Comparative Effectiveness of labor management in obese, nulliparous women

肥胖未产妇分娩管理的比较效果

基本信息

批准号：
8691434
负责人：
Nicole S. Carlson
金额：
$ 3.89万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
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/8691434
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

项目摘要

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（由适用提供）：美国处于肥胖症流行中，几乎一半的美国育龄妇女超重（BMI 25-29.9）或肥胖（BMI 30）。这个国家的肥胖症反映了种族差异，非西班牙裔黑人和西班牙裔妇女受到了不成比例的影响。肥胖的妇女特别有风险以计划外的剖宫产结束全期怀孕，这在很大程度上是由于她们的绝对慢劳动力。肥胖的妇女怀有第一批婴儿（无效的妇女）的剖宫产风险最高。当肥胖的妇女剖腹产时，她们比正常妇女更有可能经历大量的院里后发病率和死亡率。研究肌量学收缩力的体外研究表明，肥胖的细胞代谢环境可能是劳动力的收缩效率提高，劳动持续时间更长以及对普遍使用的干预措施的反应增加，以加快肥胖人群中临床观察到的劳动力。我们对肥胖妇女劳动者的正确时机和使用技术干预的理解存在差距。拟议的研究将调查肥胖的无效妇女的劳动管理，以发现与剖宫产降低的风险相关的做法。一种比较有效性方法将用于描述和比较在肥胖的无效妇女样本中，与剖宫产的结果相比，将两种不同的劳动管理模型（产科模型与护士同会模型）与剖宫产的结果进行比较。回顾性数据库分析和详细的图表审查将在科罗拉多大学医院分娩的肥胖症，无效的妇女的医院记录上进行，那里约40％的出生由护士中间管理。逻辑回归和危害分析将用于检查肥胖的肥胖，无效妇女的干预使用，干预时机和交付结果的差异。肥胖女性的匹配样本将通过承诺得分分析创建。还将检查肥胖对妇女对劳动中外源性催产素反应的生物学作用。拟议的研究研究和培训计划与申请人的长期研究目标一致，以了解肥胖无效的妇女的生物行为决定者和有效的生物内护理管理策略，以减少剖宫产的事件，其短期和长期不良后果以及无效的儿童医疗保健成本。从这项研究中获得的结果将为未来的研究提供信息，并在护士，护士助产士和医生的有效护理实践中提供新的了解，因为他们通过劳动来支持肥胖，无效的妇女的脆弱人群，从而获得安全的出生结果。