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