Dwight J Rouse

University of Alabama at Birmingham, Birmingham, Alabama, United States

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Publications (256)1463.74 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe recent maternal and neonatal delivery outcomes among women with a morbidly adherent placenta in major centers across the United States. This study reviewed a cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011 from the Assessment of Perinatal EXcellence data set. All cases of morbidly adherent placenta were identified. Maternal demographics, procedures undertaken, and maternal and neonatal outcomes were analyzed. There were 158 women with a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866). Eighteen percent of women with a morbidly adherent placenta were nulliparous and 37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a morbidly adherent placenta before delivery. Women with a prenatally suspected morbidly adherent placenta experienced large blood loss (33%), hysterectomy (92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%, respectively, in those not suspected prenatally to have a morbidly adherent placenta (P<.05 for all). Eighteen percent of women with a morbidly adherent placenta were nulliparous. Half of the morbidly adherent placenta cases were suspected before delivery and outcomes were poorer in this group, probably because the more clinically significant morbidly adherent placentas are more likely to be suspected before delivery. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 03/2015; 125(3):1. · 4.37 Impact Factor
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    ABSTRACT: To compare the rates of neonatal morbidity and cerebral palsy among preterm neonates (less than 37 weeks of gestation) delivered by cesarean for a nonreassuring fetal heart rate (FHR) tracing compared with those who did not. This was a secondary analysis of a multicenter randomized trial of MgSO4 for the prevention of cerebral palsy. Newborns of women delivered by cesarean delivery for nonreassuring FHR were compared with a control group composed of the offspring of women who labored for 2 hours or longer but did not undergo cesarean delivery for nonreassuring FHR regardless of the mode of delivery. Using multivariable analysis to adjust for potential confounders, our objective was to compare two outcomes: 1) composite neonatal morbidity (Apgar score 3 or less at 5 minutes, seizure, sepsis, necrotizing enterocolitis grade II or III, intraventricular hemorrhage grade III or IV, or death before discharge) and 2) neurologic injury (cerebral palsy) at 2 years or more of corrected age between the groups. Of the 1,291 preterm neonates who met the inclusion criteria, 177 (14%) were delivered by cesarean for nonreassuring FHR compared with 1,114 (86%) in the control group. Composite neonatal morbidity was similar between the groups (30.5 compared with 22.2%, adjusted odds ratio [OR] 1.4, 95% confidence interval [CI] 0.9-2.1). The rate of cerebral palsy of any severity (8.3 compared with 4.0%, adjusted OR 2.3, 95% CI 1.2-4.5) and moderate-to-severe cerebral palsy at 2 years of corrected age (6.0 compared with 2.2%, adjusted OR 3.2, 95% CI 1.4-7.1) was significantly higher in children born through cesarean delivery for nonreassuring FHR. Nonreassuring fetal tracing deemed so serious as to require cesarean delivery is associated with an increased risk of cerebral palsy in preterm neonates. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 03/2015; 125(3):1. · 4.37 Impact Factor
  • Maureen S Hamel, Brenna L Hughes, Dwight J Rouse
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    ABSTRACT: Oxygen is frequently administered to women in labor in the hope of improving fetal status. However there is a paucity of outcome data to support this practice. Although maternal oxygen administration may make physiologic sense, unwarranted faith in maternal oxygen therapy may delay indicated intervention or result in continued labor stimulation when neither is in the best interests of the fetus. A properly designed clinical trial would help answer whether maternal oxygen supplementation in labor should be considered an indicated intervention for non-reassuring fetal status. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; · 3.97 Impact Factor
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    ABSTRACT: To evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes. Cohort study of a random sample of deliveries performed at 25 hospitals over three years. Condition-specific protocols were collected from all hospitals and categorized independently by two authors. Data on maternal and neonatal outcomes, as well as data necessary for risk adjustment were collected. Risk-adjusted outcomes were compared according to whether the patient delivered in a hospital with condition-specific obstetric protocols at the time of delivery. Hemorrhage-specific protocols were not associated with a lower rate of postpartum hemorrhage or with fewer cases of EBL >1000cc. Similarly, in the presence of a shoulder dystocia protocol, there were no differences in the frequency of shoulder dystocia or number of shoulder dystocia maneuvers used. Conversely, preeclampsia-specific protocols were associated with fewer ICU admissions (OR 0.28, 95% CI 0.18-0.44) and fewer cases of severe maternal hypertension (OR 0.86, 95% CI 0.77-0.96). The presence of condition-specific obstetric protocols was not consistently shown to be associated with improved risk-adjusted outcomes. Our study would suggest that the presence or absence of a protocol does not matter and regulations to require protocols are not fruitful. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; · 3.97 Impact Factor
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    ABSTRACT: Objective This study aims to determine whether there is a threshold 3-hour oral glucose tolerance test (OGTT) value associated with accelerated risk of adverse pregnancy outcomes. Study Design In a secondary analysis of a cohort of women with untreated mild gestational glucose intolerance, we used generalized additive models with smoothing splines to explore nonlinear associations between each of the 3-hour OGTT values (fasting, 1-hour, 2-hour, and 3-hour) and adverse pregnancy outcomes, including the study's composite outcome (perinatal mortality, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/or birth trauma), large for gestational age birth weight, small for gestational age birth weight, shoulder dystocia, neonatal hypoglycemia, gestational hypertension (gHTN), and preeclampsia. Results Among the 1,360 eligible women, each timed OGTT value was linearly associated with increased odds of composite adverse outcome. We found evidence of a departure from linearity only for the association between fasting glucose and gHTN/preeclampsia, with a stronger association for values of 85 to 94 mg/dL (p = 0.03). We found no evidence of departure from linearity for any other OGTT values and measured outcomes (all chi-square test p-values ≥ 0.05). Conclusion In a population of untreated women with mild gestational glucose intolerance and fasting OGTT < 95 mg/dL, we found an increasing risk of gHTN with a fasting glucose between 85 and 94 mg/dL. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Perinatology 01/2015; · 1.57 Impact Factor
  • Dwight J Rouse
    Obstetrics and gynecology. 01/2015;
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    ABSTRACT: Objective This study aims to assess the risk of morbidity associated with maternal lactic acid concentration in women with possible sepsis in pregnancy. Study Design Retrospective cohort of pregnant and postpartum patients with signs of sepsis. Morbidity outcomes were compared by lactic acid concentration. Linear regression was used to evaluate the association between lactic acid and adverse outcomes. Results Out of the 850 women included, 159 had lactic acid measured. Patients with lactic acid measured had higher morbidity: positive blood cultures (16.8 vs. 5.5%, p = 0.04), admission to the intensive care unit (5 vs. 0.1%, p < 0.01) or acute monitoring unit (17.2 vs. 0.9%, p < 0.01), longer hospital stay (median 3 vs. 2 days, p < 0.01), and preterm delivery (18.3 vs. 10.9%, p = 0.05). The mean lactic concentration was higher in patients admitted to the intensive care (2.6 vs. 1.6 mmol/L, p = 0.04) and telemetry unit (2.0 vs. 1.6, p = 0.03), and in those with positive blood cultures (2.2 vs. 1.6, p < 0.01). Lactic acid was positively associated with intensive care or telemetry unit admission, adjusted odds ratio per 1 mmol/L increase in lactic acid 2.34 (95% confidence interval, 1.33-4.12). Conclusion Elevated lactic acid in pregnancy is associated with adverse maternal outcomes from presumed sepsis. In this cohort, lactic acid measurement was a marker of more severe infection. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Perinatology 12/2014; · 1.57 Impact Factor
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    ABSTRACT: To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis. © 2013 by the American Institute of Ultrasound in Medicine.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2014; 33(12):2187-92. · 1.53 Impact Factor
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    ABSTRACT: To evaluate whether treatment of mild gestational diabetes mellitus (GDM) confers sustained offspring health benefits, including a lower frequency of obesity. Follow-up study of children (ages 5-10) of women enrolled in a multicenter trial of treatment versus no treatment of mild GDM. Height, weight, blood pressure, waist circumference, fasting glucose, fasting insulin, triglycerides, and HDL cholesterol were measured. Five hundred of 905 eligible offspring (55%) were enrolled. Maternal baseline characteristics were similar between the follow-up treated and untreated groups. The frequencies of BMI ≥95th (20.8% and 22.9%) and 85th (32.6% and 38.6%) percentiles were not significantly different in treated versus untreated offspring (P = 0.69 and P = 0.26). No associations were observed for BMI z score, log waist circumference, log triglycerides, HDL cholesterol, blood pressure, or log HOMA estimated insulin resistance (HOMA-IR). The effect of treatment was different by sex for fasting glucose and log HOMA-IR (P for interaction = 0.002 and 0.02, respectively) but not by age-group (5-6 and 7-10 years) for any outcomes. Female offspring of treated women had significantly lower fasting glucose levels. Although treatment for mild GDM has been associated with neonatal benefits, no reduction in childhood obesity or metabolic dysfunction in the offspring of treated women was found. However only female offspring of women treated for mild GDM had lower fasting glucose. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes Care 11/2014; · 8.57 Impact Factor
  • Maureen S Hamel, Brenna L Hughes, Dwight J Rouse
    American journal of obstetrics and gynecology. 11/2014;
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    ABSTRACT: Objective This study aims to evaluate whether magnesium sulfate administration for neuroprotection prolongs latency in women with preterm premature rupture of membranes (PPROM) between 24 and 31(6/7) weeks' gestation. Study Design This is a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Gravid women with a singleton pregnancy between 24 and 31(6/7) weeks' gestation with PPROM without evidence of labor were randomized to receive magnesium sulfate, administered intravenously as a 6-g bolus followed by a constant infusion of 2 g per hour up to 12 hours, or placebo. Maternal outcomes for this analysis were delivery in less than 48 hours and in less than 7 days from randomization. Neonatal outcomes included a composite of respiratory distress syndrome, interventricular hemorrhage grades 3 or 4, periventricular leukomalacia, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Results A total of 1,259 women were included. The rate of delivery < 48 hours was not different in the magnesium sulfate and the placebo groups (22.2 and 20.7%, p = 0.51). Delivery < 7 days was similar between groups (55.4 and 51.4%, p = 0.16). Median latency was also similar between groups (median [interquartile range], 6.0 days [range, 2.4-13.8 days] and 6.6 days [range, 2.4-15.1 days], p = 0.29). Composite neonatal outcomes did not differ between groups. Conclusion Magnesium sulfate administration given for neuroprotection in women with a singleton gestation with PPROM and without labor before 32 weeks does not impact latency.
    American Journal of Perinatology 09/2014; · 1.57 Impact Factor
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    ABSTRACT: To evaluate the association of duration of magnesium sulfate infusion with stillbirth or death, cerebral palsy, and select adverse maternal and neonatal outcomes.
    Obstetrics and Gynecology 09/2014; · 4.37 Impact Factor
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    ABSTRACT: To use decision analysis to evaluate whether and under what conditions routine setup of intraoperative cell salvage during cesarean delivery is cost-saving.
    Obstetrics and Gynecology 09/2014; · 4.37 Impact Factor
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    ABSTRACT: Objective To evaluate inadequate gestational weight gain and fetal growth among overweight and obese women (O/O). Study Design Analysis of prospective singleton term pregnancies in which 1053 O/O gained greater (14.4± 6.2 kg) or 188 who either lost or gained <5 kg (1.1± 4.4 kg). Birth weight, fat(FM) and lean mass (LM) were assessed using anthropometry. Small for gestational age (SGA) was defined as < 10thpercentile of a standard US population. Univariable and multivariable analysis evaluated the association between weight change and neonatal morphometry. Results There was no significant difference in age, race, smoking, parity, or gestational age between groups. Weight loss or gain ≤ 5 kg was associated with SGA, 18/188 (9.6%) vs. 51/1053 (4.9%); (adjusted OR 2.6, 95% CI 1.4, 4.7; p=0.003). Neonates of women who lost or gained ≤ 5 kg had lower birth weight (3258 ± 443 g vs. 3467 ± 492g, p<0.0001), FM (403±175 vs. 471 ± 193g, p<0.0001), LM (2855±321 vs. 2995 ± 347g, p<0.0001) and smaller length, %FM and head circumference (HC). Adjusting for diabetic status, pre-pregnancy BMI, smoking, parity, study site, gestational age and gender; neonates of women who gained ≤ 5 kg had significantly lower birth weight, LBM, FM, %FM, HC and length. There were no significant differences in neonatal outcomes between those who lost weight and those who gained < 5 kg. Conclusion In O/O weight loss or gain < 5 kg is associated with increased risk of SGA and decreased neonatal FM, LM and HC.
    American journal of obstetrics and gynecology 08/2014; · 3.97 Impact Factor
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    ABSTRACT: Objective To determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care. Study Design The Assessment of Perinatal EXcellence (APEX) cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and the obstetric care provided. Results 115,502 women were included in the study. For most outcomes, between 20 and 40% of hospital differences in outcomes were related to differences in patient populations. After controlling for patient-, provider- and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes, but these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, between 50 and 100% of the inter-hospital variation in outcomes was unexplained. Conclusion Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.
    American journal of obstetrics and gynecology 08/2014; · 3.97 Impact Factor
  • Danielle Dray, Joshua D Dahlke, Dwight J Rouse
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    ABSTRACT: Solid pseudopapillary pancreatic tumor is a rare tumor affecting young women. Case reports have presented pregnancy outcomes after pancreaticoduodenectomy (Whipple procedure) in pregnancy for this neoplasm. We report a case of a woman who underwent a preconception Whipple procedure for a solid pseudopapillary pancreatic tumor who experienced recurrent pancreatitis confined to pregnancy.
    Obstetrics and Gynecology 07/2014; · 4.37 Impact Factor
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    ABSTRACT: To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes (PROM) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to 2 years of age.
    Obstetrics and Gynecology 07/2014; · 4.37 Impact Factor
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    ABSTRACT: Objective To test whether elevated umbilical cord serum inflammatory cytokine levels predicted subsequent cerebral palsy (CP) or neurodevelopmental delay (NDD). Study Design Nested case-control analysis within a clinical trial of antenatal magnesium sulfate (MgSO4) before anticipated preterm birth (PTB) for prevention of CP, with evaluation of surviving children at the age of 2. NDD was defined as a Bayley psychomotor developmental index (PDI) and/or mental developmental index (MDI) < 70. Controls, defined as surviving children without CP and with Bayley PDI and MDI ≥ 85, were matched by race and gestational age. Cord serum was analyzed for interleukin-8 (IL-8) interleukin-1 beta (IL-1β), and tumor necrosis factor-α (TNF-α) levels. Elevated cytokine levels were defined as ≥ 75th percentile in placebo-exposed controls. Analyses compared case/control cytokine levels, adjusting for MgSO4 exposure, gestational age, race/ethnicity, and sociodemographic differences. Results Logistic regression analysis with 339 cases and 276 controls showed that elevated IL-8 and IL-1β were more common in cord blood serum from infants with subsequent low MDI as compared with controls. After adjusting for additional confounders, the significant differences were no longer evident. Cytokine levels (IL-8, IL-1β, and TNF-α) were not elevated with CP or low PDI. Conclusion Cord serum IL-8, IL-1β, and TNF-α levels in preterm infants are not associated with subsequent CP or NDD.
    American Journal of Perinatology 06/2014; · 1.57 Impact Factor
  • Lindsay Maggio, Dwight J Rouse
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    ABSTRACT: Progestogens are a promising treatment in the prevention of spontaneous preterm birth in high-risk women. In women with a prior history of spontaneous preterm delivery and in women with a sonographic shortened cervix, there is considerable evidence supporting a benefit of progestogen therapy in the reduction of preterm delivery. In women with multifetal gestations, progestogen therapy has not been shown to be beneficial. Data are inconclusive in women with arrested preterm labor. Questions remain about the mechanism of progestogen action, the optimal type of progestogen, the best mode of administration, and the ideal dosing regimen.
    Clinical Obstetrics and Gynecology 06/2014; · 1.53 Impact Factor
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    ABSTRACT: Objective The objective of the article is to describe latency for patients with preterm premature membrane rupture (PPROM) between 240/7 and 316/7 weeks' gestation. Study Design Secondary analysis of data collected prospectively in a multicenter clinical trial of magnesium sulfate for cerebral palsy prevention. Women with PPROM and fewer than six contractions per hour at enrollment who were candidates for expectant management (n = 1,377) were included in this analysis. Length of latency was calculated in days by subtracting the time of delivery from the time of membrane rupture. Results At each week of gestation, median latency between 24 and 28 weeks was similar at approximately 9 days, but it was significantly shorter with PPROM at 29, 30, and 31 weeks (p < 0.001). In addition, the percentage of patients remaining undelivered at 7 days and 14 days was similar for PPROM between 24 and 28 weeks, but it decreased significantly after that. For each gestational age, the proportion of patients remaining pregnant declined in a fashion similar to an exponential pattern. Conclusion Median latency after PPROM is similar from 24 to 28 weeks' gestation, but it shortens with PPROM at and after 29 weeks.
    American Journal of Perinatology 05/2014; · 1.57 Impact Factor

Publication Stats

5k Citations
1,463.74 Total Impact Points

Institutions

  • 1993–2015
    • University of Alabama at Birmingham
      • • Department of Obstetrics and Gynecology
      • • Division of Women´s Reproductive Healthcare
      Birmingham, Alabama, United States
  • 2011–2014
    • Brown University
      • • Division of General Internal Medicine
      • • Department of Obstetrics and Gynecology
      Providence, Rhode Island, United States
    • Alpert Medical School - Brown University
      • Department of Obstetrics and Gynecology
      Providence, Rhode Island, United States
    • University of North Carolina at Chapel Hill
      • Department of Pediatrics
      Chapel Hill, NC, United States
  • 2013
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
  • 2011–2013
    • Women & Infants Hospital
      Providence, Rhode Island, United States
  • 2003–2013
    • George Washington University
      • Biostatistics Center
      Washington, Washington, D.C., United States
  • 2012
    • Society for Maternal-Fetal Medicine
      Detroit, Michigan, United States
    • University of Texas Medical Branch at Galveston
      • Department of Obstetrics and Gynecology
      Galveston, TX, United States
  • 2010–2012
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Роквилл, Maryland, United States
    • Wake Forest University
      Winston-Salem, North Carolina, United States
    • Aga Khan University Hospital, Karachi
      Kurrachee, Sindh, Pakistan
  • 2009–2012
    • University of Pittsburgh
      • • Department of Obstetrics, Gynecology and Reproductive Sciences
      • • Division of General Obstetrics and Gynecology
      Pittsburgh, PA, United States
    • Oregon Health and Science University
      • Department of Obstetrics & Gynecology
      Portland, OR, United States
    • Medical University of South Carolina
      • Department of Obstetrics and Gynecology
      Charleston, SC, United States
  • 2007–2012
    • Columbia University
      • Department of Obstetrics and Gynecology
      New York City, NY, United States
    • National Institute of Child Health and Human Development
      Maryland, United States
    • Aga Khan University, Pakistan
      Kurrachee, Sindh, Pakistan
  • 2006–2012
    • Northwestern University
      • Department of Obstetrics and Gynecology
      Evanston, IL, United States
    • Case Western Reserve University
      Cleveland, Ohio, United States
    • Drexel University College of Medicine
      • Department of Obstetrics and Gynecology
      Philadelphia, PA, United States
  • 2006–2011
    • The Ohio State University
      • Department of Obstetrics and Gynecology
      Columbus, OH, United States
    • University of Utah
      • Department of Obstetrics and Gynecology
      Salt Lake City, UT, United States
  • 2005–2011
    • University of Texas Southwestern Medical Center
      • • Department of Pediatrics
      • • Department of Obstetrics and Gynecology
      Dallas, TX, United States
  • 2009–2010
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
  • 2007–2010
    • Wayne State University
      • Department of Obstetrics and Gynecology
      Detroit, MI, United States
  • 2006–2010
    • Kaiser Permanente
      Oakland, California, United States
  • 2008
    • University of Houston
      Houston, Texas, United States
  • 1990–2003
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States