Focused obstetrical clinic for active duty junior enlisted service women: Model for improved outcomes

Objective: To evaluate the utility of an interdisciplinary clinic in improv ing perinatal outcomes for all pregnant patients of junior enlisted rank (E 4 and below) in response to previous reports that this group is at higher r isk for adverse outcomes. Methods: The study population included all junior enlisted active duty patients (E4 and below) delivering between January 1, 1993, and June 30, 1996, Outcomes for patients receiving care in a focused active duty obstetrical clinic were compared with outcomes in similar coho rts of senior active duty patients (E5 and above) and non-active duty pregn ant patients, Evaluation was based on perinatal outcomes, including chorioa mnionitis, postpartum hemorrhage, intrauterine growth retardation, cesarean delivery, preterm delivery rates (<37 weeks), postterm delivery rates (>41 . weeks), postpartum days, mean gestational age at delivery, mean delivery weights, Apgar scores at 1 and 5 minutes, preeclampsia, and premature labor , Variables with potential to confound perinatal outcomes were also studied . Confounding variables included tobacco use, gestational diabetes, chronic hypertension, thyroid disease, history of substance abuse, and alcohol use . Power analysis accomplished before initiation of the study showed adequat e sample size (>240 patients in each group) to demonstrate statistically di fferent rates of preterm delivery. Statistical analysis was done using the chi(2) test for categorical variables and Student's t test for continuous v ariables. Results: There were no statistical differences between junior act ive duty patients, senior active duty patients, and non-active duty patient s in preterm delivery and other outcome variables. Conclusion: The focused obstetrical clinic, conducted for junior enlisted soldiers by a senior nurs e practitioner, appears to provide an intervention that ensures perinatal o utcomes equal to those of both the non-active duty and the senior active du ty population.