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Mary E. D'alton - One of the best experts on this subject based on the ideXlab platform.
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Maternal–Fetal Medicine Workforce Survey: Are We Ready for Regionalized Levels of Maternal Care?
American Journal of Perinatology, 2018Co-Authors: Katharine D. Wenstrom, Mary E. D'alton, Daniel O’keefeAbstract:Objective To conduct a survey of the members of the Society for Maternal-Fetal Medicine (SMFM) to determine the practice patterns of maternal–fetal Medicine (MFM) subspecialists in the United States and to estimate the likelihood that our work force is sufficient to support the proposed MFM staffing requirements for level III and IV maternity centers. Study Design All regular SMFM members in the United States were invited to answer a 26 question survey by email. The survey queried demographic characteristics, practice type, night call arrangements, and whether the respondent's hospital was currently equipped with the services and personnel described in the requirements for level III or IV centers. Results Of the MFM specialists working full time in what would be considered a level III or IV maternity center, only 47.5% took in-house call. Of those taking only call from home or back-up call, the majority reported that during call hours, MFM antepartum and laboring patients are cared for by generalist obstetrician gynecologists; only 6.4% work with MFM hospitalists. Respondents from level III or IV centers also reported that many of their centers did not meet the criteria for nursing support, anesthesia support, or intensive care services. Conclusion These data, if confirmed, indicate that work needs to be done to upgrade services and achieve appropriate staffing to meet the proposed level III and IV criteria for maternity care.
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Maternal-Fetal Medicine Workforce Survey: Are We Ready for Regionalized Levels of Maternal Care?
American journal of perinatology, 2018Co-Authors: Katharine D. Wenstrom, Mary E. D'alton, Daniel O’keefeAbstract:Objective To conduct a survey of the members of the Society for Maternal-Fetal Medicine (SMFM) to determine the practice patterns of maternal–fetal Medicine (MFM) subspecialists in the United States and to estimate the likelihood that our work force is sufficient to support the proposed MFM staffing requirements for level III and IV maternity centers. Study Design All regular SMFM members in the United States were invited to answer a 26 question survey by email. The survey queried demographic characteristics, practice type, night call arrangements, and whether the respondent's hospital was currently equipped with the services and personnel described in the requirements for level III or IV centers. Results Of the MFM specialists working full time in what would be considered a level III or IV maternity center, only 47.5% took in-house call. Of those taking only call from home or back-up call, the majority reported that during call hours, MFM antepartum and laboring patients are cared for by generalist obstetrician gynecologists; only 6.4% work with MFM hospitalists. Respondents from level III or IV centers also reported that many of their centers did not meet the criteria for nursing support, anesthesia support, or intensive care services. Conclusion These data, if confirmed, indicate that work needs to be done to upgrade services and achieve appropriate staffing to meet the proposed level III and IV criteria for maternity care.
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Putting the "m" back in Maternal-Fetal Medicine
American journal of obstetrics and gynecology, 2012Co-Authors: Mary E. D'alton, Haywood L. Brown, William A. Grobman, Thomas J. Garite, Clarissa Bonanno, Richard L. Berkowitz, Joshua A. Copel, F. Gary Cunningham, Larry C. Gilstrap, Gary D.v. HankinsAbstract:Although maternal death remains rare in the United States, the rate has not decreased for 3 decades. The rate of severe maternal morbidity, a more prevalent problem, is also rising. Rise in maternal age, in rates of obesity, and in cesarean deliveries as well as more pregnant women with chronic medical conditions all contribute to maternal mortality and morbidity in the United States. We believe it is the responsibility of Maternal-Fetal Medicine (MFM) subspecialists to lead a national effort to decrease maternal mortality and morbidity. In doing so, we hope to reestablish the vital role of MFM subspecialists to take the lead in the performance and coordination of care in complicated obstetrical cases. This article will summarize our initial recommendations to enhance MFM education and training, to establish national standards to improve maternal care and management, and to address critical research gaps in maternal Medicine.
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Maternal-Fetal Medicine subspecialists' provision of second-trimester termination services.
American journal of perinatology, 2012Co-Authors: Jennifer L. Kerns, Melissa G. Rosenstein, Jema K. Turk, Aaron B. Caughey, Jody Steinauer, Mary E. D'altonAbstract:OBJECTIVE Most abortions for pregnancy complications occur in the second trimester. Little is known about whether Maternal-Fetal Medicine subspecialists (MFMs) perform terminations for these women. STUDY DESIGN We surveyed all members of Society of Maternal Fetal Medicine by e-mail or mail regarding second-trimester abortion provision. We conducted analyses of whether MFMs perform abortions, by what method, and how frequently. RESULTS Our response rate was 32.4% (689/2,125). Over two-thirds of respondents perform either dilation and evacuation (DE 31% perform D&Es. Male gender, frequent chorionic villus sampling provision, and being trained in D&E during fellowship are associated with performing D&Es. Nonprovision of any second-trimester abortion is significantly associated with age over 50, nonacademic practice setting, and less supportive abortion attitudes (p < 0.001). A nonsignificant trend toward association between south/southeast region and nonprovision of any second-trimester abortion is seen (p = 0.09). CONCLUSION Many MFMs include D&E and induction termination services in their practice. Supporting current D&E providers and expanding training options for MFMs may optimize care for women diagnosed with serious pregnancy complications.
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Where is the "M" in Maternal-Fetal Medicine?
Obstetrics and gynecology, 2010Co-Authors: Mary E. D'altonAbstract:In contrast to the generally encouraging trend regarding global maternal mortality, there has been an apparent increase in the maternal mortality ratio in the United States. Although maternal death remains a relatively rare adverse event in this country, programs to reduce maternal mortality also will result in a reduction in maternal morbidity, which is a far more prevalent problem. Progress in the field of Maternal-Fetal Medicine over the past several decades has been largely attributable to improvements in fetal and neonatal Medicine. We need to develop an organized, national approach focused on reducing maternal mortality and morbidity. The goal will be to outline a specific plan for clinical, educational, and research initiatives to put the "M" back in Maternal-Fetal Medicine.
Katharine D. Wenstrom - One of the best experts on this subject based on the ideXlab platform.
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Maternal–Fetal Medicine Workforce Survey: Are We Ready for Regionalized Levels of Maternal Care?
American Journal of Perinatology, 2018Co-Authors: Katharine D. Wenstrom, Mary E. D'alton, Daniel O’keefeAbstract:Objective To conduct a survey of the members of the Society for Maternal-Fetal Medicine (SMFM) to determine the practice patterns of maternal–fetal Medicine (MFM) subspecialists in the United States and to estimate the likelihood that our work force is sufficient to support the proposed MFM staffing requirements for level III and IV maternity centers. Study Design All regular SMFM members in the United States were invited to answer a 26 question survey by email. The survey queried demographic characteristics, practice type, night call arrangements, and whether the respondent's hospital was currently equipped with the services and personnel described in the requirements for level III or IV centers. Results Of the MFM specialists working full time in what would be considered a level III or IV maternity center, only 47.5% took in-house call. Of those taking only call from home or back-up call, the majority reported that during call hours, MFM antepartum and laboring patients are cared for by generalist obstetrician gynecologists; only 6.4% work with MFM hospitalists. Respondents from level III or IV centers also reported that many of their centers did not meet the criteria for nursing support, anesthesia support, or intensive care services. Conclusion These data, if confirmed, indicate that work needs to be done to upgrade services and achieve appropriate staffing to meet the proposed level III and IV criteria for maternity care.
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Maternal-Fetal Medicine Workforce Survey: Are We Ready for Regionalized Levels of Maternal Care?
American journal of perinatology, 2018Co-Authors: Katharine D. Wenstrom, Mary E. D'alton, Daniel O’keefeAbstract:Objective To conduct a survey of the members of the Society for Maternal-Fetal Medicine (SMFM) to determine the practice patterns of maternal–fetal Medicine (MFM) subspecialists in the United States and to estimate the likelihood that our work force is sufficient to support the proposed MFM staffing requirements for level III and IV maternity centers. Study Design All regular SMFM members in the United States were invited to answer a 26 question survey by email. The survey queried demographic characteristics, practice type, night call arrangements, and whether the respondent's hospital was currently equipped with the services and personnel described in the requirements for level III or IV centers. Results Of the MFM specialists working full time in what would be considered a level III or IV maternity center, only 47.5% took in-house call. Of those taking only call from home or back-up call, the majority reported that during call hours, MFM antepartum and laboring patients are cared for by generalist obstetrician gynecologists; only 6.4% work with MFM hospitalists. Respondents from level III or IV centers also reported that many of their centers did not meet the criteria for nursing support, anesthesia support, or intensive care services. Conclusion These data, if confirmed, indicate that work needs to be done to upgrade services and achieve appropriate staffing to meet the proposed level III and IV criteria for maternity care.
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Are obstetrician-gynecologists satisfied with their Maternal-Fetal Medicine consultants? A survey.
American Journal of Perinatology, 2012Co-Authors: Katharine D. Wenstrom, Kristine Erickson, Jay SchulkinAbstract:Objective To survey generalist obstetrician-gynecologists about their satisfaction with and patterns of referral to maternal–fetal Medicine (MFM) specialists. Study Design A survey was sent three times to 1030 randomly selected American Congress of Obstetricians and Gynecologists members across the country, and results were tabulated. Results A total of 516 surveys (50%) were returned; 68% of respondents were satisfied (S) with available MFM services and 31% were not satisfied (Not S). S and Not S respondents were similar with respect to age, gender, years in practice, type of practice, hours worked per week, proximity to MFM specialists, number of deliveries per year, and level of nursery in their hospital. Reasons for dissatisfaction included: MFM specialist not readily available (49%), during the day (26%), at night (35%), or on weekends (36%); MFM specialist unwilling to take care of hospitalized patients (26%); or MFM specialist does only ultrasound, chorionic villus sampling, and amniocentesis (32%). Although some generalists do not consult MFM specialists frequently, the majority of both S and Not S respondents would request an MFM consult or comanagement for 26 of 38 specific maternal, fetal, and obstetric diagnoses/complications. Conclusion The majority of obstetrician-gynecologists are satisfied with their MFM support. The dissatisfaction expressed by 31% of generalists might be ameliorated if individual MFM specialists increased their availability and/or broadened their scope of practice.
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Obstetrics and gynecology residents' attitudes toward Maternal-Fetal Medicine fellowship training.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine the Federation of Asia and , 2004Co-Authors: John Owen, Katharine D. WenstromAbstract:Objective: To assess factors associated with residents' decisions to pursue or forego fellowship training in Maternal-Fetal Medicine (MFM). Methods: A survey utilizing multiple-choice, Likert, ordinal and categorical scale questions was distributed to all (n = 2337) postgraduate year (PGY) 3 and 4 obstetrics and gynecology residents in accredited US training programs during the 2001-02 academic year. The 18-question survey sought demographic and residency training details, quality of interactions with the MFM faculty and fellows, and information about 13 specific factors that might influence a resident's decision to pursue MFM training. Results: Surveys were returned by 642 (27%) residents, equally divided between PGY 3 and 4. Only 90 (14%) residents reported either ongoing consideration of, or having already applied for, MFM training (MFM group), while 278 (43%) had considered MFM training, but chose to either stay in general practice or pursue another fellowship (neutral group). The remaining 274 (43%) ...
Peter Benn - One of the best experts on this subject based on the ideXlab platform.
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Down syndrome screening in the United States in 2001 and 2007: a survey of Maternal-Fetal Medicine specialists.
American journal of obstetrics and gynecology, 2009Co-Authors: Yu Ming Victor Fang, Peter Benn, Jay Bolnick, Winston Campbell, Anne Marie Prabulos, James F.x. EganAbstract:The purpose of this study was to determine changes in screening and performance of invasive diagnostic procedures for Down syndrome between 2001 and 2007. The Society for Maternal-Fetal Medicine members completed a survey in 2007 regarding screening tests and diagnostic procedures for Down syndrome. With the use of descriptive statistics, the chi(2) test, and the Student t test, responses from 2007 were compared with responses from a similar 2001 survey. Performance of first-trimester screening more than doubled from 2001-2007 (43.1% in 2001, 97.3% in 2007; P < .0001). Between 2001 and 2007, the use of the quad screen increased 10-fold (8.5% in 2001, 85.6% in 2007; P < .0001). There was an estimated 20% decrease in invasive diagnostic procedures that were performed in risk-positive women (53.7% in 2001, 34.2% in 2007; P < .0001). In 2007, the average fetal loss rates that were quoted by Maternal-Fetal Medicine specialists after chorionic villous sampling was 1:160 and after an amniocentesis was 1:493. Down syndrome screening evolved from 2001-2007, with an increasing emphasis on first-trimester screening. With more efficacious screening, the number of invasive procedures has declined.
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Down syndrome screening in the United States in 2001 and 2007: a survey of Maternal-Fetal Medicine specialists.
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Yu Ming Victor Fang, Peter Benn, Jay Bolnick, Anne Marie Prabulos, Winston A. Campbell, James EganAbstract:Objective The purpose of this study was to determine changes in screening and performance of invasive diagnostic procedures for Down syndrome between 2001 and 2007. Study Design The Society for Maternal-Fetal Medicine members completed a survey in 2007 regarding screening tests and diagnostic procedures for Down syndrome. With the use of descriptive statistics, the χ 2 test, and the Student t test, responses from 2007 were compared with responses from a similar 2001 survey. Results Performance of first-trimester screening more than doubled from 2001-2007 (43.1% in 2001, 97.3% in 2007; P P P Conclusion Down syndrome screening evolved from 2001-2007, with an increasing emphasis on first-trimester screening. With more efficacious screening, the number of invasive procedures has declined.
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588: Down syndrome screening strategies utilized by United States Maternal-Fetal Medicine specialists in 2007
American Journal of Obstetrics and Gynecology, 2007Co-Authors: Yu Ming Victor Fang, Peter Benn, Katherine Tribulato, Connor Fitzpatrick, Jay Bolnick, James EganAbstract:Maternal-Fetal Medicine SPECIALISTS IN 2007 YU MING VICTOR FANG, PETER BENN, KATHERINE TRIBULATO, CONNOR FITZPATRICK, JAY BOLNICK, JAMES EGAN, University of Connecticut, Obstetrics and Gynecology, Farmington, Connecticut, University of Connecticut, Department of Pediatrics, Farmington, Connecticut, University of Nebraska, Omaha, Nebraska, Boston College, Boston, Massachusetts OBJECTIVE: Ball and colleagues suggested a cohesive national strategy regarding prenatal diagnosis and screening for Down syndrome (DS). (Obstet Gynecol 2007;110: 10-17) We determined the most common DS screening strategies currently utilized by Maternal-Fetal Medicine specialists (SMFM) in the United States (US). STUDY DESIGN: SMFM members in the US were surveyed in April 2007 regarding screening patterns for fetal aneuploidy. They were asked which of the following first trimester (trim) DS screening strategies they offered: combined screening (1st trim NT, PAPP-A, B-hCG. No 2nd trim screen), integrated screening (single risk given after 1st and 2nd trim tests are completed), stepwise sequential screening (results given after each trim, final risk is calculated from 1st and 2nd trim tests), contingency screening (use specific cut-offs to offer either invasive testing, no further testing, or 2nd trim screen), independent screening (1st and 2nd trim results are evaluated independently and not combined), or other. They could choose more than one strategy. Descriptive statistics are reported. RESULTS: There were 448/1756 (26%) responses of which 30.4% offered more than one screening strategy. The frequencies of the strategies offered by respondents are presented in the graph.
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Antenatal down syndrome screening in the united states in 2001: A survey of Maternal-Fetal Medicine specialists☆
American journal of obstetrics and gynecology, 2002Co-Authors: James F.x. Egan, Lillian Kaminsky, Michael E. Deroche, Michael Barsoom, Adam Borgida, Peter BennAbstract:Abstract Objective: Our objectives were to determine patterns of antenatal Down syndrome screening and risk adjustment by Maternal-Fetal Medicine specialists in the United States in 2001. Study Design: A survey to investigate Down syndrome screening practice patterns was mailed to the 1638 members of the Society of Maternal-Fetal Medicine in the United States. Practice demographics, screening patterns, and the numeric risks quoted in counseling were analyzed. Results: Five hundred forty-three specialists (33.2%) responded; 530 of these specialists (97.6%) performed antenatal Down syndrome screening; all of them offered second-trimester screening, and 247 of them (45.5%) offered first-trimester screening. With the use of second-trimester ultrasonography, risk was increased by 69.4% of respondents and decreased by 33.1%. Amniocentesis was the most frequently used diagnostic test (83.2%), with loss rates quoted at 1:100 to 1:1000. Conclusion: Maternal-Fetal Medicine specialists show a wide in variation practices used for Down syndrome screening, modification of risk, and quoted procedure-related loss rates. This information calls for a consensus regarding risks that are quoted in Down syndrome counseling. (Am J Obstet Gynecol 2002;187:1230-4.)
C. Andrew Combs - One of the best experts on this subject based on the ideXlab platform.
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Society for Maternal-Fetal Medicine Special Statement: Updated checklists for management of monochorionic twin pregnancy.
American journal of obstetrics and gynecology, 2020Co-Authors: Iffath Abbasi Hoskins, C. Andrew CombsAbstract:Approximately 20% of twin pregnancies are monochorionic. The management of monochorionic twin pregnancy involves several additional interventions beyond the routine management of singletons or dichorionic twins. In 2015, the Society for Maternal-Fetal Medicine posted checklists for monochorionic/diamniotic twins and monochorionic/monoamniotic twins. The Society presents updated versions of these 2 checklists reflecting recent changes in practice recommendations. Suggestions for implementing the use of the checklists into antenatal care practices are also included.
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Society for Maternal-Fetal Medicine Special Statement: Updated checklist for antepartum care of pregestational diabetes mellitus.
American journal of obstetrics and gynecology, 2020Co-Authors: Afshan B. Hameed, C. Andrew CombsAbstract:Pregnancy in women with pregestational diabetes mellitus (type 1 and type 2) carries increased risks of both maternal and neonatal complications due to maternal hyperglycemia and underlying chronic conditions and comorbidities. To reduce the risk of pregnancy complications or to mitigate their effects, numerous interventions are recommended at various times during pregnancy. Since 2016, the Society for Maternal-Fetal Medicine has posted a Diabetes Antepartum Checklist on its website. An updated version of this checklist is presented here, along with suggestions for implementation into the standard antenatal care of patients with type 1 and type 2 diabetes mellitus.
Daniel O’keefe - One of the best experts on this subject based on the ideXlab platform.
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Maternal–Fetal Medicine Workforce Survey: Are We Ready for Regionalized Levels of Maternal Care?
American Journal of Perinatology, 2018Co-Authors: Katharine D. Wenstrom, Mary E. D'alton, Daniel O’keefeAbstract:Objective To conduct a survey of the members of the Society for Maternal-Fetal Medicine (SMFM) to determine the practice patterns of maternal–fetal Medicine (MFM) subspecialists in the United States and to estimate the likelihood that our work force is sufficient to support the proposed MFM staffing requirements for level III and IV maternity centers. Study Design All regular SMFM members in the United States were invited to answer a 26 question survey by email. The survey queried demographic characteristics, practice type, night call arrangements, and whether the respondent's hospital was currently equipped with the services and personnel described in the requirements for level III or IV centers. Results Of the MFM specialists working full time in what would be considered a level III or IV maternity center, only 47.5% took in-house call. Of those taking only call from home or back-up call, the majority reported that during call hours, MFM antepartum and laboring patients are cared for by generalist obstetrician gynecologists; only 6.4% work with MFM hospitalists. Respondents from level III or IV centers also reported that many of their centers did not meet the criteria for nursing support, anesthesia support, or intensive care services. Conclusion These data, if confirmed, indicate that work needs to be done to upgrade services and achieve appropriate staffing to meet the proposed level III and IV criteria for maternity care.