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Hensel D, Helou NE, Zhang F, Stout MJ, Raghuraman N, Friedman H, Carter E, Odibo AO, Kelly JC. The Impact of a Multidisciplinary Opioid Use Disorder Prenatal Clinic on Breastfeeding Rates and Postpartum Care. Am J Perinatol 2024; 41:884-890. [PMID: 35668653 DOI: 10.1055/s-0042-1748526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD. STUDY DESIGN This was a retrospective, matched, cohort study that included all patients who received prenatal care in a multidisciplinary, prenatal OUD clinic-Clinic for Acceptance Recovery and Empowerment (CARE)-between September 2018 and August 2020. These patients were maintained on opioid agonist therapy (OAT) throughout their pregnancy. CARE patients were matched to controls without OUD in a 1:4 ratio for mode of delivery, race, gestational age ± 1 week, and delivery date ± 6 months. The primary outcome was rate of exclusive breastfeeding at maternal discharge. Secondary outcomes included adherence with prenatal care (≥4 prenatal visits), adherence with postpartum care (≥1 postpartum visit), postpartum contraception plan prior to delivery, and type of postpartum contraceptive use. Conditional multivariate logistic regression was used to account for possible confounders in adjusted calculations. RESULTS A total of 210 patients were included (42 CARE and 168 matched controls). Despite having lower rates of adequate prenatal care, 40 CARE patients (95%) were exclusively breastfeeding at discharge resulting in CARE patients being significantly more likely to be breastfeeding at discharge (adjusted relative risk (aRR): 1.28, 95% confidence interval [CI]: 1.05-1.55). CARE patients and controls demonstrated no difference in postpartum visit compliance (86 vs. 81%, aRR: 1.03, 95% CI: 0.76-1.40) or effective, long-term contraception use (48 vs. 48%; aRR: 0.81, 95% CI: 0.36-1.84). CONCLUSION In the setting of multidisciplinary OUD prenatal care during pregnancy, patients with OUD were more likely to be breastfeeding at the time of discharge than matched controls, with no difference in postpartum visit compliance or effective, long-term contraception. KEY POINTS · Women with OUD are more likely to breastfeed when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in LARC use when engaged in a multidisciplinary prenatal clinic.. · Women with OUD had no difference in postpartum visit rate in a multidisciplinary prenatal clinic..
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Affiliation(s)
- Drew Hensel
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Nicole El Helou
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Fan Zhang
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Molly J Stout
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Nandini Raghuraman
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ebony Carter
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Anthony O Odibo
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeannie C Kelly
- Division of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Berghella V, Aviram A, Chescheir N, de Costa C, Dicker P, Goggins A, Gupta JK, D'Hooghe TM, Odibo AO, Papageorghiou A, Saade G, Geary M. Improving trustworthiness in research in women's health: A collective effort by OBGYN Editors. Aust N Z J Obstet Gynaecol 2024; 64:5-9. [PMID: 37496208 DOI: 10.1111/ajo.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amir Aviram
- Dan Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Chescheir
- Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caroline de Costa
- The Cairns Institute, James Cook University, Cairns, Queensland, Australia
| | - Patrick Dicker
- Department of Public Health & Epidemiology, RCSI, Dublin, Ireland
| | - Amy Goggins
- International Federation of Gynecology & Obstetrics, London, UK
| | - Janesh K Gupta
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Thomas M D'Hooghe
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
- Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | | | | | - George Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
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Trammel CJ, Beermann S, Goodman B, Marks L, Mills M, Durkin M, Raghuraman N, Carter EB, Odibo AO, Zofkie AC, Kelly JC. Hepatitis C and obstetrical morbidity in a substance use disorder clinic: a role for telemedicine? Am J Obstet Gynecol MFM 2024; 6:101219. [PMID: 37951578 DOI: 10.1016/j.ajogmf.2023.101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Hepatitis C infection often co-occurs with substance use disorders in pregnancy. Accessing hepatitis C treatment is challenging because of loss to follow-up in the postpartum period, attributable to social and financial barriers to care. Telemedicine has been explored as a means of increasing routine postpartum care, but the potential impact on retention in and completion of care for postpartum hepatitis C has not been assessed. OBJECTIVE This study aimed to evaluate the impact of hepatitis C on obstetrical morbidity in a substance use disorder-specific prenatal clinic, and the effect of Infectious Disease telemedicine consultation on subsequent treatment delivery. STUDY DESIGN We performed a retrospective cohort study of all patients in our substance use disorder prenatal clinic from June 2018 to February 2023. Telemedicine consults for hepatitis C diagnoses began in March 2020 and included electronic chart review by Infectious Disease when patients were unable to be seen. Our primary outcome was composite obstetrical morbidity (preterm birth, preeclampsia, fetal growth restriction, fetal anomaly, abruption, postpartum hemorrhage, or chorioamnionitis) compared between patients with and without active hepatitis C. We additionally evaluated rates of completed referral and initiation of hepatitis C treatment before and after implementation of telemedicine consult. RESULTS A total of 224 patients were included. Of the 222 patients who underwent screening, 71 (32%) were positive for active hepatitis C. Compared with patients without hepatitis C, a higher proportion of patients with hepatitis C were White (80% vs 58%; P=.02), had a history of amphetamine use (61% vs 32%; P<.01), injection drug use (72% vs 38%; P<.01), or overdose (56% vs 29%; P<.01), and were on methadone (37% vs 18%; P<.01). There was no difference in the primary outcome of composite obstetrical morbidity. The rate of hepatitis C diagnosis was not statistically significantly different between the pre- and posttelemedicine cohorts (N=29 [41%], N=42 [27%]), and demographics of hepatitis C virus-positive patients were similar, with most being unemployed, single, and publicly insured. A lower proportion of patients in the posttelemedicine group reported heroin use compared with the pretelemedicine cohort (62% vs 90%; P=.013). After implementation of telemedicine, patients were more likely to attend the visit (19% vs 44%; P=.03), and positive patients were much more likely to receive treatment (14% vs 57%; P<.01); 100% of visits in the posttelemedicine group occurred via telemedicine. There were 7 patients who were prescribed treatment by their obstetrician after chart review by Infectious Disease. CONCLUSION Patients with and without hepatitis C had similar maternal and neonatal outcomes, with multiple indicators of social and financial vulnerability. Telemedicine Infectious Disease consult was associated with increased follow-up and hepatitis C treatment, and obstetricians were able to directly prescribe. Because patients with substance use disorders and hepatitis C may have increased barriers to care, telemedicine may represent an opportunity for intervention.
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Affiliation(s)
- Cassandra J Trammel
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly).
| | - Shannon Beermann
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
| | - Bree Goodman
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
| | - Laura Marks
- Division of Infectious Disease, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO (Drs Marks and Durkin)
| | - Melissa Mills
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
| | - Michael Durkin
- Division of Infectious Disease, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO (Drs Marks and Durkin)
| | - Nandini Raghuraman
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
| | - Anthony O Odibo
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
| | - Amanda C Zofkie
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
| | - Jeannie C Kelly
- Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Drs Trammel, Beerman, and Goodman, Ms Mills, and Drs Raghuraman, Carter, Odibo, Zofkie, and Kelly)
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Berghella V, Aviram A, Chescheir N, de Costa C, Dicker P, Goggins A, Gupta JK, D'Hooghe TM, Odibo AO, Papageorghiou A, Saade G, Geary M. Improving trustworthiness in research in Women's Health: A collective effort by OBGYN Editors. Eur J Obstet Gynecol Reprod Biol 2024; 292:71-74. [PMID: 37976768 DOI: 10.1016/j.ejogrb.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Amir Aviram
- Dan Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nancy Chescheir
- Department of Obstetrics & Gynecology, University of North Carolina, USA
| | - Caroline de Costa
- The Cairns Institute, James Cook University, Cairns, Queensland, Australia
| | - Patrick Dicker
- Department of Public Health & Epidemiology, RCSI, Dublin, Ireland
| | - Amy Goggins
- International Federation of Gynecology & Obstetrics, London, UK
| | | | - Thomas M D'Hooghe
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA; Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | | | | | - George Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, USA
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
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Berghella V, Aviram A, Chescheir N, de Costa C, Dicker P, Goggins A, Gupta JK, D'Hooghe TM, Odibo AO, Papageorghiou A, Saade G, Geary M. Improving trustworthiness in research in women's health: A collective effort by OBGYN editors. Int J Gynaecol Obstet 2023; 163:715-719. [PMID: 37496157 DOI: 10.1002/ijgo.14964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amir Aviram
- Dan Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Chescheir
- Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caroline de Costa
- The Cairns Institute, James Cook University, Cairns, Queensland, Australia
| | - Patrick Dicker
- Department of Public Health & Epidemiology, RCSI, Dublin, Ireland
| | - Amy Goggins
- International Federation of Gynecology & Obstetrics, London, UK
| | - Janesh K Gupta
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Thomas M D'Hooghe
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
- Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | | | | | - George Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Michael Geary
- Department of Obstetrics & Gynaecology, The Rotunda Hospital, Dublin, Ireland
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Alameddine S, Capannolo G, Rizzo G, Khalil A, Di Girolamo R, Iacovella C, Liberati M, Patrizi L, Acharya G, Odibo AO, D'Antonio F. A systematic review and critical evaluation of quality of clinical practice guidelines on fetal growth restriction. J Perinat Med 2023; 51:970-980. [PMID: 36976902 DOI: 10.1515/jpm-2022-0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/08/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) on management fetal growth restriction (FGR). CONTENT Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR. SUMMARY Diagnostic criteria of FGR, recommended growth charts, recommendation for detailed anatomical assessment and invasive testing, frequency of fetal growth scans, fetal monitoring, hospital admission, drugs administrations, timing at delivery, induction of labor, postnatal assessment and placental histopathological were assessed. Quality assessment was evaluated by AGREE II tool. Twelve CPGs were included. Twenty-five percent (3/12) of CPS adopted the recently published Delphi consensus, 58.3% (7/12) an estimated fetal weight (EFW)/abdominal circumference (AC) EFW/AC <10th percentile, 8.3% (1/12) an EFW/AC <5th percentile while one CPG defined FGR as an arrest of growth or a shift in its rate measured longitudinally. Fifty percent (6/12) of CPGs recommended the use of customized growth charts to assess fetal growth. Regarding the frequency of Doppler assessment, in case of absent or reversed end-diastolic flow in the umbilical artery 8.3% (1/12) CPGs recommended assessment every 24-48, 16.7% (2/12) every 48-72 h, 1 CPG generically recommended assessment 1-2 times per week, while 25 (3/12) did not specifically report the frequency of assessment. Only 3 CPGs reported recommendation on the type of Induction of Labor to adopt. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 50%. OUTLOOK There is significant heterogeneity in the management of pregnancies complicated by FGR in published CPGs.
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Affiliation(s)
- Sara Alameddine
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giulia Capannolo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology Fondazione Policlinico Tor Vergata Università Roma Tor Vergata, Roma, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Raffaella Di Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
- Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy
| | | | - Marco Liberati
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Lodovico Patrizi
- Department of Obstetrics and Gynaecology Fondazione Policlinico Tor Vergata Università Roma Tor Vergata, Roma, Italy
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesco D'Antonio
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Berghella V, Aviram A, Chescheir N, de Costa C, Dicker P, Goggins A, Gupta JK, D'Hooghe TM, Odibo AO, Papageorghiou A, Saade G, Geary M. Improving trustworthiness in research in women's health: A collective effort by OBGYN Editors. BJOG 2023; 130:1293-1297. [PMID: 37496153 DOI: 10.1111/1471-0528.17588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amir Aviram
- Dan Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Chescheir
- Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caroline de Costa
- The Cairns Institute, James Cook University, Cairns, Queensland, Australia
| | - Patrick Dicker
- Department of Public Health & Epidemiology, RCSI, Dublin, Ireland
| | - Amy Goggins
- International Federation of Gynecology & Obstetrics, London, UK
| | - Janesh K Gupta
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Thomas M D'Hooghe
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
- Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | | | | | - George Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
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Hong J, Crawford K, Odibo AO, Kumar S. Risks of stillbirth, neonatal mortality, and severe neonatal morbidity by birthweight centiles associated with expectant management at term. Am J Obstet Gynecol 2023; 229:451.e1-451.e15. [PMID: 37150282 DOI: 10.1016/j.ajog.2023.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Determining the optimal time of birth at term is challenging given the ongoing risks of stillbirth with increasing gestation vs the risks of significant neonatal morbidity at early-term gestations. These risks are more pronounced in small infants. OBJECTIVE This study aimed to evaluate the risks of stillbirth, neonatal mortality, and severe neonatal morbidity by comparing expectant management with delivery from 37+0 weeks of gestation. STUDY DESIGN This was a retrospective cohort study evaluating women with singleton, nonanomalous pregnancies at 37+0 to 40+6 weeks' gestation in Queensland, Australia, delivered from 2000 to 2018. Rates of stillbirth, neonatal death, and severe neonatal morbidity were calculated for <3rd, 3rd to <10th, 10th to <25th, 25th to <90th, and ≥90th birthweight centiles. The composite risk of mortality with expectant management for an additional week in utero was compared with rates of neonatal mortality and severe neonatal morbidity. RESULTS Of 948,895 singleton, term nonanomalous births, 813,077 occurred at 37+0 to 40+6 weeks' gestation. Rates of stillbirth increased with gestational age, with the highest rate observed in infants with birthweight below the third centile: 10.0 per 10,000 (95% confidence interval, 6.2-15.3) at 37+0 to 37+6 weeks, rising to 106.4 per 10,000 (95% confidence interval, 74.6-146.9) at 40+0 to 40+6 weeks' gestation. The rate of neonatal mortality was highest at 37+0 to 37+6 weeks for all birthweight centiles. The composite risk of expectant management rose sharply after 39+0 to 39+6 weeks, and was highest in infants with birthweight below the third centile (125.2/10,000; 95% confidence interval, 118.4-132.3) at 40+0 to 40+6 weeks' gestation. Balancing the risk of expectant management and delivery (neonatal mortality), the optimal timing of delivery for each birthweight centile was evaluated on the basis of relative risk differences. The rate of severe neonatal morbidity sharply decreased in the period between 37+0 to 37+6 and 38+0 to 38+6 weeks, particularly for infants with birthweight below the third centile. CONCLUSION Our data suggest that the optimal time of birth is 37+0 to 37+6 weeks for infants with birthweight <3rd centile and 38+0 to 38+6 weeks' gestation for those with birthweight between the 3rd and 10th centile and >90th centile. For all other birthweight centiles, birth from 39+0 weeks is associated with the best outcomes. However, large numbers of planned births are required to prevent a single excess death. The healthcare costs and acceptability to women of potential universal policies of planned birth need to be carefully considered.
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Affiliation(s)
- Jesrine Hong
- Mater Research Institute, The University of Queensland, Brisbane, Australia; Mayne Medical School, The University of Queensland, Brisbane, Australia; Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kylie Crawford
- Mater Research Institute, The University of Queensland, Brisbane, Australia; Mayne Medical School, The University of Queensland, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Anthony O Odibo
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Sailesh Kumar
- Mater Research Institute, The University of Queensland, Brisbane, Australia; Mayne Medical School, The University of Queensland, Brisbane, Australia; National Health and Medical Research Council, Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
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Berghella V, Aviram A, Chescheir N, de Costa C, Dicker P, Goggins A, Gupta JK, D'Hooghe TM, Odibo AO, Papageorghiou A, Saade G, Geary M. Improving trustworthiness in research in Women's Health: A collective effort by OBGYN Editors. Am J Obstet Gynecol MFM 2023; 5:101085. [PMID: 37516647 DOI: 10.1016/j.ajogmf.2023.101085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Amir Aviram
- Dan Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nancy Chescheir
- Department of Obstetrics & Gynecology, University of North Carolina, USA
| | - Caroline de Costa
- The Cairns Institute, James Cook University, Cairns, Queensland, Australia
| | - Patrick Dicker
- Department of Public Health & Epidemiology, RCSI, Dublin, Ireland
| | - Amy Goggins
- International Federation of Gynecology & Obstetrics, London, UK
| | | | - Thomas M D'Hooghe
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA; Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | | | | | - George Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, USA
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
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Thayer SM, Faramarzi P, Krauss MJ, Snider E, Kelly JC, Carter EB, Frolova AI, Odibo AO, Raghuraman N. Heterogeneity in management of category II fetal tracings: data from a multihospital healthcare system. Am J Obstet Gynecol MFM 2023; 5:101001. [PMID: 37146688 DOI: 10.1016/j.ajogmf.2023.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Electronic fetal monitoring is widely used to identify and intervene in suspected fetal hypoxia and/or acidemia. Category II fetal heart rate tracings are the most common class of fetal monitoring in labor, and intrauterine resuscitation is recommended given the association of category II fetal heart rate tracings with fetal acidemia. However, limited published data are available to guide intrauterine resuscitation technique selection, leading to heterogeneity in the response to category II fetal heart rate tracings. OBJECTIVE This study aimed to characterize approaches to intrauterine resuscitation in response to category II fetal heart rate tracings. STUDY DESIGN This was a survey study administered to labor unit nurses and delivering clinicians (physicians and midwives) across 7 hospitals in a Midwestern healthcare system spanning 2 states. The survey posed 3 category II fetal heart rate tracing scenarios (recurrent late decelerations, minimal variability, and recurrent variable decelerations) and asked participants to select first- and second-line intrauterine resuscitation management strategies. The participants were asked to quantify the level of influence certain factors have on their choice using a scale from 1 to 5. Intrauterine resuscitation strategy selection was compared by clinical role and hospital type (nurses vs delivering clinicians and university-affiliated hospital vs non-university-affiliated hospital). RESULTS Of 610 providers invited to take the survey, 163 participated (response rate of 27%): 37% of participants from university-affiliated hospitals, 62% of nurses, and 37% of physicians. Maternal repositioning was the most selected first-line strategy, regardless of the type of category II fetal heart rate tracing. First-line management varied by clinical role and hospital affiliation for each fetal heart rate tracing scenario, particularly for minimal variability, which was associated with the most heterogeneity in the first-line approach. Previous experience and recommendations from professional societies were the most influential factors in intrauterine resuscitation selection overall. Of note, 16.5% of participants reported that published evidence did not influence their choice at all. Participants from a university-affiliated hospital were more likely than participants from a non-university-affiliated hospital to consider patient preference when selecting an intrauterine resuscitation technique. Nurses and delivering clinicians differed significantly in the rationale for management choices: nurses were more often influenced by advice from other healthcare providers on the team (P<.001), whereas delivering clinicians were more influenced by literature (P=.02) and ease of technique (P=.02). CONCLUSION There was significant heterogeneity in the management of category II fetal heart rate tracing. In addition, motivations for choice in intrauterine resuscitation technique varied by hospital type and clinical role. These factors should be considered when creating fetal monitoring and intrauterine resuscitation protocols.
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Affiliation(s)
- Sydney M Thayer
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Dr Thayer, Ms Faramarzi, and Drs Kelly, Carter, Frolova, Odibo, and Raghuraman).
| | - Parisa Faramarzi
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Dr Thayer, Ms Faramarzi, and Drs Kelly, Carter, Frolova, Odibo, and Raghuraman)
| | - Melissa J Krauss
- Brown School at Washington University in St. Louis, St. Louis, MO (Mses Krauss and Snider)
| | - Elsa Snider
- Brown School at Washington University in St. Louis, St. Louis, MO (Mses Krauss and Snider)
| | - Jeannie C Kelly
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Dr Thayer, Ms Faramarzi, and Drs Kelly, Carter, Frolova, Odibo, and Raghuraman)
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Dr Thayer, Ms Faramarzi, and Drs Kelly, Carter, Frolova, Odibo, and Raghuraman)
| | - Antonina I Frolova
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Dr Thayer, Ms Faramarzi, and Drs Kelly, Carter, Frolova, Odibo, and Raghuraman)
| | - Anthony O Odibo
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Dr Thayer, Ms Faramarzi, and Drs Kelly, Carter, Frolova, Odibo, and Raghuraman)
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO (Dr Thayer, Ms Faramarzi, and Drs Kelly, Carter, Frolova, Odibo, and Raghuraman)
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Rimsza RR, Perez M, Woolfolk C, Kelly JC, Carter EB, Frolova AI, Odibo AO, Raghuraman N. Video Instruction for Pushing in the Second Stage (VIPss): A randomized controlled trial. Am J Obstet Gynecol 2023:S0002-9378(23)00170-9. [PMID: 36940771 DOI: 10.1016/j.ajog.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/16/2023] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The second stage of labor requires active patient engagement. Prior studies suggest that coaching can influence second stage duration. However, a standardized education tool has not been established and patients face many barriers to accessing childbirth education before delivery OBJECTIVE: We investigated the effect of an intrapartum video pushing education tool on second stage duration. STUDY DESIGN This was a randomized controlled trial of nulliparous patients with singleton pregnancies ≥37 weeks admitted for induction or spontaneous labor with neuraxial anesthesia. Patients were consented on admission and block randomized in active labor to one of two arms in a 1:1 ratio. The study arm viewed a 4-minute video prior to the second stage on what to anticipate in second stage and pushing techniques. The control arm received the standard of care: bedside coaching at 10cm dilation from a nurse or physician. The primary outcome was second stage duration. Secondary outcomes were birth satisfaction (using Modified Mackey Childbirth Satisfaction Rating Scale), mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, and umbilical artery gases. 156 patients were needed to detect a 20% decrease in second stage duration with 80% power, 2-sided alpha 0.05, and 10% loss after randomization RESULTS: Of 161 patients, 81 were randomized to standard of care and 80 to intrapartum video education. Among these, 149 progressed to the second stage and were included in the intention-to-treat analysis: 69 video and 78 control. Maternal demographics and labor characteristics were similar between groups. Second stage duration was statistically similar between the video arm (61min [IQR 20-140]) and the control arm (49min [IQR 27-131]), P=0.77. There were no differences in mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, or umbilical artery gases between groups. Although the overall birth satisfaction score on the Modified Mackey Childbirth Satisfaction Rating Scale was similar between groups, patients in the video group rated their "level of comfort during birth" and "attitude of the doctors in birth" significantly higher/more positively than control patients. CONCLUSION Intrapartum video education was not associated with a shorter second stage. However, patients who received video education reported higher level of comfort and a more favorable perception of their physician, suggesting that video education may be a helpful tool to improve the birth experience.
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Affiliation(s)
- Rebecca R Rimsza
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Saint Louis, MO
| | - Marta Perez
- University of Texas at Austin, Dell School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Austin, TX
| | - Candice Woolfolk
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Saint Louis, MO
| | - Jeannie C Kelly
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Saint Louis, MO
| | - Ebony B Carter
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Saint Louis, MO
| | - Antonina I Frolova
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Saint Louis, MO
| | - Anthony O Odibo
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Saint Louis, MO
| | - Nandini Raghuraman
- Washington University in Saint Louis, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Saint Louis, MO
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12
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Price CR, Cornwall J, Daniel J, Chan M, Chrieki S, Vilchez G, Odibo AO, Duncan JR. Factors associated with cesarean delivery following labor induction in pregnancies with preterm preeclampsia. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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13
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Rimsza RR, Perez M, Kelly JC, Carter EB, Frolova AI, Hardy C, Odibo AO, Raghuraman N. Video instruction for pushing in the second stage (VIPss): a randomized controlled trial. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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14
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Trammel C, Lawlor ML, Jacobsen H, Mills M, Krauss M, Galati B, Raghuraman N, Carter EB, Odibo AO, Kelly JC. Patient satisfaction with buprenorphine or methadone for treatment of opioid use disorder during obstetric care. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rimsza RR, Kelly JC, Carter EB, Massa K, Frolova AI, Odibo AO, Raghuraman N. Do antenatal childbirth education classes improve birth satisfaction? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Trammel C, Marks LR, Beermann SE, Mills M, Raghuraman N, Carter EB, Odibo AO, Zofkie AC, Kelly JC. Treating hepatitis C in a substance use disorder prenatal clinic: can telemedicine make us better? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Burd J, Woolfolk C, Dombrowski M, Carter EB, Kelly JC, Frolova AI, Odibo AO, Cahill AG, Raghuraman N. How long is too long? Assessing risks of prolonged latent phase of labor. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Burd J, Woolfolk C, Frolova AI, Zofkie AC, Odibo AO, Carter EB, Kelly JC, Cahill AG, Raghuraman N. Interpregnancy interval in multiparas: does it impact the labor curve? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Huysman BC, Thayer SM, Kernberg A, Frolova AI, Zofkie AC, Odibo AO, Raghuraman N, Carter EB, Kelly JC. Rupture before 34 weeks: does offering expectant management beyond 34 weeks make a difference? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Huysman BC, Thayer SM, Kernberg A, Frolova AI, Rampersad RM, Odibo AO, Raghuraman N, Carter EB, Kelly JC. Shared decision-making aid to increase equity in the management of PPROM. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Lewkowitz AK, Stout MJ, Carter EB, Ware CF, Jackson TL, D'Sa V, Deoni S, Odibo AO, Gopalakrishnan R, Liu J, Rouse DJ, Auerbach M, Tuuli MG. Protocol for a multicenter, double-blinded placebo-controlled randomized controlled trial comparing intravenous ferric derisomaltose to oral ferrous sulfate for the treatment of iron deficiency anemia in pregnancy: The IVIDA2 trial. Contemp Clin Trials 2022; 123:106992. [PMID: 36368479 PMCID: PMC9729403 DOI: 10.1016/j.cct.2022.106992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iron deficiency anemia (IDA) is common during pregnancy and associated with adverse maternal and neonatal outcomes. Treatment with iron supplementation is recommended during pregnancy, but the optimal delivery route is unclear. Oral iron risks has high risk of gastrointestinal side effects and low absorption. Intravenous iron is infused directly but is expensive. The American College of Obstetricians and Gynecologists currently recommends oral iron to treat IDA in pregnancy with intravenous iron reserved as second-line therapy, if needed. This approach is associated with persistent anemia, increasing the risk of peripartum blood transfusion. We aim to provide data on optimal route of iron repletion for IDA in pregnancy. METHODS In IVIDA2, a double-blind, placebo controlled, multicenter randomized trial in the United States, 746 pregnant people with moderate-to-severe IDA (hemoglobin <10 g/dL and ferritin <30 ng/mL) at 24-28 weeks' gestation will be randomized 1:1 to either a single 1000 mg dose of intravenous ferric derisomaltose and oral placebo (1-3 times daily) or a single placebo infusion with 1-3 times daily 325 mg ferrous sulfate (65 mg elemental iron) tablet. The primary outcome is peripartum blood transfusion (blood transfusion from delivery to 7 days postpartum). Secondary outcomes include adverse medication reactions, maternal and neonatal hematologic indices, and offspring neurodevelopment. ETHICS AND DISSEMINATION A central ethical review board-Advarra-granted ethical approval (Pro00060930). Participating centers-Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of Ethics and dissemination: A central ethical review board-Advarra-granted ethical approval (Pro00060930). Participating centers-Women & Infants Hospital of Rhode Island, University of Michigan Medical Center, Washington University School of.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | - Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Ebony B Carter
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Crystal F Ware
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Tracy L Jackson
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Viren D'Sa
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Sean Deoni
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Anthony O Odibo
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Riley Gopalakrishnan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, USA; Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jingxia Liu
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Michael Auerbach
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, USA
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22
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Paul R, Raghuraman N, Carter EB, Odibo AO, Kelly JC, Foeller ME, Perez MJ. COVID Vaccine Information Sources Utilized by Female Healthcare Workers. Am J Obstet Gynecol MFM 2022; 4:100704. [PMID: 35931368 PMCID: PMC9345656 DOI: 10.1016/j.ajogmf.2022.100704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Clinical trials of the messenger RNA COVID-19 vaccines excluded individuals with active reproductive needs (attempting to conceive, currently pregnant, and/or lactating). Women comprise three-quarters of healthcare workers in the United States-an occupational field among the first to receive the vaccine. Professional medical and government organizations have encouraged shared decision-making and access to vaccination among those with active reproductive needs. OBJECTIVE This study aimed to characterize the information sources used by pregnancy-capable healthcare workers for information about the COVID-19 vaccines and to compare the self-reported "most important" source by the respondents' active reproductive needs, if any. STUDY DESIGN This was a web-based national survey of female, US-based healthcare workers in January 2021. Recruitment was done using social media and subsequent sharing via word of mouth. We classified the respondents into 6 groups on the basis of self-reported reproductive needs as follows: (1) preventing pregnancy, (2) attempting pregnancy, (3) currently pregnant, (4) lactating, (5) attempting pregnancy and lactating, and (6) currently pregnant and lactating. We provided respondents with a list of information sources (friends, family, obstetrician-gynecologists, pediatrician, news, social media, government organizations, their employer, and "other") and asked respondents which source(s) they used when looking for information about the vaccine and their most important source. We used descriptive statistics to characterize the information sources and compared the endorsement of government organizations and obstetrician-gynecologists, which were the most important information source between reproductive groups, using the chi-square test. The effect size was calculated using Cramér V. RESULTS Our survey had 11,405 unique respondents: 5846 (51.3%) were preventing pregnancy, 955 (8.4%) were attempting pregnancy, 2196 (19.3%) were currently pregnant, 2250 (19.7%) were lactating, 67 (0.6%) were attempting pregnancy and lactating, and 91 (0.8%) were currently pregnant and lactating. The most endorsed information sources were government organizations (88.7%), employers (48.5%), obstetrician-gynecologists (44.9%), and social media (39.6%). Considering the most important information source, the distribution of respondents endorsing government organizations was different between reproductive groups (P<.001); it was most common among respondents preventing pregnancy (62.6%) and least common among those currently pregnant (31.5%). We observed an inverse pattern among the respondents endorsing an obstetrician-gynecologist as the most important source; the source was most common among currently pregnant respondents (51.4%) and least common among those preventing pregnancy (5.8%), P<.001. The differences in the endorsement of social media as an information source between groups were significant but had a small effect size. CONCLUSION Healthcare workers use government and professional medical organizations for information. Respondents attempting pregnancy and those pregnant and/or lactating are more likely to use social media and an obstetrician-gynecologist as information sources for vaccine decision-making. These data can inform public health messaging and counseling for clinicians.
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Affiliation(s)
- Rachel Paul
- Divisions of Maternal-Fetal Medicine & Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (R. Paul and Drs Raghuraman, Carter, Odibo, Kelly, and Perez)
| | - Nandini Raghuraman
- Divisions of Maternal-Fetal Medicine & Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (R. Paul and Drs Raghuraman, Carter, Odibo, Kelly, and Perez)
| | - Ebony B Carter
- Divisions of Maternal-Fetal Medicine & Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (R. Paul and Drs Raghuraman, Carter, Odibo, Kelly, and Perez)
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine & Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (R. Paul and Drs Raghuraman, Carter, Odibo, Kelly, and Perez)
| | - Jeannie C Kelly
- Divisions of Maternal-Fetal Medicine & Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (R. Paul and Drs Raghuraman, Carter, Odibo, Kelly, and Perez)
| | - Megan E Foeller
- Maternal-Fetal Medicine, Saint Alphonsus Medical Center, Boise, ID (Dr Foeller)
| | - Marta J Perez
- Divisions of Maternal-Fetal Medicine & Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (R. Paul and Drs Raghuraman, Carter, Odibo, Kelly, and Perez).
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Di Girolamo R, Khalil A, Rizzo G, Capannolo G, Buca D, Liberati M, Acharya G, Odibo AO, D'Antonio F. Erratum to systematic review and critical evaluation of quality of clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. Am J Obstet Gynecol MFM 2022; 4:100683. [PMID: 35941065 PMCID: PMC9355748 DOI: 10.1016/j.ajogmf.2022.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Raffaella Di Girolamo
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Asma Khalil
- Fetal Medicine Unit, St. George's Hospital, London, United Kingdom (Dr Khalil)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, Rome, Italy (Dr Rizzo)
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Danilo Buca
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Marco Liberati
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden (Dr Acharya); Women's Health and Perinatology Research Group, Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway (Dr Acharya); Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway (Dr Acharya)
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Dr Odibo)
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio).
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Di Girolamo R, Khalil A, Rizzo G, Capannolo G, Buca D, Liberati M, Acharya G, Odibo AO, D'Antonio F. Systematic review and critical evaluation of quality of clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. Am J Obstet Gynecol MFM 2022; 4:100654. [PMID: 35504493 PMCID: PMC9057927 DOI: 10.1016/j.ajogmf.2022.100654] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically identify and critically assess the quality of clinical practice guidelines for the management of SARS-CoV-2 infection in pregnancy. DATA SOURCES Medline, Scopus, and ISI Web of Science databases were searched until February 15, 2022. STUDY ELIGIBILITY CRITERIA Inclusion criteria were clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. The risk of bias and quality assessments of the included clinical practice guidelines were performed using the Appraisal of Guidelines for REsearch and Evaluation II tool, which is considered the gold standard for quality assessment of clinical practice guidelines. To define a clinical practice guideline as of good quality, we adopted the cutoff score proposed by Amer et al: if the overall clinical practice guideline score was >60%, it was recommended. METHODS The following clinical points related to the management of pregnant women with SARS-CoV-2 infection were addressed: criteria for maternal hospitalization, recommendations for follow-up fetal growth scan, specific recommendations against invasive procedures, management of labor, timing of delivery, postpartum care, and vaccination strategy. RESULTS A total of 28 clinical practice guidelines were included. All recommended hospitalization only for severe disease; 46.1% (6/13) suggested a fetal growth scan after SARS-CoV-2 infection, whereas 23.1% (3/13) did not support this practice. Thromboprophylaxis with low-molecular-weight heparin was recommended in symptomatic women by 77.1% (7/9) of the clinical practice guidelines. None of the guidelines recommended administering corticosteroids only for the presence of SARS-CoV-2 infection in preterm gestation, unless specific obstetrical indication exists. Elective induction of labor from 39 weeks of gestation was suggested by 18.1% (2/11) of the clinical practice guidelines included in the present review, whereas 45.4% (5/11) did not recommend elective induction unless other obstetrical indications coexisted. There were 27% (3/11) of clinical practice guidelines that suggested shortening of the second stage of labor, and active pushing was supported by 18.1% (2/11). There was general agreement among the clinical practice guidelines in not recommending cesarean delivery only for the presence of maternal infection and in recommending vaccine boosters at least 6 months after the primary series of vaccination. The Appraisal of Guidelines for REsearch and Evaluation II standardized domain scores for the first overall assessment of clinical practice guidelines had a mean of 50% (standard deviation±21.82%), and 9 clinical practice guidelines scored >60%. CONCLUSION A significant heterogeneity was found in some of the main aspects of the management of SARS-CoV-2 infection in pregnancy, as reported by the published clinical practice guidelines.
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Affiliation(s)
- Raffaella Di Girolamo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, London, United Kingdom (Prof. Khalil)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, Università degli studi di Roma Tor Vergata, Roma, Italy (Prof. Rizzo)
| | - Giulia Capannolo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Danilo Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Marco Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden (Prof. Acharya); Women's Health and Perinatology Research Group, Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway (Prof. Acharya); Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway (Prof. Acharya)
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Prof. Odibo)
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio).
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Roeckner JT, Peterson E, Rizzo J, Flores-Torres J, Odibo AO, Duncan JR. The Impact of Mode of Delivery on Maternal and Neonatal Outcomes during Periviable Birth (22-25 Weeks). Am J Perinatol 2022; 39:1269-1278. [PMID: 35253122 DOI: 10.1055/a-1788-5802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of our study was to compare the maternal and neonatal complications of periviable birth by the delivery route. STUDY DESIGN A retrospective cohort study of periviable deliveries (220/7-256/7weeks) from 2013 to 2020 at a tertiary teaching institution was conducted. Deliveries were grouped by the mode of delivery. Excluded deliveries included pregnancy termination, anomaly, or undesired neonatal resuscitation. The primary composite maternal outcome included death, intensive care admission, sepsis, surgical site infection, unplanned operation, or readmission. Secondary outcomes included maternal blood loss, length of stay, neonatal survival, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and retinopathy of prematurity (ROP). Outcomes were compared using Student's t-test, Wilcoxon-Mann-Whitney and Chi-squared tests. Relative risk (RR) and 95% confidence intervals were calculated with log-binomial regression. p-Values <0.05 were considered significant. Demographic and intervention variables associated with the outcome and the exposure were included in an adjusted relative risk (aRR) model. Subgroup analyses of singleton pregnancies and 220/7 to 236/7 weeks deliveries were conducted. RESULTS After exclusion, 230 deliveries were included in the cohort. Maternal characteristics were similar between cohorts. For the primary outcome, cesarean delivery was associated with a trend toward increased maternal morbidity (22.6 vs. 10.7%, RR = 2.11 [1.03-4.43], aRR = 1.95 [0.94-4.03], p-value 0.07). Administration of magnesium sulfate, antenatal corticosteroids, and tocolytics were similar between cohorts. Neonatal survival to discharge was not different between the groups (54/83, 65.1% vs. 118/191, 61.8%, aRR = 0.93 [0.77-1.13]). Among the 172 neonates discharged alive, there was no difference in BPD, IVH, NEC, PDA, ROP, or intact survival. CONCLUSION Periviable birth has a high rate of maternal morbidity with a trend toward the highest risk among women undergoing cesarean delivery. These risks should be included in shared decision-making. KEY POINTS · Periviable birth has high maternal morbidity (19%) and is highest after cesarean delivery (23%).. · Route of delivery does not impact neonatal survival or intact neonatal survival.. · Head entrapment is rare during vaginal breech delivery..
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Affiliation(s)
- Jared T Roeckner
- Division of Maternal-Fetal Medicine, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, Florida
| | - Erica Peterson
- Division of Neonatology, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida
| | - Jennifer Rizzo
- Division of Maternal-Fetal Medicine, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, Florida
| | - Jaime Flores-Torres
- Division of Neonatology, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa, Florida
| | - Anthony O Odibo
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Jose R Duncan
- Division of Maternal-Fetal Medicine, University of South Florida Morsani College of Medicine and Tampa General Hospital, Tampa, Florida
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Ozmen A, Guzeloglu-Kayisli O, Tabak S, Guo X, Semerci N, Nwabuobi C, Larsen K, Wells A, Uyar A, Arlier S, Wickramage I, Alhasan H, Totary-Jain H, Schatz F, Odibo AO, Lockwood CJ, Kayisli UA. Preeclampsia is Associated With Reduced ISG15 Levels Impairing Extravillous Trophoblast Invasion. Front Cell Dev Biol 2022; 10:898088. [PMID: 35837332 PMCID: PMC9274133 DOI: 10.3389/fcell.2022.898088] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/06/2022] [Indexed: 01/29/2023] Open
Abstract
Among several interleukin (IL)-6 family members, only IL-6 and IL-11 require a gp130 protein homodimer for intracellular signaling due to lack of intracellular signaling domain in the IL-6 receptor (IL-6R) and IL-11R. We previously reported enhanced decidual IL-6 and IL-11 levels at the maternal-fetal interface with significantly higher peri-membranous IL-6 immunostaining in adjacent interstitial trophoblasts in preeclampsia (PE) vs. gestational age (GA)-matched controls. This led us to hypothesize that competitive binding of these cytokines to the gp130 impairs extravillous trophoblast (EVT) differentiation, proliferation and/or invasion. Using global microarray analysis, the current study identified inhibition of interferon-stimulated gene 15 (ISG15) as the only gene affected by both IL-6 plus IL-11 vs. control or IL-6 or IL-11 treatment of primary human cytotrophoblast cultures. ISG15 immunostaining was specific to EVTs among other trophoblast types in the first and third trimester placental specimens, and significantly lower ISG15 levels were observed in EVT from PE vs. GA-matched control placentae (p = 0.006). Induction of primary trophoblastic stem cell cultures toward EVT linage increased ISG15 mRNA levels by 7.8-fold (p = 0.004). ISG15 silencing in HTR8/SVneo cultures, a first trimester EVT cell line, inhibited invasion, proliferation, expression of ITGB1 (a cell migration receptor) and filamentous actin while increasing expression of ITGB4 (a receptor for hemi-desmosomal adhesion). Moreover, ISG15 silencing further enhanced levels of IL-1β-induced pro-inflammatory cytokines (CXCL8, IL-6 and CCL2) in HTR8/SVneo cells. Collectively, these results indicate that ISG15 acts as a critical regulator of EVT morphology and function and that diminished ISG15 expression is associated with PE, potentially mediating reduced interstitial trophoblast invasion and enhancing local inflammation at the maternal-fetal interface. Thus, agents inducing ISG15 expression may provide a novel therapeutic approach in PE.
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Affiliation(s)
- Asli Ozmen
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Ozlem Guzeloglu-Kayisli
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Selcuk Tabak
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Xiaofang Guo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Nihan Semerci
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Chinedu Nwabuobi
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Kellie Larsen
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Ali Wells
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Asli Uyar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Sefa Arlier
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Ishani Wickramage
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Hasan Alhasan
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Hana Totary-Jain
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Frederick Schatz
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Anthony O. Odibo
- Divisions of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - Charles J. Lockwood
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Umit A. Kayisli
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States,*Correspondence: Umit A. Kayisli,
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Hensel D, Zhang F, Carter EB, Frolova AI, Odibo AO, Kelly JC, Cahill AG, Raghuraman N. Severity of intrapartum fever and neonatal outcomes. Am J Obstet Gynecol 2022; 227:513.e1-513.e8. [PMID: 35598690 DOI: 10.1016/j.ajog.2022.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The few studies that have addressed the relationship between severity of intrapartum fever and neonatal and maternal morbidity have had mixed results. The impact of the duration between reaching maximum intrapartum temperature and delivery on neonatal outcomes remains unknown. OBJECTIVE To test the association of severity of intrapartum fever and duration from reaching maximum temperature to delivery with neonatal and maternal morbidity. STUDY DESIGN This was a secondary analysis of a prospective cohort of term, singleton patients admitted for induction of labor or spontaneous labor who had intrapartum fever (≥38°C). Patients were divided into 3 groups according to maximum temperature during labor: afebrile (<38°C), mild fever (38°C-39°C), and severe fever (>39°C). The primary outcome was composite neonatal morbidity (umbilical artery pH <7.1, mechanical ventilation, respiratory distress, meconium aspiration with pulmonary hypertension, hypoglycemia, neonatal intensive care unit admission, and Apgar <7 at 5 minutes). Secondary outcomes were composite neonatal neurologic morbidity (hypoxic-ischemic encephalopathy, hypothermia treatment, and seizures) and composite maternal morbidity (postpartum hemorrhage, endometritis, and maternal packed red blood cell transfusion). Outcomes were compared between the maximum temperature groups using multivariable logistic regression. Cox proportional-hazards regression modeling accounted for the duration between reaching maximum intrapartum temperature and delivery. RESULTS Of the 8132 patients included, 278 (3.4%) had a mild fever and 74 (0.9%) had a severe fever. The incidence of composite neonatal morbidity increased with intrapartum fever severity (afebrile 5.4% vs mild 18.0% vs severe 29.7%; P<.01). After adjusting for confounders, there were increased odds of composite neonatal morbidity with severe fever compared with mild fever (adjusted odds ratio, 1.93 [95% confidence interval, 1.07-3.48]). Severe fevers remained associated with composite neonatal morbidity compared with mild fevers after accounting for the duration between reaching maximum intrapartum temperature and delivery (adjusted hazard ratio, 2.05 [95% confidence interval, 1.23-3.43]). Composite neonatal neurologic morbidity and composite maternal morbidity were not different between patients with mild and patients with severe fevers. CONCLUSION Composite neonatal morbidity correlated with intrapartum fever severity in a potentially dose-dependent fashion. This correlation was independent of the duration from reaching maximum intrapartum temperature to delivery, suggesting that clinical management of intrapartum fever, in terms of timing or mode of delivery, should not be affected by this duration.
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Bligard KH, Cameo T, McCallum KN, Rubin A, Rimsza RR, Cahill AG, Palanisamy A, Odibo AO, Raghuraman N. The association of fetal acidemia with adverse neonatal outcomes at time of scheduled cesarean delivery. Am J Obstet Gynecol 2022; 227:265.e1-265.e8. [PMID: 35489441 DOI: 10.1016/j.ajog.2022.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fetal acidemia at the time of a scheduled cesarean delivery is generally unexpected. In the setting of reassuring preoperative monitoring, the duration of fetal acidemia in this scenario is presumably brief. The neonatal sequelae and risks associated with brief fetal acidemia in this setting are unknown. OBJECTIVE We aimed to assess whether fetal acidemia at the time of a scheduled prelabor cesarean delivery is associated with adverse neonatal outcomes. STUDY DESIGN This was a retrospective cohort study of singleton, term, nonanomalous, liveborn neonates delivered by scheduled cesarean delivery that was performed under regional anesthesia from 2004 to 2014 at a single tertiary care center with a universal umbilical cord gas policy. Neonates born to laboring gravidas and those whose cesarean delivery was performed for nonreassuring fetal status were excluded. All included patients had reassuring preoperative fetal monitoring. The primary outcome was a composite adverse neonatal outcome that included neonatal death, encephalopathy, therapeutic hypothermia, seizures, intubation, and respiratory distress. This outcome was compared between patients with and those without fetal acidemia (umbilical artery pH <7.2). A multivariable logistic regression was used to adjust for confounders. Cases of fetal acidemia were further characterized as respiratory, metabolic, or mixed acidemia based on additional umbilical cord gas values. Secondary analyses examining the association between the type of acidemia and neonatal outcomes were also performed. RESULTS Of 2081 neonates delivered via scheduled cesarean delivery, 252 (12.1%) had fetal acidemia at the time of delivery. Acidemia was more common in breech neonates and in neonates born to gravidas with obesity and gestational diabetes mellitus. Compared with fetuses with normal umbilical artery pH, those with fetal acidemia were at a significantly increased risk for adverse neonatal outcome (adjusted relative risk, 2.95; 95% confidence interval, 2.03-4.12). This increased risk was similar regardless of the type of acidemia. CONCLUSION Even a brief period of mild acidemia is associated with adverse neonatal outcomes at the time of a scheduled cesarean delivery despite reassuring preoperative monitoring. Addressing modifiable intraoperative factors that may contribute to fetal acidemia at the time of a scheduled cesarean delivery, such as maternal hypotension and prolonged operative time, is an important priority to potentially decrease neonatal morbidity in full-term gestations.
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Green CA, Adams JC, Goodnight WH, Odibo AO, Bromley B, Jelovsek JE, Stamilio DM, Venkatesh KK. Frequency and prediction of persistent urinary tract dilation in third trimester and postnatal urinary tract dilation in infants following diagnosis in second trimester. Ultrasound Obstet Gynecol 2022; 59:522-531. [PMID: 34369632 DOI: 10.1002/uog.23758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the frequency, associated characteristics and prognostic value of the current risk stratification system for prenatal urinary tract dilation (UTD) for predicting persistent UTD in the third trimester and subsequent postnatal UTD in the infant, following diagnosis in the second trimester. METHODS This was a single-institution retrospective cohort study of singleton pregnancies diagnosed with unilateral or bilateral UTD in the second trimester (before 28 weeks' gestation) with follow-up in the third trimester (at or after 28 weeks) between January 2017 and May 2019. In all cases, the prenatal diagnosis and stratification to low-risk (Grade A1) or increased-risk (Grade A2-3) UTD was made using the 2014 UTD consensus classification system. The primary outcomes included persistent prenatal UTD in the third trimester and postnatal UTD up to 6 months of age. We performed multivariable analysis to assess whether patient and second- and third-trimester sonographic characteristics (such as UTD laterality, other renal abnormality (calyceal dilation, abnormal parenchymal appearance, abnormal ureter or bladder) and anteroposterior renal pelvic diameter (AP-RPD)) were associated with the study outcomes. We assessed the predictive value of the current risk stratification system (Grade A1 vs Grade A2-3) in the second and third trimesters for persistent prenatal UTD and postnatal UTD using the area under the receiver-operating-characteristics curve (AUC). RESULTS Of 26 620 second-trimester ultrasound assessments in the study period, 347 patients were diagnosed with UTD in the second trimester and had third-trimester follow-up, of whom 150/347 (43% (95% CI, 38-49%)) had persistent UTD in the third trimester. Among the 282/347 (81%) patients with postnatal follow-up available, the frequency of postnatal UTD was 49/282 (17% (95% CI, 13-22%)), and among the subset with persistent UTD in the third trimester, the frequency of postnatal UTD was 46/102 (45% (95% CI, 35-55%)). The most frequent postnatal diagnosis was transient UTD (76%), followed by duplicated collecting system (10%). Of infants originally diagnosed with UTD in the second trimester, 2% (7/347) required surgery; stated differently, of the 49 infants with postnatal UTD, 14% (7/49) required surgery. At second-trimester diagnosis, sonographic predictors of both persistent prenatal UTD and postnatal UTD included the presence of other renal abnormality and UTD Grade A2-3. At third-trimester follow-up, predictors of postnatal UTD were larger mean AP-RPD and UTD Grade A2-3, while all cases had other renal abnormality. Second-trimester diagnosis of UTD Grade A2-3 had satisfactory discrimination for predicting persistent prenatal UTD (AUC, 0.64 (95% CI, 0.58-0.70)) and postnatal UTD (AUC, 0.72 (95% CI, 0.63-0.81)), as did third-trimester UTD Grade A2-3 for predicting postnatal UTD (AUC, 0.66 (95% CI, 0.56-0.76)). CONCLUSIONS The majority of cases of prenatal UTD did not result in postnatal UTD, and of those that did, very few required surgery. Follow-up third-trimester assessment after a second-trimester diagnosis of UTD is warranted. The current risk stratification system by UTD grade, based on the 2014 UTD consensus classification, can be used to predict postnatal UTD with fair accuracy. Further research is needed to determine whether the predictive performance of this system can be improved by incorporating additional risk factors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - J C Adams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - W H Goodnight
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - A O Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - B Bromley
- Department of Obstetrics and Gynecology and Reproductive Biology, Massachusetts General Hospital and Diagnostic Ultrasound Associates, Boston, MA, USA
| | - J E Jelovsek
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - D M Stamilio
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC, USA
| | - K K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
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Odibo AO, Kayisli U, Lu Y, Kayisli O, Schatz F, Odibo L, Chen H, Bronsteen R, Lockwood CJ. Longitudinal assessment of spiral artery and intravillous arteriole blood flow and adverse pregnancy outcome. Ultrasound Obstet Gynecol 2022; 59:350-357. [PMID: 34396628 PMCID: PMC9435956 DOI: 10.1002/uog.23760] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Superb microvascular imaging (SMI) has been shown to improve visualization of small vessels by suppressing global motions while preserving low-flow components, such as the microvessels in the placenta. We sought to determine if SMI-aided visualization of flow velocity waveforms in the spiral arteries (SA) and intravillous fetal arterioles (IVA) could predict fetal growth restriction (FGR), gestational hypertension (GH) and/or pre-eclampsia (PE). METHODS This was a prospective longitudinal study of singleton pregnancies without fetal anomaly, receiving prenatal care in one of two medical centers over a 5-year period. Using SMI-aided color Doppler, SA and IVA flow velocity was measured at three timepoints: 11 + 0 to 14 + 0, 18 + 0 to 22 + 6 and 28 + 0 to 34 + 6 weeks of gestation. SA and IVA flow velocity waveforms were reported as resistance indices (RI). RI values were analyzed using multilevel modeling; individual regression curves were estimated and combined to obtain the reference intervals for SA-RI and IVA-RI in uncomplicated pregnancies. The primary clinical outcome was FGR and secondary outcomes were PE and GH. FGR was defined as estimated fetal weight < 10th percentile. Student's t-test was used to compare deviation from expected RI between normal and complicated pregnancies. RESULTS Among 540 pregnancies included in the analysis, 18 (3.3%) had FGR, 31 (5.7%) PE and 61 (11.3%) GH. In uncomplicated pregnancies, the SA-RI decreased progressively with advancing gestation, whereas the IVA-RI increased with gestational age. In the third trimester, the mean SA-RI and IVA-RI values were significantly higher in the FGR group compared with pregnancies that did not develop FGR, while the mean SA-RI was significantly higher in PE compared with non-PE pregnancies. There was no significant difference in mean SA-RI or IVA-RI between pregnancies with vs those without GH at any gestational age. When all three adverse outcomes were combined, SA-RI was significantly higher in pregnancies with these outcomes when compared to uncomplicated pregnancies in the third trimester (mean ± SD, 0.29 ± 0.12 vs 0.26 ± 0.12; P = 0.02). In screening for FGR using SA-RI, the areas under the receiver-operating-characteristics curves (AUC) were 0.68, 0.73 and 0.73 in the first, second and third trimesters, respectively. The respective AUCs for IVA-RI were 0.72, 0.72 and 0.73 for each trimester. CONCLUSIONS SA-RI and IVA-RI, measured using SMI technology, were significantly higher in pregnancies at risk for FGR in late gestation. Larger studies are needed to determine if SA and IVA flow are reliable predictors of adverse pregnancy outcome. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A O Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - U Kayisli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - Y Lu
- Study Design and Data Analysis Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | - O Kayisli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - F Schatz
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - L Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
| | - H Chen
- Study Design and Data Analysis Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | - R Bronsteen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - C J Lockwood
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Morsani College of Medicine, Tampa, FL, USA
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Di Mascio D, Khalil A, Rizzo G, Kasprian G, Caulo M, Manganaro L, Odibo AO, Flacco ME, Giancotti A, Buca D, Liberati M, Timor-Tritsch IE, D'Antonio F. Reference ranges for fetal brain structures using magnetic resonance imaging: systematic review. Ultrasound Obstet Gynecol 2022; 59:296-303. [PMID: 34405927 DOI: 10.1002/uog.23762] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the methodology of studies reporting reference ranges for fetal brain structures on magnetic resonance imaging (MRI). METHODS MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to 31 December 2020 to identify studies investigating biometry and growth of the fetal brain and reporting reference ranges for brain structures using MRI. The primary aim was to evaluate the methodology of these studies. A list of 26 quality criteria divided into three domains, including 'study design', 'statistical and reporting methods' and 'specific aspects relevant to MRI', was developed and applied to evaluate the methodological appropriateness of each of the included studies. The overall quality score of a study, ranging between 0 and 26, was defined as the sum of scores awarded for each quality criterion and expressed as a percentage (the lower the percentage, the higher the risk of bias). RESULTS Fifteen studies were included in this systematic review. The overall mean quality score of the studies evaluated was 48.7%. When focusing on each domain, the mean quality score was 42.0% for 'study design', 59.4% for 'statistical and reporting methods' and 33.3% for 'specific aspects relevant to MRI'. For the 'study design' domain, sample size calculation and consecutive enrolment of women were the items found to be at the highest risk of bias. For the 'statistical and reporting methods' domain, the presence of regression equations for mean and SD for each measurement, the number of measurements taken for each variable and the presence of postnatal assessment information were the items found to be at the highest risk of bias. For the 'specific aspects relevant to MRI' domain, whole fetal brain assessment was not performed in any of the included studies and was therefore considered to be the item at the highest risk of bias. CONCLUSIONS Most of the previously published studies reporting fetal brain reference ranges on MRI are highly heterogeneous and have low-to-moderate quality in terms of methodology, which is similar to the findings reported for ultrasound studies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - G Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - G Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - M Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. D'Annunzio' University, Chieti, Italy
| | - L Manganaro
- Department of Radiology, Sapienza University of Rome, Rome, Italy
| | - A O Odibo
- Division of Maternal-Fetal Medicine, University of South Florida, Tampa, FL, USA
| | - M E Flacco
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - D Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - M Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - I E Timor-Tritsch
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York, NY, USA
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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El Helou N, Okuagu C, Raghuraman N, Turnbull D, Williams D, Odibo AO, Lindley KJ, Stout MJ. Postpartum Patients’ Perceived Knowledge of their Hypertensive Disease and Likelihood of Postpartum Follow-Up. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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El Helou N, Cook CR, Katherine N, Carter EB, Odibo AO, Stout MJ, Kelly JC, Raghuraman N. Impact of the COVID-19 pandemic on outpatient postpartum care utilization. Am J Obstet Gynecol 2022. [PMCID: PMC8696582 DOI: 10.1016/j.ajog.2021.11.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Thayer SM, Faramarzi P, Krauss M, Snider E, Kelly JC, Carter EB, Frolova AI, Odibo AO, Raghuraman N. A standardized protocol for management of Category II tracings: provider perceptions of benefits and barriers. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hensel DM, Zhang F, Carter EB, Frolova AI, Odibo AO, Kelly JC, Cahill AG, Raghuraman N. Severity of Intrapartum Fever and Neonatal Outcomes: What Temperature is Too High? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holroyd L, El Helou N, Raghuraman N, Carter EB, Odibo AO, Kelly JC. The impact of multiple buprenorphine induction attempts on maternal and neonatal outcomes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Odibo AO, Kayisli U, Bronsteen R, Lockwood C. Prediction of small for gestational age neonates by combining maternal risk factors with biophysical markers. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xu E, Raghuraman N, Bligard KH, Dicke J, Odibo AO, Frolova AI. Umbilical artery Doppler changes in fetal growth restriction with intermittently absent umbilical artery end-diastolic flow. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Semerci-Gunay N, Guo X, Taylor A, Ozmen A, Guzeloglu-Kayisli O, Odibo L, Lockwood C, Odibo AO, Kayisli U. Enhanced Placental Angiopoietin-like Protein 2 Levels in Fetal Growth Restriction. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Brady M, Paul R, Frolova AI, Odibo AO, Raghuraman N, Kelly JC, Carter EB. Neonatal outcomes associated with insulin infusion during labor. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kernberg A, Raghuraman N, Carter EB, Odibo AO, Perez MJ, Russell S, Holroyd L, Kelly JC. Shared Decision Making: Women Undergoing Expectant Management with Prelabor Rupture of Membranes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Watkins VY, peinan Zhao, Frolova AI, Carter EB, Kelly JC, Odibo AO, England SK, Raghuraman N. How does physical activity change throughout pregnancy? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Watkins VY, peinan Zhao, Frolova AI, Carter EB, Kelly JC, Odibo AO, England SK, Raghuraman N. The impact of physical activity during pregnancy on fetal growth. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Beermann SE, Porcelli BA, Durkin MJ, Marks LR, Raghuraman N, Carter EB, Odibo AO, Kelly JC. The impact of hepatitis C on obstetric outcomes in an opioid use disorder-specific prenatal clinic. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhong L, Ruan J, Bell L, Chery J, Iyer V, Wang V, Sun C, Craigo S, Mhatre M, House M, Peterson A, Mauban E, Wang XY, Hensel DM, Min C, Oakes MC, Raghuraman N, Carter EB, Odibo AO, Kelly JC. Differences in obstetric complications between Asian and White patients at two tertiary care centers. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Thayer SM, Faramarzi P, Krauss M, Snider E, Kelly JC, Carter EB, Frolova AI, Odibo AO, Raghuraman N. Heterogeneity in management of Category II fetal tracings: data from a multi-hospital healthcare system. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Hirshberg JS, Raghuraman N, Zhang F, Carter EB, Odibo AO, Frolova AI, Saucedo AM, Ghartey J, Harper LM, Cahill AG. To check or not to check: are intrapartum cervical exams associated with maternal fever? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Odibo AO, Sinkey RG, Zhang F, Salama N, Stout MJ, Tuuli MG, Frolova AI, Ros ST, Lockwood C. Impact of higher dose on pharmacokinetics of 17-alpha hydroxyl progesterone caproate (17OHPC) in obese women. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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El Helou N, Okuagu C, Raghuraman N, Turnbull D, Williams D, Odibo AO, Stout MJ, Lindley KJ. Patients' Perceptions of Long-Term Health Risks: Survey of Patients in a Multidisciplinary Postpartum Hypertension Clinic. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huysman BC, Odibo AO, Carter EB, Kelly JC, Frolova AI, Cahill AG, Raghuraman N. Making the diagnosis of non-reassuring fetal status: Potential for implicit bias. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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