Andrei Rebarber

Icahn School of Medicine at Mount Sinai, Manhattan, New York, United States

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Publications (122)237.53 Total impact

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    ABSTRACT: To estimate independent risk factors for cesarean delivery in patients with twin pregnancies attempting vaginal delivery.
    American journal of obstetrics and gynecology. 07/2014;
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    ABSTRACT: Objective: To estimate the association between maternal obesity and adverse outcomes in patients without placenta previa or accreta undergoing a tertiary or higher cesarean delivery. Study design: Retrospective cohort of patients cared for by a single MFM practice undergoing a tertiary or higher cesarean delivery from 2005 to 2013. Patients attempting vaginal delivery and patients with placenta accreta and/or placenta previa were excluded. We estimated the association of maternal obesity (prepregnancy BMI ≥ 30 kg/m2) and maternal outcomes. The primary outcome was a composite of severe maternal morbidity (uterine rupture, hysterectomy, blood transfusion, cystotomy requiring repair, bowel injury requiring repair, intensive care unit admission, thrombosis, re-operation, or maternal death). Results: Three hundred and forty four patients met inclusion criteria, 73 (21.2%) of whom were obese. The composite outcome was significantly higher in the obese group (6.8% versus 1.8%, p = 0.024, aOR 4.36, 95% CI 1.21, 15.75). The incidence of several individual adverse outcomes were also increased in obese women, including blood transfusion (4.1% versus 0.7%, p = 0.033, aOR 7.36, 95% CI 1.19, 45.34), wound separation or infection (20.5% versus 5.9%, p < 0.001, aOR 4.05, 95% CI 1.75, 9.36) and 1-min Apgar score less than 7 (6.8% versus 1.9%, p = 0.024, aOR 4.40, 95% CI 1.21, 15.94). Conclusions: In patients undergoing a tertiary or higher cesarean delivery without placenta previa or accreta, obesity increases the risk of adverse outcomes. Obese patients are at risk for blood transfusion, low 1-min Apgar scores and postoperative wound complications.
    Journal of Maternal-Fetal and Neonatal Medicine. 07/2014;
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    ABSTRACT: Introduction: To evaluate whether maternal serum α-fetoprotein (MSAFP) improves the detection rate for open neural tube defects (ONTDs) and ventral wall defects (VWD) in patients undergoing first-trimester and early second-trimester fetal anatomical survey. Material and Methods: A cohort of women undergoing screening between 2005 and 2012 was identified. All patients were offered an ultrasound at between 11 weeks and 13 weeks and 6 days of gestational age for nuchal translucency/fetal anatomy followed by an early second-trimester ultrasound at between 15 weeks and 17 weeks and 6 days of gestational age for fetal anatomy and MSAFP screening. All cases of ONTD and VWD were identified via query of billing and reporting software. Sensitivity and specificity for detection of ONTD/VWD were calculated, and groups were compared using the Fisher exact test, with p < 0.05 as significance. Results: A total of 23,790 women met the criteria for inclusion. Overall, 15 cases of ONTD and 17 cases of VWD were identified; 100% of cases were diagnosed by ultrasound prior to 18 weeks' gestation; none were diagnosed via MSAFP screening (p < 0.001). First-trimester and early second-trimester ultrasound had 100% sensitivity and 100% specificity for diagnosing ONTD/VWD. Discussion: Ultrasound for fetal anatomy during the first and early second trimester detected 100% of ONTD/VWD in our population. MSAFP is not useful as a screening tool for ONTD and VWD in the setting of this ultrasound screening protocol. © 2014 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 07/2014; · 1.90 Impact Factor
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    ABSTRACT: Preeclampsia and IUGR are correlated in singleton pregnancies. The objective of this study was to estimate their relationship in twin pregnancies.
    American journal of obstetrics and gynecology. 05/2014;
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    ABSTRACT: Abstract Objective: We sought to estimate the association between CL and fFN and each pathway leading to preterm birth in twin pregnancies. Methods: Cohort study of 560 patients with twin pregnancies who underwent routine serial CL and fFN screening from 22-32 weeks in one maternal fetal medicine practice from 2005-2013. We calculated the association between a short CL (≤20mm) or positive fFN with overall preterm birth <32 weeks, and then subdivided the analysis into preterm birth <32 weeks from preterm labor, PPROM, and indicated causes. We excluded cases of monochorionic-monoamniotic placentation, vasa previa, twin-twin transfusion, and patients with cerclage. Results: The overall rate of preterm birth <32 weeks was 6.9% (3.9% from preterm labor, 1.6% from PPROM, and 1.4% indicated). A short cervix was associated with preterm birth <32 weeks arising from preterm labor (12.4% vs. 2.0%, p<0.001), but not PPROM (1.9% vs. 1.3%, p=0.651). Positive fFN was associated with preterm birth <32 weeks both from preterm labor (17.0% vs. 2.4%, p<0.001) as well as from PPROM (5.7% vs. 1.0%, p=0.034). Neither was significantly associated with preterm birth <32 weeks from indicated causes. Conclusions: The mechanism leading toward preterm influences the accuracy of screening tests chosen to assess risk in twin pregnancies. A shortened cervical length and positive fFN is associated with spontaneous preterm labor and birth < 32 weeks. However, PPROM does not appear to be preceded by a short cervix, but is preceded by a positive fFN. Neither test is associated with indicated preterm birth.
    Journal of Maternal-Fetal and Neonatal Medicine. 05/2014;
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    ABSTRACT: To report obstetric outcomes in a series of women with prior uterine rupture or prior uterine dehiscence managed with a standardized protocol. Series of patients delivered by a single maternal-fetal medicine practice from 2005 to 2013 with a history of uterine rupture or uterine dehiscence. Uterine rupture was defined as a clinically apparent, complete scar separation in labor or before labor. Uterine dehiscence was defined as an incomplete and clinically occult uterine scar separation with intact serosa. Patients with prior uterine rupture were delivered at approximately 36-37 weeks of gestation or earlier in the setting of preterm labor. Patients with prior uterine dehiscence were delivered at 37-39 weeks of gestation based on obstetric history, clinical findings, and ultrasonographic findings. Patients with prior uterine rupture or uterine dehiscence were followed with serial ultrasound scans to assess fetal growth and lower uterine segment integrity. Outcomes measured were severe morbidities (uterine rupture, hysterectomy, transfusion, cystotomy, bowel injury, mechanical ventilation, intensive care unit admission, thrombosis, reoperation, maternal death, perinatal death). Fourteen women (20 pregnancies) had prior uterine rupture and 30 women (40 pregnancies) had prior uterine dehiscence. In these 60 pregnancies, there was 0% severe morbidity noted (95% confidence interval [CI] 0.0-6.0%). Overall, 6.7% of patients had a uterine dehiscence seen at the time of delivery (95% CI 2.6-15.9%). Among women with prior uterine rupture, the rate was 5.0% (95% CI 0.9-23.6%), whereas among women with prior uterine dehiscence, the rate was 7.5% (95% CI 2.6-19.9%). Patients with prior uterine rupture or uterine dehiscence can have excellent outcomes in subsequent pregnancies if managed in a standardized manner, including cesarean delivery before the onset of labor or immediately at the onset of spontaneous preterm labor. LEVEL OF EVIDENCE:: III.
    Obstetrics and Gynecology 04/2014; 123(4):785-789. · 4.80 Impact Factor
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    ABSTRACT: Abstract Objective: To estimate the association between maternal weight gain and spontaneous preterm birth (SPTB) in twin pregnancies. Methods: A case-control study of patients with twin pregnancies and a normal prepregnancy BMI (18.5 - 24.9 kg/m(2)) in one maternal-fetal medicine practice from 2005-2013. We reviewed maternal weight in 6 time periods: prepregnancy, 12-15 6/7 weeks, 16 - 19 6/7 weeks, 20 - 23 6/7 weeks, 24 - 27 6/7 weeks, and 28 - 31 6/7 weeks. We compared maternal weight gain patterns across pregnancy between patients who did and did not have SPTB <32 weeks. Student's t-test and chi-square were used for analysis. Results: 382 patients were included, 29 (7.6%) of whom had SPTB <32 weeks. The baseline height, weight, and BMI did not differ between the groups, nor did maternal age, IVF status, race, or chorionicity. Patients with SPTB <32 weeks had significantly less weight gain as early as 15 6/7 weeks (2.9 +/- 4.6 vs. 7.3 +/- 6.6 lbs, p<0.001), and this continued until 31 6/7 weeks (25.3 +/- 8.7 vs. 30.8 +/- 10.9 lbs, p=0.037). Conclusions: In twin pregnancies with a normal prepregnancy BMI, there is a significant association between SPTB <32 weeks and lower maternal weight gain, particularly prior to 16 weeks. Future studies are needed to test if prepregnancy or early nutritional interventions in twin pregnancies can reduce the risk of preterm birth and improve neonatal outcomes in this high-risk population.
    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 03/2014; · 1.36 Impact Factor
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    ABSTRACT: Objectives- The purpose of this study was to estimate the prevalence and persistence rate of vasa previa in at-risk pregnancies using a standardized screening protocol. Methods- We conducted a descriptive study of patients with a diagnosis of vasa previa from a single ultrasound unit between June 2005 and June 2012. Vasa previa was defined as a fetal vessel within 2 cm of the internal cervical os on transvaginal sonography. Screening for vasa previa using transvaginal sonography with color flow mapping was performed routinely in the following situations: resolved placenta previa, prior pregnancy with vasa previa, velamentous insertion of the cord in the lower uterine segment, placenta succenturiata in the lower uterine segment, and twin gestations. Results- A total of 27,573 patients were referred to our unit for fetal anatomic surveys over the study period. Thirty-one cases of vasa previa were identified, for an incidence of 1.1 per 1000 pregnancies. Twenty-nine cases had full records available for analysis. Five patients (17.2%) had migration and resolution of the vasa previa. When the diagnosis was made during the second trimester (<26 weeks), there was a 23.8% resolution rate (5 of 21); when the diagnosis was made in the third trimester, none resolved (0 of 8 cases). Of the 24 pregnancies (5 twin gestations and 19 singleton gestations) with persistent vasa previa, there was 100% perinatal survival and a median length of gestation of 35 weeks (range, 27 weeks 5 days-36 weeks 5 days). No known missed cases were identified over the study period. Conclusions- The use of standardized screening for vasa previa based on focused criteria was found to be effective in diagnosing vasa previa, with a 100% survival rate. Vasa previa diagnosed during the second trimester resolves in approximately 25% of cases.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2014; 33(1):141-7. · 1.40 Impact Factor
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    ABSTRACT: Objective To estimate the effect of oocyte donation on pregnancy outcomes in patients with twin pregnancies conceived via IVF. Design Retrospective cohort study. Setting Patients with IVF twin pregnancies delivered by one maternal–fetal medicine practice from 2005 to 2013. Patient(s) Fifty-six patients with IVF twin pregnancies who had oocyte donation and 56 age-matched controls with IVF twin pregnancies who used autologous oocytes. We excluded women aged >50 years because there were no age-matched controls aged >50 years using autologous oocytes. Intervention(s) None. Main Outcome Measure(s) Gestational hypertension, pre-eclampsia. Result(s) The baseline characteristics were similar between the groups, including maternal age, race, parity, chorionicity, and comorbidities. The mean (±SD) age was 43.0 ± 6.0 vs. 41.9 ± 1.7 years. There were no differences in outcomes between the groups in regard to preterm birth, birth weight, or gestational diabetes. There was a greater incidence of gestational hypertension (32.1% vs. 13.0%) and pre-eclampsia (28.3% vs. 13.0%) in the group that underwent IVF with donor oocytes. Conclusion(s) In patients who conceive twin pregnancies using IVF, oocyte donation increases the risk of gestational hypertension and pre-eclampsia. However, this did not translate into increased rates of preterm birth or low birth weight. Patients who require oocyte donation should be carefully counseled regarding the increased risk for pre-eclampsia and gestational hypertension but should be reassured that oocyte donation does not seem to lead to other adverse outcomes.
    Fertility and sterility 01/2014; · 3.97 Impact Factor
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    ABSTRACT: To report the obstetrical outcomes in patients with twin pregnancies who underwent an emergency/physical exam-indicated cerclage and to compare them to patients with singleton pregnancies undergoing the same procedure. Patients who underwent emergency/physical exam-indicated cerclage in the second trimester in one maternal-fetal medicine practice from July 1997 to March 2012 were reviewed. We defined an emergency/physical exam-indicated cerclage as any cerclage placed in a patient with a dilated cervix on examination or membranes visible at the external cervical os on speculum examination. We compared outcomes between patients with singleton and twin pregnancies using non-parametric testing. There were 43 patients (12 twin and 31 singleton pregnancies) who underwent emergency/physical exam-indicated cerclage placement. The median gestational age at cerclage placement, cervical dilation, maternal age, and cerclage type were similar between the groups. Comparing twins to singletons, the median time from cerclage placement to delivery was similar (92 vs. 106 days, p=0.330), as was the median gestational age at delivery (33.5 vs. 35.0 weeks, p=0.244). The likelihood of delivery at >32 weeks (75.0% vs. 71.0%, p>0.999) and the likelihood of neonatal survival to discharge (83.3% vs. 83.9%, p>0.999) were also similar. Emergency/physical exam-indicated cerclage in twin pregnancies can be associated with favorable outcomes, including a high likelihood of delivery at >32 weeks and a high likelihood of survival. Their outcomes appear similar to singleton pregnancies. Cerclage should be considered an option for patients with twin pregnancies and a dilated cervix in the second trimester.
    European journal of obstetrics, gynecology, and reproductive biology 11/2013; · 1.97 Impact Factor
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    ABSTRACT: Abstract Objective: The objective was to determine if the rate of abnormal biochemical markers is different in pregnancies conceived by donor oocyte versus those conceived by autologous oocytes. Methods: This is a retrospective cohort study of patients who underwent risk assessment for aneuploidy. Pregnancies conceived by egg donation were matched with control groups who conceived using their own eggs. The primary outcomes were incidence of low PAPP-A or free bHCG in the 1(st) trimester or elevated MSAFP, free bHCG, or Inhibin A, or low uE3 in the 2(nd) trimester. Results: 260 singleton gestations were identified who conceived via oocyte donor. There was a significantly higher rate of unexplained elevated MSAFP in pregnancies conceived by egg donation (8% vs 2%, p=0.028) compared to a control group matched by maternal age. There was also a significantly higher rate of unexplained elevated MSAFP in pregnancies conceived by egg donation (7% vs. 2%, p=0.01) compared to a control group matched by age of the egg donor. Conclusion: Pregnancies conceived by egg donation are more likely to have an unexplained elevation in MSAFP compared to pregnancies not conceived by egg donation regardless of age. Egg donation itself is not associated with other biochemical abnormalities.
    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 11/2013; · 1.36 Impact Factor
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    ABSTRACT: Abstract Objective: To estimate whether the severity of uterine anomaly is associated with the risk of adverse pregnancy outcomes. Methods: Retrospective cohort study of patients delivered by one maternal fetal medicine group from 2005-2012. We included 158 patients with a singleton pregnancy and a uterine anomaly, as well as an equal number of randomly selected unexposed singleton pregnancies delivered by the same group. Patients with uterine anomalies were subdivided into those with major fusion defects (unicornuate, bicornuate, didelphys) and minor fusion defects (arcuate, septate, t-shaped). Results: The incidence of adverse pregnancy outcomes increased across unexposed patients, patients with minor fusion defects, and patients with major fusion defects. These included preterm birth <37 weeks, preterm birth <35 weeks, birth weight <10(th) percentile, birth weight <5(th) percentile, preeclampsia, malpresentation, and cesarean delivery. Conclusion: The incidence of adverse pregnancy outcomes and cesarean delivery is increased in patients with minor fusion defects and is further increased in patients with major fusion defects.
    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 09/2013; · 1.36 Impact Factor
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    ABSTRACT: Abstract Objective: To report blood pressure (BP) across gestation in patients with twin pregnancy. Methods: Historical cohort of all twin pregnancies managed by one maternal-fetal medicine practice from 2005 - 2012. Patients with chronic hypertension were excluded. We reviewed all outpatient BP measurements taken during pregnancy and compared systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) for every 2-week interval starting at 6 weeks. All BP measurements were taken manually in the seated upright position. Results: There were 520 patients with twin pregnancies managed over the study period, 19 (3.7%) were excluded for chronic hypertension, leaving 501 patients for analysis. There were a total of 4,985 BP measurements (9.95 per patient) during pregnancy. Starting at 6 weeks' gestation, the SBP, DBP, and MAP remained stable until 30 weeks' gestation, when all three began to rise significantly until 38 weeks (p<0.001). There was no drop in BP in the second trimester. The 95(th) percentile for systolic BP did not exceed 121 mmHg until 30 weeks and the 95(th) percentile for diastolic BP did not exceed 80 mmHg until 34 weeks. The 4-10 week postpartum DBP and MAP were significantly higher than the initial DBP and MAP <10 weeks. Conclusions: In patients with twin pregnancies, the BP remains stable from 6 weeks until 30 weeks, at which time it begins to rise steadily. The 95(th) percentile for SBP and DBP prior to 30 weeks are approximately120 and 80 mmHg, respectively.
    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 09/2013; · 1.36 Impact Factor
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    ABSTRACT: To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients. Retrospective cohort study of all patients managed in one maternal-fetal medicine practice from June 2005 to May 2012. We included all singleton pregnancies delivered at ≥20 weeks of gestation. All AMA patients (age ≥35 years at their estimated delivery date) underwent weekly biophysical profile testing beginning at 36 weeks, as well as planned delivery at 41 weeks, or sooner if indicated. We compared the rate of fetal death at ≥20 weeks and fetal death at ≥36 weeks in AMA vs. non-AMA patients. Fetal deaths due to lethal and chromosomal abnormalities were excluded. 4469 patients met the inclusion criteria: 1541 (34.5%) were AMA and 2928 (65.5%) were non-AMA. Using our AMA protocol for surveillance and timing of delivery, the incidence of stillbirth was similar to the non-AMA population (stillbirth ≥20 weeks: 3.9 per 1000 vs. 3.4 per 1000, p=0.799; stillbirth ≥36 weeks: 1.4 per 1000 vs. 1.1 per 1000, p=0.773). When looking at women age <35, age 35-39, and age ≥40, the incidence of stillbirth ≥20 weeks and ≥36 weeks did not increase across the three groups. Our findings were similar when we excluded all patients with other indications for antepartum surveillance. In AMA patients, antepartum surveillance and delivery at 41 weeks appears to reduce the risk of stillbirth to that of the non-AMA population. Routine antepartum surveillance should be considered in all AMA patients.
    European journal of obstetrics, gynecology, and reproductive biology 08/2013; · 1.97 Impact Factor
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    ABSTRACT: Abstract Objective: To determine whether routine cervical length (CL) and fetal fibronectin (fFN) screening is associated with improved clinical outcomes in asymptomatic patients with twin pregnancies. Study design: We compared outcomes between two large cohorts of twin pregnancies who delivered in New York City from 2003-2012. One cohort (n=532) was managed by a single group practice, delivered at one large academic medical center, and underwent routine serial CL and fFN screening. The second cohort (n=456) delivered at a second large academic center and only underwent CL and fFN testing as clinically indicated. Outcomes measured include cerclage placement, preterm birth (PTB), spontaneous PTB (sPTB), and antenatal corticosteroid (ACS) exposure. Results: Rates of cerclage placement, PTB, and SPTB were similar between the two groups. However, routine CL and fFN screening was associated with improved rates of ACS exposure in patients who delivered <34 weeks (91.3% vs. 74.7%, p=0.005) and 34-36 6/7 weeks (41.3% vs. 13.9%, p<0.001) without increased ACS exposure in women who delivered at term. In patients who delivered <34 weeks, routine CL and fFN screening was significantly associated with improved rates of ACS exposure within 1-14 days of delivery and within 1-7 days of delivery. Conclusion: In twin pregnancies, routine CL and fFN screening does not reduce the risk of PTB or SPTB. However, the routine use of these tests is associated with significantly improved ACS exposure and timing for women who deliver preterm without increasing ACS exposure to women who deliver at term.
    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 08/2013; · 1.36 Impact Factor
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    ABSTRACT: Abstract Objective: In singleton pregnancies, a uterine anomaly is a known risk factor for preterm birth and fetal growth restriction. Data on outcomes of twin pregnancies with uterine anomalies is limited to case reports. The objective of this study was to compare outcomes in twin pregnancies based on the presence or not of a uterine anomaly. Methods: This was a retrospective cohort of twin pregnancies managed by a single maternal-fetal medicine practice from 2005 - 2012. Patients with monoamniotic twins and twin-twin transfusion syndrome were excluded. Pregnancy outcomes were compared between patients with and without a uterine anomaly. Nonparametric tests (Fisher's exact test, Mann-Whitney U) were used for analysis. A p-value of ≤0.05 was considered significant. Results: 556 twin pregnancies were included, 17 (3.1%) of whom had a known uterine anomaly (9 septate uterus, 3 bicornuate, 3 arcuate, 1 unicornuate, and 1 didelphys). Patients with a uterine anomaly had significantly worse outcomes, including cerclage, preterm birth, and lower median birth weights. Birth weight less than the 10(th) or 5(th) percentile for gestational age was not more common in patients with a uterine anomaly, nor was there an increase in birth weight discordancy. Conclusion: In patients with twin pregnancies, the presence of a uterine anomaly is associated with an increased risk of cerclage, preterm birth and lower birth weights, but not fetal growth restriction.
    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 06/2013; · 1.36 Impact Factor
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    ABSTRACT: A randomized study published in 2003 by the National Institute of Child Health and Human Development Maternal Fetal Medicine Units network showed efficacy of 17-alpha hydroxyprogesterone caproate (17P) for the prevention of recurrent preterm delivery. Between 2003 and 2011 the drug was often provided by compounding pharmacies. In 2011, the US Food and Drug Administration (FDA) approved the drug for this indication. The objective of this study was to evaluate the impact of FDA approval on physician attitudes and perceptions regarding use of 17P as a drug for preventing recurrent preterm delivery. A 10-min online survey using a structure closed-ended questionnaire format was designed and administered from 17 June 2011 to 7 July 2011 among 401 obstetricians distributed evenly throughout the USA. There is nearly universal awareness of 17P for the prevention of preterm birth (93 %), with a large majority (80 %) of obstetricians having reported prescribing the medication. However, surveyed physicians reported that the average proportion of eligible patients seen in their practice but not prescribed 17P in 2009-2010 was 41 %. Financial and logistical barriers carried the most weight (approximately 75 %) in the decision not to prescribe 17P to an eligible patient. Forty-one percent of respondents cited lack of FDA approval of 17P as a deterrent to prescribing the medication. Thirty-nine percent of respondents had professional liability concerns regarding prescribing compounded 17P. Assuming the same out-of-pocket expense for patients, two-thirds of obstetricians would choose to prescribe Makena(®). Awareness of 17P for the prevention of preterm birth among obstetricians is high. FDA-approved medications seem to have physician preference due to enhanced assurance for product efficacy and safety.
    Clinical Drug Investigation 06/2013; · 1.70 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 06/2013; · 3.56 Impact Factor
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    ABSTRACT: Abstract Objective: To compare pregnancy outcomes in twin pregnancies based on maternal prepregnancy body mass index (BMI). Methods: Historical cohort study of all twin pregnancies >24 weeks managed by one maternal-fetal medicine practice from 2005-2012. We compared pregnancy outcomes between prepregnancy obese (BMI ≥30 kg/m(2)) and normal weight women (BMI 18.5 - 24.99 kg/m(2)). We also compared prepregnancy normal weight women to overweight women (BMI 25 - 29.99 kg/m(2)) and underweight women (BMI <18.5 kg/m(2)). Chi square, Fisher's exact test, Student's t-test, and one-way ANOVA were used as appropriate. A p-value of <0.05 was considered significant. Results: 514 patients with twin pregnancies were included. Prepregnancy obesity was associated with gestational hypertension (34.1% vs. 17.9%, p=0.011), preeclampsia (27.3% vs. 14.4%, p=0.028), and gestational diabetes (22.2% vs. 4.7%, p<0.001). Prepregnancy overweight was associated with gestational diabetes (13.7% vs. 4.7%, p=0.002). Prepregnancy underweight was not associated with any adverse pregnancy outcomes. Comparing outcomes across normal weight, overweight, and obese women, the rates of gestational diabetes and gestational hypertension increased significantly across the three groups. Conclusion: In patients with twin pregnancy, prepregnancy obesity is associated with adverse pregnancy outcomes, including gestational diabetes, gestational hypertension, and preeclampsia.
    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 06/2013; · 1.36 Impact Factor
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    ABSTRACT: Objective Twin pregnancy is associated with an increased incidence of preeclampsia. However, it is unknown if the risk factors for preeclampsia in twin pregnancies are the same as those in singleton pregnancies.Methods Case-control analysis of all twin pregnancies managed by one maternal-fetal medicine practice from 2005 to 2012. Patients with chronic hypertension were excluded, as were monochorionic-monoamniotic twins. We compared patient and pregnancy characteristics between patients who did and did not develop preeclampsia, according to standard American College of Obstetricians and Gynecologists definitions. Odds ratios, adjusted odds ratios (aORs), and 95% confidence intervals (CIs) were obtained using chi-square analysis and logistic regression.Results Of the patients with twin pregnancies, 513 were included, and 76 (14.8%) patients developed preeclampsia. On univariable analysis, the risk factors associated with preeclampsia in twin pregnancies were egg donation, nonwhite race, nulliparity, prepregnancy obesity, and gestational diabetes. On adjusted analysis, the risk factors independently associated with preeclampsia were egg donation (aOR 2.409, 95% CI 1.051, 5.524) and prepregnancy obesity (aOR 2.367, 95% CI 1.079, 5.192).Conclusions In twin pregnancy, the risk factors independently associated with preeclampsia are egg donation and prepregnancy obesity.
    American Journal of Perinatology 04/2013; · 1.57 Impact Factor

Publication Stats

436 Citations
237.53 Total Impact Points

Institutions

  • 2007–2014
    • Icahn School of Medicine at Mount Sinai
      • Department of Obstetrics, Gynecology, and Reproductive Science
      Manhattan, New York, United States
  • 2013
    • Carnegie Corporation of New York
      New York City, New York, United States
    • Weill Cornell Medical College
      • Department of Obstetrics and Gynecology
      New York City, New York, United States
  • 2009–2013
    • Society for Maternal-Fetal Medicine
      New York City, New York, United States
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2004–2013
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
  • 2008–2009
    • Mount Sinai Medical Center
      New York City, New York, United States
  • 1998–2008
    • CUNY Graduate Center
      New York City, New York, United States
  • 2005
    • Nassau University Medical Center
      East Meadow, New York, United States
  • 2004–2005
    • NYU Langone Medical Center
      • Department of Obstetrics and Gynecology
      New York City, NY, United States
  • 2001–2002
    • New York University
      • Department of Obstetrics and Gynecology
      New York City, NY, United States