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Mortality is lower for patients with ovarian cancer treated at high-volume hospitals. The reduction in mortality does not appear to be the result of lower complications rates but rather a result of the ability of high-volume hospitals to rescue patients with complications.

BACKGROUND Gastroschisis is a severe congenital anomaly the etiology of which is unknown. Research evidence supports attempted vaginal delivery for pregnancies complicated by gastroschisis in the absence of obstetric indications for cesarean delivery. OBJECTIVE The objectives of the study evaluating pregnancies complicated by gastroschisis were to: (i) determine the proportion of women undergoing planned cesarean versus attempted vaginal delivery; and (ii) provide up-to-date epidemiology on risk factors associated with this anomaly. STUDY DESIGN This population-based study of United States natality records from 2005–2013 evaluated pregnancies complicated by gastroschisis. Women were classified based on whether they attempted vaginal delivery or underwent a planned cesarean (n=24,836,777). Obstetrical, medical, and demographic characteristics were evaluated. Multivariable log-linear regression models were developed to determine factors associated with mode of delivery. Factors associated with the occurrence of the anomaly were also evaluated in log-linear models. RESULTS Of 5,985 pregnancies with gastroschisis, 63.5% (n=3,800) attempted vaginal delivery and 36.5% (n=2,185) underwent planned cesarean delivery. The rate of attempted vaginal delivery increased from 59.7% in 2005 to 68.8% in 2013. Earlier gestational age and Hispanic ethnicity were associated with lower rates of attempted vaginal delivery. Factors associated with the occurrence of gastroschisis included young age, smoking, high educational attainment, and being married. Protective factors included chronic hypertension, black race, and obesity. The incidence of gastroschisis was 3.1 per 10,000 pregnancies and did not increase during the study period. CONCLUSION Attempted vaginal delivery is becoming increasingly prevalent for women with a pregnancy complicated by gastroschisis. Recommendations from research literature findings may be diffusing into clinical practice. A significant proportion of women with this anomaly still deliver by planned cesarean suggesting further reduction of surgical delivery for this anomaly is possible.

Objective To determine how well antenatal corticosteroids (ACS) were timed, based on the indication for administration for women delivering preterm.Design Retrospective cohort study.Setting Tertiary medical centre.Population Six hundred and thirty women who had singleton preterm births between 24 and 34 weeks' gestational age.Methods Charts from 2006 to 2011 were reviewed for indications for ACS administration, which included premature rupture of membranes, threatened preterm labour, risk factors for spontaneous preterm birth such as short ultrasound cervical length, positive fetal fibronectin, and hypertensive disorders of pregnancy. Charts were reviewed for timing of ACS administration in relation to delivery.Main outcome measures The primary outcome was optimal timing, defined as administration of ACS ≥24 hours to ≤7 days prior to delivery.Results Of 630 women who delivered preterm, 589 (93%) received ACS prior to delivery. ACS timing was optimal in 40% (238 of 589) of cases. Women with hypertensive disorders were most likely to have steroids optimally timed (62%). Asymptomatic women at increased risk for preterm delivery were less likely to receive optimally timed ACS (12%). The majority of women who received steroids >2 weeks prior to delivery (57%) received a second course.Conclusion A majority of women who delivered preterm did not receive optimally timed ACS. Diagnostic tools that identified women at risk for preterm birth were not able to identify patients for appropriate steroid timing. Given the range of clinical scenarios in which patients are at increased risk for preterm delivery, further research is needed to assist clinicians in optimising steroid administration.