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Upcoming
important dates, next steps for the SIVB Initiative...
(The Support for Birth initiative's weekly email newsletter comes out every Tuesday. As a reminder, it is your job as key contact to share relevant information with other team members at your hospital.)
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AJOG: Obstetrical and perinatal outcomes among women with gestational hypertension, mild preeclampsia, and mild chronic hypertension. (September 2011)
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|  In last week's webinar the AJOG article on GHTN, mild preeclampsia and mild chronic HTN was discussed. According to this retrospective, multicenter study with over 228,000 deliveries, the greatest risk for postpartum hemorrhage, blood transfusions, ICU admissions, and the lowest risk for stillbirths were women with GHTN. The infants of these GHTN women were at an increased risk for ventilator assistance, RDS, use of surfactant and having NEC. On the other hand, the greatest risk for abruption and hypertension during the postpartum period was in the group with preeclampsia. The infants of preeclampic women were at the greatest risk for IUGR, PNA, and an intracranial bleed. Uterine rupture and thrombotic events were greatest among women with mild chronic HTN and infants of these women had better outcomes than the other two groups.
Since it was noted that women with GHTN are at a greater risk for morbidity than women with mild chronic HTN, 'induction of labor now has been suggested for women with mild hypertensive disease who have achieved 37 weeks gestation' to avoid maternal morbidity.
It was also noted that 'significantly more stillbirths occurred in the control group, likely because the 3 hypertensive groups had higher rates of induction before this event.'
The investigators noted that although the delay of inductions may increase the maternal morbidity, other complications associated with inductions (especially of an unripe cervix) as well as cesarean delivery rates at 37 weeks and their morbidities should also be considered.
to read this article
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Data Collection - Deadline the 20th of the Month
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Please remember to get your data in by the 20th of each month to so data reports can be available for our teams and webinars.
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Learning Session - November 2nd at the McKimmon Center in Raleigh
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|  Pre-register your team here
At our next learning session, let's share our great work and come prepared to talk about Phase II!
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Data Details - Jessica Phipps
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|  Hypertensive disease rates over time
During the Webinar last week there was some anecdotal discussion of increasing numbers of pre-eclampsia patients in the summer months, so I agreed to look at our sample to see if there might be evidence of increased rate of pre-eclampsia in our data. We do not collect diagnosis of pre-eclampsia, we DO collect "Hypertensive Disease" which includes: "chronic hypertension, gestational hypertension, preeclampsia, eclampsia, HELLP syndrome."
Based on looking at the rate of reported hypertensive disease over time, there is no uptick during the summer; in fact, in June and July, the reported rates are slightly lower than other months so far.
There are a few possible reasons for this discrepancy between what our teams reported anecdotally and what the data actually shows:
1) Our teams on the call also reported an uptick in overall deliveries in the summer. While this isn't something that we can test using our data due to our sampling methodology, it could be that our teams are noticing more pre-eclampsia patients because they have more patients overall. Ten percent of 100 is 10 but if you have 150 patients, you'll see 15 pre-eclamptic patients - this is still the same rate of pre-eclampsia, yet you're seeing more pre-eclampsia.
2) We may not be effectively capturing cases of pre-eclampsia; if they come in and go straight for a cesarean section; we may not accurately capture them depending on if you're facility considers them a "scheduled" cesarean.
3) It could be due to confirmation bias; because teams believe that pre-eclampsia increases in the summer, teams may tend to notice the pre-eclampsia cases even more.
If anyone has any literature on rates of pre-eclampsia going up in the summer, please share it with us!
Cesarean rates for use of epidural
On the Webinar last week, we had a question about the rate of cesareans for women who have an epidural vs. those who do not have an epidural. Our rates of epidural have been relatively stable over time, hovering around 80% of women in our sample receiving an epidural. Without adjusting for any other factors, there is a statistically significant difference in cesarean rate between women who receive an epidural and those who do not. Women who have an epidural have a 22.8% cesarean rate (95% confidence interval, 21.82% to 23.81%) and women who do not have an epidural have a 26.21% cesarean rate (95% confidence interval 24.05% to 28.45%).
One hypothesis for the higher rate of cesareans for women who do not have an epidural is that some of those women may be experiencing indications for a cesarean before they have an epidural placed. Unfortunately, we do not have complete data regarding time in labor for a large number of patients and thus cannot adjust for time in labor. The take-home message here is that our cesarean rate is higher in women who do not have an epidural, yet this might be due to heavy confounding.
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Contact
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Amanda French, MSN, RNC-OB, CNS
amanda.french@pqcnc.org
Phone: (336) 675-2787
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