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Maternal Child

Pregnancy

Welcome! To the newly reorganized Pregnancy page. Please take a few moments to familiarize yourself with the new sections in alphabetic order, followed by a Miscellaneous section

Hot Topics

Monthly Online MCH and Women's Health Newsletter, CCC Corner

• See Hot Topics featured each month

Access to Care

Do all hospitals need cesarean delivery capability?

• Leeman(s): Outcome based study: Zuni, New Mexico

Native American Community with a 7% Cesarean Delivery Rate

• Leeman(s): What explains the low rate in Zuni?

Medicaid Coverage of Perinatal Services: Results of a National Survey

• See the survey results on-line

Prenatal care

• Barriers to Medi-Cal lead to inadequate prenatal care

Homelessness

• Increased preterm birth

Advanced Life Support in Obstetrics

• The ALSO® course: manage emergencies obstetrics

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Alaska Native, American Indian, Ethnic & Minority Women

Aberdeen Area Infant Mortality Study (AAIMS): Leslie Randall, et al

• Audio and Powerpoint Conference Archive

Low Birthweight in Minority and High-Risk Women

• Effective ways to deliver services to Minority Women

Perinatal Study at Keams 1979, Charles North M.D.

• Interesting information for historical comparison (PowerPoint Presentation in 5 parts)

Racial and Ethnic Disparities in Infant Mortality Rates

• Demonstrate the need to decrease infant mortality in U.S. cities

Targeted interventions to address maternal needs of minority women

• Higher pregnancy-related deaths than non-Hispanic white women

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Beta Strep 

CDC: Revised Group B Streptococcal Disease Guidelines

• Screen all women at 35-37 weeks, among other changes

Group B Streptococcus in Alaska Native pregnant women and neonates

• Montse Soriano-Gabarro's Abstract for the ICAAC
• Power point (.PPT) presentation - 1.9 MB

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Birth Trends

Births: Preliminary Data for 2001

• CDC report presents preliminary data for 2001 on births in U.S.

Births: Data for 2000

• This CDC report presents data for 2000 on births in the United States

Prevalence of Selected Maternal Behaviors and Experiences, Pregnancy Risk Assessment Monitoring System (P.R.A.M.S.), 1999

• A wide range of pregnancy behaviors are reported: prenatal care to breastfeeding.

Births to Teenagers in the United States, 1940-2000

• This report tracks teen birth rates for more than half a century

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Cystic Fibrosis

Ob-Gyns offering large-scale cystic fibrosis screening

• A.C.O.G. recommends screening for cystic fibrosis to all couples

Cystic Fibrosis Carrier Testing: The Decision is Yours

• A.C.O.G. Patient education brochure.

Cystic Fibrosis Testing: What Happens If Both My Partner and I Are Carriers?

• A.C.O.G. Patient education brochure.

Preconception and Prenatal Carrier Screening for Cystic Fibrosis

• Publication at A.C.O.G. store.

Cystic Fibrosis Foundation publications

• Visit the on-line store.

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Diabetes in Pregnancy

Diabetes in Pregnancy Management Guidelines

• Diabetes in Pregnancy Guidelines (Word 190 KB)

Case Management - Diabetes in Pregnancy

• RPMS, CMS (PPT 201k) and Hard Copy: Shelley Thorkelson
• Gestational Diabetes Mellitus Tracking Sheet  (Word 325k) (q-man)

American Diabetes Association Offerings

• General information
• Information for health professionals
• Clinical practice guidelines
• Patient education for gestational diabetes

Children of moms who smoked during pregnancy at greater risk for diabetes

• Montgomery SM ,Ekbom A. Smoking during pregnancy and diabetes mellitus in a British longitudinal birth cohort. BMJ 2002;324:26-27.

Breastfeeding as a type 2 diabetes prevention intervention

• Suzan Murphy and Charlton Wilson, from the Phoenix Diabetes Center (Word)

Sansum Diabetes Research Institute

• Increasing healthy babies born to women with diabetes, and type 2 diabetes in children

Adverse outcome with one elevated OGTT value

• Kim HS, Chang KH, Yang JI, Yang SC, Lee HJ, Ryu HS . Int J Gynaecol Obstet 2002 Aug;78(2):131-8

Indian Health Programs and Practices: Diabetes in Pregnancy (PDF)

IHS National Diabetes Program

• Public health effort to prevent and control diabetes

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Evidence Based Information from A.H.R.Q.

• A -Z: AHRQ - Evidence Based practice
• Clinical Preventive Services, 2nd Ed. (Sroll down to: Congenital Disorders or Prenatal Disorders)
• Congenital Disorders or Prenatal Disorders
• Cesarean delivery: increased death compared to vaginal delivery
• Chronic hypertension associated with 11-fold increase in preeclampsia risk
• Down syndrome: risk a procedure-related miscarriage
• First-time mothers who have unassisted deliveries fare better
• Improving maternity care

• Homelessness: increased preterm birth
• Low Birthweight: 1992-98 Patient Outcomes
• Management of chronic hypertension during pregnancy
• Management of preterm labor
• Management of prolonged pregnancy
• Maternal fever during labor is predictor of infection-related infant death
• Prenatal care: lack of effect on low birth weight
• Prenatal care: Barriers to Medi-Cal lead to inadequate prenatal care
• Postpartum hospital stays: Reduce readmission of newborns
• Risk of uterine rupture during labor is higher for women with a prior cesarean
• Screening Bacterial Vaginosis in Pregnancy
• Screening Diabetes Mellitus, Adult Type II
• Social stressors increase preterm births
• Venous Thromboembolism

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H.I.V. in Pregnancy

HIV AND SYPHILIS EPIDEMIOLOGY: Navajo Nation

• PUBLIC HEALTH EMERGENCY! 2001 - 2003

HIV Testing Among Pregnant Women

• United States and Canada, 1998-2001

H.I.V. tests for all pregnant women

• Universal screening with patient notification

What is the latest in H.I.V. treatment and management?

• Resource for approved treatment guidelines for H.I.V. and AIDS.

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Infectious Disease

Clinical practice improvement on Chlamydial screening in adolescent girls

Maternal fever during labor is predictor of infection-related infant death

Pregnant women are 20 times more likely to get listeriosis

• Newborns suffer the serious effects of infection

Prevention and Control of Influenza Recommendations of ACIP

Sexually Transmitted Diseases Treatment Guidelines 2002, C.D.C.

• CDC Division of Sexually Transmitted Diseases Updates, CDC

Team approach boosts chlamydia screening of teenage girls from 5% to 65%

Web based Epidemiology in the IHS: Track Chlamydia and get CME

Midwives

What is a nurse midwife?

• What does a nurse midwife do? Want to talk to a midwife? Here is a great site to get introduced to nurse midwives that care for American Indians and Alaska Natives

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Mercury and Fish Consumption

Mercury Levels in Young Children and Women of Childbearing Age

• Methyl mercury exposures strategy to reduce Hg exposure

What is a safe amount of fish to eat during pregnancy?

• The F.D.A. recommends women can safely eat 12 ounces per week
  
• F.D.A. Consumer Advisory
  
• F.D.A. Center for Food Safety and Applied Nutrition

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Perinatology

Perinatology Corner

• Indian Health Oriented CME/CEUs: Graded recommendations and references

Harbor U.C.L.A. perinatology conferences

• Variety of subjects: Amniotic fluid embolism, I.U.G.R.

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Preterm Labor

Management of preterm labor

Preterm Labor: EBM Recommendations from ACOG

• Synopsis: Practice Bulletin on Preterm Labor, No. 43, May 2003

Social stressors increase preterm births

Oral Disease in Preterm Labor and Low Birthweight (PPT 2MB)

• Dr. Todd Smith, Periodontist at Phoenix Indian Medical Center

Antenatal corticosteroids revisited: Repeat courses, N.I.H. Consensus

• Data are insufficient to support repeat courses of antenatal corticosteroids

Measurement of uterine contraction frequency does NOT predict preterm delivery

• NEJM January 24, 2002 (346:250-255 ) Iams JD, et al

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Providers Partnership Project: A.C.O.G. / M.C.H.B. / H.R.S.A.

• About the project
• The Providers Partnership addresses health promotion/risk reduction behaviors
• Key issues. HIV, psychosocial screening and providing technical assistance
• Building Public/Private Partnerships to Address Perinatal HIV: A Case Study in Connecticut. Determining how to increase rates of HIV counseling and testing of pregnant women in the state
• Getting involved
• Publications
• New funding available for adolescent health efforts
• Maternal and Child Health Bureau, H.R.S.A. / H.H.S

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Safe Motherhood

C.D.C.'s Safe Motherhood

• Safe Motherhood strategies to decrease morbidity and mortality

Shortened interval to avoid pregnancy after receipt of rubella-containing vaccine

• now recommends shortening the interval from 3 months to 28 days

• Prenatal exposure to alcohol is one of the leading preventable causes of birth defects and mental retardation

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Smoking in Pregnancy

Active and Passive Tobacco Exposure

• A serious pediatric health problem

Smoke Free Families

• Helping pregnant smokers quit takes a team. Join ours.

Smoking Cessation Makes Cents

• The Cost-Effectiveness of Tobacco Interventions

Smoking During Pregnancy in the 1990s

• The rate of smoking during pregnancy dropped 33 percent between 1990 and 1999

Substance Abuse

Defining the National Agenda for Fetal Alcohol Syndrome

• And Other Prenatal Alcohol-Related Effects

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Vaginal Birth After Cesarean Delivery (VBAC)

Vaginal birth after cesarean birth

• California, 1996-2000

Vaginal birth after cesarean delivery: immediate availability recommended

• Recommendation Level C (A.C.O.G. Practice Bulletin Number 5, July 1999)

Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-99

• Cesareans are now on the rise

AHRQ: Risk of Uterine Rupture

• Uterine rupture is higher for women with a prior cesarean delivery

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Violence Against Pregnant Women

Violence against Native women, Indian Health web site

Pregnancy-associated assault hospitalizations

Pregnancy-associated injury deaths

Violence, substance abuse, and motor vehicle collisions, 1990-1999

Pregnant women with stressful events more likely to be physically abused

• Usually by their partners. September 2001 Mat Child Hlth J 5(3), pp. 145-152

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Miscellaneous

Albuquerque Service Unit: Medical Record - Prenatal and Pregnancy Flow sheet

• Albuquerque Area prenatal history, intake, lab, and maternity flow sheet. Word: Page 1 (WORD 98k) | Page 2 (WORD 57k)

CDC: Who should not get the smallpox vaccine?

• Pregnant women and other FAQs

Health Canada: Pregnancy

• Health Canada presents many pregnancy-related subjects

OBGYN.net

• Physician-reviewed network for pregnancy, women's health and index

Medical Evaluation in Cases of Fetal Demise

• Pregnancy loss, support, and protocols

Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation

• Unlinking the circulations renders the pregnancy "functionally" dichorionic, which results in decreased neonatal morbidity

Women with Smallpox Vaccine Exposure During Pregnancy

• United States, 2003

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