Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study.

PURPOSE: To provide an estimate of the incidence of peripartum hysterectomy in the state of New Jersey and calculate the effect of mode of delivery and prior obstetric history. METHODS: A perinatal-linked dataset provided by the Maternal Child Health Epidemiology Program in the New Jersey Department of Health was used to obtain information from birth certificates and hospital discharge records. Using multivariate logistic regression, various demographic and clinical factors were assessed for association with peripartum hysterectomy. RESULTS: A total of 1,004,116 births were identified between 1997 and 2005 and 853 peripartum hysterectomies were performed (0.85/1,000 deliveries). Parity increased the risk of hysterectomy with nulliparous women having approximately half the risk compared to multiparous women. Cesarean delivery with no previous c-section almost doubled the risk (OR 2.20, CI 1.80-26.69) while in the presence of a previous c-section the risk was almost four times higher (OR 4.51, CI 3.76-5.40). Operative vaginal delivery did not result in any increase in the risk. CONCLUSIONS: Mode of delivery and prior obstetric history are major risk factors for peripartum hysterectomy. Patients desiring cesarean delivery need to be counseled on the risk of this serious complication.

Impact of mode of delivery on neonatal complications: trends between 1997 and 2005.

OBJECTIVE: This study examined whether rates of selected neonatal complications vary by mode of delivery and whether these rates are changing as a result of the increasing cesarean delivery rate. METHOD: Birth certificates in New Jersey from 1997 to 2005 were matched to hospital discharge records for mothers and newborns. RESULTS: In New Jersey, the total cesarean section rate for 2005 was 35.3%, a relative increase of 46% since 1997 (from 24.2%). Rates of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS), regardless of mode of delivery, increased between 1997 and 2005 from 3.3 to 3.9% and 2.1 to 2.4%, respectively. Newborn injuries declined sharply (from 4.1 to 2.6%), whereas intra-ventricular hemorrhage (IVH) rates remained stable. The rates of RDS, TTN and IVH were highest for cesarean delivery without trial of labor, while the rate of injuries was highest for instrumental vaginal delivery. CONCLUSION: Neonatal complication rates varied by mode of delivery and decreased with gestational age.

Disparities in asthma hospitalizations among children seen in the emergency department.

We examined the race/ethnicity variation in the risk of hospitalization among children seen in the emergency department (ED) for asthma. ED and hospitalization records for children 1 to 19 years of age in New Jersey for 2004 and 2005 were linked. The dataset identified 47,548 ED and hospitalizations among 37,216 children. ED and hospitalization rates indicated persistent disparities in pediatric asthma. ED admission rates were similar across race/ethnic groups, suggesting similar management of pediatric asthma patients once they are seen in the ED. Integrating existing ED and hospitalization records will enhance asthma surveillance and the targeting of interventions to reduce race/ethnicity disparities.

Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes?

Reports by the Institute of Medicine (IOM) recommend that gestational weight gain goals should be modified according to prepregnancy body mass index (BMI), which could result in better maternal and infant outcomes. The authors assessed whether the risk of the pregnancy outcomes such as rate of cesarean section to primiparous and multiparous women, macrosomia, and breastfeeding at 10 weeks postpartum can be modified by following the IOM guidelines for gestational weight gain irrespective of prepregnancy BMI. Staff from the New Jersey Pregnancy Risk Assessment Monitoring System interviewed a sample of women who delivered live births in New Jersey during 2002 through 2005 (n = 7661). In New Jersey, 18% of mothers were obese, 13% were overweight, and 16% were underweight. In logistic regression analyses, after controlling for maternal characteristics, the effect of prepregnancy obesity and weight gain more than 34 lb independently and significantly increased the risk of all four adverse outcomes. For no outcomes was the 25- to 34-pound weight gain category significantly distinguishable from the 16- to 24-pound reference category. These results strongly support the idea that the IOM weight gain recommendation (education during preconception regarding the importance of optimal BMI at the start of pregnancy) will help to achieve better pregnancy outcomes in obese and overweight women.

Surveillance of cesarean section deliveries, New Jersey, 1999-2004.

BACKGROUND: Nationally and in New Jersey, the cesarean delivery rate has been increasing steadily for nearly a decade, and especially since 1999. The purpose of this study was to describe recent trends in cesarean section delivery in New Jersey. METHODS: Data on delivery method, medical indications and patient characteristics were extracted from electronic birth certificate files. RESULTS: Cesarean section deliveries increased as a proportion of live births by 6 percent annually. Growth was roughly uniform across Robson's clinical classification. Repeat cesareans contributed only proportionately to the overall trend. The greatest acceleration was observed for procedures without trial of labor, and in medical situations where cesarean delivery had been relatively rare. CONCLUSIONS: Medical indications recorded on the birth certificate explained little of the rapid growth in utilization of cesarean delivery, since trends were comparable in most categories we examined. A sustained autonomous shift in practice patterns, patient preferences, or both seems the most likely driver of the overall trend.

Pediatric hospitalizations for asthma: use of a linked file to separate person-level risk and readmission.

INTRODUCTION: Disparities in asthma hospitalization by gender, age, and race/ethnicity are thought to be driven by a combination of 2 factors: disease severity and inadequate health care. Hospitalization data that fail to differentiate between numbers of admissions and numbers of individuals limit the ability to derive accurate conclusions about disparities and risks. METHODS: Hospitalization records for pediatric asthma patients (aged one to 14 years) were extracted from New Jersey Hospital Discharge Files (for the years 1994 through 2000) and then linked by patient identifiers using a probabilistic matching algorithm. The analysis file contained 30,400 hospital admissions for 21,016 children. Hospitalization statistics were decomposed into persons hospitalized and number of hospitalizations. Analysis of readmission within 180 days of discharge used additional records from 2001 to avoid bias due to truncated observation. RESULTS: Overall, 22.9% of children in our analysis had repeat asthma admissions within the same age interval, accounting for 30.9% of all hospitalizations. Also among all children, 11.7% had at least one readmission within 180 days of a prior discharge. The risk of hospitalization was higher for boys, decreased by age for both genders, was lowest for white children and highest for black children. Readmission rates were higher for black and Hispanic girls than boys in older age groups, but were otherwise relatively uniform by gender and age. CONCLUSION: Decomposition of ratios of total hospitalizations to population illuminates components of risk and suggests specific causes of disparity.