Comparative Effectiveness of labor management in obese, nulliparous women

肥胖未产妇分娩管理的比较效果

• 批准号: 8588769
• 负责人: Nicole S. Carlson
• 金额: $ 3.84万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8588769
• 关键词: Accounting; Admission activity; Adult; Affect; Age; Area; Biological; Biology; Birth; Caring; Cells; Cessation of life; Colorado; Complication; Country; Databases; Disease; Dose; Dystocia; Environment; Epidemic; Fellowship; Female of child bearing age; Funding; Goals; Health; Health Care Costs; High Risk Woman; Hispanics; Hospital Records; Hospitals; In Vitro; Incidence; Infusion procedures; Intervention; Logistic Regressions; Maternal Mortality; Mediator of activation protein; Membrane; Metabolic; Midwife; Minority Groups; Modeling; Morbidity - disease rate; Myometrial; National Research Service Awards; Neonatal; Not Hispanic or Latino; Nurse Midwives; Nurses; Obesity; Operative Surgical Procedures; Outcome; Overweight; Oxytocin; Patients; Physicians; Pregnancy; Pregnant Women; Preparation; Reporting; Research; Research Training; Risk; Rupture; Sampling; Side; Techniques; Time; TimeLine; Training; Training Programs; United States; Universities; Vaginal delivery procedure; Vulnerable Populations; Weight; Woman; Work; adverse outcome; base; biobehavior; career; child bearing; comparative effectiveness; compare effectiveness; dosage; ethnic minority population; experience; hazard; health disparity; interstitial; intrapartum; mortality; pre-doctoral; pregnant; prevent; public health relevance; reproductive; research study; response; socioeconomics; statistics; time use

DESCRIPTION (provided by applicant): The United States is in the midst of an obesity epidemic, with nearly half of U.S. women of childbearing age being either overweight (BMI 25-29.9) or obese (BMI¿30). Obesity in this country reflects an ethnic disparity, with non- Hispanic black and Hispanic women disproportionately affected. Obese women are at particular risk to end their full-term pregnancies with unplanned cesarean delivery, in large part due to their abnormally slow labors. Obese women pregnant with their first babies (nulliparous women) are at the highest risk for unplanned cesarean delivery. When obese women have cesarean delivery, they are more likely than normal-weight women to experience significant post-cesarean morbidity and mortality. In vitro research investigating myometrial contractility suggests that the cellular metabolic milieu of obesity may account for the decreased contractile efficiency in labor, longer labor duration, and decreased response to commonly-used interventions to hasten labor that are clinically observed in obese populations. Gaps exist in our understanding of the correct timing and use of technological interventions in the labors of obese women. The proposed study will investigate the labor management of obese, nulliparous women to discover the practices associated with decreased risk of cesarean delivery. A Comparative Effectiveness approach will be used to describe and compare two different labor management models (obstetrician model vs. nurse-midwife model) against the outcome of cesarean delivery in a sample of obese, nulliparous women. Retrospective database analysis and detailed chart-review will be performed on the hospital records of obese, nulliparous women delivering at the University of Colorado Hospital, where approximately 40% of births are managed by nurse-midwives. Logistic regression and hazard analysis will be used to examine the differences in intervention use, intervention timing, and delivery outcomes between samples of obese, nulliparous women in the nurse-midwife vs. obstetrician models of labor care. Matched samples of obese women will be created via propensity score analysis. Biologic effect of obesity on women's response to exogenous oxytocin in labor will also be examined. The proposed research study and training plan are congruent with the applicant's long-term research goals to understand the biobehavioral determinants and effective intrapartum care management strategies for obese nulliparous women in order to decrease the incidence of cesarean delivery, its short and long-term adverse consequences, and the cost of healthcare for nulliparous childbearing women. Results obtained from this study will inform future research and promote new understanding of effective care practices for nurses, nurse- midwives, and physicians as they support the vulnerable population of obese, nulliparous women through labor to a safe birth outcome.

描述（由申请人提供）：美国正处于肥胖流行病之中，近一半的美国育龄妇女超重（BMI 25-29.9）或肥胖（BMI 30）。这个国家的肥胖反映了种族差异，非西班牙裔黑人和西班牙裔妇女受到的影响不成比例。肥胖妇女特别有可能以计划外的剖腹产结束足月妊娠，这在很大程度上是由于她们异常缓慢的分娩。怀孕第一胎的肥胖妇女（未经产的妇女）计划外剖腹产的风险最高。当肥胖妇女剖宫产时，她们比正常体重的妇女更有可能经历显着的剖宫产后发病率和死亡率。研究子宫肌层收缩性的体外研究表明，肥胖的细胞代谢环境可能导致分娩时收缩效率降低、分娩持续时间延长以及对临床上观察到的肥胖人群中常用的加速分娩干预措施的反应降低。我们对肥胖妇女分娩时技术干预的正确时机和使用的理解存在差距。这项拟议的研究将调查肥胖，未经产妇女的劳动管理，以发现与降低剖宫产风险相关的做法。将使用比较有效性方法描述和比较两种不同的分娩管理模式（产科医生模式与护士-助产士模式）与肥胖、未经产女性样本中剖宫产结局。将对在科罗拉多大学医院分娩的肥胖、未经产女性的医院记录进行回顾性数据库分析和详细的图表审查，该医院约40%的分娩由护士助产士管理。Logistic回归和风险分析将被用来检查干预使用的差异，干预时机，和分娩结果之间的肥胖，未经产妇的妇女在护士助产士与产科医生的分娩护理模式。将通过倾向评分分析创建肥胖女性的匹配样本。肥胖对妇女在分娩中对外源性催产素反应的生物学影响也将被研究。拟议的研究和培训计划与申请人的长期研究目标一致，即了解肥胖未产妇的生物行为决定因素和有效的产时护理管理策略，以降低剖宫产的发生率、短期和长期不良后果以及未产妇的医疗保健费用。从这项研究中获得的结果将为未来的研究提供信息，并促进对护士，护士-助产士和医生有效护理实践的新理解，因为他们通过劳动支持肥胖，未经产妇女的弱势群体获得安全的分娩结果。