the degree of adherence to the new the American College of Obstetricians and Gynecologists/Society for Maternal–Fetal Medicine guidelines in labor arrest management. Study Design A retrospective study of term, live, singleton deliveries with intrapartum primary cesarean delivery solely for failed induction of labor or labor arrest. Adherence was defined according to the Safe Prevention of the Primary Cesarean Delivery 2014 criteria. We evaluated adherence and compared maternal and perinatal outcomes, delivery time frame, and billing provider. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). Results Two-hundred six deliveries met the inclusion criteria; 73% were deemed not adherent to the guidelines. The majority of cases were under the care of nonacademic private practice OB/GYN physicians. The adherence rate was higher in the active phase of labor (45%) than in second stage (17%) and latent phase (14%). There were no differences in perinatal outcomes between the two groups. The adherence to guidelines was higher among academic OB/GYN physicians (aRR, 2.24, 95% CI, 1.49–3.36) and during the weekday–night shift (aRR, 1.81, 95% CI, 1.10–2.98). Conclusion Despite recent guidelines aimed to reduce the primary cesarean delivery rate, most cesarean deliveries performed for labor arrest disorders were not adherent to the guidelines.

scholarly journals Risk of Cesarean Delivery for Women with Obesity Using a Standardized Labor Induction Protocol

2021 ◽  
Author(s):  
Rebecca F. Hamm ◽  
Christina P. Teefey ◽  
Cara D. Dolin ◽  
Celeste P. Durnwald ◽  
Sindhu K. Srinivas ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Prospective Trial ◽  
Secondary Analysis ◽  
Active Phase ◽  
Labor Induction ◽  
Adjusted Relative Risk ◽  
Labor Management ◽  
Increased Risk ◽  
Unfavorable Cervix ◽  
Failed Induction

Objective We aimed to determine the risk of cesarean among women with obesity undergoing labor induction within a prospective trial that utilized a standardized labor protocol. Study Design This was a secondary analysis of a randomized trial of induction methods. Term (≥37 weeks) women with intact membranes undergoing induction with an unfavorable cervix (Bishop's score ≤6 and dilation ≤2 cm) were included. The trial utilized a labor protocol that standardized induction and active labor management, with recommendations for interventions at particular time points. Only women with a recorded body mass index (BMI) at prenatal care start were included in this analysis. The primary outcome was cesarean delivery compared between obese (≥30 kg/m2) and nonobese (<30 kg/m2) women. Indication for cesarean was also evaluated. Results A total of 465 women were included: 207 (44.5%) obese and 258 (55.5%) nonobese. Women with obesity had a higher risk of cesarean compared with women without obesity (33.3 vs. 23.3%, p = 0.02), even when adjusting for parity, weight change over pregnancy, and indication for induction (adjusted relative risk [aRR] = 1.79, 95% confidence interval [CI]: [1.34–2.39]). Compared with women without obesity, women with obesity had a higher risk of failed induction (47.8 vs. 26.7%, p = 0.01) without a difference in arrest of active phase (p = 0.39), arrest of descent (p = 0.95) or fetal indication (p = 0.32), despite adherence to a standardized labor protocol. Conclusion Compared with women without obesity, women with obesity undergoing an induction are at increased risk of cesarean, in particular a failed induction, even within the context of standardized induction management. As standardized practices limit provider variation in labor management, this study may support physiologic differences in labor processes secondary to obesity. Key Points

scholarly journals Optimizing the control group for evaluating ART outcomes: can outpatient claims data yield a better control group?

2021 ◽  
Author(s):  
Judy E. Stern ◽  
Chia-Ling Liu ◽  
Xiaohui Cui ◽  
Daksha Gopal ◽  
Howard J. Cabral ◽  
...  
Keyword(s):  
Claims Data ◽  
Comparison Group ◽  
Birth Certificate ◽  
Treated Group ◽  
Fertility Treatment ◽  
Obstetric Outcomes ◽  
Control Group ◽  
Chronic Hypertension ◽  
Adjusted Relative Risk ◽  
Insurance Claims Data

Abstract Purpose We previously developed a subfertile comparison group with which to compare outcomes of assisted reproductive technology (ART) treatment. In this study, we evaluated whether insurance claims data in the Massachusetts All Payers Claims Database (APCD) defined a more appropriate comparison group. Methods We used Massachusetts vital records of women who delivered between 2013 and 2017 on whom APCD data were available. ART deliveries were those linked to a national ART database. Deliveries were subfertile if fertility treatment was marked on the birth certificate, had prior hospitalization with ICD code for infertility, or prior fertility treatment. An infertile group included women with an APCD outpatient or inpatient ICD 9/10 infertility code prior to delivery. Fertile deliveries were none of the above. Demographics, health risks, and obstetric outcomes were compared among groups. Multivariable generalized estimating equations were used to calculate adjusted relative risk (aRR) and 95% confidence intervals (CI). Results There were 70,726 fertile, 4,763 subfertile, 11,970 infertile, and 7,689 ART-treated deliveries. Only 3,297 deliveries were identified as both subfertile and infertile. Both subfertile and infertile were older, and had more education, chronic hypertension, and diabetes than the fertile group and less than the ART-treated group. Prematurity (aRR = 1.15–1.17) and birthweight (aRR = 1.10–1.21) were increased in all groups compared with the fertile group. Conclusion Although the APCD allowed identification of more women than the previously defined subfertile categorization and allowed us to remove previously unidentified infertile women from the fertile group, it is not clear that it offered a clinically significantly improved comparison group.

PENENTUAN DAERAH PRIORITAS PELAYANAN AKTA KELAHIRAN DENGAN METODE K-NN DAN K-MEANS

2020 ◽  
Vol 17 (1) ◽  
pp. 319-328
Author(s):  
Ade Muchlis Maulana Anwar ◽  
Prihastuti Harsani ◽  
Aries Maesya
Keyword(s):  
Nearest Neighbor ◽  
Information Gain ◽  
Birth Certificate ◽  
Population Data ◽  
Community Services ◽  
Birth Certificates ◽  
Similar Data ◽  
K Nearest Neighbor ◽  
Civil Registration ◽  
The Family

Population Data is individual data or aggregate data that is structured as a result of Population Registration and Civil Registration activities. Birth Certificate is a Civil Registration Deed as a result of recording the birth event of a baby whose birth is reported to be registered on the Family Card and given a Population Identification Number (NIK) as a basis for obtaining other community services. From the total number of integrated birth certificate reporting for the 2018 Population Administration Information System (SIAK) totaling 570,637 there were 503,946 reported late and only 66,691 were reported publicly. Clustering is a method used to classify data that is similar to others in one group or similar data to other groups. K-Nearest Neighbor is a method for classifying objects based on learning data that is the closest distance to the test data. k-means is a method used to divide a number of objects into groups based on existing categories by looking at the midpoint. In data mining preprocesses, data is cleaned by filling in the blank data with the most dominating data, and selecting attributes using the information gain method. Based on the k-nearest neighbor method to predict delays in reporting and the k-means method to classify priority areas of service with 10,000 birth certificate data on birth certificates in 2019 that have good enough performance to produce predictions with an accuracy of 74.00% and with K = 2 on k-means produces a index davies bouldin of 1,179.

Racial Disparities in Allergic Outcomes Persist to Age 10 Years in Black and White Children

PEDIATRICS ◽  
2020 ◽  
Vol 146 (Supplement 4) ◽  
pp. S330.2-S331
Author(s):  
Timothy Chow ◽  
Jeffrey Chambliss
Keyword(s):  
Racial Disparities ◽  
White Children ◽  
Black And White

scholarly journals Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Nagase ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Takeya Hara ◽  
Aiko Okada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Multivariate Regression ◽  
Placenta Previa ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

When race trumps political ideology: Black teachers who advocate for social responsibility are penalized by both liberals and conservatives

2021 ◽  
pp. 014616722199402
Author(s):  
Grace N. Rivera ◽  
Phia S. Salter ◽  
Matt Friedman ◽  
Jaren Crist ◽  
Rebecca J. Schlegel
Keyword(s):  
Social Responsibility ◽  
Racial Disparities ◽  
Political Ideology ◽  
Personal Responsibility ◽  
Black Teachers ◽  
Political Orientation ◽  
Hiring Decisions ◽  
Black And White ◽  
Teacher Race ◽  
Teaching Position

Meritocracy is a prominent narrative embedded in America’s educational system: work hard and anyone can achieve success. Yet, racial disparities in education suggest this narrative does not tell the full story. Four studies ( N = 1,439) examined how applicants for a teaching position are evaluated when they invoke different narratives regarding who or what is to blame for racial disparities (i.e., individuals vs. systems). We hypothesized these evaluations would differ depending on teacher race (Black/White) and evaluator political orientation. Results revealed conservatives evaluated Black and White applicants advocating for personal responsibility more favorably than applicants advocating for social responsibility. Liberals preferred social responsibility applicants, but only when they were White. They were more ambivalent in their evaluations and hiring decisions if the applicants were Black. Our findings suggest that Black applicants advocating for social change are penalized by both liberal and conservative evaluators.

scholarly journals Birth and Fetal Death Records and Environmental Exposures: Promising Data Elements for Environmental Public Health Tracking of Reproductive Outcomes

2009 ◽  
Vol 124 (6) ◽  
pp. 825-830 ◽  
Author(s):  
Edward Fitzgerald ◽  
Daniel Wartenberg ◽  
W. Douglas Thompson ◽  
Allison Houston
Keyword(s):  
Public Health ◽  
Fetal Death ◽  
Birth Certificate ◽  
Environmental Exposures ◽  
Birth Certificates ◽  
Parental Occupation ◽  
Environmental Public Health ◽  
Health Tracking ◽  
Environmental Public Health Tracking ◽  
Data Elements

Objectives. We inventoried and reviewed the birth and fetal death certificates of all 50 U.S. states to identify nonstandard data items that are environmentally relevant, inexpensive to collect, and might enhance environmental public health tracking. Methods. We obtained online or requested by mail or telephone the birth certificate and fetal death record forms or formats from each state. Every state data element was compared to the 2003 standards promulgated by the National Center for Health Statistics to identify any items that are not included on the standard. We then evaluated these items for their utility in environmentally related analyses. Results. We found three data fields of potential interest. First, although every state included residence of mother at time of delivery on the birth certificate, only four states collected information on how long the mother had lived there. This item may be useful in that it could be used to assess and reduce misclassification of environmental exposures among women during pregnancy. Second, we found that father's address was listed on the birth certificates of eight states. This data field may be useful for defining paternal environmental exposures, especially in cases where the parents do not live together. Third, parental occupation was listed on the birth certificates of 15 states and may be useful for defining parental workplace exposures. Our findings were similar for fetal death records. Conclusion. If these data elements are accurate and well-reported, their addition to birth, fetal death, and other health records may aid in environmental public health tracking.

scholarly journals Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Claramonte Nieto ◽  
Eva Meler Barrabes ◽  
Sandra Garcia Martínez ◽  
Mireia Gutiérrez Prat ◽  
Bernat Serra Zantop
Keyword(s):  
Risk Factor ◽  
Gestational Diabetes ◽  
Maternal Age ◽  
Placenta Previa ◽  
Significant Risk ◽  
Advanced Maternal Age ◽  
Obstetric Outcomes ◽  
Chronic Hypertension ◽  
Mediterranean Population ◽  
Confounding Factors

Abstract Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

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