Health Commissioner s Workgroup on Infant Mortality Data Delivery Method Analysis Gestational Age at Birth Analysis

1. Health Commissioner�s Workgroupon Infant Mortality Data Delivery Method Analysis Gestational Age at Birth Analysis 

2. Delivery Analysis Data Source- Virginia Health Information (VHI) database VHI- 1993 with passage of the Patient Level Database System Act All Payor claims database A silent epidemic that takes the lives of more children than any other cause � more than what we imagine to be the leading causes of death in childhood�. Explain slide� We spend countless hours discussing suicide and homicide �as we should�� but we need to focus on the silent but deadly issue of infants dying in the first year of life. A silent epidemic that takes the lives of more children than any other cause � more than what we imagine to be the leading causes of death in childhood�. Explain slide� We spend countless hours discussing suicide and homicide �as we should�� but we need to focus on the silent but deadly issue of infants dying in the first year of life.

3. From 1996 to 2007, the percentage of Cesarean births* has increased from 22% to 35% of all live births in Virginia. National trends are similar. If these trends hold, Cesarean births will represent 50% of all births in Virginia in 9 years (2016). Healthy People 2010 established a goal of 15% Cesarean births among low-risk (full-term, singleton, vertex presentation) women**. *Includes primary and repeat Cesareans. ** This data does not explicitly identify full-term, singleton, and/or vertex presentation. From 1996 to 2007, the percentage of Cesarean births* has increased from 22% to 35% of all live births in Virginia. National trends are similar. If these trends hold, Cesarean births will represent 50% of all births in Virginia in 9 years (2016). Healthy People 2010 established a goal of 15% Cesarean births among low-risk (full-term, singleton, vertex presentation) women**. *Includes primary and repeat Cesareans. ** This data does not explicitly identify full-term, singleton, and/or vertex presentation.

4. Some authorities have proposed that the rise in Cesarean births is due to the increase number of women requesting surgical birth for convenience reasons. There was thought that White women would be more likely to request a convenience birth and would show a higher percentage than other racial/ethnic groups. This graph shows that the White and Black women were very similar and mirrors the state rate. Asian women had the highest percentage.Some authorities have proposed that the rise in Cesarean births is due to the increase number of women requesting surgical birth for convenience reasons. There was thought that White women would be more likely to request a convenience birth and would show a higher percentage than other racial/ethnic groups. This graph shows that the White and Black women were very similar and mirrors the state rate. Asian women had the highest percentage.

5. In the late nineties and up to the 2005, many journal articles appeared addressing the safety of Vaginal Birth after Cesarean (VBAC). Even though numerous citations are in the literature, there are no randomized trials comparing maternal and neonatal outcomes for both repeat cesarean delivery or VBAC, so recommendations are based on data from large clinical studies. In 2004, ACOG published the Practice Bulletin that stated that VBAC can be a safe option in many patients, but the Bulletin described multiple risks and complications associated with VBAC. This graph shows the change in practice in Virginia as VBAC became less frequent. In the late nineties and up to the 2005, many journal articles appeared addressing the safety of Vaginal Birth after Cesarean (VBAC). Even though numerous citations are in the literature, there are no randomized trials comparing maternal and neonatal outcomes for both repeat cesarean delivery or VBAC, so recommendations are based on data from large clinical studies. In 2004, ACOG published the Practice Bulletin that stated that VBAC can be a safe option in many patients, but the Bulletin described multiple risks and complications associated with VBAC. This graph shows the change in practice in Virginia as VBAC became less frequent.

6. This graph shows that the infant mortality rate since 1998 has not increased significantly or in some cases decreased but that the Cesarean birth rate has significantly increased during that same time period. This graph shows that the infant mortality rate since 1998 has not increased significantly or in some cases decreased but that the Cesarean birth rate has significantly increased during that same time period.

7. As expected, vaginal births without induction procedure codes* are more evenly distributed throughout the week. Compared to this group ("control"), Cesareans and vaginal births with induction procedures codes are admitted more frequently on weekdays. Approximately, 75% of vaginal births (w/o induction procedure codes) occur on a weekday whereas 86% of Cesarean births occur on a weekday. As expected, vaginal births without induction procedure codes* are more evenly distributed throughout the week. Compared to this group ("control"), Cesareans and vaginal births with induction procedures codes are admitted more frequently on weekdays. Approximately, 75% of vaginal births (w/o induction procedure codes) occur on a weekday whereas 86% of Cesarean births occur on a weekday.

8. Across the regions of Virginia the percent of Cesarean birth does not vary significantly.Across the regions of Virginia the percent of Cesarean birth does not vary significantly.

9. Variation in % Cesarean Births by Hospital* Virginia, 2007 There is variation across Virginia birth hospitals on the percentage of Cesarean births. Further study would be needed to further explain this variation. There is variation across Virginia birth hospitals on the percentage of Cesarean births. Further study would be needed to further explain this variation.

10. Gestational Age Analysis The data on birth and gestational age are collected through the Vital Records Data Base. These data are collected under the Code of Virginia regulations governing reporting of vital events, which are compiled, aggregated and reported on by VDH�s Division of Health Statistics. The gestational age is collected by the physician or other delegated professional at the bedside during the birth process.

12. Based upon the number of the total preterm births, the majority happen in the 33-36 week gestation group. Over the past 10 years, there appears to have been an increase in the number of preterm births overall. Although our goal should be 37+ completed weeks gestation, note how the 33-36 week group is increasing. Based upon the number of the total preterm births, the majority happen in the 33-36 week gestation group. Over the past 10 years, there appears to have been an increase in the number of preterm births overall. Although our goal should be 37+ completed weeks gestation, note how the 33-36 week group is increasing.

13. 11% of all births are preterm. Approximately 8% over the last 10 years are in the 33-36 week gestation group. 11% of all births are preterm. Approximately 8% over the last 10 years are in the 33-36 week gestation group.

14. Preterm babies are more likely to die. Any preterm birth (as defined as < 37 weeks gestation) is 20 times more likely to die than a full-term infant. Two out of 10 babies born at 24-28 weeks will die. There has been no significant improvement in the 24-28 week group despite changes in technology. Preterm babies are more likely to die. Any preterm birth (as defined as < 37 weeks gestation) is 20 times more likely to die than a full-term infant. Two out of 10 babies born at 24-28 weeks will die. There has been no significant improvement in the 24-28 week group despite changes in technology.