David M Stamilio

Washington University in St. Louis, Saint Louis, MO, United States

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Publications (191)391.67 Total impact

  • David M Stamilio, Christina M Scifres
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    ABSTRACT: To estimate the association of obesity and extreme obesity with maternal complications after cesarean delivery.
    Obstetrics and gynecology. 07/2014;
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    ABSTRACT: Previous studies have shown mixed results for pregnancy outcomes after loop electrosurgical excision procedure (LEEP); however, evidence is lacking regarding the pregnancy outcome of spontaneous abortion with respect to time elapsed from LEEP to pregnancy. We investigated risks of spontaneous abortion and preterm birth as they relate to time elapsed from LEEP to pregnancy. A 10-year, multicenter cohort study of women who underwent LEEP was performed between 1996 and 2006. Trained research nurses conducted telephone interviews with all patients to complete data extraction unavailable in charts. Median time from LEEP to pregnancy for spontaneous abortion compared with no spontaneous abortion and preterm birth before 34 and before 37 weeks of gestation compared with term birth were estimated. Patients with time intervals less than 12 months compared with 12 months or more from LEEP to pregnancy were then compared with identify adjusted odds ratios for spontaneous abortion and preterm birth. Five hundred ninety-six patients met inclusion criteria. Median time from LEEP to pregnancy was significantly shorter for women with a spontaneous abortion (20 months [interquartile range 11.2-40.9] compared with 31 months [interquartile range 18.7-51.2]; P=.01) but did not differ for women with a term birth compared with preterm birth. Women with a time interval less than 12 months compared with 12 months or more were at significantly increased risk for spontaneous abortion (17.9% compared with 4.6%; adjusted odds ratio 5.6; 95% confidence interval 2.5-12.7). No increased risk was identified for preterm birth before 34 weeks of gestation or before 37 weeks of gestation. Women with a shorter time interval from LEEP to pregnancy are at increased risk for spontaneous abortion but not preterm birth. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 11/2013; · 4.80 Impact Factor
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    ABSTRACT: To estimate the utility of the fetal-pelvic index (FPI) in predicting cesarean among nulliparous and women undergoing trial of labor after cesarean (TOLAC). This prospective cohort study included subjects at 2 hospitals from the University of Pennsylvania Health system. The study sample included nulliparous women and TOLAC women, with non-anomalous pregnancies at ≥ 37 weeks of gestation in vertex presentation (n=221 and 207 respectively). FPI score was calculated using ultrasound based fetal biometric measures performed within 2 weeks of delivery and x-ray pelvimetry performed within 48 hours of delivery. Multivariable logistic regression was used to develop a clinical predictive index for cesarean delivery, including FPI and clinical factors, in nulliparous women or women attempting TOLAC. The prediction models were tested for accuracy with the area under the receiver operating characteristics (ROC) curve. Higher FPI scores was associated with greater odds of cesarean. A unit increase in FPI score increased the odds of cesarean by 15% [adjusted odds ratio (aOR): 1.15, 95% confidence interval (CI): 1.09, 1.21] for nulliparous women and 15% for TOLAC women (aOR: 1.15, 95% CI: 1.10, 1.20) after adjusting for maternal age, race, medical risk factors, and labor method. Among nulliparous women, the ROC curve analysis estimated an area under the curve of 0.88, with positive and negative predictive values of 76% and 87%, respectively. Similar findings were observed in the subgroup of TOLAC women. The FPI can accurately identify women at high risk for cesarean when combined with clinical risk factors.
    American journal of obstetrics and gynecology 06/2013; · 3.28 Impact Factor
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    ABSTRACT: OBJECTIVE: To determine whether x-ray measures of the mid-pelvis can be used to predict cesarean delivery. STUDY DESIGN: Women were enrolled prospectively and x-ray pelvimetry was performed post-partum, with readers blinded to the outcome. Groups were determined by mid-pelvis measures (transverse diameter [TD], anterior-posterior diameter [APD], and circumference [MC]) ≤10th percentile. The primary outcome was cesarean delivery. Univariable, stratified, and multivariable analyses were performed to estimate the effect of midpelvis measures on cesarean delivery. Receiver operator characteristics (ROC) curves were created to estimate the predictive value of mid-pelvis measures of cesarean delivery. RESULTS: 426 women were included. Subjects with APD or MC ≤10th percentile were at greater risk of cesarean (risk ratio (RR) for APD 4.8, 95% confidence interval (CI) 3.9-5.8, RR for MC 3.8, 95% CI 3.1-4.8). TD ≤10th percentile was not associated with an increased risk of cesarean delivery. The area under the ROC curves for APD, MC and TD were 0.88, 0.85, and 0.69, respectively (p<0.01). CONCLUSION: Simple radiographic measures of the mid-pelvis on x-ray can provide a useful adjunct to clinical information in determining who should attempt a vaginal delivery.
    American journal of obstetrics and gynecology 03/2013; · 3.28 Impact Factor
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    ABSTRACT: : To estimate whether previous loop electrosurgical excision procedure (LEEP) affects the risk of cesarean delivery. : A secondary analysis of a multicenter retrospective cohort study was performed. Women who underwent a prior LEEP were compared with two unexposed cohorts: 1) women with prior screening cervical cytology only; and 2) women with prior cervical punch biopsy. The pregnancy evaluated in this analysis was the first pregnancy of a duration more than 20 weeks of gestation after the identifying cervical procedure. Stratified and multivariable logistic regression analyses were used to control for confounding. : Five hundred ninety-eight women with prior LEEP, 588 women with screening cytology only, and 552 women with cervical biopsy were included in this study. After adjusting for relevant confounders, similar rates of cesarean delivery were seen in women with prior LEEP (31.6%) and women with prior cervical cytology only (29.3%, adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 0.79-1.41). Likewise, no differences were found in rates of cesarean delivery when women with prior LEEP were compared with those with a prior punch biopsy (29.0%, adjusted OR 0.99, 95% CI 0.74-1.33). Among women who had a cesarean delivery, arrest of labor was the indication for cesarean delivery in a similar proportion of women in the groups (LEEP compared with cytology only, P=.12; LEEP compared with biopsy, P=.50). Loop electrosurgical excision procedure specimen size did not vary by delivery mode. Length of time between LEEP and subsequent pregnancy also did not influence delivery mode. : Loop electrosurgical excision procedure does not affect mode of delivery in the subsequent pregnancy. : II.
    Obstetrics and Gynecology 01/2013; 121(1):39-45. · 4.80 Impact Factor
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    ABSTRACT: The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Margulis AV, Mitchell AA, Gilboa SM, et al; National Birth Defects Prevention Study. Use of topiramate in pregnancy and risk of oral clefts. Am J Obstet Gynecol 2012;207:405.e1-7.
    American journal of obstetrics and gynecology 11/2012; 207(5):435-6. · 3.28 Impact Factor
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    ABSTRACT: In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Margulis AV, Mitchell AA, Gilboa SM, et al; National Birth Defects Prevention Study. Use of topiramate in pregnancy and risk of oral clefts. Am J Obstet Gynecol 2012;207:405.e1-7.
    American journal of obstetrics and gynecology 11/2012; 207(5):e1-2. · 3.28 Impact Factor
  • Molly J Stout, Christina M Scifres, David M Stamilio
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    ABSTRACT: Objective: To evaluate urine protein-to-creatinine ratio (UPC) alone and with uric acid and clinical factors to predict or exclude significant proteinuria in preeclampsia evaluations. Methods: Retrospective cohort study patients undergoing evaluation for preeclampsia. Greater than 300 mg of protein in a 24-h collection was the gold standard defining proteinuria against which UPC performance was measured. Bivariable, multivariable, and Receiver Operating Characteristic Curve (ROC) analyses were performed. Sensitivity, specificity, predictive values, and likelihood ratios were calculated for multiple cut-points of UPC alone and with uric acid. Results: In a cohort of 356 patients, the area under the curve for UPC in the diagnosis of proteinuria was 0.81. No single cut-point of UPC was diagnostic of preeclampsia. UPC values ≤0.08 or ≥1.19 have useful negative or positive predictive values of 86% and 96%. Uric acid and clinical factors did not improve the detection of significant proteinuria. Conclusion: Extreme values of UPC ratio ≤0.08 or ≥1.19 have favorable predictive values, which could enable the rapid diagnosis of preeclampsia without a 24-h urine collection.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2012; · 1.36 Impact Factor
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    ABSTRACT: The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Bernard J-P, Cuckle HS, Stirnemann JJ, et al. Screening for fetal spina bifida by ultrasound examination in the first trimester of pregnancy using fetal biparietal diameter. Am J Obstet Gynecol 2012;207:306.e1-5.
    American journal of obstetrics and gynecology 10/2012; 207(4):340-1. · 3.28 Impact Factor
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    ABSTRACT: In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Bernard J-P, Cuckle HS, Stirnemann JJ, et al. Screening for fetal spina bifida by ultrasound examination in the first trimester of pregnancy using fetal biparietal diameter. Am J Obstet Gynecol 2012;207:306.e1-2.
    American journal of obstetrics and gynecology 10/2012; 207(4):e1-2. · 3.28 Impact Factor
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    ABSTRACT: OBJECTIVE: The purpose of this study was to assess whether early amniotomy reduces the duration of labor or increases the proportion of subjects who are delivered within 24 hours in nulliparous patients who undergo labor induction. STUDY DESIGN: We performed a randomized controlled trial that compared early amniotomy to standard management in nulliparous labor inductions. Inclusion criteria were nulliparity, singleton, term gestation, and a need for labor induction. Subjects were assigned randomly to early amniotomy (artificial rupture of membranes, ≤4 cm) or to standard treatment. There were 2 primary outcomes: (1) time from induction initiation to delivery and (2) the proportion of women who delivered within 24 hours. RESULTS: Early amniotomy shortens the time to delivery by >2 hours (19.0 vs 21.3 hours) and increases the proportion of induced nulliparous women who deliver within 24 hours (68% vs 56%). These improvements in labor outcomes did not come at the expense of increased complications. CONCLUSION: Early amniotomy is a safe and efficacious adjunct in nulliparous labor inductions.
    American journal of obstetrics and gynecology 08/2012; · 3.28 Impact Factor
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    ABSTRACT: We sought to characterize the labor of women attempting trial of labor after cesarean (TOLAC) who experience uterine rupture. We conducted a secondary analysis of a nested case-control study of women attempting TOLAC. Women experiencing uterine rupture (cases) were compared to 2 reference groups: successful TOLAC and failed TOLAC. Interval-censored regression was used to estimate the median time to progress 1 cm in dilation and the total time from 4-10 cm. A total of 115 cases were compared to 341 successful TOLAC and 120 failed TOLAC. The time to progress 1 cm was similar between groups until 7-cm dilation. After 7 cm, cases of uterine rupture required longer to progress than successful TOLAC (median [95th percentile] time from 7-8 cm: 0.38 [1.91] vs 0.16 [0.79] hours; from 8-9 cm: 0.28 [1.10] vs 0.10 [0.39] hours). Women with a uterine rupture had labor curves similar to those with a failed TOLAC. Women with labor dystocia in the active phase of labor should be closely monitored for uterine rupture in TOLAC.
    American journal of obstetrics and gynecology 06/2012; 207(3):210.e1-6. · 3.28 Impact Factor
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    ABSTRACT: The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Haran G, Elbaz M, Fejgin MD, et al. A comparison of surface acquired uterine electromyography and intrauterine pressure catheter to assess uterine activity. Am J Obstet Gynecol 2012;206:412.e1-5.
    American journal of obstetrics and gynecology 05/2012; 206(5):449. · 3.28 Impact Factor
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    ABSTRACT: In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Haran G, Elbaz M, Fejgin MD, et al. A comparison of surface acquired uterine electromyography and intrauterine pressure catheter to assess uterine activity. Am J Obstet Gynecol 2012;206:412.e1-5.
    American journal of obstetrics and gynecology 05/2012; 206(5):e1-2. · 3.28 Impact Factor
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    ABSTRACT: To test the hypothesis that omission of the bladder flap in primary and repeat cesarean deliveries shortens operating time without increasing intraoperative and postoperative complications. We randomized 258 women undergoing primary and repeat cesarean deliveries at 32 weeks of gestation or more to creation (n=131) or omission (n=127) of the bladder flap. Emergency cesarean deliveries, planned vertical uterine incisions, and previous abdominal surgeries besides cesarean deliveries were excluded. The primary outcome measure was total operating time. Secondary outcomes were bladder injury, incision-to-delivery time, incision-to-fascial closure time, estimated blood loss, postoperative microhematuria, postoperative pain, hospital days, endometritis, and urinary tract infection. Analysis followed the intention-to-treat principle. The median skin incision to delivery interval was shorter with omission of the bladder flap (9 [range 1-43] compared with 10 [range 2-70] minutes; P=.04), but there was no difference in total operating time (51 [range 18-124] minutes compared with 51 [range 16-178]; P=.10). No bladder injuries occurred in either group and there were no significant differences in estimated blood loss, change in hemoglobin level, postoperative microhematuria, postoperative pain, hospital days, endometritis, or urinary tract infection. Omission of the bladder flap at primary and repeat cesarean deliveries does not increase intraoperative or postoperative complications. Incision-to-delivery time is shortened but total operating time appears unchanged. ClinicalTrials.gov,www.ClinicalTrials.gov, NCT00918996. I.
    Obstetrics and Gynecology 03/2012; 119(4):815-21. · 4.80 Impact Factor
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    ABSTRACT: The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Chen Y-H, Kang J-H, Lin C-C, et al. Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 2012;206:136.e1-5. The full discussion appears at www.AJOG.org, pages e1-2.
    American Journal of Obstetrics and Gynecology. 02/2012; 206(2):176.
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    ABSTRACT: In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Chen Y-H, Kang J-H, Lin C-C, et al. Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 2012;206:136.e1-5.
    American journal of obstetrics and gynecology 02/2012; 206(2):e1-2. · 3.28 Impact Factor
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    ABSTRACT: We sought to estimate the risk of uterine rupture associated with labor induction in women attempting trial of labor after cesarean (TOLAC) accounting for length of labor. This was a nested case-control study of women attempting TOLAC within a multicenter retrospective cohort study of women with a prior cesarean. Time-to-event analyses were performed with time zero defined as the first cervical exam of 4 cm. Subjects experienced the event (uterine rupture) or were censored (delivered). In all, 111 cases of uterine rupture were compared to 607 controls. When accounting for length of labor, the risk of uterine rupture in induced labor was similar to the risk in spontaneous-onset labor (hazard ratio, 1.52; 95% confidence interval, 0.97-2.36). An initial unfavorable cervical exam was associated with an increased risk of uterine rupture compared to spontaneous (hazard ratio, 4.09; 95% confidence interval, 1.82-9.17). After accounting for labor duration, induction is not associated with an increased risk of uterine rupture in women undergoing TOLAC.
    American journal of obstetrics and gynecology 01/2012; 206(1):51.e1-5. · 3.28 Impact Factor
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    ABSTRACT: The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Quintero RA, Quintero LF, Chmait R, et al. The quantitative lung index (QLI): a gestational age-independent sonographic predictor of fetal lung growth. Am J Obstet Gynecol 2011;205:544.e1-8. The full discussion appears at www.AJOG.org, pages e1-2.
    American journal of obstetrics and gynecology 12/2011; 205(6):577. · 3.28 Impact Factor
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    ABSTRACT: We compared maternal and neonatal outcomes in women who received prophylactic antibiotics prior to skin incision to those who received antibiotics at cord clamp. We performed a randomized clinical trial at two sites. Eligible women included those undergoing nonemergency cesarean at 36 weeks' gestation or greater. Subjects were randomized (permuted blocks) into one of two treatments: "preoperative antibiotics" (cefazolin 1 g given <30 minutes prior to skin incision) or "intraoperative antibiotics" (cefazolin 1 g at cord clamping). Patients who reported an allergy to penicillin received clindamycin 900 mg. The trial primary outcome was a composite of maternal infectious morbidities, defined as having any one of the following: (1) postoperative fever (defined as oral temperature >38°C on two separate occasions more than 6 hours apart, after the initial 24-hour postoperative period); (2) wound infection (defined as purulent discharge from the incision); (3) endomyometritis (defined as fundal tenderness and fever malodorous lochia, fever); (4) urinary tract infection (defined as fever, positive urine culture). We enrolled a total of 434 subjects in this study, with 217 in each group. Overall, we found no difference in composite maternal infectious morbidity between those who received antibiotics preoperatively and those who received antibiotics at cord clamp (relative risk = 1.2, 95% confidence interval 0.7 to 1.5). Neonatal outcomes were also similar between the two intervention arms. The rate of suspected sepsis was similar between the two groups. There were no cases of antibiotic resistance in the neonates. Either preoperative antibiotic therapy or antibiotic administration after cord clamp is a reasonable clinical method for reducing the risk of postcesarean infectious morbidity.
    American Journal of Perinatology 12/2011; 29(4):273-6. · 1.57 Impact Factor

Publication Stats

1k Citations
391.67 Total Impact Points

Institutions

  • 2007–2013
    • Washington University in St. Louis
      • Department of Obstetrics and Gynecology
      Saint Louis, MO, United States
  • 2006–2012
    • University of Washington Seattle
      • • Department of Obstetrics and Gynecology
      • • Department of Pediatrics
      Seattle, WA, United States
    • Washington & Lee University
      Lexington, Virginia, United States
    • Northwestern University
      • Department of Obstetrics and Gynecology
      Evanston, IL, United States
  • 2011
    • University of Pittsburgh
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Pittsburgh, PA, United States
  • 2008
    • Saint Louis University
      • College for Public Health & Social Justice
      Saint Louis, MI, United States
  • 1999–2007
    • University of Pennsylvania
      • • Department of Medicine
      • • Department of Obstetrics and Gynecology
      • • Center for Clinical Epidemiology and Biostatistics
      Philadelphia, PA, United States
  • 1997–2005
    • Hospital of the University of Pennsylvania
      • Department of Obstetrics and Gynecology
      Philadelphia, Pennsylvania, United States