Document Detail

Re-evaluating the role of the MFM specialist: lead, follow, or get out of the way.
MedLine Citation:
PMID:  16318976     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the effect of sub-specialty prenatal care provided to high-risk obstetrical patients in a community perinatal center as a function of whether consultation and referral to a Maternal-Fetal Medicine (MFM) sub-specialist was at the discretion of the generalist, required by the insurance carrier, or by patient choice. METHODS: Demographics, management, and perinatal outcomes for high-risk patients managed exclusively by MFM were compared with those managed by generalists who were later referred to MFM after problems arose. RESULTS: Despite similar demographics, high-risk patients managed exclusively by a single MFM had less prematurity, lower cesarean section rates, fewer low 5-minute Apgar scores (1.3% vs. 5.5%, p < 0.001), and lower perinatal mortality rates (8.0/1000 vs. 47.6/1000, p < 0.001) than those referred at a later date. CONCLUSIONS: In this setting, earlier MFM care resulted in better outcomes. These data suggest that the 'gatekeeper' model of generalist to MFM might be better the other way around.
Robert D Eden; Ann Penka; David W Britt; Ellen J Landsberger; Mark I Evans
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  18     ISSN:  1476-7058     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-12-01     Completed Date:  2006-04-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  253-8     Citation Subset:  IM    
The Desert Perinatal Center, Palm Springs, CA 19475, USA.
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MeSH Terms
Apgar Score
Cesarean Section / statistics & numerical data
Fetal Distress / epidemiology
Gestational Age
Health Maintenance Organizations
Infant Mortality
Infant, Newborn
Length of Stay / statistics & numerical data
Physician's Role*
Pregnancy Outcome*
Pregnancy, High-Risk*
Premature Birth / epidemiology
Prenatal Care
Referral and Consultation*
Time Factors
United States / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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