The Florida Perinatal Quality Collaborative (FPQC), which is based in the Chiles Center for Healthy Mothers and Babies and is part of the USF College of Public Health, has won the Sapphire Award from the Florida Blue Foundation for its effort to improve health outcomes for mothers and infants through quality care.

The FPQC team includes, back row from left are: Doug Hardy, Winnie Palmer neonatologist and FPQC Neonatal Consultant and MOM Medical Lead; Karen Harris, ACOG District XII Chair, FPQC Obstetrical Consultant, ACT Medical Co-Lead; Annette Phelps, FPQC Nursing Consultant; Lori Reeves, March of Dimes Regional Program Services Director, FPQC Steering Committee Member; Karen Bruder, USF COM, FPQC Obstetrical Consultant and ACT Medical Co-Lead; Judette Louis, USF COM, FPQC Obstetrical Consultant and HIP Medical Lead; Kris Albers, FDOH, FPQC Steering Committee Member; and Yuri Sebastiao, FPQC Graduate Assistant. Seated from left are: Maya Balakrishnan, USF COM, FPQC QI Director; Linda Detman; William Sappenfield, USF COPH and FPQC and the Chiles Center; Emily Bronson; and Charlie Mahan.

The FPQC was selected from among 120 nominees to win the top award in organization category and will receive $50,000 and was presented with the award April 21 in Orlando. A video highlighting their work was shown at the awards presentation and features many familiar USF faces.

The award helps validate the work and mission of the FPQC, said William M. Sappenfield, MD, MPH, CPH, professor and chair of the Department of Community and Family Health in the USF College of Public Health.

“The Sapphire Award demonstrates credibility of the reach the FPQC has in the eyes of others,” said Dr. Sappenfield, who co-directs FPQC and directs the Chiles Center. “The award money will go to support current quality initiatives the will help us have an even greater impact on the lives of mothers and infants.”

The USF-based FPQC works to provide the best health outcomes possible for mothers and infants through receiving high quality evidence-based perinatal care. Its mission is to advance perinatal health care quality and patient safety for all of Florida’s mothers and infants through the collaboration of all FPQC stakeholders in the development of joint quality improvement initiatives, the advancement of data-driven best practices and the promotion of education and training.

Accepting the Sapphire Award are, from left, Dr. William Sappenfield, Linda Detman and Emily Bronson.

Public health scholars and community leaders gather to highlight 20 years of the Chiles Center’s statewide contributions to the health of mothers, children and families

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As they celebrated the last 20 years of successes, staff and friends of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies looked toward a future of building upon the Chiles family legacy to make an even bigger difference in the lives of women, children and families.

Officials from the university, USF College of Public Health, and the community, joined by members of the Chiles family, gathered Feb. 23 for a special tribute to Rhea Chiles, wife of the late Florida Gov. Lawton Chiles. Rhea Chiles passed away Nov. 8 at age 84 at her home in Anna Maria Island, Fla.

Rhea Chiles shared her husband’s advocacy for public health issues related to reducing high rates of infant mortality and prematurity, leading to the founding of the USF College of Public Health’s Lawton and Rhea Chiles Center for Healthy Mothers and Babies in 1996. The center gained a permanent freestanding building on the USF Tampa campus in 2001. This year marks the 20^th anniversary of the research, program and policy institute, which has attracted more than $88 million in grants and garnered the respect of maternal and child health experts across the U.S. and abroad.

USF System President Judy Genshaft joined College of Public Health and community leaders in the Feb. 23 special tribute to Rhea Chiles that also celebrated the history and future of the USF College of Public Health’s Lawton and Rhea Chiles Center for Healthy Mothers and Babies.

“Lawton and Rhea Chiles were visionaries who made a difference in the lives of Floridians. Their great legacy was grounded in knowing that thriving communities begin with healthy mothers and babies,” said USF System President Judy Genshaft. “They understood that the best way to secure the future was by investing in children. At USF, we share that commitment and pledge to act upon it for decades to come.”

In their remarks, Chiles Center Founding Director Charles Mahan, MD, dean and professor emeritus of the College of Public health, and current Chiles Center Director William Sappenfield, MD, MPH, professor and chair of the Department of Community and Family Health, bridged the rich history of the center with plans for its future.  They were joined by several other speakers from Chiles Center’s past and present.

The tribute to their mother was attended by, from left: Tandy Chiles, Rhea Chiles and Ed Chiles.

Remembering the Past

 Dr. Mahan, an OB-GYN, spoke about the bond he forged with then U.S. Sen. Lawton Chiles and wife Rhea in the early 1980s when the senator served as chair of the landmark National Commission to Prevent Infant Mortality and they attended public hearings together.

When Chiles was elected Florida governor in 1991, he asked Dr. Mahan to remain as state health officer on loan from the medical school at the University of Florida. Gov. Chiles and Dr. Mahan began work on a concept for statewide center to promote and protect the health of pregnant women and infants. The Chiles Center’s originally intended location was the University of Florida, the governor’s alma mater, Dr. Mahan said, but that was before the state established its first college of public health at USF and several years later Dr. Mahan was appointed as dean.

Dr. Charles Mahan, dean emeritus of the College of Public Health and founding director of the Chiles Center, spoke about the center’s history.

“The Chiles’ idea was that the center would be a think tank, a way to come up with new programs to help Florida and the United States move up in the world in terms of our mother and baby outcomes,” Dr. Mahan said.

“Rhea and Lawton Chiles worked as a team. I don’t believe I’ve ever seen a couple in public life who were so totally linked together in their thinking… and that was so often seen in their deep, honest interest in mothers and children.”

That deep-seated interest had a personal component. One of Lawton and Rhea Chiles’ grandchildren was born prematurely and spent time in a neonatal intensive care unit at Shands Hospital. But, rather than pushing for more funding to expand NICU treatment, the Chiles focused their efforts on prevention and early intervention to advance prenatal and perinatal care.

By informing policy and working with community partners to improve maternal and child health outcomes, the Chiles Center played a lead role in helping the state substantially cut its infant mortality rates. This work was helped immensely, Dr. Mahan said, by Rhea Chiles advocacy for a hallmark feature of state’s bipartisan Healthy Start legislation enacted in 1991 – the establishment across Florida of public-private coalitions empowered to prioritize community needs and act on behalf of families. No other state has such coalitions, which continue to thrive today, he added.

Betty Castor, who served as president of USF when the Chiles Center was founded, speaks with Steve Freedman, PhD, adjunct professor in the USF College of Public Health.

Building upon a legacy of success

Among the Chiles Center’s accomplishments over the years:

• Provides technical assistance to Healthy Start Coalitions so that they can more meaningfully use maternal and child health data.
• Expanded prenatal care and outreach childbirth education to low-income pregnant women.
• Began the Central Hillsborough Healthy Start, which later transitioned from its university-based Chiles Center location to become a successful freestanding community organization serving the needs of East Tampa. The program grew from a $2 million grant to a diversified non-profit organization, known as REACHUP, Inc., with about $15 million in funding.
• Led a national Friendly Access program, partnering with the Disney Institute, to train health department clinic staff to be more customer-service oriented in providing care.
• Florida Covering Kids and Families, working with collaborators across the state, surpassed the federal goal for Florida in enrolling people for health care coverage in the federal health insurance marketplaces.
• Founded and directs the Florida Perinatal Quality Collaborative (FPQC), which provides leadership and consultation to public and private partners across Florida, often joining perinatal quality collaboratives in other states, to launch health care quality improvement initiatives.
• Established the Annual Chiles Center Lecture, which draws leading physicians and research scientists in maternal and child health care or policy from the U.S. and Central and South American to exchange ideas..

This year marks the 20th anniversary of the Chiles Center, which has attracted more than $88 million in grants and garnered the respect of maternal and child health experts across the U.S. and abroad.

Transitioning to a New Paradigm

Looking toward the future, the Chiles Center and its community partners have begun to broaden their approaches to maternal and child health. Rather than try to address all the needs of women during pregnancy, Dr. Sappenfield said, the center has begun to focus more holistically on women to more positively affect the health trajectory of their children’s lives.

“We’ve now discovered that our (greatest) impact on a pregnancy is not only with the mother, but it may even start with the mother’s mother,” Dr. Sappenfield said.

“It’s the mother’s health care and preventive practices that tend to define what happens to the entire family,” he said. “So, we need to address the overall health of women across their life course, especially in the early years, because if we have healthy women we have healthy children and families – which all adds to the health of the community.”

Dr. William Sappenfield, chair of the Department of Community and Family Health and current director of the Chiles Center, spoke about plans for broadening the center’s maternal and child health agenda.

Through the FPQC, directed by Dr. Sappenfield, the Chiles Center also analyzes big data to better understand health issues, to determine which programs work. and to guide evidence-based health policy that drives prevention and quality improvement.

Dr. Sappenfield pointed to one of the FPQC’s first successes: This March of Dimes-supported, multistate pilot project radically reduced rates of early elective deliveries – inductions of labor and Cesarean sections without a medical reason before 39 weeks of gestation that can cause low-birth weight babies with serious complications. Florida has now caught up with most other states. Recently launched FPQC initiatives target ways to reduce hypertension (high blood pressure) during pregnancy and maternal hemorrhaging during delivery – both leading causes of pregnancy-related illnesses and deaths in Florida.

Future goals also include evaluating Florida’s expanded home visiting program led by the Florida Association of Healthy Start Coalitions to help better identify and intervene early in mental health and family violence issues, Dr. Sappenfield said. “The return on investment for home visits is huge – as much as $24 for every $1 invested in some programs. That’s not just in improved health, but in helping keep kids in school and out of prisons.”

Dr. Mahan shows off the tie given to him by Lawton Chiles.

Inspired By a Lasting Legacy

Several members of the Chiles family, including son Ed and daughters Tandy and Rhea, attended the tribute to their mother Rhea Chiles.

Reflecting on the event, Ed Chiles said his mother understood that “top-down solutions” to problems as complex as infant mortality and prematurity did not work. Grassroots efforts beginning at the community level were required to effectively address the needs underserved groups, like, for example, home visits by doulas who live in the same neighborhoods as the high-risk pregnant women they visit, he said.

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“Both Mom and Dad realized if you did not start at the beginning, especially with mothers and children, then you were never going to be able to fix problems down the line, or you would have a lot more difficulty doing that.”

Ed Chiles recalled that his father and mother never wanted a building named after them, but they agreed because it represented a cause that was so important to them.

“It was such a privilege to be here and get reacquainted with the work being done at the Lawton and Rhea Chiles Center for Healthy Mothers and Babies. What an incredible legacy,” he said.

“The idea that this center has spawned a group of public health experts… and now the young students coming after them, who are making life-changing differences in the lives of mothers, children and families — that is powerful.”

Sound bites from the other speakers:

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“We owe a great debt to Rhea Chiles. For over 20 years in the Chiles Center, and over 30 years in the College of Public Health, there have been countless students and scholars working together and growing into passionate professionals who can carry on the work that was her dream.”

Donna Petersen, ScD, dean of the USF College of Public Health

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“When we do this kind of applied, time-sensitive work, we often don’t have a chance to stop and think about the breadth of what’s being done. Listening to the whole story – Charlie Mahan providing the history, and all of the speakers talking about what we do – was one of those opportunities to see how everything is connected.”

Ellen Daley, PhD, professor and co-director, Center for Transdisciplinary Research on Women’s Health

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“We engaged communities with nontraditional providers… training women from neighborhoods with the highest rates of infant mortality to be doulas so they could provide support before, during and after pregnancies… We have data now to show these things work.”

Dee Jeffers, MPH, RN, former program director, Chiles Center

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“Since the establishment of the Florida Perinatal Quality Collaborative, we have more obstetricians and pediatricians talking to one another… We’re looking at the best evidence and starting to turn them into products that will change practice.” 

John Curran, MD, associate vice president, USF Health, and co-director of the Chiles Center-based FPQC 

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“We’ve made significant advances in children’s health care in the last 20 years… but looking ahead we need to help build systems of care that will enable parents of developmentally delayed children to obtain a broader range of care, so that we enable every child to achieve their highest potential.”

Russell Kirby, PhD, USF Distinguished Professor and Marrell Endowed Chair in Community and Family Health

Ed Chiles takes a photo of some of the memorabilia in the Chiles Center commemorating the work of his parents Lawton and Rhea Chiles.

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To listen to WUSF Florida Matters show on the Rhea Chiles tribute and Chiles Center legacy, click here.

Video by Sandra C. Roa and photos by Eric Younghans, USF Health Communications & Marketing

From molecular discoveries to health policy applications, Drs. Maureen Groer and William Sappenfield have built impressive careers working to improve perinatal care.

Many parents may never understand how the health of their children begins long before birth, but USF Health’s Maureen Groer, PhD, and William Sappenfield, MD, MPH, are both passionate about translating research into better health care and outcomes for mothers and babies.

Dr. Groer, who holds a PhD in physiology, is a pediatric nurse, family nurse practitioner and the Gordon Keller Professor at the USF College of Nursing. She works primarily at the micro level – examining the molecular mechanisms underlying immunology, biology and behavior and how the “crosstalk” among these systems may affect the health of infants and their mothers.

USF College of Nursing’s Maureen Groer, RN, PhD, FAAN, a nurse physiologist with more than 35 years experience, studies underlying biobehavioral mechanisms affecting the health of infants and their mothers.

Dr. Sappenfield, a pediatrician and epidemiologist, is professor and chair of Community and Family Health at the USF College of Public Health, director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, and co-director of the Florida Perinatal Quality Collaborative.   He works at the macro level – joining a variety of stakeholders to distill population data about diseases and their risk factors, treatment patterns and socioeconomic conditions into meaningful policies and practices to improve the health of mothers and babies.

USF College of Public Health’s William Sappenfield, MD, MPH, is a pediatrician and epidemiologist working with stakeholders at the local, state and national levels to improve the quality of perinatal care.

Linking the gut microbiome of premature infants with long-term health

The beneficial balance of trillions of bacteria, viruses and other microorganisms in the digestive tract – known as the gut microbiome – has become a hot research topic. Dr. Groer is particularly interested in the link between the gut microbiome in premature babies and their long-term health. Increasing evidence shows that the interaction of microbe populations and controlled inflammation in the gut plays a critical role in developing a healthy immune system. Other studies point to a gut-brain microbe connection with neuropsychiatric illnesses, such as autism, and attention deficit hyperactivity disorder.

In full-term healthy infants a “signature” gut microbiome – influenced by diet, where someone lives and other environmental determinants — is typically established by age 3.  But when infants are born too early, the proper evolution of the gut may be disrupted by various factors, including delivery by Cesarean section (C-section), physiological immaturity of the baby’s organs, and extended time in the neonatal intensive care unit (NICU).

While the NICU provides lifesaving supportive care, babies who spend their first weeks or months there, instead of living at home, receive multiple antibiotics, undergo stressful invasive procedures, interact less with their mothers, and typically ingest more formula milk than breast milk, which would transfer the mother’s own beneficial gut bacteria to the lactating infant.

The USF College of Nursing Biobehavioral Laboratory that Dr. Groer oversees is one of the top wet labs for nursing science in the country.

The National Institute of Nursing Research recently awarded Dr. Groer a $2.7 million, five-year grant to study how DNA extracted from the gut microbiome of preterm infants may be influencing their growth and development. The discoveries by USF and others may ultimately help devise ways to modify the mix of bugs in the premature baby’s gut to create the best microbiome possible for long-term physical and mental health.

“We don’t yet have the science to develop tailored probiotic treatments, but I think that’s the future,” Dr. Groer said. “This research might lead to early diagnosis and treatment of chronic bowel diseases, ways to reduce allergies and autoimmune diseases, and even new ways of preventing depression and anxiety.”

Dr. Groer with Adetola Louis Jacques, MD, a maternal-fetal medicine fellow in the Department of Obstetrics and Gynecology, collaborate on data for a manuscript. Dr. Groer works with researchers across several disciplines.

Continuously funded by the National Institutes of Health for the last 15 years, Dr. Groer works with colleagues in nursing, medicine, anthropology, developmental psychology, microbiology and other disciplines. Her work has contributed to a better understanding of the biobehavioral mechanisms underlying mother-infant interactions, including the growing body of evidence about the extensive health benefits of breastfeeding.

“To attract the kind of research funding we need to launch and support big studies, nurses need to understand metabolism, genomics, microbiomics and proteomics,” Dr. Groer said. We need this type of data-driven laboratory environment to contribute to the next generation of science, which is molecular.”

Using the power of meaningful data to help transform perinatal care quality

Even though he is a board-certified pediatrician, Dr. Sappenfield decided to embark on a career of public health research and practice instead of entering a traditional medical practice following his residency. He earned a master’s of public health degree from Harvard and completed postdoctoral training in preventive medicine and applied epidemiology at the Centers for Disease Control and Prevention (CDC).

“I fell in love with public health, because it was a way I could impact the health of children and families on a population basis, not just one child at a time,” Dr. Sappenfield said. “Knowing I can work with others to make a true measurable difference in lives of mothers, children and families gives me all energy I need to get up every day and go again.”

Dr. Sappenfield outside the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, which he directs. The statewide center is based at the USF College of Public Health.

One of Dr. Sappenfield’s key academic achievements to help transform quality of care for pregnant women and newborns has been co-founding and co-directing the Florida Perinatal Quality Collaborative (FPQC) with John Curran, MD, professor of pediatrics and an associate vice president at USF Health.

The FPQC provides leadership and technical assistance to public and private partners across the state, often joining perinatal quality collaboratives in other states to launch health care quality improvement initiatives. Physicians, nurse midwives, nurses, public health professionals, hospitals, advocates, policy makers and payers voluntarily and collectively work together on select evidence-based initiatives to make measurable improvements in Florida’s maternal and infant health outcomes.

“Most of the initiatives we’re funded to do at $100,000 to $200,000 per year have been saving millions of dollars in costs while also improving health care and the quality of lives of mothers and babies,” Dr. Sappenfield said.

For example, one of FPQC’s first successes was its participation in a March of Dimes-supported, multistate pilot project to reduce escalating rates of early elective deliveries – inductions of labor and C-sections without a medical reason before a baby reaches a full 39 weeks gestational age.  Babies delivered before full term are at higher risk for serious complications, including respiratory distress, brain injuries, learning disabilities, and breastfeeding problems.

Dr. Sappenfield works with colleagues at the Chiles Center.

A recent demonstration project to reduce potentially deadly central-line associated infections in newborns saved an estimated $8 million over 18 months by avoiding infections, reducing hospital stays, and preventing deaths, Dr. Sappenfield said. Using hospital-specific data monitoring and hands-on training, the FPQC helped 18 Florida NICUs establish practices proven to reduce infection, including rigorous catheter insertion protocols and techniques for maintaining a sterile environment.

A new project to start in September focuses on improving the use of antenatal steroids, medications shown to safely reduce complications for premature babies when given at the optimal time to women at high risk for preterm deliveries. A second initiative expected to launch in November targets hypertension (high blood pressure) during pregnancy, one of the leading causes of pregnancy-related illnesses and deaths in Florida.

“With quality improvement, we’re trying to take what we’ve learned (works) from research and put into place systems and practices to make sure everyone gets those benefits,” Dr. Sappenfield said.

Dr. Sappenfield, a pioneer in applying epidemiology to issues affecting maternal and child health, has worked in the field for more than 30 years. “There’s never been a more exciting time than now,” he says.

Dr. Sappenfield is optimistic about the potential to make even greater advances in maternal and child health.

“I’ve been working to try to improve the health of mothers and babies for 30 years, and there’s never been a more exciting time than now,” he said. “Everyone is willing to work together to make a difference in the lives of these mothers and babies.”

Photos and video by Sandra Roa, USF Health Communications

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A board-certified pediatrician, Dr. William Sappenfield never entered traditional medical practice. While finishing his residency, he decided he wanted to enter academics, instead. Following the advice of his father, a professor and associate dean at a medical school, he applied to an NIH-CDC research training program.

“I fell in love with public health,” said Sappenfield, Community and Family Health professor/department chair and director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies. “Even though I liked the idea of taking care of children and families one at a time, I became enamored with the ability to help multiple children and families at the same time by using epidemiology as a tool.”

A widely recognized pioneer in his field, Sappenfield received the U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau Director’s Award “for outstanding leadership and mentoring in promoting MCH epidemiologists nationwide” at the Association of Maternal and Child Health Programs annual conference in Washington, D.C., in late January.

Read full story.

USF Health faculty among authors of national study published in Obstetrics and Gynecology

Multistate, hospital-based quality improvement programs can be remarkably effective at reducing early elective deliveries of babies, a study published April 8 in the journal Obstetrics & Gynecology reports.

The March of Dimes, which partly funded the study, calls the findings good news, because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.

In the group of 25 participating hospitals, the rate of elective early-term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason before a baby reaches a full 39 weeks gestational age) fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.

Florida did even better than the other four states involved in the March of Dimes national project, said William Sappenfield, MD, MPH, director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the USF College of Public Health.  Dr. Sappenfield, co-chair of the March of Dimes prematurity initiative, and John Curran, MD, an associate vice president at USF Health and executive director of the Florida Perinatal Quality Collaborative (FPQC), were among the authors of the multistate study.

“The initiative coordinated by the FPQC at USF Health and the Chiles Center reduced the (early-term delivery) rate in Florida’s pilot hospitals to the same low national study rate of 5 percent, even though our state’s pilot hospitals started the initiative with a substantially higher rate of 38 percent,”  said Dr. Sappenfield.  “This would not have been possible without our partnership with the March of Dimes and our obstetrical consultants from Florida’s new district of the American Congress of Obstetricians and Gynecologists.”

L to R: USF leaders of the Florida Perinatal Quality Collaborative include Linda Detman PhD, Department of Community and Family Health at the Chiles Center for Healthy Mothers and Babies; William Sappenfield, MD, MPH, director of the Chiles Center; and USF Health’s John Curran, MD, executive director of the FPQC.

“Reducing unnecessary early deliveries to less than 5 percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” said Edward R.B. McCabe, MD, medical director of the March of Dimes.  “This project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied. Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital’s overall preterm birth rate.”

The initiative focused on implementation of a toolkit called “Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age,” to guide changes in early term delivery practices.  The toolkit was developed in partnership with March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health.

This was the first project of a collaborative with perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Florida, Illinois, New York and Texas. These five states account for an estimated 38 percent of all births in the United States.

Florida hospitals participating in FPQC pilot study were St. Joseph’s Hospital in Tampa, Lee Memorial Health System in Ft. Myers, Plantation General Hospital in Plantation, Santa Rosa Medical Center in Milton, South Miami Hospital in Miami, and Broward General Medical Center in Ft. Lauderdale.

The study targeted deliveries that were not medically necessary during the 37th and 38th week of fetal gestation. Even babies born just a few weeks early have higher rates of hospitalization and illness compared to full-term infants.

The six Florida hospitals participating in FPQC pilot study were St. Joseph’s Hospital in Tampa, Lee Memorial Health System in Ft. Myers, Plantation General Hospital in Plantation, Santa Rosa Medical Center in Milton, South Miami Hospital in Miami, and Broward General Medical Center in Ft. Lauderdale.  For an earlier story on USF’s role in the statewide, multihospital initiative, click here.

“This study is only the beginning,” said Dr. Sappenfield, a professor in the USF Department of Community and Family Health. “Not only do other hospitals in Florida need to reduce their rates of non-medically indicated deliveries, but this is the first of many needed perinatal quality improvement initiatives in Florida to assure that all our mothers and infants have access to quality health care.”

The FPQC, in coordination with hospitals, obstetricians, pediatricians, nurses and nurse midwives, is developing new statewide initiatives to reduce preterm births, avert infections and prevent maternal deaths.

The March of Dimes urges hospitals, health care providers, and patients to follow the American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own.  The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing.

“A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Bryan T. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology.

The March of Dimes is the leading nonprofit organization for pregnancy and baby health. With chapters nationwide and its premier event, March for Babies, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit marchofdimes.com or nacersano.org.

Anne DeLotto Baier of USF Health Communications contributed to this story.
Photo by Eric Younghans, USF Health Communications

USF public health leader involved in the FDOH investigation comments

Florida’s rate of ectopic pregnancy deaths jumped in 2009-10 – an increase that may be associated with delays in obtaining care and illicit drug use, according to a new report by the U.S. Centers for Disease Control and Prevention.  The state’s rise in ectopic pregnancy deaths, published in the CDC’s Feb. 17 issue of Morbidity & Mortality Weekly Report, runs counter to the national trend of steadily declining deaths.

“It was surprising,” said one of the report’s co-authors Dr. William Sappenfield, director of the Chiles Center for Healthy Mothers and Babies at USF, who was maternal-child health epidemiologist at the Florida Department of Health when the study was conducted.

“Nationwide, ectopic pregnancy death rates are going down, because the condition has become much easier and quicker to diagnose and treat,” said Dr. Sappenfield, chair of Community and Family Health at the USF College of Public Health.

Dr. William Sappenfield of the USF College of Public Health was a co-author of the report published in the CDC’s Mortality & Morbidity Weekly.

Ectopic pregnancy occurs when an egg is fertilized outside the uterus, usually in the fallopian tube.  If it remains undetected the pregnant woman may die if the tube ruptures, leading to rapid blood loss.

Improvements in pregnancy testing, ultrasound examination and outpatient treatments, including laparoscopic surgery and medications, have contributed to the decline in deaths. This success is largely dependent on access to care so women with signs and symptoms of ectopic pregnancy can be identified and treated before tube rupture, shock and severe blood loss.

Dr. Sappenfield helped staff the multidisciplinary team investigating ectopic pregnancy deaths in Florida, based on a review of cause death, risk factors and prevention opportunities.

Florida’s ectopic pregnancy mortality ratio was similar to the national rate of 0.6 deaths per 100,000 live births during 1999–2008, but increased abruptly to 2.5 during 2009-2010.  This four-fold increase appeared to be linked in part to lack of access to care. The researchers found that the 13 women who died in the one year (2009-2010) were more likely to have collapsed from a hemorrhage before seeking care than the 11 women who died the previous decade from ectopic pregnancies. Of the eight women who collapsed during 2009-2010, six tested positive for illicit drug use.

“We clearly have not reached our potential to prevent this life-threatening condition,” Dr. Sappenfield said.

Based on their review, the investigators wrote: “Efforts to prevent ectopic pregnancy deaths need to ensure early access to care, promote awareness about early pregnancy testing and ectopic pregnancy risk, and raise public awareness about substance abuse risks, especially during pregnancy.”

While ectopic pregnancy cannot be prevented, Dr. Sappenfield said, pregnant women and those of childbearing age should not delay seeking medical attention for continuing abdominal or pelvic pain, usually 6 to 8 weeks after a missed period.  Better to quickly rule out an ectopic pregnancy than to risk future fertility and perhaps dangerous complications if the pregnancy ruptures the fallopian tube.

Story by Anne DeLotto Baier, USF Health Communications