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State of the Hudson Valley Region

State of the Hudson Valley Region. James F. Smith, Jr., MD Chief of Perinatal Medicine Westchester Medical Center/NYMC. Who is here?. Regional Perinatal Center Affiliate Hospitals Regional Perinatal Forum Perinatal Networks (LHVPN, MISN) County Departments of Health March of Dimes

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State of the Hudson Valley Region

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  1. State of the Hudson Valley Region James F. Smith, Jr., MD Chief of Perinatal Medicine Westchester Medical Center/NYMC

  2. Who is here? • Regional Perinatal Center • Affiliate Hospitals • Regional Perinatal Forum • Perinatal Networks (LHVPN, MISN) • County Departments of Health • March of Dimes • Other Regional Stakeholders • Who are all these people?

  3. Regional Perinatal Center • Advanced perinatal/neonatal services • Teaching • Research • Outreach • Management of databases for affiliate hospitals

  4. Orange Regional Medical Center St. Luke’s Good Samaritan Bon Secours St. Anthony’s Vassar Brothers Putnam Hudson Valley Phelps St. John’s Sound Shore Our Lady of Mercy St. Francis Sound Shore 2007 About 17,534 deliveries! RPC — Our Affiliates

  5. Mini-Grant Recipients • Lower Hudson Valley Perinatal Network (LHVPN) • LHVPN Community Health Education Day (CHED) • Planned Parenthood Hudson Peconic, Inc. • Increasing Access to Prenatal Care in Westchester County for Under-served, Low Income & Spanish Speaking Women (BROCHURE) • Hudson Valley Hospital Center Planned Parenthood Hudson Peconic, Inc. • Traveling Health Fair

  6. Regional Perinatal Forum • Collaboration between the RPC and: • Perinatal Networks - CPPSN • Affiliate Hospitals • Regional Non-Hospital Providers • Relevant Non-Provider Groups • Insurance • Intervention programs • March of Dimes • Community Based Organizations • County Departments of Health • Others

  7. Comprehensive Prenatal Perinatal Services Network • “CPPSN” • Community Based Organizations • Organize perinatal information • Facilitate access to health care systems at local level • Improve regional perinatal outcomes

  8. Comprehensive Prenatal Perinatal Services Network (CPPSN) • Maternal Infant Services Network • Lower Hudson Valley Perinatal Network

  9. Clinical Services Regional Perinatal Centers Prevention Services Perinatal Networks Regional Perinatal Forum NYS Perinatal Health Infrastructure

  10. Hudson Valley Maternal Overweight % Livebirths to Mothers with BMI> 26, 2006 NYSDOH Data, Bureau of Biometrics and Health Statistics

  11. Hudson Valley Maternal Overweight by Race and Ethnicity % Livebirths to Mothers with BMI> 26, 2006 NYSDOH Data, Bureau of Biometrics and Health Statistics

  12. Source: EBC Data 2006, 2007

  13. Source: EBC Data 2007

  14. Source: EBC Data 2007

  15. -----National rate in red for primary c/s is 31% Source: EBC Data 2007

  16. Source: EBC Data 2007 -----National rate in red for primary c/s is 24.3%

  17. “Britney's scheduled Sept. 15 C-section was moved up a day after she began experiencing early contractions. Celebrity Role Models

  18. Celebrity Role Models

  19. Trends and Incidence of Cesarean Delivery

  20. Electronic Fetal Monitoring?

  21. Acute Tocolysis • Effective in delaying delivery up to 48 hours • 24 to 34 weeks • Steroid administration • Consider transport to RPC

  22. Magnesium Sulfate

  23. Tocolytics • Lyell, et al. Obstet Gynecol 2007; 110:61-7 • Magnesium vs. Nifedipine • Primary outcome—prevention of preterm delivery and uterine quiescence for 48 hours

  24. Tocolysis Outcome Magnesium Nifedipine Primary * 87% 72% Del <48 h 7.6% 8.0% Del <37 w 57% 57% <32 w 11% 8% GA at del. 35.8 w 36.0 w Newborn LOS * 8.8 d 4.2 d

  25. Source: SPDS- NICU Module 2004-2007

  26. Antenatal Steroid Use, SPDS NICU ModuleData

  27. Summary • 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

  28. OB Howard Blanchette, MD James Smith, MD Michael Kessler, MD Neonatology Edmund La Gamma, MD Heather Brumberg, MD, MPH Susan Marchwinski, RN, C, MS Donna Dozor, RN, MS Clare Nugent, RN, C Acknowledgements Thanks to the entire Hudson Valley Regional Perinatal Forum Steering Committee MISN Caren Fairweather, MPS Stephanie Sosnowski, ICCE LHVPN Cheryl Hunter-Grant, MSW Lorraine Anglin, MPH Michelle Gordon Jeet Lund LHVPN Steering Committee

  29. State of the Hudson Valley Region James F. Smith, Jr., MD Chief of Perinatal Medicine Westchester Medical Center/NYMC

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