Search

Objective The aim of the study is to compare perinatal outcomes for women with greater social needs, as identified by the Community Health Needs Assessment, to those of women living in other areas of the county. Study Design This was a retrospective cohort study of pregnant women delivering at a large inner-city county hospital. Perinatal outcomes were analyzed for women living within a target area with substantial health disparities and social needs, and compared with those women living outside the target area. Statistical analysis included student's t -test, Chi square, and logistic regression. Results Between January 2015 and July 2020, 66,936 women delivered at Parkland hospital. Of these, 7,585 (11%) resided within the target area. These women were younger (26.8 ± 6.5 vs. 27.9 ± 6.4 years, p < 0.001), more likely to be black (37 vs. 13%, p < 0.001), and had a higher body mass index or BMI (33.3 ± 7.0 vs. 32.6 ± 6.4 kg/m 2 , p < 0.001). All women were likely to access prenatal care, with 7,320 (96.5%) in the target area and 57,677 (97.2%) outside the area attending at least one visit. Adverse perinatal outcomes were increased for women living within the target area, which persisted after adjustment for age, race, and BMI. This included an increased risk of preeclampsia (adjusted risk ratio [aRR] 1.1, 95% confidence interval or CI [1.03, 1.2]) and abruption (aRR 1.3, 95% CI [1.1, 1.7]), as well as preterm birth before both 34 weeks (aRR 1.3, 95% CI [1.2, 1.5]) and 28 weeks (aRR 1.3, 95% CI [1.02,1.7]). It follows that neonatal ICU admission (aRR 2.1, 95% CI [1.3, 3.4]) and neonatal death (aRR 1.2, 95% CI [1.1, 1.3]) were increased within the target area. Interestingly, rate of postpartum visit attendance was higher in the target area (57 vs. 48%), p < 0.001. Conclusion Even among vulnerable populations, women in areas with worse health disparities and social needs are at greater risk of adverse perinatal outcomes. Efforts to achieve health equity will need to address social disparities. Key Points At a county hospital, 97% of women accessed prenatal care. Greater social needs were associated with adverse perinatal outcomes. Differences persisted with adjustment for age, race, and BMI. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the rate and impact of episiotomy on maternal and newborn outcomes before and after restricted use of episiotomy. Study Design This population-based observational study used an obstetric database of all deliveries since 1990 that has been maintained with quality checks. Inclusion criteria were vaginal deliveries at ≥37 weeks. Exclusion criteria included fetal malformations, multifetal gestations, or fetal deaths known on arrival to Labor and Delivery. The primary outcomes of interest were episiotomy, perineal lacerations, and newborn outcomes. To evaluate the impact of restrictive episiotomy, data from 1990 to 1997 (35% overall episiotomy rate) were compared with data from 2010 to 2017 (2.5% overall episiotomy rate). Univariable analysis of maternal and infant outcomes were performed comparing the two-time epochs with the Pearson's Chi-squared test. Results Overall, 268,415 women met inclusion criteria and 49,089 (18.2%) had an episiotomy. The rate of episiotomy decreased from 37% of deliveries in 1990 to 2% in 2017. A total of 82,082 deliveries occurred in the 1990 to 1997 epoch and 57,183 in 2010 to 2017. Indicated use of episiotomy was associated with a significant decrease in third and fourth degree lacerations. Immediate newborn condition (5-minute Apgar's score ≤3 and umbilical artery pH <7.1) and neonatal outcomes (intraventricular hemorrhage [IVH] grade 3/4, positive culture sepsis, neonatal seizures, and neonatal demise) were not significantly different. Conclusion Selective, indicated use of episiotomy compared with routine was associated with lower rates of third/fourth-degree lacerations with no change in neonatal outcomes. The common obstetric practice of routinely performing episiotomy, presumably to prevent perineal trauma, proved untrue when analyzed over almost three decades. Key Points Episiotomy use decreased overtime at our institution. Decreased episiotomy use was associated with significant improvement in maternal outcomes. Neonatal outcomes were unchanged suggesting no deleterious effects with restricted episiotomy. [ABSTRACT FROM AUTHOR]