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Gulersen M, Jeganathan S, Hemphill J, Grayver E, Gajer R, Blitz MJ, Rochelson B, Pessel C. Sociodemographic risk factors associated with patient follow-up after implementation of a CardioObstetrics program. Pregnancy Hypertens 2023; 32:7-9. [PMID: 36801837 DOI: 10.1016/j.preghy.2023.02.004] [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: 12/05/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
Given the association of adverse pregnancy outcomes with risk of developing cardiovascular disease and cardiac events later in life, our institution launched a CardioObstetrics (CardioOB) program aimed to provide long-term care for patients at risk. We performed a retrospective cohort study in order to investigate which patient characteristics were associated with CardioOB follow-up following the inception of the program. We identified several sociodemographic factors and pregnancy characteristics such as increased maternal age, non-English language preferred, married marital status, referral during the antepartum period, and discharged with antihypertensive medications after delivery associated with a higher likelihood of CardioOB follow-up.
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Affiliation(s)
- Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
| | - Sumithra Jeganathan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Julie Hemphill
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Evelina Grayver
- Department of Cardiology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Reva Gajer
- Department of Cardiology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Matthew J Blitz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, South Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Bay Shore, NY, USA
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Cara Pessel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Prasannan L, Blitz MJ, Augustine S, Kohn N, Rochelson B, Pessel C. Perinatal outcome after persistence of abnormal umbilical artery Doppler indices in the growth-restricted fetus following betamethasone administration. J Matern Fetal Neonatal Med 2020; 35:3620-3625. [PMID: 33108909 DOI: 10.1080/14767058.2020.1834532] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND An optimal approach for providing sufficient antenatal surveillance for fetal growth restriction (FGR) has yet to be elucidated. Moreover, there is scant literature on the fetal response to betamethasone and its effect on fetal Dopplers. OBJECTIVE To compare persistence of umbilical artery Doppler abnormalities after corticosteroid administration and adverse perinatal outcome in growth restricted fetuses. METHODS Retrospective cohort study (2008-2018) of singleton gestations with FGR (EFW <10th percentile) and umbilical artery Doppler abnormalities (absent or reversed end diastolic velocity) between 24 and 34 weeks of gestation at two institutions. Included patients had Dopplers performed before betamethasone administration and again within 1 week. Excluded were multiple gestations, chromosomal abnormalities, fetal anomalies, or missing outcome information. Pregnancies with persistently abnormal Dopplers were compared with those in which an improvement of Dopplers was noted. The primary outcome was a composite that consisted of indicated preterm birth <32 weeks, 1 or 5 min APGAR score <7, intrauterine fetal demise, and neonatal demise. Secondary outcomes included length of NICU stay, ventilator support, gestational age at delivery, interval between steroids and delivery, and birth weight. RESULTS Fifty-three FGR pregnancies met inclusion criteria. Umbilical artery Dopplers improved after steroids in 32% (n = 17). No difference in the frequency of the primary outcome was observed between the persistently abnormal Doppler and improved Doppler groups (72.2% vs. 70.6%, respectively), and there was no difference in any of the secondary outcomes. CONCLUSIONS Perinatal outcomes in FGR pregnancies were not affected by improved versus persistently abnormal umbilical artery Dopplers after betamethasone administration.
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Affiliation(s)
- Lakha Prasannan
- Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Matthew J Blitz
- Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Stephanie Augustine
- Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Nina Kohn
- Biostatistics Unit, Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
| | - Cara Pessel
- Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, USA
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Fonteneau L, Le Meur N, Cohen-Akenine A, Pessel C, Brouard C, Delon F, Desjeux G, Durand J, Kirchgesner J, Lapidus N, Lemaitre M, Tala S, Thiébaut A, Watier L, Rudant J, Guillon-Grammatico L. [The use of administrative health databases in infectious disease epidemiology and public health]. Rev Epidemiol Sante Publique 2017. [PMID: 28624133 DOI: 10.1016/j.respe.2017.03.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The public health burden resulting from infectious diseases requires efforts in surveillance and evaluation of health care. The use of administrative health databases (AHD) and in particular the French national health insurance database (SNIIRAM) is an opportunity to improve knowledge in this field. The SNIIRAM data network (REDSIAM) workshop dedicated to infectious diseases conducted a narrative literature review of studies using French AHD. From the results, benefits and limits of these new tools in the field of infectious diseases are presented. METHODS Publications identified by the members of the workgroup were collected using an analytical framework that documented the pathology of interest, the aim of the study, the goal of the developed algorithm, the kind of data, the study period, and the presence of an evaluation or a discussion of the performance of the performed algorithm. RESULTS Fifty-five articles were identified. A majority focused on the field of vaccination coverage and joint infections. Excluding vaccine coverage field, the aim of 28 studies was epidemiological surveillance. Twenty-six studies used hospital databases exclusively, 18 used ambulatory databases exclusively and 4 used both. Validation or discussion of the performed algorithm was present in 18 studies. CONCLUSIONS The literature review confirmed the interest of the French AHD in the infectious diseases field. The AHD are additional tools of the existing surveillance systems and their use will probably be more frequent in the coming years given their advantage and reliability. However, incoming users need to be assisted. Thus, the workgroup will contribute to a reasonable use of AHD and support future developments.
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Affiliation(s)
- L Fonteneau
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | | | - A Cohen-Akenine
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Pessel
- Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Brouard
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - F Delon
- REDSIAM, groupe de travail infectieux, France; Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - G Desjeux
- REDSIAM, groupe de travail infectieux, France; Caisse nationale militaire de sécurité sociale, Toulon, France
| | - J Durand
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - J Kirchgesner
- REDSIAM, groupe de travail infectieux, France; Inserm, unité mixte de recherche en santé 1136, institut Pierre-Louis d'épidémiologie et de santé publique, Paris, France
| | - N Lapidus
- REDSIAM, groupe de travail infectieux, France; Département de santé publique, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), Sorbonne universités, UPMC université Paris 06, hôpital Saint-Antoine, AP-HP, 75000 Paris, France
| | - M Lemaitre
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - S Tala
- REDSIAM, groupe de travail infectieux, France; Département études sur l'offre de soins, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - A Thiébaut
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - L Watier
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - J Rudant
- REDSIAM, groupe de travail infectieux, France; Département études de santé publique, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - L Guillon-Grammatico
- REDSIAM, groupe de travail infectieux, France; Service d'information médicale d'épidémiologie et d'économie de la santé, unité régionale d'épidémiologie hospitalière (UREH), université F.-abelais, CHRU de Tours, 37000 Tours, France
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Drassinower D, Vink J, Pessel C, Vani K, Brubaker SG, Zork N, Ananth CV. Effect of cervical cerclage on rate of cervical shortening. Ultrasound Obstet Gynecol 2015; 46:718-723. [PMID: 25652890 DOI: 10.1002/uog.14810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/17/2014] [Revised: 01/13/2015] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Although cerclage has been shown to reduce the risk of recurrent preterm birth in a high-risk patient population, the mechanism by which this occurs is not well understood. Our objective was to evaluate whether cerclage affects the rate of cervical shortening taking into account exposure to 17-hydroxyprogesterone and vaginal progesterone. METHODS This was a retrospective cohort study of women who had serial cervical length measurements due to a history of spontaneous preterm delivery. Demographic data, obstetric history, progesterone administration, delivery information and serial cervical length measurements were collected. The rate of cervical shortening was compared in women with and without cerclage. Subgroup analyses were performed to compare rates of cervical shortening by indication for cerclage (history indicated vs ultrasound indicated) and outcome in the current pregnancy (cerclage vs no cerclage among those who delivered preterm). RESULTS A total of 414 women were included of whom 32.4% (n = 134) had a cerclage. There was no difference in the rate of cervical shortening between the cerclage (0.8 mm/week) and no-cerclage (1.0 mm/week, P = 0.43) groups. The rates of cervical shortening among history-indicated and ultrasound-indicated cerclage groups were similar (0.9 vs 1.3 mm/week, respectively, P = 0.2). Among patients with a preterm delivery in the index pregnancy, the rates of cervical shortening among those with (1.31 mm/week) and without (1.28 mm/week, P = 0.78) cerclage were also similar. CONCLUSION Cervical shortening among women with cerclage occurs at a similar rate to that among women without a cerclage, regardless of indication for cerclage or pregnancy outcome.
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Affiliation(s)
- D Drassinower
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - J Vink
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - C Pessel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - K Vani
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - S G Brubaker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - N Zork
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - C V Ananth
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
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Drassinower D, Vink J, Zork N, Pessel C, Vani K, Brubaker SG, Ananth CV. Does the rate of cervical shortening after cerclage predict preterm birth? J Matern Fetal Neonatal Med 2015; 29:2233-9. [PMID: 26373381 DOI: 10.3109/14767058.2015.1085963] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate whether the rate of cervical shortening after cerclage can predict spontaneous preterm birth (SPTB). METHODS Women who had cervical length (CL) assessments after cerclage placement were identified. The rate of cervical shortening and its relationship with SPTB was established using a generalized linear regression model. Secondary outcomes included relationship between cervical shortening and risk of SPTB in those with a post-cerclage CL <25 mm versus ≥25 mm at 18-20 weeks; and the rate of cervical shortening in women who delivered preterm compared with those who delivered at term. RESULTS One hundred thirty-four patients were included and 30 (22.4%) delivered at <36 weeks. A rate of cervical shortening of 1 mm/week conferred a risk of SPTB of 22%. Among women with cerclage who had a CL <25 mm at 18-20 weeks, 1 mm/week of cervical shortening was associated with a 59% risk of SPTB. Patients with cerclage who delivered at term had a slower rate of cervical shortening compared to those who delivered preterm (0.62 mm versus 1.40 mm per week, p = 0.008). CONCLUSIONS The rate of cervical shortening after cerclage placement is associated with the risk of SPTB. Sonographic surveillance of the rate of cervical shortening may be useful in assessing risk for SPTB in patients with cerclage.
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Affiliation(s)
- Daphnie Drassinower
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , and
| | - Joy Vink
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , and
| | - Noelia Zork
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , and
| | - Cara Pessel
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , and
| | - Kavita Vani
- b Department of Obstetrics and Gynecology , Columbia University Medical Center, New York, NY, USA , and
| | - Sara G Brubaker
- a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , and
| | - Cande V Ananth
- b Department of Obstetrics and Gynecology , Columbia University Medical Center, New York, NY, USA , and.,c Department of Epidemiology , Joseph L. Mailman School of Public Health, New York, NY, USA
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Pessel C, Merriam A, Vani K, Brubaker SG, Zork N, Zhang Y, Simpson LL, Gyamfi-Bannerman C, Miller R. Do Doppler studies enhance surveillance of uncomplicated monochorionic diamniotic twins? J Ultrasound Med 2015; 34:569-575. [PMID: 25792571 DOI: 10.7863/ultra.34.4.569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine whether isolated abnormal Doppler indices before 28 weeks predict adverse pregnancy outcomes in uncomplicated monochorionic diamniotic (MCDA) twins. METHODS A retrospective cohort study of MCDA twin pregnancies receiving antenatal testing at a single center between 2007 and 2013 was conducted. Sonographic surveillance, including Doppler velocimetric studies of the umbilical artery, ductus venosus, and middle cerebral artery of each twin, was initiated by 28 weeks and repeated at least every 2 weeks. All pregnancies were deemed "uncomplicated" at initial sonography, without evidence of polyhydramnios, oligohydramnios, intrauterine growth restriction, twin growth discordance of at least 20%, structural or chromosomal anomalies, or unclear chorionicity. Pregnancies were divided into 2 groups: those with isolated Doppler abnormalities before 28 weeks and those with normal Doppler indices. The primary outcome was a composite including twin-twin transfusion syndrome, intrauterine growth restriction of more than 1 twin, growth discordance of at least 20%, preterm delivery before 34 weeks for fetal indications, or demise of more than 1 fetus. RESULTS Ninety-six patients were included, with 22 (22.9%) having isolated Doppler abnormalities before 28 weeks. The incidence of the primary outcome did not differ between groups (36.4% versus 28.4%; P = .47). The abnormal Doppler group underwent a greater number of sonographic examinations (15 versus 10; P= .001) and more antenatal admissions for fetal concerns (50.0% versus 12.2%; P < .001). CONCLUSIONS Isolated Doppler abnormalities are commonly encountered in uncomplicated MCDA pregnancies before 28 weeks yet are not clearly predictive of twin-specific complications. Doppler abnormalities were associated with increased sonographic surveillance and antenatal hospitalizations, suggesting an influence on physician practice patterns. Data may not support Doppler studies before 28 weeks for routine MCDA twin monitoring.
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Affiliation(s)
- Cara Pessel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Audrey Merriam
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Kavita Vani
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Sara G Brubaker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Noelia Zork
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Yuan Zhang
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Lynn L Simpson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Cynthia Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
| | - Russell Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.)
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Brubaker SG, Pessel C, Zork N, Gyamfi-Bannerman C, Ananth CV. Vaginal progesterone in women with twin gestations complicated by short cervix: a retrospective cohort study. BJOG 2014; 122:712-8. [DOI: 10.1111/1471-0528.13188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- SG Brubaker
- Division of Maternal-Fetal Medicine; Columbia University; New York City NY USA
| | - C Pessel
- Division of Maternal-Fetal Medicine; Columbia University; New York City NY USA
| | - N Zork
- Division of Maternal-Fetal Medicine; Columbia University; New York City NY USA
| | - C Gyamfi-Bannerman
- Division of Maternal-Fetal Medicine; Columbia University; New York City NY USA
| | - CV Ananth
- Department of Obstetrics and Gynecology; Columbia University; New York City NY USA
- Department of Epidemiology; Columbia University; New York City NY USA
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Abstract
Maternal cardiac disease is a major cause of non-obstetric morbidity and accounts for 10-25% of maternal mortality. Valvular heart disease may result from congenital abnormalities or acquired lesions, some of which may involve more than one valve. Maternal and fetal risks in pregnant patients with valve disease vary according to the type and severity of the valve lesion along with resulting abnormalities of functional capacity, left ventricular function, and pulmonary artery pressure. Certain high-risk conditions are considered contraindications to pregnancy, while others may be successfully managed with observation, medications, and, in refractory cases, surgical intervention. Communication between the patient׳s obstetrician, maternal-fetal medicine specialist, obstetrical anesthesiologist, and cardiologist is critical in managing a pregnancy with underlying maternal cardiac disease. The management of the various types of valve diseases in pregnancy will be reviewed here, along with a discussion of related complications including mechanical prosthetic valves and infective endocarditis.
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Affiliation(s)
- Cara Pessel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W. 168th St, PH-16, New York, NY 10032..
| | - Clarissa Bonanno
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W. 168th St, PH-16, New York, NY 10032
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9
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Drassinower D, Vani K, Zork N, Pessel C, Brubaker S, Vink J. 123: Cervical length after cerclage predicts preterm birth. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.156] [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: 11/30/2022]
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10
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Običan S, Drassinower D, Zork N, Pessel C, Brubaker S, Vink J, Friedman A. 795: Clinical presentation of prior preterm delivery as a risk factor for subsequent cervical shortening. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.828] [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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11
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Pessel C, Fratto V, Laifer-Narin S, Simpson LL, Nhan-Chang CL. Going out on a limb for a difficult diagnosis: a case report. Clin Imaging 2013; 38:63-6. [PMID: 24080370 DOI: 10.1016/j.clinimag.2013.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/15/2013] [Revised: 08/01/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
Sacral tumors with fetiform features are rare and pose a diagnostic challenge to the ultrasonologist. Sacrococcygeal teratomas (SCT) and parasitic twins can have very similar sonographic features but have different implications to an affected pregnancy. While postnatal histopathology is ultimately necessary to distinguish between a SCT and a heteropagus twin, certain characteristics, such as the presence of a vertebral column and the pattern and rate of tumor growth, may be useful to guide counseling and management decisions.
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Affiliation(s)
- Cara Pessel
- Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, NY.
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Pessel C, Moni S, Zork N, Brubaker S, Vink J, Fuchs K, Nhan-Chang CL, Ananth CV, Gyamfi-Bannerman C. The effect of intramuscular progesterone on the rate of cervical shortening. Am J Obstet Gynecol 2013; 209:269.e1-7. [PMID: 23747451 DOI: 10.1016/j.ajog.2013.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/29/2013] [Accepted: 05/13/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate whether 17-alpha-hydroxyprogesterone caproate (17-OHPC) exposure is associated with the rate of cervical shortening. STUDY DESIGN Women with a history of spontaneous preterm delivery (PTD) at <37 weeks' gestation who had serial cervical length measurements (2009-2012) were identified. 17-OHPC administration and outcome data were collected. We excluded patients with multiple gestations, indicated PTDs, major fetal anomalies, cerclage, and vaginal progesterone use. The rate of cervical shortening was modeled in relation to 17-OHPC status with the use of methods for longitudinal data analysis. RESULTS Two hundred thirty-seven patients with 1171 cervical length measurements were included, of whom 184 patients (77.6%) were exposed to 17-OHPC. Gestational age, number of previous PTDs, gestational age at initiation, and interval between cervical length examinations were similar between the 2 groups, although women who were not exposed to 17-OHPC were more likely to have delivered multiples in their previous PTD (24.5% vs 4.4%; P < .01). In the entire cohort, the rate of cervical shortening was identical, regardless of 17-OHPC exposure (0.85 mm per week). Among term deliveries, the rates of cervical shortening per week, on average, were 0.9 and 0.8 mm per week among women with and without 17-OHPC, respectively (P = .76). Among preterm deliveries, the corresponding rates were 0.8 and 1.2 mm, respectively, among women with and without 17-OHPC (P = .67). CONCLUSION Cervical shortening among women with previous preterm delivery occurs at a similar rate, regardless of exposure to 17-OHPC.
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Roman AS, Pessel C, Fox N, Klauser CK, Saltzman D, Rebarber A. Vaginal fetal fibronectin as a predictor of spontaneous preterm delivery in triplet gestations. J Matern Fetal Neonatal Med 2012; 25:1921-3. [DOI: 10.3109/14767058.2012.677964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schwartz N, Mandel D, Shlakhter O, Coletta J, Pessel C, Timor-Tritsch IE, Salafia CM. Placental morphologic features and chorionic surface vasculature at term are highly correlated with 3-dimensional sonographic measurements at 11 to 14 weeks. J Ultrasound Med 2011; 30:1171-1178. [PMID: 21876086 DOI: 10.7863/jum.2011.30.9.1171] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the potential for 3-dimensional sonographic measurement of the early placenta in predicting ultimate placental morphologic features at delivery. METHODS In this prospective cohort study, we collected 3-dimensional sonographic volume sets of placentas at 11 to 14 weeks and then collected the placentas after delivery. The sonographic data were manipulated to obtain various novel measurements of early gross placental morphologic features and the umbilical cord insertion location. The placental weight, chorionic plate area, cord location, and mean chorionic vascular density were obtained from the delivered postpartum placentas. Analyses were performed to identify potential early placental characteristics that were correlated with the ultimate placental morphologic features. The placental weight, cord marginality, and mean chorionic vascular density served as the outcome measures of interest. RESULTS Measurements of the early placental volume correlated with the delivered placental weight. An irregular early placental shape, as measured by sonography, was significantly inversely correlated with placental weight (P < .05). The placental morphologic index, a measure of a flatter placenta, was inversely correlated with both the placental weight and chorionic plate area, possibly indicating the importance of placental thickness even in the first trimester before villous arborization. In addition, early sonographic measures of the location of the umbilical cord insertion were significantly correlated with the ultimate marginality of the cord insertion as well as the mean chorionic vascular density (P < .05). CONCLUSIONS Many important ultimate placental morphologic features are likely predetermined early in pregnancy. Three-dimensional sonography may play an increasing role in the in utero evaluation of the early placenta.
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Affiliation(s)
- Nadav Schwartz
- Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, 3400 Spruce St, 2000 Courtyard, Philadelphia, PA 19104, USA.
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Roman A, Pessel C, Fox N, Klauser C, Saltzman D, Rebarber A. 463: Fetal fibronectin as a predictor of spontaneous preterm birth in triplet gestations. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.482] [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: 11/30/2022]
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Schwartz N, Pessel C, Coletta J, Krieger AM, Timor-Tritsch IE. Early biometric lag in the prediction of small for gestational age neonates and preeclampsia. J Ultrasound Med 2011; 30:55-60. [PMID: 21193705 DOI: 10.7863/jum.2011.30.1.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes. METHODS In this retrospective cohort study, the crown-rump length at 11 to 14 weeks and the head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, transverse cerebellar diameter, and estimated fetal weight at 18 to 24 weeks were converted to an estimated gestational age using published regression formulas. Sonographic fetal growth (difference between each biometric gestational age and the crown-rump length gestational age) minus expected fetal growth (number of days elapsed between the two scans) yielded the biometric growth lag. These lags were tested as predictors of small for gestational age (SGA) neonates (≤10th percentile) and preeclampsia. RESULTS A total of 245 patients were included. Thirty-two (13.1%) delivered an SGA neonate, and 43 (17.6%) had the composite outcome. The head circumference, biparietal diameter, abdominal circumference, and estimated fetal weight lags were identified as significant predictors of SGA neonates after adjusted analyses (P < .05). The addition of either the estimated fetal weight or abdominal circumference lag to maternal characteristics alone significantly improved the performance of the predictive model, achieving areas under the curve of 0.72 and 0.74, respectively. No significant association was found between the biometric lag variables and the development of preeclampsia. CONCLUSIONS Routinely available biometric data can be used to improve the prediction of adverse outcomes such as SGA. These biometric lags should be considered in efforts to develop screening algorithms for adverse outcomes.
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Affiliation(s)
- Nadav Schwartz
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Schwartz N, Coletta J, Pessel C, Feng R, Timor-Tritsch IE, Parry S, Salafia CN. Novel 3-dimensional placental measurements in early pregnancy as predictors of adverse pregnancy outcomes. J Ultrasound Med 2010; 29:1203-1212. [PMID: 20660454 DOI: 10.7863/jum.2010.29.8.1203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We sought to determine whether novel approaches to volumetric assessment of the early placenta can yield significant predictors of adverse outcome. METHODS We measured placental volume (PV) at 11 to 14 weeks using virtual organ computer-aided analysis and normalized the PV to the crown-rump length (CRL) to yield the placental quotient (PQ = PV/CRL). We also calculated the mean placental diameter (MPD) from 4 measurements taken at 45 degrees intervals to serve as a surrogate for the fetal-maternal surface area. On the fetal side, the distance from the cord insertion (CI) to the placental margin was measured every 45 degrees. Mean cord distance (MCD) is proposed as a novel descriptor of the chorionic plate and CI. Sonographic variables were analyzed as predictors of a composite adverse pregnancy outcome (COMP = small for gestational age [SGA], preeclampsia, spontaneous preterm birth, or neonatal intensive care unit admission). RESULTS A total of 135 patients were included, and 40 (29.6%) had an adverse outcome. The mean PQ (P = .02) and MCD (P = .02) were significantly lower in patients with COMP, although MPD was not significantly different (P = .26). A PQ of less than 1.00 (relative risk [RR], 2.3 [95% confidence interval, 1.4-2.7]) and an MCD of less than 4.00 cm (RR, 1.8 [1.1-2.9]) conferred an increased risk for COMP. Prediction models adjusting for parity and race yielded favorable characteristics [PV: area under the curve [AUC], 0.796; P = .04; PQ: AUC, 0.802; P = .03; MCD: AUC, 0.800; P = .04; and MPD: AUC, 0.782; P = .07). Secondary models targeting SGA as the sole outcome also showed excellent prediction (PV: AUC, 0.820; PQ: AUC, 0.810; MCD: AUC, 0.827; and MPD: AUC, 0.795). CONCLUSIONS In addition to volume, 3-dimensional sonography allows for novel techniques to measure other aspects of gross placental morphologic characteristics and CI, which can yield promising biologically plausible early predictors of fetal growth and adverse perinatal outcome.
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Affiliation(s)
- Nadav Schwartz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Schwartz N, Coletta J, Srinivas S, Pessel C, Timor IE, Parry S, Salafia C. 366: Placental volume measurements early in pregnancy predict adverse perinatal outcomes. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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