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News Article | October 26, 2016
Site: www.eurekalert.org

Approximately one in three pregnant women in the U.S. deliver babies by cesarean delivery. While cesarean delivery may be life-saving for the mother, the baby or both, the rapid increase in cesarean birth rates over the past decade raises concerns that this type of delivery may be overused. Women & Infants Hospital of Rhode Island, a Care New England hospital, has been accepted into the American College of Nurse-Midwives (ACNM) Reducing Primary Cesareans Project. Women & Infants is working with other hospitals from across the United States and ACNM to improve healthy outcomes for mothers and families by focusing on reducing the incidence of first cesarean sections in low-risk women who have never given birth. "Our team of academic and community-based midwives is thrilled to champion this interprofessional opportunity to strengthen our current knowledge of what promotes healthy labor and birth," said Elisabeth Howard, PhD, CNM, FACNM, director of nurse midwifery in the Department of Obstetrics and Gynecology at Women & Infants Hospital and associate professor of obstetrics and gynecology (clinical) at The Warren Alpert Medical School of Brown University. "As providers, midwives possess considerable expertise in physiologic approaches to the care of women during childbirth. We look forward to working with others both here and around the country to identify the optimal care practices that will lead to a reduction in the cesarean section rate." The Reducing Primary Cesareans (RPC) Project is part of the ACNM Healthy Birth Initiative® (HBI), a long-term effort with representatives from leading maternity care organizations. HBI focuses on preserving normalcy by promoting evidence-based practices that support a healthy birth based on a pregnant woman's own physiology. The HBI works to encourage a consistent approach to birth practices and is focused on reducing those that are not evidence-based. Funded by the Transforming Birth Fund, the RPC Project builds on the HBI by offering unique opportunities for maternity care professionals and health systems to initiate action steps known as bundles. When implemented, these bundles prompt hospital system change that is aimed at reducing the incidence of primary cesarean births in the United States, which has continued to increase without associated improvements in health outcomes for mothers and babies. Women & Infants will work with the multi-disciplinary Reducing Primary Cesareans Quality Improvement (QI) expert panel and ACNM staff to identify areas of improvement and track process and outcome measures to demonstrate improvement in readiness, assessment, reliable and appropriate care, recognition and response, and systems learning. Women & Infants will implement at least one of three bundles, based on a data-driven analysis of the major cause of first cesarean in low-risk women at that hospital: Maureen G. Phipps, MD, MPH, chair and Chace-Joukowsky Professor of Obstetrics and Gynecology and assistant dean for Teaching and Research in Women's Health at the Alpert Medical School, professor of epidemiology at the Brown University School of Public Health, and chief of obstetrics and gynecology at Women & Infants Hospital and Care New England Health System, said, "We look forward to working with ACNM and the multi-hospital quality collaborative, and feel proud of the role we will play as champions of fewer cesarean births." About the American College of Nurse-Midwives The American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. With roots dating to 1929, ACNM sets the standard for excellence in midwifery education and practice in the United States and strengthens the capacity of midwives in developing countries. Its members are primary care providers for women throughout the lifespan, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. ACNM reviews research, administers and promotes continuing education programs, and works with organizations, state and federal agencies, and members of Congress to advance the well-being of women and infants through the practice of midwifery. Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for activities unique to women and newborns, Women & Infants is the 12th largest stand-alone obstetrical service in the country and the largest in New England with approximately 8,500 deliveries per year. A Designated Baby-Friendly® USA hospital, a 2015 and 2016 Women's Choice Award/America's Best Hospitals for Obstetrics and for Cancer Care, a 2015 and 2016 Women's Choice Award/Best Breast Centers, U.S.News & World Report 2014-15 Best Children's Hospital in Neonatology and a 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened what was at the time the country's largest, single-family room neonatal intensive care unit. Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, women's mental health, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, breast disease, obstetric medicine, and reproductive endocrinology and infertility. Women & Infants has been designated as a Breast Imaging Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center of Biomedical Research Excellence for Perinatal Biology by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of NRG Oncology, the Maternal Fetal Medicine Units Network, the Neonatal Research Network, and the Pelvic Floor Disorders Network.


Kaczka D.W.,University of Iowa | Herrmann J.,University of Iowa | Zonneveld C.E.,Neonatal Research | Tingay D.G.,University of Melbourne | And 5 more authors.
Anesthesiology | Year: 2015

Background: Despite the theoretical benefits of high-frequency oscillatory ventilation (HFOV) in preterm infants, systematic reviews of randomized clinical trials do not confirm improved outcomes. The authors hypothesized that oscillating a premature lung with multiple frequencies simultaneously would improve gas exchange compared with traditional single-frequency oscillatory ventilation (SFOV). The goal of this study was to develop a novel method for HFOV, termed "multifrequency oscillatory ventilation" (MFOV), which relies on a broadband flow waveform more suitable for the heterogeneous mechanics of the immature lung. Methods: Thirteen intubated preterm lambs were randomly assigned to either SFOV or MFOV for 1 h, followed by crossover to the alternative regimen for 1 h. The SFOV waveform consisted of a pure sinusoidal flow at 5 Hz, whereas the customized MFOV waveform consisted of a 5-Hz fundamental with additional energy at 10 and 15 Hz. Per standardized protocol, mean pressure at airway opening () and inspired oxygen fraction were adjusted as needed, and root mean square of the delivered oscillatory volume waveform (Vrms) was adjusted at 15-min intervals. A ventilatory cost function for SFOV and MFOV was defined as, where Wt denotes body weight. Results: Averaged over all time points, MFOV resulted in significantly lower VC (246.9 ± 6.0 vs. 363.5 ± 15.9 ml2 mmHg kg-1) and (12.8 ± 0.3 vs. 14.1 ± 0.5 cm H2O) compared with SFOV, suggesting more efficient gas exchange and enhanced lung recruitment at lower mean airway pressures. Conclusion: Oscillation with simultaneous multiple frequencies may be a more efficient ventilator modality in premature lungs compared with traditional single-frequency HFOV. © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

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