Optimized search for parameters useful in the interpretation of fetal heart rate data.

A comprehensive computerized perinatal data management system was used to acquire and process FHR data and to link this information to a set of control and outcome variable for 1000 deliveries. Multivariate correlation analyses and stepwise linear regression techniques were used to study the interrelationships between risk factors of pregnancy and labor, monitored data, obstetric interventions, and outcome. It was found that while some FHR characteristics, such as moderate-to-severe bradycardia, lack of beat-to-beat variability, and severe variable decelerations were significantly associated with poor outcome, others, such as accelerations, early decelerations, mild bradycardia, and mild-to-moderate tachycardia, were positively correlated with good outcome. Several statistical models for outcome prediction were developed using FHR data alone and also in conjunction with small subsets of control variables.

Midwifery, 1977.

On January 1, 1974, an autonomous midwifery service was formed at Roosevelt Hospital in New York City to provide an obstetric service to "private" patients. While the autonomy was complete, physician consultation and participation provided by the "full-time or senior resident" staff were always available. We are now aware that this plan as opposed to any other, provided the ingredient of consumer-desired empathy of the midwife coupled with instant obstetric expertise that assured every patient the availability of modern obstetric practice. Four hundred and fifty-four patients cared for by midwives were compared to a random sample of 500 patients cared for by attending obstetricians. A striking similarity in the two groups was evident. Certain items, such as operative deliveries, were higher in the private patient group. The midwifery group had a low incidence of complications, but the incidence of acute complications made it apparent that an operating room suite must be immediately available. It is eminently clear that a low-risk group can be identified but there is no possible way to identify a "no risk" population.