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Background: This study compared clinical and financial outcomes for low‐risk birthing people between those attended by midwives and those attended by obstetricians during hospital births. Methods: We conducted a retrospective cohort analysis of births from January 1, 2016 to December 31, 2020 at hospitals participating in a perinatal quality improvement collaborative, Obstetrical Care Outcomes Assessment Program (OB COAP), in the Northwest region of the United States and estimated risk ratios using a multivariate regression approach with a modified Poisson binomial for mode of delivery, labor interventions, and newborn outcomes comparing midwife‐led to obstetrician‐led care. Using publicly available data on average costs of vaginal and cesarean births, we then extrapolated the cost differences in care between midwives and obstetricians. Results: Births in the midwife group were less likely to be associated with induction (17.6% vs. 20.3% RR 0.74; 95% CI 0.70–0.78), epidural use (58.9% vs. 76.3% RR 0.78; 95% CI 0.77–0.80), and episiotomy (2.2% vs. 3.4% RR 0.68; 95% CI 0.58–0.81). Cesarean birth was also lower in the midwifery group (7.8% vs. 12.3% RR 0.68, 95% CI 0.62–0.73), without a corresponding increase in risk in adverse neonatal outcomes. We estimated that expanding midwifery care to 100% of low‐risk births across the United States could save as much as $340 million per year. Conclusions: Midwifery care is associated with a lower risk of cesarean birth and other interventions versus care provided by obstetricians and is therefore likely lower‐cost. [ABSTRACT FROM AUTHOR]

The case of two twin babies who shared the same placenta is reported. Normally, twins who share the same placenta are identical twins of the same sex. But these twins were fraternal and were male and female. They were the result of in vitro fertilization, which may have been responsible for causing this unusual twin pregnancy.

Objectives: To investigate correlations between sonographic soft markers and biochemical markers (human chorionic gonadotrophin, alpha-fetoprotein, and estriol) for Down syndrome in the second trimester of pregnancy., Methods: A total of 2183 women with apparently normal singleton fetuses who underwent second-trimester sonography (14-22 weeks) and maternal serum biochemical testing (triple test) were identified. Seven sonographic markers were recorded: nuchal fold thickness, humerus length, femur length, renal pyelectasis, hyperechoic bowel, echogenic intracardiac focus, and choroid plexus cysts., Results: Weak negative but statistically significant correlations were observed between human chorionic gonadotropin (multiples of the median) and both femur length (multiples of the median; Spearman p = -0.073; P < .01) and humerus length (multiples of the median; Spearman p = -0.083; P < .01). No other correlations significant at the 1% level were observed between femur length (multiples of the median) or humerus length (multiples of the median) and the biochemical markers. There were no significant correlations between nuchal fold thickness and any of the 3 biochemical markers. At the 5% (P < .05) level, the median human chorionic gonadotropin level (multiples of the median) was lower when an echogenic intracardiac focus was detected. Hyperechoic bowel also tended to be associated with higher median human chorionic gonadotropin (multiples of the median) and alpha-fetoprotein (multiples of the median) levels (P < .05)., Conclusions: We found that sonographic and biochemical markers for trisomy 21 are largely independent in unaffected pregnancies. For accurate risk estimation, correlations in both affected and unaffected pregnancies need to be considered. No or minimal correlation between sonographic markers and serum screening tests indicates that they can be used as independent modifiers of the maternal age-specific risk for Down syndrome.