Influence of gestational age and reason for prior preterm birth on rates of recurrent preterm delivery.

OBJECTIVE: We sought to compare rates of recurrent spontaneous preterm birth (SPTB) in women receiving 17-α-hydroxyprogesterone caproate (17P) with prior SPTB due to preterm labor (PTL) vs preterm premature rupture of membranes (PPROM). STUDY DESIGN: Women with singleton gestation having 1 prior SPTB enrolled at 16-24.9 weeks' gestation for weekly outpatient 17P administration were identified from a database. Rates of recurrent SPTB were compared between those with prior SPTB due to PTL or PPROM overall and by gestational age at prior SPTB. RESULTS: Records from 2123 women were analyzed. The prior PTL group vs the prior PPROM group experienced higher rates of recurrent SPTB at <37 weeks (29.7% vs 22.9%, P = .004), <35 weeks (14.0% vs 9.1%, P = .004), and <32 weeks (5.9% vs 3.3%, P = .024), respectively. CONCLUSION: Reason and gestational age of prior SPTB influence the likelihood of recurrent SPTB in women receiving 17P prophylaxis.

Characteristics associated with severe perineal and cervical lacerations during vaginal delivery.

OBJECTIVE: To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. METHODS: The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors. RESULTS: Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8%], 293 [0.6%] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1%], 212 multiparous [0.5%]). Risks for third- or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity. CONCLUSION: Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable.

The effect of new antepartum weight gain guidelines and prepregnancy body mass index on the development of pregnancy-related hypertension.

We evaluated the impact of adherence to the new Institute of Medicine weight gain guidelines within each prepregnancy body mass index (PPBMI) category on the development of pregnancy-related hypertension (PRH). Patients with singleton term deliveries (≥37 weeks) with documented PPBMI and pregnancy weight gain information were identified from a database of women enrolled for outpatient nursing services. Included were women without history of cardiovascular disease, PRH, or diabetes at initiation of services (N = 7676). Data were stratified by PPBMI (underweight = < 18.5 kg/m(2); normal weight = 18.5 to 24.9 kg/m(2); overweight = 25.0 to 29.9 kg/m(2); obese = ≥ 30.0 kg/m(2)). PRH rates were compared overall and within each PPBMI group for those women gaining less than recommendations, within recommendations, and above recommendations using Pearson's chi-square and Kruskal-Wallis H test statistics. Overall, PRH rates were 5.0%, 5.4%, and 10.8% for less than, within, and above recommendation groups, respectively (P < 0.001). Above recommendation weight gain resulted in higher PRH incidence in each PPBMI category (underweight 7.6%, normal weight 6.2%, overweight 12.4%, and obese 17.0%), reaching statistical significance in all but the underweight PPBMI group. Excessive weight gain above established guidelines was associated with increased rates of PRH. Regardless of PPBMI, women should be counseled to avoid excessive weight gain during pregnancy.

The maternal body mass index: a strong association with delivery route.

OBJECTIVE: We sought to assess body mass index (BMI) effect on cesarean risk during labor. STUDY DESIGN: The Consortium on Safe Labor collected electronic data from 228,668 deliveries. Women with singletons > or = 37 weeks and known BMI at labor admission were analyzed in this cohort study. Regression analysis generated relative risks for cesarean stratifying for parity and prior cesarean while controlling for covariates. RESULTS: Of the 124,389 women, 14.0% had cesareans. Cesareans increased with increasing BMI for nulliparas and multiparas with and without a prior cesarean. Repeat cesareans were performed in > 50% of laboring women with a BMI > 40 kg/m(2). The risk for cesarean increased as BMI increased for all subgroups, P < .001. The risk for cesarean increased by 5%, 2%, and 5% for nulliparas and multiparas with and without a prior cesarean, respectively, for each 1-kg/m(2) increase in BMI. CONCLUSION: Admission BMI is significantly associated with delivery route in term laboring women. Parity and prior cesarean are other important predictors.

Respiratory morbidity in late preterm births.

CONTEXT: Late preterm births (340/7-366/7 weeks) account for an increasing proportion of prematurity-associated short-term morbidities, particularly respiratory, that require specialized care and prolonged neonatal hospital stays. OBJECTIVE: To assess short-term respiratory morbidity in late preterm births compared with term births in a contemporary cohort of deliveries in the United States. DESIGN, SETTING, AND PARTICIPANTS: Retrospective collection of electronic data from 12 institutions (19 hospitals) across the United States on 233,844 deliveries between 2002 and 2008. Charts were abstracted for all neonates with respiratory compromise admitted to a neonatal intensive care unit (NICU), and late preterm births were compared with term births in regard to resuscitation, respiratory support, and respiratory diagnoses. A multivariate logistic regression analysis compared infants at each gestational week, controlling for factors that influence respiratory outcomes. MAIN OUTCOME MEASURES: Respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, respiratory failure, and standard and oscillatory ventilator support. RESULTS: Of 19,334 late preterm births, 7055 (36.5%) were admitted to a NICU and 2032 had respiratory compromise. Of 165,993 term infants, 11,980 (7.2%) were admitted to a NICU, 1874 with respiratory morbidity. The incidence of respiratory distress syndrome was 10.5% (390/3700) for infants born at 34 weeks' gestation vs 0.3% (140/41,764) at 38 weeks. Similarly, incidence of transient tachypnea of the newborn was 6.4% (n = 236) for those born at 34 weeks vs 0.4% (n = 155) at 38 weeks, pneumonia was 1.5% (n = 55) vs 0.1% (n = 62), and respiratory failure was 1.6% (n = 61) vs 0.2% (n = 63). Standard and oscillatory ventilator support had similar patterns. Odds of respiratory distress syndrome decreased with each advancing week of gestation until 38 weeks compared with 39 to 40 weeks (adjusted odds ratio [OR] at 34 weeks, 40.1; 95% confidence interval [CI], 32.0-50.3 and at 38 weeks, 1.1; 95% CI, 0.9-1.4). At 37 weeks, odds of respiratory distress syndrome were greater than at 39 to 40 weeks (adjusted OR, 3.1; 95% CI, 2.5-3.7), but the odds at 38 weeks did not differ from 39 to 40 weeks. Similar patterns were noted for transient tachypnea of the newborn (adjusted OR at 34 weeks, 14.7; 95% CI, 11.7-18.4 and at 38 weeks, 1.0; 95% CI, 0.8-1.2), pneumonia (adjusted OR at 34 weeks, 7.6; 95% CI, 5.2-11.2 and at 38 weeks, 0.9; 95% CI, 0.6-1.2), and respiratory failure (adjusted OR at 34 weeks, 10.5; 95% CI, 6.9-16.1 and at 38 weeks, 1.4; 95% CI, 1.0-1.9). CONCLUSION: In a contemporary cohort, late preterm birth, compared with term delivery, was associated with increased risk of respiratory distress syndrome and other respiratory morbidity.

An examination of the clinical benefits and cost-effectiveness of tocolytic replacement following recurrent preterm labor.

We examined pregnancy outcomes in women receiving nifedipine tocolysis having recurrent preterm labor (RPTL). Singleton gestations enrolled for outpatient nursing surveillance and prescribed nifedipine tocolysis were identified (N = 4748). Women hospitalized for RPTL at <35 weeks then resuming outpatient surveillance were included (N = 1366). Pregnancy outcomes of women resuming nifedipine (N = 830) were compared with those having an alteration in treatment to continuous subcutaneous terbutaline (N = 536). Overall, 56.7% (2692/4748) experienced RPTL. Half (50.7%) were stabilized and resumed outpatient surveillance with nifedipine or continuous subcutaneous terbutaline. Infants from women resuming nifedipine versus those with alteration of treatment to terbutaline were more likely to deliver at <35 weeks (28.0% versus 13.8%), weigh <2500 g (32.9% versus 20.3%), and require a stay in the neonatal intensive care unit (34.0% versus 23.1%), all P < 0.001. Alteration of tocolytic treatment following RPTL resulted in a decreased incidence of preterm birth and low birth weight, resulting in less admission to the neonatal intensive care unit and fewer nursery days.

Excessive weight gain among obese women and pregnancy outcomes.

We evaluated pregnancy outcomes in obese women with excessive weight gain during pregnancy. A retrospective study was performed on all obese women. Outcomes included rates of preeclampsia (PEC), gestational diabetes, cesarean delivery (CD), preterm delivery, low birth weight, very low birth weight, macrosomia, 5-minute Apgar score of <7, and neonatal intensive care unit (NICU) admission and were stratified by body mass index (BMI) groups class I (BMI 30 to 35.9 kg/m(2)), class II (36 to 39.9 kg/m(2)), and class III (>or=40 kg/m(2)). Gestational weight change was abstracted from the mother's medical chart and was divided into four categories: weight loss, weight gain of up to 14.9 pounds, weight gain of 15 to 24.9 pounds, and weight gain of more than 25 pounds. A total 20,823 obese women were eligible for the study. Univariate analysis revealed higher rates of preeclampsia, gestational diabetes, Cesarean deliveries, preterm deliveries, low birth weight, macrosomia, and NICU admission in class II and class III obese women when compared with class I women. When different patterns of weight gain were used as in the logistic regression model, rates of PEC and CD were increased. Excessive weight gain among obese women is associated with adverse outcomes with a higher risk as BMI increases.

Preventing adhesions in obstetric and gynecologic surgical procedures.

Adhesive disease represents a significant cause of morbidity for postoperative patients. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. The technology of adhesion prevention has significantly progressed. There are 3 methods approved by the US Food and Drug Administration for the prevention of postoperative adhesions, including Adept((R)), Interceed((R)), and Seprafilm((R)). The latter barrier is the most widely studied. This article reviews the current choices available for adhesion prevention barriers as well as surgical adjuncts that traditionally have been studied for that purpose.

Rectal misoprostol vs 15-methyl prostaglandin F2alpha for retained placenta after second-trimester delivery.

OBJECTIVE: The purpose of this study was to compare rectal misoprostol (RM) with 15-methyl prostaglandin F2alpha (PGF(2alpha)) for the management of retained placenta after second-trimester deliveries. STUDY DESIGN: A retrospective study of all second-trimester deliveries between the years 2000 and 2005 was performed. Women were divided into 2 groups, depending on whether they received RM or PGF(2alpha) after the delivery. RESULTS: Three hundred three second-trimester deliveries were analyzed. The time from the administration of medications to the placental delivery was significantly shorter in women who received PGF(2alpha), compared with the RM group (49.5 vs 89 minutes; P < .01). Women who received PGF(2alpha) had lower rates of retained placenta (4.9% vs 12.4%; P = .02). CONCLUSION: The use of PGF(2alpha) after second-trimester deliveries results in shorter third stage of labor and lower rates of retained placenta compared with RM.

Prenatal depression restricts fetal growth.

OBJECTIVE: To identify whether prenatal depression is a risk factor for fetal growth restriction. METHODS: Midgestation (18-20 weeks GA) estimated fetal weight and urine cortisol and birthweight and gestational age at birth data were collected on a sample of 40 depressed and 40 non-depressed women. Estimated fetal weight and birthweight data were then used to compute fetal growth rates. RESULTS: Depressed women had a 13% greater incidence of premature delivery (Odds ratio (OR)=2.61) and 15% greater incidence of low birthweight (OR=4.75) than non-depressed women. Depressed women also had elevated prenatal cortisol levels (p=.006) and fetuses who were smaller (p=.001) and who showed slower fetal growth rates (p=.011) and lower birthweights (p=.008). Mediation analyses further revealed that prenatal maternal cortisol levels were a potential mediator for the relationship between maternal symptoms of depression and both gestational age at birth and the rate of fetal growth. After controlling for maternal demographic variables, prenatal maternal cortisol levels were associated with 30% of the variance in gestational age at birth and 14% of the variance in the rate of fetal growth. CONCLUSION: Prenatal depression was associated with adverse perinatal outcomes, including premature delivery and slower fetal growth rates. Prenatal maternal cortisol levels appear to play a role in mediating these outcomes.

Antenatal factors predicting subsequent need for insulin treatment in women with gestational diabetes.

OBJECTIVE: To identify characteristics indicative of subsequent requirement of insulin in patients with gestational diabetes (GDM). METHODS: Identified from a database were patients with GDM not receiving insulin or oral hypoglycemic agents at enrollment for outpatient education and surveillance. Maternal characteristics were compared between patients achieving glycemic control with diet and those requiring insulin. Cox proportional hazards regression was used to assess multiple effects of significant univariate factors. RESULTS: Data from 2365 patients were analyzed. Patients requiring insulin were more likely to be multiparous, obese, have a history of GDM, be diagnosed at <28 weeks of gestation, and have a fasting blood glucose of >95 mg/dL, a glucose tolerance test 3-hour blood glucose of >140 mg/dL, and a glycosylated hemoglobin (A1c) of >or=6% at diagnosis of GDM. CONCLUSIONS: Laboratory values at diagnosis of GDM were the strongest indicators of subsequent need for insulin treatment. Patients with fasting blood glucose of >95 mg/dL and A1c values >or=6% at diagnosis of GDM should receive close surveillance of daily blood glucose.

Management of recurrent preterm labor in twin gestations with nifedipine tocolysis.

We examined outcomes of twin pregnancies complicated by recurrent preterm labor receiving nifedipine tocolysis. In a retrospective study design, twin pregnancies receiving outpatient preterm labor surveillance services and oral nifedipine tocolysis following a diagnosis of preterm labor were identified from a database ( N = 1421). Eligible for inclusion were patients subsequently rehospitalized with recurrent preterm labor symptoms ( N = 862). Included were patients at < 35 weeks' gestation, having intact membranes, and remaining undelivered for > 48 hours after recurrent preterm labor ( N = 656). Pregnancy outcomes of women resuming nifedipine tocolysis ( N = 418) following hospitalization were compared with those having an alteration in treatment ( N = 238) to continuous subcutaneous terbutaline. Alteration of tocolytic treatment versus resuming nifedipine resulted in increased pregnancy prolongation (34.7 +/- 18.8 days versus 27.5 +/- 19.9 days, P < 0.001), with delivery of fewer low birth weight (67.2% versus 78.3%, P < 0.001) and very low birth weight infants (6.5% versus 15.0%, P < 0.001) and a decreased incidence of neonatal intensive care unit admission (44.7% versus 52.9%, P = 0.005). In twin pregnancies receiving nifedipine tocolysis, alteration of tocolytic treatment to subcutaneous terbutaline following hospitalization for recurrent preterm labor symptoms had a positive impact on pregnancy prolongation and neonatal outcomes.

Antepartum uterine contraction patterns in twin pregnancies with and without preterm labor and delivering before or after 36 weeks.

OBJECTIVE: The purpose of this study was to identify differences in antepartum uterine contraction frequency (UCF) in twin pregnancies with and without preterm labor (PTL). STUDY DESIGN: Twin gestations enrolled for outpatient surveillance with twice daily electronic uterine activity monitoring and telephonic nursing assessment, without interventional delivery were identified. Mean UCF for each gestational week was compared between women without PTL or preterm delivery (PTD) < 36 weeks (controls) and those with a PTL diagnosis delivering at < 36 weeks (PTL/PTD group), and those with PTL with delivery > or = 36 weeks (PTL/GAD > or = 36 group). RESULTS: Data from 7891 patients with 267,840 monitored hours were analyzed. UCF at each gestational week was significantly higher for patients experiencing PTL with or without PTD compared to control. UCF was similar for patients with PTL with or without PTD < 36. CONCLUSION: Twin pregnancies complicated with PTL have a higher UCF than those that do not experience PTL. Outpatient surveillance may be beneficial in this population.

Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes.

OBJECTIVE: The objective of the study was to determine the frequency of fetal death in women 40 years of age or older (AMA). STUDY DESIGN: Retrospective study of all singleton pregnancies delivered at our institution between the years 1989 and 2004 was performed. The primary outcome measure was the risk of fetal death at various gestational ages. We also investigated the frequency of maternal comorbidities, preterm delivery (PTD), and low and very low birth weights (LBW, VLBW). RESULTS: Data were available for 126,402 singleton deliveries. AMA was an independent risk factor for fetal death at 28-31 weeks (adjusted odds ratio [AOR] 2.93, 95% confidence interval [CI] 1.76-4.92), 32-36 (AOR 1.73, 95% CI 1.05-2.83), 37-39 weeks (AOR 1.63, 95% CI 0.97-2.75), and 40-41 weeks (AOR 2.28, 95% CI 1.18-4.4). AMA was associated with increased rates of PTD, LBW, and VLBW. CONCLUSION: AMA is associated with an increased rate of fetal death and other adverse obstetrical outcomes. Antepartum fetal surveillance may be warranted in these women.

The advanced life support in obstetrics course as an orientation tool for obstetrics and gynecology residents.

OBJECTIVE: This study was undertaken to assess the utility of the Advanced Life Support in Obstetrics Course for obstetrics/gynecology first-year residents by triangulating pretest and posttest scores on written test of knowledge by interns, with qualitative surveys by residents, and faculty. STUDY DESIGN: Obstetrics/gynecology interns took a quantitative pretest and posttest on obstetric emergencies. These postgraduate first-year residents were also surveyed about their qualitative expectations about the course in advance and about their evaluation of the course after course completion. RESULTS: Nine postgraduate first year residents took the Advanced Life Support in Obstetrics course and participated in this study on June 2005. Postgraduate first year residents demonstrated an increase of 31% between mean pretest and posttest scores. Postgraduate first year residents found the course to be a good, hands-on practical review of common obstetric problems. Obstetrics/gynecology faculty and residents agreed that the course was useful hands tool for orientation. CONCLUSION: Advanced Life Support Obstetrics course is an effective educational tool during orientation for obstetrics/gynecology residents.

Gestational age at initiation of 17-hydroxyprogesterone caproate (17P) and recurrent preterm delivery.

OBJECTIVE: To compare rates of recurrent preterm birth between women starting treatment with 17alpha-hydroxyprogesterone caproate (17P) at 16-20.9 weeks of gestation versus 21-26.9 weeks. METHODS: Women enrolled in an outpatient program of education, nursing assessment and weekly 17P injections beginning at 16-26.9 weeks were eligible. Included were patients with singleton pregnancies and a history of preterm delivery (PTD). Pregnancy outcome was compared between women starting 17P at 16-20.9 weeks (n=156) and those starting 17P at 21-26.9 weeks (n=119) using Fisher's exact and Mann-Whitney U test statistics (p<0.05 considered significant). RESULTS: Mean gestational age at delivery (36.8 +/- 3.0 vs. 36.7 +/- 2.5) and rates of PTD at <37 weeks (40.4% vs. 48.7%), <35 weeks (16.7% vs. 16.8%) and <32 weeks (5.1% vs. 5.0%) were similar between the groups; all p > 0.05. CONCLUSIONS: Rates of preterm delivery were similar in patients initiating 17P at 16-20.9 or 21-26.9 weeks. A larger sample size is warranted in order to confirm our findings.

The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes.

OBJECTIVE: To identify the impact of suboptimal blood glucose control on neonatal outcomes in women with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: Included were patients with singleton gestation enrolled in an outpatient GDM management program for at least 7 days who delivered at term. Blood glucose control was defined as an average fasting blood glucose of <95 mg/dl, 1-h postprandial of <140 mg/dl, or 2-h postprandial of <120 mg/dl. Data were compared between patients with optimal blood glucose control (n = 2,030) and those with suboptimal blood glucose control (n = 1,188). The primary study outcome was a composite variable consisting of macrosomia, large-for-gestational-age, hypoglycemia, jaundice, or stillbirth. RESULTS: Over one-third of infants in the poorly controlled group were positive for at least one factor comprising the composite variable compared with 24% from the controlled group (P < 0.001). CONCLUSIONS: Suboptimal glycemic control in women with GDM is associated with adverse neonatal outcome. Careful monitoring of blood glucose levels and initiation of appropriate treatment are essential in the care of women with GDM.

Acute onset headache complicating labor epidural caused by intrapartum pneumocephalus.

BACKGROUND: Epidural placement for obstetric anesthesia is a common procedure. Pneumocephalus, the introduction of air into the cranial cavity after epidural placement, is a rare complication encountered when air is used for identification of the epidural space. CASE: A 42-year-old primipara undergoing epidural placement reported sudden onset of severe headache with associated neurologic symptoms and nuchal rigidity. Emergent CT scan revealed pneumocephalus. With conservative management, her symptoms resolved with interval resumption of the air collection evidenced on interval CT. CONCLUSION: Acute onset headache after epidural placement can present with impressive neurologic signs and symptoms. Prompt identification of the cause of this pathology is of vital importance to delineate pneumocephalus from potentially treatable or life-threatening disorders.

Significance of accidental extensions in the lower uterine segment during cesarean delivery.

OBJECTIVES: This study was undertaken to determine risk factors and perioperative complications associated with accidental extensions in the lower uterine segment during cesarean deliveries (CDs). STUDY DESIGN: This is a retrospective chart review of all CDs performed at Jackson Memorial Hospital/University of Miami between the years 1999 and 2002. Operative reports were reviewed to abstract data on the occurrence of extensions. Indication for CD, cervical status at the time of CD, birth weight, and fetal presentation and position were included in the analyses. Postoperative hematocrits, length of surgery, estimated blood loss, decline in hematocrit by 10%, need for transfusion, or hysterectomy were compared among CD with and without extensions. RESULTS: A total of 2,811 CDs were available for this study. Accidental extensions in the lower uterine segment occurred in 6.6% of the cases. Extensions were more commonly found in primary CD (8% vs 5%, P < .01. Extensions were more frequent if cervical dilatation was 8 cm or greater (18.3% vs 7%, P < .01), complete effacement (15% vs 8%, P < .01) station greater than +1 (16% vs 6.9%, P < .01), and if the fetal position was noted to be in the occiput posterior position (10% vs 5%, P < .01). When extensions were present, length of surgery was longer (56 vs 49 minutes, P < .01) and estimated blood loss was greater (994 +/- 675 mL vs 936 +/- 370 mL, P < .01). Arrest of descent as indication for CD was found to be an independent risk factor for the occurrence of extensions during CD (odds ratio 2.6, 95% CI 1.5-4.5, P = .001). CONCLUSION: Extensions in the lower uterine segment during CD do not increase maternal morbidity.

Assessing perinatal hepatitis B screening and neonatal prophylaxis in a large, multiethnic county.

OBJECTIVE: To assess the completeness of maternal screening and appropriateness of newborn prophylaxis for hepatitis B virus (HBV) in 2001 in Florida's largest county. STUDY DESIGN: A retrospective cohort study sampled 1% of deliveries at all hospitals in Miami-Dade County that had delivery suites. Abstractors reviewed mothers' and newborns' charts before discharge to determine whether newborns received appropriate HBV prophylaxis based on mothers' hepatitis B virus surface antigen (HBsAg) status at 12 hours postpartum. At each hospital, deliveries were sampled sequentially until the target number was reached. Sampling was donefor March-August 2001. RESULTS: Among 339 deliveries at 14 hospitals, the mother's HBsAg status was known within 12 hours of delivery for 286, or 84.4% (95% CI 80.1-88.1%). Of the 53 infants whose mothers' HBsAg status was unknown, 15 (28.3%) were vaccinated within 12 hours of delivery; both infants whose mothers were HBsAg positive received vaccine and immune globulin within 12 hours delivery. CONCLUSION: While HBsAg screening of pregnant women is widespread in Miami-Dade County, the information is not consistent used to protect infants who mothers' HBsAg status unknown.