The closure of maternity services in Massachusetts. The impact on the obstetricians.

A survey is presented of Massachusetts physicians who were staff members at hospitals which closed their obstetric services. Both personal and practice impacts are presented as well as the physicians' evaluation of their present maternity units in comparison to the closed units. The personal impact on responding physicians was small. Few reported significant financial or patient loss. While significant practice changes were reported, adverse comments were few, and the present obstetric unit was viewed as an improvement over the closed unit in ever one-half the cases. These findings support the concept of consolidation as a component of programs for regional planning of maternity care.

The impact of regionalization programs on patterns of perinatal care.

A questionnaire developed to assess changes in patterns of perinatal care related to regionalization programs was sent to all 505 members of The American College of Obstetricians and Gynecologists in the state of Massachusetts. Respondents reported changes in facilities, services, educational experience, and referral and transfer patterns. The implications of these changes are discussed.

The closure of maternity services in Massachusetts. The causes, process, and hospital impact.

There has been a decline in the number of maternity services in Massachusetts from 120 in 1960 to 65 in 1975. Further consolidation must be carefully thought out with all options and possible outcomes thoroughly explored. The Massachusetts Maternity and Newborn Regionalization Project and the Massachusetts Hospital Association conducted a preliminary survey of Massachusetts Maternity services that had closed to understand the causes, process,, and hospital impact. The findings of this preliminary investigation, in addition to identifying areas for more intensive future research, provide some observations that should be of assistance to those considering a maternity service closure.

Regional planning--effects on the obstetrician-gynecologist.

Both the precepts and the impact of regional planning for maternity care are often misunderstood. Here, a summary of 8 separate studies in 5 geographic regions describes the reactions of obstetrician-gynecologists to systems of regional planning, as well as their use of the system and the impact of regional planning on their practices. Overall, few physicians acquired new obstetric privileges, and closure of maternity services had limited impact on their practices. Approximately 50% of the physicians referred some patients to level 2 or 3 units, but only 25% actually transferred patients in a given year. The perceptions of a majority of physicians were of improvement in patient services and physician education as a result of regional planning activities. Recommendations are offered for additional needed studies of regional planning efforts.

An evaluation of two rapid bacteriuria screening procedures.

Two commercially available rapid bacteriuria screening procedures were evaluated for routine screening for 10(4) or more colony forming units per milliliter of pathogenic bacteria in two female patient populations. In 694 obstetric patients with 56 cases of significant bacteriuria, the sensitivity, specificity, positive predictive, and negative predictive values, respectively, were as follows: for Chemstrip LN, 69.6, 83.4, 26.9, and 96.9%; and for Bac-T-Screen, 96.4, 56.0, 16.1, and 99.4%. In 143 nonpregnant females with 32 cases of significant bacteriuria, these values were: for Chemstrip LN, 71.9, 75.7, 46.0, and 90.3%; and for Bac-T-Screen, 84.4, 65.8, 41.5, and 93.6%. These results indicate that the LN strip did not have acceptable sensitivity in either patient group. The Bac-T-Screen had better sensitivity, particularly for obstetric patients; however, a high false-positive rate and high cost per test may restrict its use in those clinical settings where culture is available and cost-effective.

An investigation of mood states in women taking oral contraceptives.

PIP: Longitudinal studies with psychological interviews and tests were performed to investigate emotional changes in 72 women (under age 35) taking oral contraceptives. The analysis was based on patients at the Boston Lying-In Hospital (BLI, 28) and at the Peter Bent Brigham Hospital (PBBH, 44). Most women at BLI had 5 or more children; most at PBBH had 1 or more children. 79% of the BLI sample were 26 or older; 61% of the PBBH sample were 25 or under. The former hospital administered Enovid (5 mg) or Enovid-E (2.5 mg); the latter hospital administered Enovid-E (2.5 mg or 5 mg). After preliminary examination of results, it was considered justifiable to analyze the data for both groups together. During therapy the patients as a group perceived themselves as in nondepressive states. Psychiatrists detected depression in some patients, but too infrequently to change the mean depression scores. Most instances of depression were linked to the disillusionment of women expecting unreasonable benefits, such as cure of frigidity or end of marital conflict, with pill use. Religion, amount of education, and number of children had no observable effect on the depression scores. No evidence for depression arising from religion-related guilt in Catholic women was found. Sedative-like effects, which occurred in a few patients, need further investigation. 5 case histories are detailed.^ieng

Unemployed youth and health: findings from the pilot phase of a longitudinal study.

Contemporary research perspectives on the impact of unemployment on health and well-being among young people have tended to focus on a rather narrow range of outcomes, typically those in the mental health domain. The impetus for the proposed longitudinal study, the main dimensions of which are described in this paper, reflects the need for a more comprehensive profiling of the health needs and experiences of young people if effective interventions tailored to their short and long term health needs are to be developed. The proposed study includes variables from a wide range of domains and adopts an interdisciplinary perspective. The feasibility of the approach, both in terms of establishing appropriately stratified samples and determining the acceptability and utility of the measures proposed has been examined during an extensive pilot phase. Findings from the database established during this phase are presented. These focus on multi-dimensional comparisons of health and well-being between employed and unemployed young people, the impact of socio-economic status of origin on cardiovascular and other indicators, and the correlates of health and well-being among the unemployed. The results point to the potential complexity of the influences on health status and behaviour and the need to develop comprehensive models of this for research and intervention purposes.

Method failures of laparoscopic tubal sterilization in a residency training program. A comparison of the tubal ring and spring-loaded clip.

A prospective, randomized study of 365 women undergoing interval laparoscopic tubal sterilization in a residency training program was undertaken to compare method failures. Two occlusive techniques were compared, the spring-loaded clip (Hulka-Clemens) and the tubal ring (Falope Ring). Patients were randomized to either Falope Rings or Hulka-Clemens clips as the primary method. Demographic characteristics, educational level and operator experience were similar in the two groups. Follow-up at an average of 16 months (range, 6-24) revealed eight pregnancies (4.5%) in 176 women in the clip group and five pregnancies (2.6%) in the ring group. The Hulka-Clemens clip and the Falope Ring have similar incidences of method failure when employed by inexperienced operators. We question the usefulness of chromopertubation utilizing methylene blue dye to ensure proper placement of the occlusive device.

Teenage obstetric complications.

PIP: Adolescent pregnancy is associated with a high degree of risk for the mother and her baby which may be mitigated by good prenatal care, intensive nutritional counseling, and attention to social problems. A study of 222 predominately black, single adolescents who delivered at the University of Tennessee Center for the Health Sciences during the 2-month period between December 1977 and February 1978 revealed an increased incidence of hypertension and convulsive disorders as well as a high rate of toxemia and fetal distress during labor and delivery. Birth weights of less than 2500 gm were associated with a 12% incidence of prematurity, and nearly 15% of the newborns required intensive care (23 had high-risk Apgar scores at 1 minute and 18 at 5 minutes). Perinatal mortality was 54/1000. In this population, teenage pregnancy is viewed as an accepted and even welcome occurrence, supporting the finding that poor neonatal care is a prime cause of the increased complications of adolescent pregnancy. Comprehensive personal services are required to achieve patient compliance with prenatal medical care.^ieng