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High-risk pregnancies: study supports earlier referrals to specialists.(Obstetrics)
HOUSTON -- High-risk obstetric patients who were exclusively managed by a maternal-fetal medicine specialist from 20 weeks' gestation had lower rates of preterm delivery, cesarean delivery, fetal distress, and perinatal mortality than patients who were managed by general obstetricians and referred to specialists only on an as-needed basis, a study has found.
Dr. Robert Eden, Dr. Mark I. Evans, and their associates at St. Luke's-Roosevelt Hospital Center in New York studied 2,614 high-risk obstetric patients who were ultimately referred to maternal-fetal medicine specialists at a community hospital.
"There was a better outcome on every variable with early management by a maternal-fetal medicine specialist." Dr. Evans said at the annual meeting of the Society for Gynecologic Investigation, where he presented several posters outlining the study.
Results suggest that the so-called gate-keeper model that filters access to specialty care through a generalist may not be the best approach for high-risk obstetric patients. "Our data suggest that early referral for total care when high-risk complications exist may provide more optimal outcomes for less cost in known high-risk patients. Perhaps the referrals should go from high risk to low risk and not the other way," Dr. Evans said.
Patients managed in the level III community perinatal center were, by definition, high risk by virtue of their medical and/or pregnancy histories. Nearly 20% had previous cesarean deliveries, almost 3% had previous intrauterine fetal deaths, and roughly 2% had previous neonatal deaths.
Demographic characteristics were nearly identical between the 1,204 patients managed exclusively by a maternal-fetal medicine specialist from 20 weeks on and the 1,410 who were referred as needed later in pregnancy.
Preterm deliveries occurred in 22% and 32% of the patients referred early or later in pregnancy, respectively. Primary cesareans were performed in 17% of patients referred early and in 23% referred later, and cesareans for fetal distress were required in 8% and 12%, respectively. Perinatal mortality was 12.4 per ...
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Source: HighBeam Research, High-risk pregnancies: study supports earlier referrals to...