Objective To estimate the incidence, etiology and complications of pancreatitis in pregnancy and identify factors associated with adverse outcomes. Methods Chart review of all patients diagnosed with pancreatitis and pregnancy from 1992–2001 at 15 participating hospitals. Information was collected on presentation, management and outcome, along with the number of deliveries at each hospital. Results During the 10 years of the study, 101 cases of pancreatitis occurred among 305,101 deliveries, yielding an incidence of one in 3,021 (.03%). There were no maternal deaths; perinatal mortality was 3.6%. Eighty-nine women had acute pancreatitis and twelve women had chronic pancreatitis. The majority (66%) of cases of acute pancreatitis were biliary in origin, and they were associated with better outcomes than non-biliary etiologies. Cases of gallstone pancreatitis that received surgical or endoscopic intervention during pregnancy had lower rates of preterm delivery and recurrence than those that were conservatively managed, but this difference was not significant (p=0.2). Alcohol was responsible for 12.3% of acute pancreatitis and 58% of chronic pancreatitis and was associated with increased rates of recurrence and preterm delivery. A calcium level, triglycerides or both was not obtained in half of cases identified as idiopathic. Conclusion Pancreatitis is a rare event in pregnancy, occurring in approximately 3 in 10,000 pregnancies. While it is most often acute and related to gallstones, non-biliary causes should be sought, as they are associated with worse outcomes.

PURPOSE Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODSWe undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULTSThe cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000).CONCLUSIONS Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates. Ann Fam Med 2012;10:530-537. doi:10.1370/afm.1403. INTRODUCTIONT he cesarean rate in the United States has risen from 5.5% in 1970 to 16.5% in 1980 1 to 21% in 1996 to 32.9% in 2009. 2,3 A 2011 study calculates that if trends continue, the 2020 cesarean rate will be 56.2%. 4 The 2007 primary cesarean rate was 23.4%. 5 The vaginal birth after cesarean (VBAC) rate-the percentage of pregnant women who give birth vaginally after a previous cesarean-has fallen from a high of 28.3% in 1996 1 to 8.5% in 2006. 6 The World Health Organization (WHO) and Healthy People 2020 have suggested the ideal cesarean rate should be around 15%. 7,8 The 2010 National Institutes of Health consensus conference on VBAC highlighted high-grade evidence that maternal mortality risk is decreased by VBAC compared with a repeat cesarean (3.8 vs 13.4 of 100,000).2 Data suggest decreasing the primary cesarean delivery rate and increasing the VBAC rate as key strategies to decrease the US cesarean rate. 9Amish communities ascribe religious and cultural value to childbearing. 10,11 Contraception, including sterilization, may be prohibited. 10Advanced maternal age and grand multiparity are common. Amish women of Southwest Wisconsin generally give birth at home attended by an unlicensed birth attendant, mother, mother-in-law, or neighbor. Formal education for men and women is through 8th grade, and women do not work outside the home. Amish culture prohibits electricity, telephone service, and car ownership, leading to delays ...

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Although evidence‐based interventions to reduce underage drinking have been identified, dissemination into ‘real‐world’ communities remains challenging. The purpose of this community‐based translational research is to test SAMHSA's Strategic Prevention Framework (SPF) as a model for such dissemination and evaluate its effect on alcohol use by youth aged 12–17. From 2001–2009 in Eau Claire, Wisconsin we used the SPF to assess community needs and implement a comprehensive strategy of evidence‐based programs targeting youth, parents and the community. Over this time, youth alcohol measures from middle and high school surveys showed an 8.6% decline in past‐month alcohol use (p<.05) and a 20.5% decline in ease of obtaining alcohol (p<.05). From 2004 to 2009 there was a 5.8% decrease in binge alcohol use (p<.05) and a 12.0% increase in perceived parental disapproval of alcohol use (p<.05). Based on our findings, the SPF is a promising model for communities seeking to reduce underage drinking. © 2012 Wiley Periodicals, Inc.

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