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Pregnancy and neonatal outcome information is frequently used in disease management to evaluate the cost-effectiveness of prenatal interventions and for other research and reporting activities. The purpose of this study was to determine if a telephone interview process is a reliable methodology for collecting pregnancy outcomes. High-risk patients from a large maternal–fetal medicine practice who received outpatient preterm labor management services from January 1996 to June 2001 were identified. Patient-reported pregnancy outcome data for 285 mothers and 478 infants were collected via a telephone interview by a perinatal nurse and compared to pregnancy outcome data abstracted from the maternal and infant hospital records. Overall, concordance and/or Kappa coefficients between maternal report and the medical record were high for delivery date (96.4%), birth weight within 100 grams (88.9%), Cesarean delivery (99.0%, Kappa = 0.98), and high-level nursery admission (91.2%, Kappa = 0.82). Both singleton and multiple gestation types accurately reported pregnancy outcome information. A telephone interview with a skilled nurse can be a reliable methodology for collection of valuable clinical and research data related to pregnancy outcome. Data collected in this manner and maintained in a database may be used with a high level of confidence by health care providers, payers, and researchers. ( Population Health Management 2010;13:27–32) [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the cost savings of outpatient management services for women with pregnancy-related hypertensive conditions. The outpatient management program included verbal and written patient education related to the hypertensive disease process during pregnancy as well as self-care procedures. Biometric data (ie, automated blood pressure measurement, qualitative urine protein) were collected at least daily by the patient and transmitted telephonically to a nursing call center. Data were evaluated and subjective symptoms assessed daily. Electronic records were maintained and reports provided to the prescribing physician and case manager. Included for analysis were: patients with pregnancy-related hypertensive conditions receiving outpatient services between January 1999 and November 2003, singleton gestation, no history of chronic hypertension, and gestational age of 20.0–36.9 weeks at start of outpatient program ( n = 1140). Maternal characteristics, antenatal hospitalization and length of stay, progression of disease, and neonatal outcome were analyzed. To evaluate cost-effectiveness, a model was developed to compare the cost of the program plus adjunctive antenatal hospitalization, to control data. The mean gestational age at program start was 32.6 weeks. Antenatal hospital admission was required for 24.8% of patients, with a mean length of stay of 2.3 days per admission. Progression to severe preeclampsia occurred in 14.3% of patients. Mean gestational age at delivery was 37.0 weeks. Antepartum charges averaged $10,327 per control patient and $4,888 per program patient, a difference of $5,439. For each dollar spent on outpatient management, an average of $2.50 was saved. Utilizing outpatient management services for women with pregnancy-related hypertension reduces the need for inpatient care and is cost-effective. (Disease Management 2006;9:236–241) [ABSTRACT FROM AUTHOR]

Objective . To determine the interval to spontaneous delivery following discontinuation of continuous subcutaneous terbutaline (SQT). Methods . Singleton and twin gestations receiving outpatient preterm labor management services with SQT were identified from a database. Patients having SQT discontinued at 33.0–35.9 weeks (in a stable condition, not hospitalized and with known cervical status at discontinuation) with subsequent spontaneous labor and delivery were included ( n = 1420). Data were compared by gestation type, week of SQT discontinuation and cervical dilatation using Kruskal–Wallis and Fisher's exact test analyses ( p<50.05 statistically significant). Results. Spontaneous preterm delivery occurred in 63.0% of singletons and 87.9% of twins. Although stable at SQT discontinuation, 32.5% of singletons and 59.9% of twins delivered within three days. The interval from discontinuation of SQT to delivery was less for twin than singleton gestations (5.1+6.5 vs. 11.0+10.5 days, respectively, p<50.001). Conclusions. Preterm discontinuation of SQT should be avoided if additional pregnancy prolongation is desired. [ABSTRACT FROM AUTHOR]

ABSTRACT: Statistics show increased incidence of poor perinatal outcomes among minority women. Certain perinatal risk factors are more prevalent among these women. Prenatal care is important in evaluating risk, promoting health, and managing complications in pregnancy, yet disparity of and access to care place these vulnerable women at increased risk. [Copyright &y& Elsevier]

OBJECTIVE:: To identify the etiology and impact of preterm delivery in twin gestations. STUDY DESIGN:: Twin gestations delivered at 33.0 to 36.9 weeks were identified in a perinatal database, and categorized by indication for delivery. Deliveries were identified as indicated, or non-indicated (discretionary). Neonatal outcomes were measured by birth weight, length of stay, NICU admission, and ventilator utilization. Data were divided and analyzed by indicated or discretionary delivery, and gestational age at delivery. RESULTS:: Analyzed were 3252 twin gestations (6504 infants), with 78%having indicated delivery. Of the 22%with discretionary delivery, nearly 40%required NICU admission. With each advancing week of gestation, there was a significant decrease in incidence of NICU admission and nursery days. CONCLUSION:: The majority of preterm deliveries were indicated, though 22%were discretionary. It is vital to consider neonatal morbidity and costs related to gestational age when choosing discretionary delivery.Journal of Perinatology (2005) 25, 4-7. doi:10.1038/sj.jp.7211205 Published online 14 October 2004 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To compare pregnancy and economic outcomes in women receiving inpatient vs outpatient tocolysis with continuous subcutaneous terbutaline (SQT). STUDY DESIGN:: Identified within a database were women prescribed SQT at 24.0 to 33.9 weeks' gestation following stabilization of an acute episode of preterm labor. Women with cervical dilatation >3?cm, and/or maternal or fetal instability were excluded. Those with prolonged inpatient care were matched 1:1 to those discharged with outpatient follow-up by cervical dilatation, gestational age, and fetal number yielding 90 matched pairs (180 women). RESULTS:: Inpatients had an earlier gestational age at delivery (34.1±2.9 vs 35.8±1.9 weeks, p<0.001), higher preterm birth rate (86.7% vs 74.4%, p=0.043) and higher overall costs ($56,089±$47,944 vs $25,540±$25,847, p<0.001) than outpatients. CONCLUSION:: Outpatient management resulted in improved pregnancy outcomes at a cost less than that of inpatient management in this analysis of women treated with SQT.Journal of Perinatology (2004) 24, 515-519. doi:10.1038/sj.jp.7211139 Published online 13 May 2004 [ABSTRACT FROM AUTHOR]