{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T23:07:37Z","timestamp":1788908857782,"version":"build-2803163510"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To describe a maternal\u2013fetal medicine (MFM)\u2013led, protocolized, integrated care model in which subspecialists serve as system-level clinical governors, and to present associated outcomes relative to regional, national, and published benchmarks and existing maternity care models.<\/jats:p>\n                  <jats:p>We conducted a single-system descriptive analysis of a moderately sized, integrated, MFM-led women's health organization with more than 3,500 annual deliveries during 2024\u20132025. Outcomes were evaluated across five domains: preterm birth (PTB) prevention, low-risk cesarean reduction, diabetes management, maternal opioid use disorder (OUD), and low-dose aspirin (LDASA) use for preeclampsia prevention. Performance was compared with Clark County, Nevada, national, and literature-based benchmarks, and the organizational structure with existing maternity care models.<\/jats:p>\n                  <jats:p>The PTB rate was 10.0%, compared with 11.4% in Clark County. The nulliparous, term, singleton, vertex cesarean rate was 24.6%, compared with 28.5% in Clark County; the Society for Maternal Fetal Medicine (SMFM) cesarean rate was 12.0%, compared with 16.7% in Nevada. Self-monitored blood glucose adherence was 96% versus 68% nationally. Pharmacologic treatment for neonatal opioid withdrawal syndrome was 11.1%, versus published rates of 50 to 85%. LDASA self-reported use reached 95% among eligible patients. Applying published per-case costs, estimated annual savings from PTB prevention and low-risk cesarean reduction were $4.03 million. Unlike other models, this architecture places MFM subspecialists in system-level governance roles, designing and disseminating protocols across all obstetric provider types while integrating high- and low-risk care.<\/jats:p>\n                  <jats:p>This community-based model operationalizes the SMFM call for a transformed maternity care team by combining subspecialist governance with multi-domain protocol implementation. It is designed to identify and treat at-risk patients before progression to high-risk status and adverse outcomes.<\/jats:p>","DOI":"10.1055\/a-2949-9626","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:04:31Z","timestamp":1788390271000},"source":"Crossref","is-referenced-by-count":0,"title":["Transforming Obstetric Care Through an MFM-led Architectural System: A Proposed Model for High-value Care"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5052-639X","authenticated-orcid":false,"given":"Brian K.","family":"Iriye","sequence":"additional","affiliation":[{"name":"High Risk Pregnancy Center, Hera Womens Health, Nevada, United States","place":["Las Vegas"],"department":["Maternal Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manijeh K.","family":"Kamyar","sequence":"additional","affiliation":[{"name":"High Risk Pregnancy Center, Hera Womens Health, Nevada, United States","place":["Las Vegas"],"department":["Maternal Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1377\/hlthaff.2012.1030","article-title":"Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues","volume":"32","author":"K B Kozhimannil","year":"2013","journal-title":"Health Aff (Millwood)"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/j.ajog.2006.03.013","article-title":"Is there a useful cesarean birth measure? 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