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

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

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

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

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

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

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

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

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

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

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

13. Source: EBC Data 2006, 2007

14. Source: EBC Data 2007

16. -----National rate in red for primary c/s is 31%

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

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

20. Trends and Incidence of Cesarean Delivery

21. Electronic Fetal Monitoring?

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

23. Magnesium Sulfate

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

25. Tocolysis Outcome MagnesiumNifedipine Primary *87% 72% Del <48 h7.6% 8.0% Del <37 w57% 57% <32 w11% 8% GA at del.35.8 w 36.0 w Newborn LOS *8.8 d 4.2 d

26. Source: SPDS- NICU Module 2004-2007

27. Antenatal Steroid Use, SPDS NICU Module Data

28. 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

29. Acknowledgements 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 LHVPN Cheryl Hunter-Grant, MSW Lorraine Anglin, MPH Michelle Gordon Jeet Lund LHVPN Steering Committee MISN Caren Fairweather, MPS Stephanie Sosnowski, ICCE Thanks to the entire Hudson Valley Regional Perinatal Forum Steering Committee

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