Marshall Carpenter

Publications (57)498.06 Total impact

• Article: Risk of Uterine Rupture and Placenta Accreta With Prior Uterine Surgery Outside of the Lower Segment.

  Cynthia Gyamfi-Bannerman, Sharon Gilbert, Mark B Landon, Catherine Y Spong, Dwight J Rouse, Michael W Varner, Steve N Caritis, Paul J Meis, Ronald J Wapner, Yoram Sorokin, Marshall Carpenter, Alan M Peaceman, Mary J Oʼsullivan, Baha M Sibai, John M Thorp, Susan M Ramin, Brian M Mercer
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE:: Women with a prior myomectomy or prior classical cesarean delivery often have early delivery by cesarean because of concern for uterine rupture. Although theoretically at increased risk for placenta accreta, this risk has not been well-quantified. Our objective was to estimate and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery. METHODS:: Women with prior myomectomy or prior classical cesarean delivery were compared with women with a prior low-segment transverse cesarean delivery to estimate rates of both uterine rupture and placenta accreta. RESULTS:: One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low-segment transverse cesarean delivery were evaluated. Mean gestational age at delivery differed by group (P<.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low-segment transverse cesarean delivery (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group (P-MMX group) was 0% (95% confidence interval [CI] 0-1.98%). The frequency of uterine rupture in the low-segment transverse cesarean delivery group (LTC group) (0.41%) was not statistically different from the risk in the P-MMX group (P>.99) or in the prior classical cesarean delivery group (PC group) (0.88%; P=.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of the P-MMX group compared with 0.19% in the LTC group (P>.99) and 0.88% in the PC group (P=.01 relative to the LTC group). The adjusted odds ratio for the PC group (relative to LTC group) was 3.23 (95% CI 1.11-9.39) for uterine rupture and 2.09 (95% CI 0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the PC group and 13.6% for the LTC group (P>.99). CONCLUSION:: A prior myomectomy is not associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low.
  Obstetrics and Gynecology 12/2012; 120(6):1332-1337. · 4.73 Impact Factor
• Article: Association of polymorphisms in neuroprotection and oxidative stress genes and neurodevelopmental outcomes after preterm birth.

  Maged M Costantine, Erin A S Clark, Yinglei Lai, Dwight J Rouse, Catherine Y Spong, Brian M Mercer, Yoram Sorokin, John M Thorp, Susan M Ramin, Fergal D Malone, Marshall Carpenter, Menachem Miodovnik, Mary J O'Sullivan, Alan M Peaceman, Steve N Caritis
  [show abstract] [hide abstract]
  ABSTRACT: To estimate the associations between polymorphisms in neuronal homeostasis, neuroprotection, and oxidative stress candidate genes and neurodevelopmental disability. This was a nested case-control analysis of a randomized trial of magnesium sulfate administered to women at imminent risk for early (before 32 weeks) preterm birth for the prevention of death or cerebral palsy in their offspring. We evaluated 21 single-nucleotide polymorphisms (SNPs) in 17 genes associated with neuronal homeostasis, neuroprotection, or oxidative stress in umbilical cord blood. Cases included infant deaths (n=43) and children with cerebral palsy (n=24), mental delay (Bayley Mental Developmental Index less than 70; n=109), or psychomotor delay (Bayley Psychomotor Developmental Index less than 70; n=91) diagnosed. Controls were race-matched and sex-matched children with normal neurodevelopment. Associations between each SNP and each outcome were assessed in logistic regression models assuming an additive genetic pattern, conditional on maternal race and infant sex, and adjusting for study drug assignment, gestational age at birth, and maternal education. The odds of cerebral palsy were increased more than 2.5 times for each copy of the minor allele of vasoactive intestinal polypeptipe (VIP, rs17083008) (adjusted odds ratio 2.67, 95% confidence interval 1.09-6.55, P=.03) and 4.5 times for each copy of the minor allele of N-methyl-D-aspartate receptor subunit 3A (GRIN3A, rs3739722) (adjusted odds ratio 4.67, 95% CI 1.36-16.01, P=.01). The association between the advanced glycosylation end product-specific receptor (AGER, rs3134945) SNP and mental delay was modulated by study drug allocation (P=.02). Vasoactive intestinal polypeptipe and GRIN3A SNPs may be associated with cerebral palsy at age 2 in children born preterm.
  Obstetrics and Gynecology 09/2012; 120(3):542-50. · 4.73 Impact Factor
• Article: Relationship between 17-hydroxyprogesterone caproate concentrations and gestational age at delivery in twin gestation.

  Steve N Caritis, Hyagriv N Simhan, Yuan Zhao, Dwight J Rouse, Alan M Peaceman, Anthony Sciscione, Catherine Y Spong, Michael W Varner, Fergal D Malone, Jay D Iams, Brian M Mercer, John M Thorp, Yoram Sorokin, Marshall Carpenter, Julie Lo, Susan M Ramin, Margaret Harper
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE: We sought to evaluate in women with twin gestation the relationship between 17-hydroxyprogesterone caproate (17-OHPC) concentration and gestational age at delivery and select biomarkers of potential pathways of drug action. STUDY DESIGN: Blood was obtained between 24-28 weeks (epoch 1) and 32-35 weeks (epoch 2) in 217 women with twin gestation receiving 17-OHPC or placebo. Gestational age at delivery and concentrations of 17-OHPC, 17-hydroxyprogesterone, progesterone, C-reactive protein (CRP), and corticotrophin-releasing hormone were assessed. RESULTS: Women with higher concentrations of 17-OHPC delivered at earlier gestational ages than women with lower concentrations (P < .001). Women receiving 17-OHPC demonstrated significantly higher (P = .005) concentrations of CRP in epoch 1 than women receiving placebo but CRP values were similar in epoch 2 in both groups. A highly significant (P < .0001) positive relationship was observed between 17-OHPC concentration and progesterone and 17-hydroxyprogesterone concentrations at both epochs. Corticotropin-releasing hormone concentrations did not differ by treatment group. CONCLUSION: 17-OHPC may adversely impact gestational age at delivery in women with twin gestation.
  American journal of obstetrics and gynecology 08/2012; · 3.28 Impact Factor
• Article: Elective repeat cesarean delivery compared with spontaneous trial of labor after a prior cesarean delivery: a propensity score analysis.

  Sharon A Gilbert, William A Grobman, Mark B Landon, Catherine Y Spong, Dwight J Rouse, Kenneth J Leveno, Michael W Varner, Steve N Caritis, Paul J Meis, Yoram Sorokin, Marshall Carpenter, Mary J O'Sullivan, Baha M Sibai, John M Thorp, Susan M Ramin, Brian M Mercer
  [show abstract] [hide abstract]
  ABSTRACT: The purpose of this study was to determine outcomes, after the use of propensity score techniques, to create balanced groups according to whether a woman undergoes elective repeat cesarean delivery (ERCD) or trial of labor (TOL). Women who were eligible for a TOL with 1 previous low transverse incision were categorized according to whether they underwent an ERCD or TOL. A propensity score technique was used to develop ERCD and TOL groups with comparable baseline characteristics. Outcomes were assessed with conditional logistic regression. The rates of endometritis, operative injury, respiratory distress syndrome, and newborn infant infection were lower and the rates of hysterectomy and wound complication were higher in the ERCD group. Propensity score techniques can be used to generate comparable ERCD and TOL groups. Some types of maternal morbidity (such as hysterectomy) are higher; other types (such as operative injury) are lower in the ERCD group. Although the absolute risk is low, neonatal morbidity appears to be lower in the ERCD group.
  American journal of obstetrics and gynecology 04/2012; 206(4):311.e1-9. · 3.28 Impact Factor
• Article: Effect of antenatal corticosteroids on respiratory morbidity in singletons after late-preterm birth.

  Cynthia Gyamfi-Bannerman, Sharon Gilbert, Mark B Landon, Catherine Y Spong, Dwight J Rouse, Michael W Varner, Paul J Meis, Ronald J Wapner, Yoram Sorokin, Marshall Carpenter, Alan M Peaceman, Mary J O'Sullivan, Baha M Sibai, John M Thorp, Susan M Ramin, Brian M Mercer
  [show abstract] [hide abstract]
  ABSTRACT: To evaluate whether neonates born to women who previously had received antenatal corticosteroids and then delivered a late-preterm-birth neonate had less respiratory morbidity compared with those not exposed to antenatal corticosteroids. This is a secondary analysis from a multicenter observational study regarding mode of delivery after previous cesarean delivery. We compared women who received one course of antenatal corticosteroids with unexposed parturients and evaluated various respiratory outcomes among those having a singleton, late-preterm-birth neonate. We controlled for potential confounders including gestational age at delivery, diabetes, mode of delivery, and maternal race. Five thousand nine hundred twenty-four patients met the inclusion criteria; 550 received steroids and 5,374 did not. In the univariable model, compared with unexposed women, those who received antenatal corticosteroids appeared more likely to have neonates who required ventilatory support (11.5% compared with 8.6%, P=.022), had respiratory distress syndrome (RDS) (17.1% compared with 12.2%, P=.001), developed transient tachypnea of the newborn (12.9% compared with 9.8%, P=.020), or required resuscitation in the delivery room (55.8% compared with 49.7%, P=.007). After controlling for confounding factors, we found no significant differences among the groups regarding all of the above outcomes with an odds ratio for RDS of 0.78 (95% confidence interval, 0.60-1.02) and ventilator support of 0.75 (95% confidence interval, 0.55-1.03). Exposure to antenatal corticosteroids does not significantly affect respiratory outcomes among those with a subsequent late-preterm birth.
  Obstetrics and Gynecology 03/2012; 119(3):555-9. · 4.73 Impact Factor
• Article: Stillbirth Collaborative Research Network: design, methods and recruitment experience.

  Corette B Parker, Carol J R Hogue, Matthew A Koch, Marian Willinger, Uma M Reddy, Vanessa R Thorsten, Donald J Dudley, Robert M Silver, Donald Coustan, George R Saade, Deborah Conway, Michael W Varner, Barbara Stoll, Halit Pinar, Radek Bukowski, Marshall Carpenter, Robert Goldenberg
  [show abstract] [hide abstract]
  ABSTRACT: The Stillbirth Collaborative Research Network (SCRN) has conducted a multisite, population-based, case-control study, with prospective enrollment of stillbirths and livebirths at the time of delivery. This paper describes the general design, methods and recruitment experience. The SCRN attempted to enroll all stillbirths and a representative sample of livebirths occurring to residents of pre-defined geographical catchment areas delivering at 59 hospitals associated with five clinical sites. Livebirths <32 weeks gestation and women of African descent were oversampled. The recruitment hospitals were chosen to ensure access to at least 90% of all stillbirths and livebirths to residents of the catchment areas. Participants underwent a standardised protocol including maternal interview, medical record abstraction, placental pathology, biospecimen testing and, in stillbirths, post-mortem examination. Recruitment began in March 2006 and was completed in September 2008 with 663 women with a stillbirth and 1932 women with a livebirth enrolled, representing 69% and 63%, respectively, of the women identified. Additional surveillance for stillbirths continued until June 2009 and a follow-up of the case-control study participants was completed in December 2009. Among consenting women, there were high consent rates for the various study components. For the women with stillbirths, 95% agreed to a maternal interview, chart abstraction and a placental pathological examination; 91% of the women with a livebirth agreed to all of these components. Additionally, 84% of the women with stillbirths agreed to a fetal post-mortem examination. This comprehensive study is poised to systematically study a wide range of potential causes of, and risk factors for, stillbirths and to better understand the scope and incidence of the problem.
  Paediatric and Perinatal Epidemiology 09/2011; 25(5):425-35. · 2.31 Impact Factor
• Article: The Stillbirth Collaborative Research Network (SCRN) placental and umbilical cord examination protocol.

  Halit Pinar, Matthew A Koch, Hal Hawkins, Josefine Heim-Hall, Bahig Shehata, Vanessa R Thorsten, Marshall Carpenter, Amy Lowichik, Uma M Reddy
  [show abstract] [hide abstract]
  ABSTRACT: The Stillbirth Collaborative Research Network (SCRN) was organized to study the scope and causes of stillbirth (SB) in the United States. The objective of this report is to describe the approach used for the placental examination performed as part of the study. The SCRN consists of a multidisciplinary team of investigators from five clinical sites, the National Institute of Child Health and Human Development, and the Data Coordination and Analysis Center. The study is a population-based cohort and nested case-control study, with prospective enrollment of women with SB and live births (LB) at the time of delivery. Detailed and standardized postmortem examination was performed on SB and placental examination in both groups. A total of 663 women with SB and 1932 women with LB were enrolled into the case-control study. In the SB group, there were 707 fetuses. Of these cases, 654 (98.6%) had placental examination. Of these LB controls, 1804 (93.4%) had placental examination. This is the largest prospective study to include population-based SB and LB, using standardized postmortem and placental examination, medical record review, maternal interview, collection of samples, and a multidisciplinary team of investigators collaborating in the analyses. Thus it has the potential to provide high-level evidence regarding the contribution of placental abnormalities to stillbirth.
  American Journal of Perinatology 06/2011; 28(10):781-92. · 1.32 Impact Factor
• Article: Placental endothelial nitric oxide synthase in multiple and single dose betamethasone exposed pregnancies.

  Heather L Mertz, Lisa Mele, Catherine Y Spong, Donald J Dudley, Ronald J Wapner, Jay D Iams, Yoram Sorokin, Alan Peaceman, Kenneth J Leveno, Steve N Caritis, Menachem Miodovnik, Brian M Mercer, John M Thorp, Mary J O'Sullivan, Susan M Ramin, Marshall Carpenter, Dwight J Rouse, Baha Sibai
  [show abstract] [hide abstract]
  ABSTRACT: To compare endothelial nitric oxide synthase expression and capillary density (CDS) in placentas exposed to single or multiple courses of betamethasone. Placental specimens exposed to single vs repeat courses of betamethasone were analyzed through immunohistochemistry and digital image quantification for endothelial nitric oxide synthase and CD34. Quantified endothelial nitric oxide synthase staining, calculated capillary density, ratio of endothelial nitric oxide synthase to capillary density, and clinical characteristics were compared. Linear regression was performed with these as dependent variables. Mean and maximum capillary density were increased (P = .013 and .005) and the ratio of endothelial nitric oxide synthase to capillary density decreased (P = .016) in specimens exposed to 4 courses of betamethasone compared with 1 to 3 courses. Exposure to 4 courses of betamethasone was associated with increased capillary density, but not with endothelial nitric oxide synthase expression. Exposure to 4 courses of betamethasone is associated with increased placental capillary density. The placental effects of multiple courses of betamethasone are unrelated to endothelial nitric oxide synthase expression.
  American journal of obstetrics and gynecology 04/2011; 204(6):545.e11-6. · 3.28 Impact Factor
• Article: Pharmacokinetics of 17-hydroxyprogesterone caproate in multifetal gestation.

  Steve N Caritis, Shringi Sharma, Raman Venkataramanan, Dwight J Rouse, Alan M Peaceman, Anthony Sciscione, Catherine Y Spong, Michael W Varner, Fergal D Malone, Jay D Iams, Brian M Mercer, John M Thorp, Yoram Sorokin, Marshall Carpenter, Julie Lo, Susan Ramin, Margaret Harper
  [show abstract] [hide abstract]
  ABSTRACT: The purpose of this study was to define the pharmacokinetic parameters of 17-hydroxyprogesterone caproate (17-OHPC) in multifetal gestation. Blood was obtained at 24-28 weeks' gestation and at 32-35 weeks gestation in 97 women with twin and 26 women with triplet gestation who were receiving 17-OHPC. Six of the women with twins had daily blood sampling for 7 days between 24 and 28 weeks' gestation, and pharmacokinetic parameters were estimated with the use of noncompartmental analysis. Modeling was applied to estimate the population parameters and to simulate various treatment scenarios. The apparent half-life of 17-OHPC was 10 days. Body mass index significantly impacted 17-OHPC concentrations, but fetal number and parity did not. Apparent clearance was significantly greater in African American than in white women (P = .025). This is the first pharmacokinetic analysis of 17-OHPC in pregnant women. Determination of half-life, covariates that affect plasma 17-OHPC concentrations, and the modeling of drug behavior provide insights into this drug's pharmacologic properties during multifetal pregnancy.
  American journal of obstetrics and gynecology 03/2011; 205(1):40.e1-8. · 3.28 Impact Factor
• Article: Repeated course antenatal steroids, inflammation gene polymorphisms, and neurodevelopmental outcomes at age 2.

  Erin A S Clark, Lisa Mele, Ronald J Wapner, Catherine Y Spong, Yoram Sorokin, Alan Peaceman, Jay D Iams, Kenneth J Leveno, Margaret Harper, Steve N Caritis, Brian M Mercer, John M Thorp, Susan M Ramin, Marshall Carpenter, Dwight J Rouse
  [show abstract] [hide abstract]
  ABSTRACT: We sought to evaluate the interaction between repeated-course antenatal corticosteroids and inflammation gene polymorphisms with neurodevelopmental outcomes at age 2 years. We conducted nested case-control analysis of a randomized controlled trial of single- vs repeated-course antenatal corticosteroids. Cases had mental and/or psychomotor delay at age 2 years. Controls had normal neurodevelopment. Previous analyses of 125 cases and 147 controls identified 4 inflammation gene polymorphisms associated with neurodevelopmental delay at age 2 years. The interaction between repeated-course corticosteroids and the interleukin (IL)-6 -174 genotype with neurodevelopmental delay was significant (P = .046). The IL-6 -174 GG genotype was associated with neurodevelopmental delay at age 2 years in the single-course corticosteroid group (odds ratio, 6.47; 95% confidence interval, 1.86-22.50). Exposure to repeated-course antenatal corticosteroids abrogated this genotype effect (odds ratio, 1.30; 95% confidence interval, 0.48-3.54). Results were unchanged after controlling for potential confounders. Repeated-course antenatal steroids may reduce the increased risk of neurodevelopmental delay at age 2 years associated with IL-6 -174 GG genotype.
  American journal of obstetrics and gynecology 02/2011; 205(1):79.e1-5. · 3.28 Impact Factor
• Article: The Effect of Plurality and Obesity on Betamethasone Concentrations in Women at Risk for Preterm Delivery

  Cynthia Gyamfi, Lisa Mele, Ronald J. Wapner, Catherine Y. Spong, Alan Peaceman, Yoram Sorokin, Donald J. Dudley, Francee Johnson, Kenneth J. Leveno, Steve N. Caritis, Brian M. Mercer, John M. Jr. Thorp, Mary J. O'Sullivan, Susan M. Ramin, Marshall Carpenter, Dwight J. Rouse, Menachem Miodovnik, Baha Sibai
  [show abstract] [hide abstract]
  ABSTRACT: Administration of antenatal corticosteroids to women who are at risk for preterm delivery and carry singletons decreases the incidence of respiratory distress syndrome in their prematurely born infants. However, it is unclear whether antenatal corticosteroids decrease the incidence of respiratory distress syndrome in women with multiple gestations. The effect of maternal obesity on the volume of distribution of betamethasone has not been evaluated, and some investigators are concerned that the concentration of drug available to the fetus may be different in an obese mother as compared with a nonobese mother. This study was designed to determine whether the concentration of betamethasone in maternal serum or fetal cord blood differed between singleton and twin pregnancies and between obese and nonobese women. Data were obtained from analysis of biological fluids collected within a randomized, double-blinded, placebo-controlled clinical trial. All participants receiving weekly doses of betamethasone were identified. Univariate analysis was used to compare betamethasone concentrations in singleton versus twin gestations and in obese (body mass index, <30 kg/m2) versus normal weight (body mass index, <30 kg/m2) women. A total of 100 samples were analyzed (45 cord blood and 55 maternal blood). In univariate analysis, there was a significant increase in median cord blood betamethasone concentrations among twin gestations (4.4 ng/mL, interquartile range [IQR], 2.5–8.2, vs. singletons, 1.4 ng/mL; IQR, 1.0–3.0 [P = 0.002]) and a nonsignificant increase in median maternal serum betamethasone concentrations among obese (5.0 ng/mL; IQR, 2.7–7.6) versus nonobese (4.3 ng/mL; IQR, 3.0–6.1) women (P = 0.74). However, after adjustment for possible confounders, no differences were noted in concentrations of betamethasone in maternal serum and cord blood between singletons and twins or between nonobese and obese women. These findings fail to support that there is a significant association between serum betamethasone concentrations and either plurality or obesity.
  Obstetrical and Gynecological Survey 12/2010; 66(1):1-2. · 2.51 Impact Factor
• Article: Mode of delivery in women with antepartum fetal death and prior cesarean delivery.

  Mildred M Ramirez, Sharon Gilbert, Mark B Landon, Dwight J Rouse, Catherine Y Spong, Michael W Varner, Steve N Caritis, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M Peaceman, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Brian M Mercer
  [show abstract] [hide abstract]
  ABSTRACT: We describe obstetric outcomes in a group of patients with prior cesarean delivery (CD) presenting with an intrauterine fetal demise (IUFD). A secondary analysis of an observational study of women with prior CD was performed. All antepartum singleton pregnancies with a prior CD and IUFD ≥20 weeks' gestation or 500 g were evaluated. Two hundred nine patients met inclusion criteria for analysis. The mean gestational age ± standard deviation at delivery was 31.3 ± 6.5 weeks. The trial of labor rate was 75.6% (158/209), and the vaginal birth after cesarean (VBAC) success rate was 86.7%. Labor induction or augmentation occurred in 83.3% of attempted VBAC. Uterine rupture occurred in five women (2.4%), and in 3.4% of those being induced but none of these required hysterectomy. Women with a history of previous CD and an IUFD often undergo trial of labor with a high VBAC success rate. Uterine rupture complicates 2.4% of such cases.
  American Journal of Perinatology 11/2010; 27(10):825-30. · 1.32 Impact Factor
• Article: Absence of mitochondrial progesterone receptor polymorphisms in women with spontaneous preterm birth.

  Tracy A Manuck, Thomas M Price, Elizabeth Thom, Paul J Meis, Mitchell P Dombrowski, Baha Sibai, Catherine Y Spong, Dwight J Rouse, Jay D Iams, Hyagriv N Simhan, Mary J O'Sullivan, Menachem Miodovnik, Kenneth J Leveno, Deborah Conway, Ronald J Wapner, Marshall Carpenter, Brian Mercer, Susan M Ramin, John M Thorp, Alan M Peaceman
  [show abstract] [hide abstract]
  ABSTRACT: The truncated mitochondrial progesterone receptor (PR-M) is homologous to nuclear PRs with the exception of an amino terminus hydrophobic membrane localization sequence, which localizes PR-M to mitochondria. Given the matrilineal inheritance of both spontaneous preterm birth (SPTB) and the mitochondrial genome, we hypothesized that (a) PR-M is polymorphic and (b) PR-M localization sequence polymorphisms could result in variable progesterone-mitochondrial effects and variable responsiveness to progesterone prophylaxis. Secondary analysis of DNA from women enrolled in a multicenter, prospective, study of 17 alpha-hydroxyprogesterone caproate (17OHPC) versus placebo for the prevention of recurrent SPTB. DNA was extracted from stored saliva. The PR-M localization sequence was sequenced on 344 patients. Sequences were compared with the previously published 48 base-pair sequence, and all were identical. We did not detect genetic variation in the mitochondrial localization sequence of the truncated PR-M in a group of women at high risk for SPTB.
  Reproductive sciences (Thousand Oaks, Calif.) 10/2010; 17(10):913-6. · 2.31 Impact Factor
• Article: Placenta and umbilical cord abnormalities seen with stillbirth.

  Halit Pinar, Marshall Carpenter
  [show abstract] [hide abstract]
  ABSTRACT: Placental lesions identified in cases of stillbirth are of clinical interest and are frequently invoked as having a causal role. However, most of the placental changes found in stillbirth are also seen in liveborn pregnancies, and are of uncertain pathogenetic significance. Much of the literature addressing placental lesions found in stillbirth is descriptive, listing cases of interest without adequate controls. Further, lesions are described qualitatively, often with inadequate description of examination and sampling protocols. In this manuscript we describe the placental characteristics that are most frequently listed in stillbirth case series, including entities associated with maternal diseases. First, we describe how macroscopic placental, cord, and membrane findings can provide answers to midwives and physicians at the time of delivery and how the placenta should be handled in the delivery room to optimize the histopathological examination. Second, we provide a brief organization of histological findings of the pathogenesis of conditions associated with fetal death.
  Clinical obstetrics and gynecology 09/2010; 53(3):656-72. · 2.06 Impact Factor
• Article: The effect of plurality and obesity on betamethasone concentrations in women at risk for preterm delivery.

  Cynthia Gyamfi, Lisa Mele, Ronald J Wapner, Catherine Y Spong, Alan Peaceman, Yoram Sorokin, Donald J Dudley, Francee Johnson, Kenneth J Leveno, Steve N Caritis, Brian M Mercer, John M Thorp, Mary J O'Sullivan, Susan M Ramin, Marshall Carpenter, Dwight J Rouse, Menachem Miodovnik, Baha Sibai
  [show abstract] [hide abstract]
  ABSTRACT: Antenatal corticosteroids (ACS) decrease respiratory distress syndrome in singleton gestations. Twin data are less clear. Obesity and body mass index (BMI) also affect medication distribution volume. We evaluated whether maternal or neonatal cord betamethasone concentrations differed in twin gestations or obese patients. Participants receiving betamethasone in a randomized controlled trial of weekly ACS were identified. We analyzed maternal delivery and cord serum betamethasone concentrations comparing singletons with twins and obese (BMI > or =30 kg/m(2)) with nonobese women. Fifty-five maternal and 45 cord blood samples were available. Unadjusted median maternal serum concentrations appeared paradoxically higher in both twin gestations and the obese. However, after controlling for confounders, there were no differences in betamethasone concentrations in maternal serum or cord blood between singletons and twins (P = .61 vs P = .14) or nonobese and obese women (P = .67 vs .12). Maternal and umbilical cord blood serum betamethasone concentrations are not different in twin gestations or obese women.
  American journal of obstetrics and gynecology 09/2010; 203(3):219.e1-5. · 3.28 Impact Factor
• Article: Association of fetal inflammation and coagulation pathway gene polymorphisms with neurodevelopmental delay at age 2 years.

  Erin A S Clark, Lisa Mele, Ronald J Wapner, Catherine Y Spong, Yoram Sorokin, Alan Peaceman, Jay D Iams, Kenneth J Leveno, Margaret Harper, Steve N Caritis, Menachem Miodovnik, Brian M Mercer, John M Thorp, Susan M Ramin, Marshall Carpenter, Dwight J Rouse
  [show abstract] [hide abstract]
  ABSTRACT: The purpose of this study was to evaluate the association between fetal inflammation and coagulation gene single-nucleotide polymorphisms (SNPs) and neurodevelopmental delay at age 2 years. We conducted a case-controlled secondary analysis of a randomized trial of single- vs multiple-course corticosteroids. Multiplex assay assessed 46 SNPs. Cases had mental developmental and/or psychomotor delay at age 2 years. Control subjects had normal neurodevelopment. One hundred twenty-five cases and 147 control subjects were analyzed. Allele frequencies were different between cases and control subjects for interleukin (IL)1beta-511 (P = .009), IL4R-148 (P = .03), IL6-174 (P = .02), and IL6-176 (P = .007). Genotype frequencies were different for IL1beta-511 (P = .03) and IL6-174 (P = .04). Results for IL1beta-511, IL4R-148, and IL6-176 remained significant after logistic regression analysis. IL1beta-511 and IL6-176 minor alleles were associated with increased risk of neurodevelopmental delay (odds ratio, 3.1; 95% confidence interval [CI], 1.2-8.2 and 2.2; 95% CI, 1.2-3.9, respectively). IL4R-148 minor allele was protective (odds ratio, 0.6; 95% CI, 0.4-0.9). Fetal SNPs in IL1beta, IL-4R, and IL-6 may be associated with neurodevelopmental delay at age 2 years.
  American journal of obstetrics and gynecology 07/2010; 203(1):83.e1-83.e10. · 3.28 Impact Factor
• Article: Maternal and neonatal outcomes of repeat cesarean delivery in women with a prior classical versus low transverse uterine incision.

  Tiki Bakhshi, Mark B Landon, Yinglei Lai, Catherine Y Spong, Dwight J Rouse, Kenneth J Leveno, Michael W Varner, Steve N Caritis, Paul J Meis, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M Peaceman, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Brian M Mercer
  [show abstract] [hide abstract]
  ABSTRACT: We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor at ≥36 weeks. Outcomes were compared between women with a previous classical CD and those with a prior low transverse CD. Of the 7936 women who met study criteria, 122 had a prior classical CD. Women with a prior classical CD had a higher rate of classical uterine incision at repeat CD (12.73% versus 0.59%; P < 0.001), had longer total operative time and hospital stay, and had higher intensive care unit admission. Uterine dehiscence was more frequent in women with a prior classical CD (2.46% versus 0.27%, odds ratio 9.35, 95% confidence interval 1.76 to 31.93). After adjusting for confounding factors, there were no statistical differences in major maternal or neonatal morbidities between groups. Uterine dehiscence was present at repeat CD in 2.46% of women with a prior classical CD. However, major maternal morbidities were similar to those with a prior low transverse CD.
  American Journal of Perinatology 05/2010; 27(10):791-6. · 1.32 Impact Factor
• Article: White's classification of maternal diabetes and vaginal birth after cesarean delivery success in women undergoing a trial of labor.

  Clint M Cormier, Mark B Landon, Yinglei Lai, Catherine Y Spong, Dwight J Rouse, Kenneth J Leveno, Michael W Varner, Hyagriv N Simhan, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M Peaceman, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Brian M Mercer
  [show abstract] [hide abstract]
  ABSTRACT: To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White's Classification. This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included. Vaginal birth after cesarean delivery success rates and maternal and neonatal complications were compared based on White's Classification. Of 11,856 women who underwent trial of labor, 624 met all study criteria (class A1, 356; A2, 169; B, 70; C, 21; D/R/F, 8). Vaginal birth after cesarean delivery success in each group was: A1, 68.5% (95% confidence interval [CI] 63.4-73.3%); A2, 55% (95% CI 47.2-62.7%); B, 70% (95% CI 57.9-80.4%); C, 47.6% (95% CI 25.7-70.2%); and D/F/R, 12.5% (95% CI 0.3-52.7%). Maternal and neonatal complications were rare and not found to be different among groups. Our study provides estimates for VBAC success based on White's classification and indicates a relatively low rate of perinatal complications after VBAC attempt for diabetic women. III.
  Obstetrics and Gynecology 01/2010; 115(1):60-4. · 4.73 Impact Factor
• Article: The effect of maternal body mass index on neonatal outcome in women receiving a single course of antenatal corticosteroids.

  Jason N Hashima, Yinglei Lai, Ronald J Wapner, Yoram Sorokin, Donald J Dudley, Alan Peaceman, Catherine Y Spong, Jay D Iams, Kenneth J Leveno, Margaret Harper, Steve N Caritis, Michael Varner, Menachem Miodovnik, Brian M Mercer, John M Thorp, Mary J O'Sullivan, Susan M Ramin, Marshall Carpenter, Dwight J Rouse, Baha Sibai
  [show abstract] [hide abstract]
  ABSTRACT: The aim of this study was to determine the effect of maternal body mass index on the incidence of neonatal prematurity morbidities in those who receive corticosteroids. This was a secondary analysis of a trial of corticosteroids in women at risk for preterm birth. Women receiving a single course of corticosteroids were classified by their prepregnancy body mass index (<25 and > or = 25) and compared on a composite outcome comprised of several neonatal morbidities and on each individual outcome. Of 183 eligible women, 96 (52.5%) had a body mass index of <25 and 87 (47.5%) had a body mass index of > or = 25. The composite outcome occurred more frequently in the body mass index of > or = 2 5 group (28.7%), compared with those with a body mass index of <25 (18.8%), although this was not statistically significant (odds ratio, 1.75; 95% confidence interval, 0.83-3.72). Body mass index was not associated with outcomes after adjusting for confounding. Maternal body mass index did not affect neonatal prematurity morbidities in those receiving corticosteroids.
  American journal of obstetrics and gynecology 12/2009; 202(3):263.e1-5. · 3.28 Impact Factor
• Article: Does information available at admission for delivery improve prediction of vaginal birth after cesarean?

  William A Grobman, Yinglei Lai, Mark B Landon, Catherine Y Spong, Kenneth J Leveno, Dwight J Rouse, Michael W Varner, Atef H Moawad, Hyagriv N Simhan, Margaret Harper, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Mary J O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Susan M Ramin, Brian M Mercer
  [show abstract] [hide abstract]
  ABSTRACT: We sought to construct a predictive model for vaginal birth after cesarean (VBAC) that combines factors that can be ascertained only as the pregnancy progresses with those known at initiation of prenatal care. Using multivariable modeling, we constructed a predictive model for VBAC that included patient factors known at the initial prenatal visit as well as those that only become evident as the pregnancy progresses to the admission for delivery. We analyzed 9616 women. The regression equation for VBAC success included multiple factors that could not be known at the first prenatal visit. The area under the curve for this model was significantly greater ( P < 0.001) than that of a model that included only factors available at the first prenatal visit. A prediction model for VBAC success, which incorporates factors that can be ascertained only as the pregnancy progresses, adds to the predictive accuracy of a model that uses only factors available at a first prenatal visit.
  American Journal of Perinatology 10/2009; 26(10):693-701. · 1.32 Impact Factor