state of the hudson valley region james f. smith, jr., md chief of perinatal medicine westchester...
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State of the State of the Hudson Valley Hudson Valley
RegionRegionJames F. Smith, Jr., MDJames F. Smith, Jr., MDChief of Perinatal MedicineChief of Perinatal Medicine
Westchester Medical Westchester Medical Center/NYMCCenter/NYMC
Who is here?Who is here? Regional Perinatal CenterRegional Perinatal Center Affiliate HospitalsAffiliate Hospitals Regional Perinatal ForumRegional Perinatal Forum Perinatal Networks (LHVPN, MISN)Perinatal Networks (LHVPN, MISN) County Departments of HealthCounty Departments of Health March of DimesMarch of Dimes Other Regional StakeholdersOther Regional Stakeholders
Who are all these people?Who are all these people?
Regional Perinatal Regional Perinatal CenterCenter
Advanced perinatal/neonatal Advanced perinatal/neonatal servicesservices
TeachingTeaching ResearchResearch OutreachOutreach Management of databases for Management of databases for
affiliate hospitalsaffiliate hospitals
RPC — Our AffiliatesRPC — Our Affiliates Orange Regional Orange Regional
Medical CenterMedical Center St. Luke’sSt. Luke’s Good SamaritanGood Samaritan Bon SecoursBon Secours St. Anthony’sSt. Anthony’s Vassar BrothersVassar Brothers PutnamPutnam Hudson ValleyHudson Valley PhelpsPhelps St. John’s Sound ShoreSt. John’s Sound Shore Our Lady of MercyOur Lady of Mercy St. FrancisSt. Francis Sound ShoreSound Shore
20072007 About 17,534 About 17,534
deliveries!deliveries!
Mini-Grant RecipientsMini-Grant Recipients Lower Hudson Valley Perinatal Network Lower Hudson Valley Perinatal Network
(LHVPN)(LHVPN) LHVPN Community Health Education Day LHVPN Community Health Education Day
(CHED)(CHED)
Planned Parenthood Hudson Peconic, Inc.Planned Parenthood Hudson Peconic, Inc. Increasing Access to Prenatal Care in Increasing Access to Prenatal Care in
Westchester County for Under-served, Low Westchester County for Under-served, Low Income & Spanish Speaking Women Income & Spanish Speaking Women (BROCHURE) (BROCHURE)
Hudson Valley Hospital Center Planned Hudson Valley Hospital Center Planned Parenthood Hudson Peconic, Inc.Parenthood Hudson Peconic, Inc. Traveling Health Fair Traveling Health Fair
Regional Perinatal Regional Perinatal ForumForum
Collaboration between the RPC and:Collaboration between the RPC and: Perinatal Networks - CPPSNPerinatal Networks - CPPSN Affiliate HospitalsAffiliate Hospitals Regional Non-Hospital ProvidersRegional Non-Hospital Providers Relevant Non-Provider GroupsRelevant Non-Provider Groups
InsuranceInsurance Intervention programsIntervention programs March of DimesMarch of Dimes Community Based OrganizationsCommunity Based Organizations County Departments of HealthCounty Departments of Health OthersOthers
Comprehensive Prenatal Comprehensive Prenatal Perinatal Services NetworkPerinatal Services Network
““CPPSN”CPPSN” Community Based OrganizationsCommunity Based Organizations
Organize perinatal informationOrganize perinatal information Facilitate access to health care systems Facilitate access to health care systems
at local levelat local level Improve regional perinatal outcomesImprove regional perinatal outcomes
Comprehensive Prenatal Comprehensive Prenatal Perinatal Services Network Perinatal Services Network
(CPPSN)(CPPSN)• Maternal Infant Services Network
• Lower Hudson Valley Perinatal Network
NYS Perinatal Health NYS Perinatal Health InfrastructureInfrastructure
Clinical Services
Regional Perinatal Centers
Prevention Services
Perinatal Networks
Regional Perinatal Forum
Hudson Valley Maternal Hudson Valley Maternal OverweightOverweight
0
5
10
15
20
25
30
35
40
45
Dutchess Orange Putnam Rockland Sullivan Westchester Ulster Nation
% Livebirths to Mothers with BMI> 26, 2006 NYSDOH Data, Bureau of Biometrics and Health Statistics
Hudson Valley Maternal Hudson Valley Maternal Overweight Overweight
by Race and Ethnicityby Race and Ethnicity
0
10
20
30
40
50
60
Dutchess Orange Putnam Rockland Sullivan Westchester Ulster
White BlackHispanic
% Livebirths to Mothers with BMI> 26, 2006 NYSDOH Data, Bureau of Biometrics and Health Statistics
Prenatal Care at WMC over Time
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
First Trimester Prenatal Care Adequacy of Prenatal Care
Per
cen
t o
f D
eliv
erie
s
2006 2007
Source: EBC Data 2006, 2007
Source: EBC Data 2007
Preterm Rates at WMC Compared to Region and Healthy People 2010 Goals
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Total Preterm Rate (< 37 weeks) Preterm Rate (32-36 weeks) Preterm Rate (< 32 weeks)
WMC 2007
Region 2007
2010 Goals
Source: EBC Data 2007
High Risk Pregnancy and Delivery at WMC in 2007
0%
2%
4%
6%
8%
10%
12%
14%
16%
Diabetes
(Prepreg./Gest.)
Hypertension
(Prepreg./Gest./
Eclampsia)
Prolonged Rupture of
Membranes
(12+hours)
Maternal Transfusion Infertility Treatments
(OI,IUI,or ART)
WMC
Region
Source: EBC Data 2007
Total Cesarean Births
17.40%
35.80%
25.20%
35.30%
45%47%
37.10%
48.10%
32.10%
37.10%
53.10%
39.20%
34.50% 35.30%
0%
10%
20%
30%
40%
50%
60%
Good Sam
Hudson V
alle
y
Phelps
Putnam
St. Jo
hn's
Sound Shore
Vassa
r
WM
C
St. Luke
's
Bon Sec
ours
St. Anth
onyOLM
Orange
Total R
PC
Per
cen
t o
f A
ll B
irth
s
-----National rate in red for primary c/s is 31%
Source: EBC Data 2007
Primary Cesarean Births Across Network
20.7%
9.9%
23.5%
18.3%
27.2%
10.0%
18.1%
31.7%
29.1%29.7%
18.4%
24.9%26.9%
21.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
% o
f L
ive B
irth
s
-----National rate in red for primary c/s is 24.3%
““Britney's Britney's scheduled Sept. scheduled Sept. 15 C-section15 C-section was moved up a was moved up a day after she day after she began began experiencing experiencing early early contractions. contractions.
Celebrity Role Models
Celebrity Role ModelsCelebrity Role Models
Trends and Incidence of Cesarean Trends and Incidence of Cesarean DeliveryDelivery
Electronic Fetal Electronic Fetal Monitoring?Monitoring?
Acute TocolysisAcute Tocolysis
Effective in delaying delivery Effective in delaying delivery up to 48 hoursup to 48 hours
24 to 34 weeks24 to 34 weeks Steroid administrationSteroid administration Consider transport to RPCConsider transport to RPC
Magnesium SulfateMagnesium Sulfate
TocolyticsTocolytics
Lyell, et al. Obstet Gynecol 2007; Lyell, et al. Obstet Gynecol 2007; 110:61-7110:61-7
Magnesium vs. NifedipineMagnesium vs. Nifedipine Primary outcome—prevention of Primary outcome—prevention of
preterm delivery and uterine preterm delivery and uterine quiescence for 48 hoursquiescence for 48 hours
TocolysisTocolysis
OutcomeOutcome Magnesium Magnesium NifedipineNifedipinePrimary *Primary * 87%87% 72% 72%
Del Del <48 h<48 h 7.6%7.6% 8.0% 8.0%Del Del <37 w<37 w 57%57% 57% 57%
<32 w<32 w 11%11% 8% 8%
GA at del.GA at del. 35.8 w35.8 w 36.0 w 36.0 w
Newborn LOS *Newborn LOS * 8.8 d8.8 d 4.2 d 4.2 d
Source: SPDS- NICU Module 2004-2007
Percent Survival of Admitted Babies by Gestational Age over 4 years
0
10
20
30
40
50
60
70
80
90
100
<24 weeks 24-25weeks
26-27weeks
28-31weeks
32-36weeks
37-42weeks
total
Gestational Age
Per
cen
t 2004200520062007
2007 Outborn
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
< 24 weeks 24-25 weeks 26-27 weeks 28-31 weeks 32-36 weeks 37-42 weeks Total
Gestational Age
Perc
ent of O
utb
orn
Adm
issio
ns
2007 Inborn
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
< 24 w eeks 24-25 w eeks 26-27 w eeks 28-31 w eeks 32-36 w eeks 37-42 w eeks Total
Gestation Age
Perc
en
t o
f In
bo
rn A
dm
issio
ns
Antenatal Steroid Use, SPDS NICU Module
Data
SummarySummary EBC Outcomes:
As Regional Center, sicker mothers, more c/s, and higher prematurity rates
Regional c/s rates vary by center
EBC Data Quality
Future directions Fetal Diagnostic and Health Center
Multispecialty diagnostic team Fetal interventional program
Increased Regional Preconceptual Health Awareness Access Implementation
AcknowledgementsAcknowledgements
OBOBHoward Blanchette, MDHoward Blanchette, MD
James Smith, MDJames Smith, MDMichael Kessler, MDMichael Kessler, MD
NeonatologyNeonatologyEdmund La Gamma, MDEdmund La Gamma, MD
Heather Brumberg, MD, MPHHeather Brumberg, MD, MPHSusan Marchwinski, RN, C, MSSusan Marchwinski, RN, C, MS
Donna Dozor, RN, MSDonna Dozor, RN, MSClare Nugent, RN, CClare Nugent, RN, C
LHVPNLHVPNCheryl Hunter-Grant, MSWCheryl Hunter-Grant, MSW
Lorraine Anglin, MPHLorraine Anglin, MPHMichelle Gordon Michelle Gordon
Jeet LundJeet LundLHVPN Steering Committee LHVPN Steering Committee
MISNMISNCaren Fairweather, MPSCaren Fairweather, MPS
Stephanie Sosnowski, ICCEStephanie Sosnowski, ICCE
Thanks to the entire Thanks to the entire Hudson Valley Regional Hudson Valley Regional
Perinatal Forum Steering CommitteePerinatal Forum Steering Committee
State of the State of the Hudson Valley Hudson Valley
RegionRegionJames F. Smith, Jr., MDJames F. Smith, Jr., MDChief of Perinatal MedicineChief of Perinatal Medicine
Westchester Medical Westchester Medical Center/NYMCCenter/NYMC