Patricia Devine

State University of New York Downstate Medical Center, Brooklyn, NY, United States

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Publications (17)45.71 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Abstract Objective: To identify possible predictive factors associated with emergent delivery of antenatally diagnosed placenta accreta and to estimate association between emergent delivery and adverse maternal outcomes in comparison to elective delivery. Methods: A retrospective study of all patients with placenta accreta diagnosed antenatally and confirmed pathologically, who were delivered between 2000 and 2010. Baseline characteristics and outcomes of emergent deliveries were compared with elective deliveries. Results: A total of 48 women met inclusion criteria, of which 24 (50%) were delivered emergently. 79.2% of emergent deliveries were preceded by antenatal bleeding (p = 0.0005), and 62.5% were preceded by recurrent bleeding (p = 0.001). Comparison of elective and emergent deliveries revealed no clinical significant difference in maternal outcome. Conclusions: Antenatal bleeding is associated with an increased risk of emergent delivery. Emergent delivery in a tertiary care facility with immediate access to blood bank and ICU capabilities does not appear to be associated with an increased risk of adverse maternal outcomes. Consequently, some patients may be candidates for delivery later than 34 weeks of gestation.
    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 01/2013; · 1.36 Impact Factor
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    ABSTRACT: : Despite the efficacy of vaccines against human papillomavirus (HPV), vaccination rates remain low in many countries. We estimated the acceptability and satisfaction of HPV vaccination in postpartum women. : Postpartum women aged 18-26 years were offered the quadrivalent HPV vaccine. Women were vaccinated during hospitalization after delivery, at the 6-week postpartum visit, and at a third dedicated vaccination visit. The primary outcome was completion of all three vaccinations. Secondary outcomes included the influence of knowledge and attitudes of HPV, decisional conflict, and satisfaction. : A total of 150 women were enrolled. Overall, seven (4.7%) women did not receive any doses of the vaccine, 62 (41.3%) received one dose, 35 (23.3%) received two doses, and 46 (30.7%) completed the series and received all three doses of the vaccine. Knowledge of HPV and HPV-related disease, attitudes about HPV, and decisional conflict were not associated with completion of the vaccine series (P>.05). The vaccine was well tolerated with few side effects. The majority of women reported a high degree of satisfaction with postpartum vaccination; 97.2% thought vaccination was worthwhile, 98.6% thought postpartum vaccination was convenient, and 99.3% were happy they participated. Furthermore, 50.4% of women reported that they would not have otherwise asked about vaccination. After vaccination, only 17.5% said they would have rather made a separate trip for vaccination. : A strategy of postpartum HPV vaccination is convenient and associated with a high degree of patient satisfaction. : II.
    Obstetrics and Gynecology 10/2012; 120(4):771-82. · 4.80 Impact Factor
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    ABSTRACT: Currently a leading indication for cesarean hysterectomy among multiparous women, placenta accreta is associated with significant maternal morbidity and mortality. A 34-year-old woman with a pregnancy complicated by placenta previa and previous cesarean deliveries was transferred to our institution following late diagnosis of placenta percreta. She underwent cesarean hysterectomy complicated by substantial hemorrhage. Massive blood product replacement precipitated severe hyperkaIemia and hypocalcemia with resultant asystole. Cardiac bypass with concomitant obligate anticoagulation was temporarily required while normalizing the patient's electrolytes. Numerous surgical and medical interventions were required to achieve hemostasis, and the patient survived to hospital discharge with moderate residual morbidity. Optimal management of placenta accreta requires a multidisciplinary approach within a tertiary center possessing extensive resources necessary for managing the most severe complications.
    The Journal of reproductive medicine 01/2012; 57(1-2):58-60. · 0.75 Impact Factor
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    Anesthesiology 08/2011; 115(4):852-7. · 5.16 Impact Factor
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    ABSTRACT: Providing transfusion support for patients with placenta accreta is a challenging task. There is no consensus on predelivery transfusion planning for these patients and the prevalence of massive transfusion is unknown. With little published experience, it is difficult to predict blood component usage accurately. Therefore, this retrospective study spanning 14 years quantified blood usage and clinical outcome in a group of patients with placenta accreta. A retrospective medical record review identified 66 patients with placenta accreta who presented for delivery. Data were extracted from the patients' medical records related to patient demographics, pathology diagnosis, blood component usage, operative course, and clinical outcome. Selected variables were analyzed for statistical association with total blood component usage. The range of blood component usage was 0 to 46 red blood cell (RBC) units, 0 to 48 random-donor platelet unit equivalents, 0 to 64 plasma units, and 0 to 30 cryoprecipitate units. The incidence of transfusion was 95% (mean RBC use, 10 ± 9 units; median, 6.5 units), with 39% of patients requiring 10 or more RBC units and 11% requiring 20 or more RBC units. Blood component use did not differ significantly between the pathology-defined placenta accreta subtypes. Potential clinical laboratory variables that would predict increased blood component use were not identified. The delivery of patients with placenta accreta is a high-risk procedure that requires multidisciplinary planning and adequate resources to optimize outcome. Transfusion services should have a protocol for managing these cases that addresses preoperative blood component preparation and intraoperative management, should massive hemorrhage occur.
    Transfusion 06/2011; 51(12):2627-33. · 3.53 Impact Factor
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    ABSTRACT: We examined predictors of massive blood loss for women with placenta accreta who had undergone hysterectomy. A retrospective review of women who underwent peripartum hysterectomy for pathologically confirmed placenta accreta was performed. Characteristics that are associated with massive blood loss (≥ 5000 mL) and large-volume transfusion (≥ 10 units packed red cells) were examined. A total of 77 patients were identified. The median blood loss was 3000 mL, with a median of 5 units of red cells transfused. There was no association among maternal age, gravidity, number of previous deliveries, number of previous cesarean deliveries, degree of placental invasion, or antenatal bleeding and massive blood loss or large-volume transfusion (P > .05). Among women with a known diagnosis of placenta accreta, 41.7% had an estimated blood loss of ≥ 5000 mL, compared with 12.0% of those who did not receive the diagnosis antenatally with ultrasound scanning (P = .01). There are few reliable predictors of massive blood loss in women with placenta accreta.
    American journal of obstetrics and gynecology 03/2011; 205(1):38.e1-6. · 3.28 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2011; 204(1).
  • Jason D Wright, Patricia Devine
    Obstetrics and Gynecology 11/2010; 116(5):1222-3. · 4.80 Impact Factor
  • Obstetrics and Gynecology 08/2010; 116(2 Pt 1):429-34. · 4.80 Impact Factor
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    ABSTRACT: To examine factors that influence the morbidity and mortality of peripartum hysterectomy and analyze the effect of hospital volume on maternal mortality. We examined women who underwent peripartum hysterectomy at the time of cesarean delivery in a quality and resource utilization database. Procedure-associated intraoperative, perioperative, and postoperative medical complications, length of stay, intensive care unit use, and maternal mortality were analyzed. Hospitals were stratified into tertiles based on procedure volume and complications and compared using adjusted generalized estimating equations. Results are reported as odds ratios. Maternal mortality among the 2,209 women who underwent peripartum hysterectomy was 1.2%. After adjusting for other clinical and demographic factors, perioperative mortality was 71% (odds ratio 0.29, 95% confidence interval 0.10-0.88) lower in women who underwent operation at high-volume hospitals compared with those treated at low-volume facilities. Hospital volume had no effect on the rates of intraoperative injuries, medical complications, length of stay, or transfusion. In contrast, compared with women treated at low-volume centers, patients who underwent operation at high-volume hospitals had a lower incidence of perioperative surgical complications (odds ratio 0.66, 95% confidence interval 0.47-0.93) and a lower rate of intensive care unit usage (odds ratio 0.53, 95% confidence interval 0.34-0.83). Peripartum hysterectomy is associated with substantial morbidity and mortality. Maternal mortality is lower when the procedure is performed in high-volume hospital settings. II.
    Obstetrics and Gynecology 06/2010; 115(6):1194-200. · 4.80 Impact Factor
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    ABSTRACT: To perform a population-based analysis to examine the morbidity and mortality of peripartum hysterectomy in comparison with nonobstetric hysterectomy. Data from the Nationwide Inpatient Sample were used to compare peripartum and nonobstetric hysterectomy in women younger than 50 years of age. Intraoperative, perioperative, and postoperative medical complications were examined. The outcomes of peripartum and nonobstetric hysterectomy were compared using chi square. Odds ratios were calculated using multivariable logistic regression models for each individual complication. A total of 4,967 women who underwent peripartum hysterectomy and 578,179 patients who had a nonobstetric hysterectomy were identified. Bladder (9% compared with 1%) and ureteral (0.7% compared with 0.1%) injuries were more common for peripartum hysterectomy (P<.001). There were no differences in the rates of intestinal or vascular injuries between peripartum and nonobstetric hysterectomy. Rates of reoperation (4% compared with 0.5%), postoperative hemorrhage (5% compared with 2%), wound complications (10% compared with 3%), and venous thromboembolism (1% compared with 0.7%) were all higher in women who underwent peripartum hysterectomy. In multivariable analysis, the odds ratio for death for peripartum compared to nonobstetric hysterectomy was 14.4 (95% confidence interval 9.84-20.98). Peripartum hysterectomy is accompanied by substantial morbidity and mortality. Compared with nonobstetric hysterectomy, the procedure is associated with increased rates of both intraoperative and postoperative complications. The mortality of peripartum hysterectomy is more than 25 times that of hysterectomy performed outside of pregnancy. II.
    Obstetrics and Gynecology 06/2010; 115(6):1187-93. · 4.80 Impact Factor
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    Fadi G Mirza, Patricia C Devine, Sreedhar Gaddipati
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    ABSTRACT: Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality. Potential complications include maternal injury or death, shock, internal hemorrhage, intrauterine fetal demise, direct fetal injury, abruptio placentae, and uterine rupture. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as blunt abdominal trauma, pelvic fractures, or penetrating trauma. Many of the assessment and management aspects of obstetric trauma are unique to pregnancy, although initial evaluation and resuscitation should always be maternally directed. Once maternal stability is established, vigilant evaluation of fetal well-being becomes warranted. Continuous fetal heart monitoring, ultrasonography, computed tomography, open peritoneal lavage, and/or exploratory laparotomy may be indicated in a case of obstetric trauma. In view of the significant impact of trauma on the pregnant woman and her fetus, preventive strategies are paramount.
    American Journal of Perinatology 03/2010; 27(7):579-86. · 1.57 Impact Factor
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    Patricia C Devine
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    ABSTRACT: Despite advances is medical and surgical therapy, obstetric hemorrhage remains a significant medical problem for both the developing and developed world. Depending on the definition that is used, postpartum hemorrhage complicates up to 18% of all deliveries. It is the single most important cause of maternal mortality worldwide, accounting for 25% to 30% of all maternal deaths, and it is the most common maternal morbidity in the developed world. Most cases of hemorrhage are related to uterine atony and abnormal placentation; however, many patients have no identifiable risk factors. Implementation of the active management of labor has resulted in a significant reduction in the incidence postpartum hemorrhage. However, a large number of cases still involve suboptimal care, with delays in diagnosis and treatment identified as common deficiencies.
    Seminars in perinatology 05/2009; 33(2):76-81. · 2.33 Impact Factor
  • Patricia C Devine, Jason D Wright
    Seminars in perinatology 05/2009; 33(2):75. · 2.33 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2008; 199(6).
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2008; 199(6).
  • Russell S Miller, Patricia C Devine, E Blair Johnson
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    ABSTRACT: The purpose of this study was to evaluate the performance of a sonographic measurement of fetal asymmetry, abdominal diameter minus biparietal diameter (AD - BPD), in the prediction of shoulder dystocia (SD) in a patient population that was unselected for diabetes mellitus (DM) status. Patients who underwent sonographic estimations of fetal biometric measurements within 14 days of vaginally delivered live-born singleton neonates weighing 3400 g or greater at a tertiary care institution were included in this retrospective cohort. The mean AD - BPD was retrospectively compared in deliveries complicated by SD with those without SD by the Student t test. A receiver operating characteristic curve was generated to determine the optimal cutoff for SD prediction. Test performance characteristics of AD - BPD were determined. Of 5204 deliveries, 332 met inclusion criteria. Shoulder dystocia complicated 23 deliveries (6.9%). The mean AD - BPD was significantly higher in the dystocia group (2.39 versus 1.97; P = .0002). With an AD - BPD of 2.6 cm or greater, the risk rates of SD were 25% for unselected patients and 38.5% with DM. An AD - BPD of 2.6 cm or greater identifies a subset of patients with and without DM at risk for SD.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2007; 26(11):1523-8. · 1.40 Impact Factor

Publication Stats

84 Citations
40 Downloads
1k Views
45.71 Total Impact Points

Institutions

  • 2013
    • State University of New York Downstate Medical Center
      • Department of Obstetrics and Gynecology
      Brooklyn, NY, United States
  • 2009–2011
    • Columbia University
      • Department of Obstetrics and Gynecology
      New York City, NY, United States
  • 2010
    • CUNY Graduate Center
      New York City, New York, United States