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ABSTRACT: OBJECTIVE: Despite pregnant women's increased morbidity and mortality from influenza, vaccination rates remain low. This study intended to evaluate barriers to pregnant women's uptake of influenza vaccine. STUDY DESIGN: A survey was designed that assessed participant demographics, knowledge, beliefs, attitudes, and general experiences with seasonal and 2009 novel H1N1 influenza. Associations between patient characteristics and vaccine uptake were then assessed. RESULTS: 88 women completed the survey. Women who correctly answered >75% of knowledge questions regarding influenza were significantly more likely to accept the influenza vaccine (seasonal: p=0.04, H1N1: p<0.01). Conversely, patients who declined the vaccine were more likely to hold false beliefs, such as perceiving that the vaccine was not protective (seasonal: p<0.01, H1N1: p<.01) and that they were not at risk for influenza (seasonal: p< 0.01). CONCLUSION: The reasons for influenza vaccine declination in pregnant patients include lower levels of knowledge and unfavorable attitudes regarding the safety and efficacy of the vaccine, and suggest the importance of education as a tool to improve vaccination uptake.
Vaccine 04/2013; · 3.77 Impact Factor
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ABSTRACT: Objective To validate a five-factor scoring system that identifies parturients who experience near-miss morbidity.Study Design and Setting This study was conducted in an urban, tertiary care hospital over a 2-year period. A narrative case summary was prepared for women with high potential for significant obstetric morbidity. The summary was then reviewed by three physicians, and the extent of morbidity was assigned based on subjective assessment. The same cases were then scored using the proposed five-factor scoring system previously described by Geller et al. Test characteristics of the scoring system were assessed.Results Eight hundred fifteen cases with a high potential for significant morbidity were identified. Subjective review and the scoring system classified 4.5% and 4.2% as near-miss morbidity, respectively, with the scoring system having a corresponding sensitivity of 81.1% (95% confidence interval 64.8 to 92.0%) and a specificity of 99.5% (95% confidence interval 98.7 to 99.9%).Conclusion The scoring system produced similar results to those obtained at its initial development and demonstrated acceptable sensitivity and specificity for identifying near-miss morbidity.
American Journal of Perinatology 07/2012; · 1.32 Impact Factor
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ABSTRACT: We sought to evaluate the effectiveness of a pharmaceutical labeling strategy intended to improve comprehension of a teratogen warning.
This is a secondary analysis that evaluated women of childbearing age who were assigned prescription containers with the current teratogen warning, a label with simplified text, or a label with simplified text and icons. The association between label type and understanding of label instructions was assessed.
A total of 132 women were interviewed. Comprehension of the icon label (94%) was higher than for the standard and enhanced text-only labels (76% and 79%), respectively (P < .05). Adjustment for age, race/ethnicity, education, literacy, and number of current medications revealed that the label with the enhanced text and icon yielded superior comprehension (risk ratio vs standard, 1.26; 95% confidence interval, 1.04-1.53; risk ratio vs enhanced, 1.22; 95% confidence interval, 1.02-1.46).
In our study, a teratogen warning label that had easy-to-read messages with icons significantly improved comprehension.
American journal of obstetrics and gynecology 02/2011; 204(4):318.e1-5. · 3.28 Impact Factor
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ABSTRACT: To explore the extent to which pregnant women understand the symptoms and potential complications related to preeclampsia and to determine the factors that are associated with better understanding.
This was a cross-sectional study in which 112 pregnant patients were interviewed to determine their preeclampsia knowledge. Knowledge was evaluated using a 25-item survey addressing the symptoms, consequences, and proper patient actions associated with preeclampsia. Patients were also asked in an open-ended question to define preeclampsia; all responses were rated by three obstetricians. Information about demographics, medical and obstetrical history, and health literacy was also obtained. Health literacy was assessed using the short Test of Functional Health Literacy in Adults (S-TOFHLA).
Patients correctly answered only 43% of the 25 questions assessing preeclampsia knowledge. Moreover, only 14% of the patients were able to provide a definition that correctly reflected the syndrome. Factors associated with a greater proportion of correct answers on the questionnaire were higher literacy, multiparity, history of preeclampsia, and receipt of information about preeclampsia from a clinician or another information source (e.g., the Internet, television, a book, or a friend).
Pregnant patients have a generally poor understanding of preeclampsia, although improved understanding is associated with having received information about the disease. Further investigation will be needed to determine how best to educate patients and whether this education can also decrease adverse outcomes associated with this syndrome.
Hypertension in Pregnancy 09/2010; 31(3):341-9. · 1.69 Impact Factor
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ABSTRACT: To determine if gestational age (GA) at the time of ultrasound impacts the positive predictive value of shortened femur and humerus lengths (FL, HL) for trisomy 21 (T21).
Sonograms from 14 to 21 and 6/7 weeks' gestation were collected over a 28 month period. Multiple gestations or fetuses with major structural anomalies were excluded. Biometric data and GA were obtained; the expected HL (or FL): observed HL (or FL) ratios were calculated using two regression formulas (Benacerraf and Nyberg). A HL ratio <0.90 and a FL ratio <0.91 were considered shortened. T21 fetuses were identified through database and chart review. Positive predictive values (PPV) for T21 of the shortened bone ratios were determined, then stratified by GA.
Of the 2606 ultrasounds, 8.9% and 18.9% of fetuses had shortened HL and FL ratios, respectively, using the Benacerraf formula. Shortened ratios were noted significantly less commonly (2.3 and 4.4%, respectively, P < 0.001 for each) using the Nyberg formula. With either formula, abnormal bone ratios were more frequently documented with a GA less than 17 weeks (P < 0.001). There were 17 T21 pregnancies.
GA and formula selection influence the performance of long bone ratios as soft markers for T21 in the second trimester.
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 07/2010; 23(7):642-5. · 1.36 Impact Factor
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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
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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
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ABSTRACT: To estimate the relationship between inherited thrombophilias and intrauterine growth restriction (IUGR) using meta-analytic techniques.
A literature review identified case-control and cohort studies evaluating the relationship between IUGR and the following thrombophilias: homozygous or heterozygous factor V Leiden or prothrombin (PT) G20210A mutations and homozygous methylenetetrahydrofolate reductase (MTHFR) C677T mutation. Using mixed effects and random-effects models, the association between thrombophilias and IUGR was explored. Publication bias was assessed with funnel plots and corrected for with Duval and Tweedie's trim-and-fill method.
The following number of related studies were found: studies evaluating relationships between factor V Leiden mutation and IUGR, 12 case-control and four cohort; between PT mutation and IUGR, 11 case-control and 0 cohort; and between MTHFR C677T homozygosity and IUGR, 10 case-control and two cohort. The overall summary odds ratio (OR) for the association between factor V Leiden and IUGR was significant (OR 1.23, 95% confidence interval [CI] 1.04-1.44); however, this was mainly driven by the positive association seen in the case-control studies (OR 1.91, 95% CI 1.17-3.12). The association between PT and IUGR was only explored in case-control studies yielding a summary OR that was not significant (OR 1.52, 95% CI 0.98-2.35). The overall summary OR for the association between MTHFR and IUGR was not significant (OR 1.01, 95% CI 0.88-1.17), but was significant for the case-control studies alone (OR 1.35, 95% CI 1.04-1.75). For both factor V Leiden and MTHFR mutations, a funnel-plot analysis of the case-control studies suggests publication bias. When the trim-and fill-method was used to correct for the publication bias, these summary estimates were no longer significant.
The association between inherited thrombophilias and IUGR can only be discerned in case-control studies and seems to be largely because of publication bias.
III.
Obstetrics and Gynecology 07/2009; 113(6):1206-16. · 4.73 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the frequency with which 6 different fetal cardiac views taken during a fetal ultrasound examination at 18 to 22 weeks' gestation can be obtained satisfactorily for cardiac anomaly screening using either a 2-dimensional (2D) static or 3-dimensional (3D) fast acquisition technique.
A prospective study of 100 low-risk women undergoing an anatomic survey was performed. Standard static 2D and 3D fast acquisition volumes were obtained on all patients. The 2D and 3D images were assigned, in a random order, to be independently graded by 3 reviewers. The degree of inter-reviewer agreement was assessed through the use of the Cohen kappa statistic. The factors contributing to satisfactory imaging were evaluated by random effects logistic regression.
A significant proportion of both 2D and 3D images were judged unsatisfactory for screening purposes. However, 2D images were significantly more likely, for all cardiac views, to be judged satisfactory (P < .05). The odds ratios for the 2D technique's being more likely than the 3D technique to provide images satisfactory for screening were 2.6 for the 4-chamber view, 2.4 for the right ventricular outflow tract, 4 for the left ventricular outflow tract, 3.2 for the 3-vessel view, 8.6 for the aortic arch, and 2.2 for the ductal arch.
In this prospective study, static 2D imaging was significantly more likely than fast acquisition 2D imaging to yield cardiac views of high enough quality to satisfactorily screen for anomalies.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2009; 28(5):595-601. · 1.25 Impact Factor
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ABSTRACT: To estimate the association between professional liability insurance premiums for obstetricians and late preterm induction (LPI) rates.
Data from the National Center for Health Statistics were used to identify all Illinois women pregnant with singletons at 34 weeks' gestation from 1991 to 2003. The independent association between LPI (induction between 34 and 37 weeks' gestation) rates and the previous year's obstetric malpractice insurance premiums was evaluated using linear regression.
The mean annual LPI rate (5.4/1000 in 1991 to 15.2/1000 in 2003, P < 0.001) nearly tripled, and obstetricians' professional liability insurance premiums ($55,480 to $110,613, P < 0.001) approximately doubled. After adjusting for race, previous cesarean delivery, marital status, and the presence of antepartum risk factors for indicated preterm delivery, LPI rates increased by 1/1000 births (P = 0.004) for each annual $10,000 increase in the county's obstetric malpractice insurance premium.
Rising premiums are associated with increased frequency of LPI among women with singleton gestations.
Medical care 03/2009; 47(4):425-30. · 3.24 Impact Factor
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ABSTRACT: Our objective was to determine whether preterm birth of a singleton is associated with an increased risk of preterm birth of twins in a subsequent pregnancy. We identified all women who delivered a singleton followed by twins at Northwestern Memorial Hospital during a 10-year period. Using a cohort study design, we compared women with preterm singleton deliveries to women with term singleton deliveries with regard to their subsequent twin pregnancy outcomes. Two hundred ninety-three were identified who delivered a singleton followed by twins. Women who delivered a preterm singleton were significantly more likely to deliver subsequent preterm twins (73.9% versus 44.4%, odds ratio 3.5, 95% confidence interval 1.4 to 9.3). This significant difference persisted in multivariable analysis after controlling for ethnicity (adjusted odds ratio 3.3, 95% confidence interval 1.3 to 8.7). We concluded that preterm birth of a singleton is associated with an increased risk of preterm delivery in a subsequent twin gestation.
American Journal of Perinatology 11/2008; 25(10):657-9. · 1.32 Impact Factor
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ABSTRACT: We sought to develop a predictive model for gestational age at delivery after placement of an emergent cerclage in the second trimester. Data were obtained for women undergoing emergent cerclage in response to documented cervical change on physical examination at a university hospital between 1980 and 2000. Hierarchically optimal classification tree analysis (CTA) was used to predict delivery prior to 24 weeks, between 24 and 27 6/7 weeks, or after 27 6/7 weeks. One hundred sixteen women were available for analysis. Delivery prior to 24 weeks was best predicted by presence of prolapsed membranes and gestational age at cerclage placement; delivery between 24 and 27 6/7 weeks was best predicted by parity alone; delivery of at least 28 weeks was best predicted by cervical dilation and length, presence of prolapsed membranes, and parity. When choosing a single model to predict delivery at the three different gestational age periods, the last model yielded the most accurate results. CTA can be used to construct a predictive model for outcome after emergent cerclage that may be informative for both patients and physicians.
American Journal of Perinatology 10/2008; 25(7):443-8. · 1.32 Impact Factor
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ABSTRACT: To evaluate whether an outpatient antibiotic regimen decreased group B streptococcal (GBS) colonization to preclude the use of intrapartum antibiotics.
A double-blind randomized controlled trial evaluating prenatal oral amoxicillin versus placebo with the primary outcome of GBS colonization at the time of labor.
Of those patients receiving both amoxicillin and a repeat culture at the time of labor, 6 of the 14 (43%) tested positive for GBS colonization. Given persistent GBS colonization of 67% (10/15) in the placebo group, treatment with amoxicillin did not significantly impact colonization at the time of delivery (P=0.20).
A regimen of outpatient amoxicillin was associated with persistent GBS colonization in 43% of women at the time of labor. Oral prenatal antibiotic prophylaxis against GBS does not sufficiently reduce colonization to preclude intrapartum intravenous antibiotics.
International Journal of Gynecology & Obstetrics 06/2008; 101(2):125-8. · 2.05 Impact Factor
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ABSTRACT: Our purpose was to assess economic and health consequences of elective induction at term.
A decision-tree model incorporating a Markov analysis was used to compare the decision either to electively induce labor at term or expectantly manage the pregnancy until 42 weeks' gestation. Main outcome measures, stratified by parity, cervical ripeness, and gestational age at induction, were number of cesarean deliveries and costs to the health care system.
By use of baseline estimates, induction at any gestational age, regardless of parity and cervical ripeness, required expenditures from the medical system. Although never cost saving, inductions were less expensive at later gestational ages, for multiparous patients, and for those women with a favorable cervix. Sensitivity analysis demonstrated a robust model.
Elective induction of labor at term is not cost saving and results in a large excess of cesarean deliveries. Costs are significantly altered by the timing of the induction, parity, and cervical ripeness.
American Journal of Obstetrics and Gynecology 11/2002; 187(4):858-63. · 3.47 Impact Factor
