William A Grobman

University of Illinois at Chicago, Chicago, Illinois, United States

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Publications (238)676.09 Total impact

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    ABSTRACT: We sought to compare the predictive power of published modified obstetric early warning scoring systems (MOEWS) for the development of severe sepsis in women with chorioamnionitis. This was a retrospective cohort study using prospectively collected clinical observations at a single tertiary unit (Chicago, IL). Hospital databases and patient records were searched to identify and verify cases with clinically diagnosed chorioamnionitis during the study period (June 2006 through November 2007). Vital sign data (heart rate, respiratory rate, blood pressure, temperature, mental state) for these cases were extracted from an electronic database and the single worst composite recording was identified for analysis. Global literature databases were searched (2014) to identify examples of MOEWS. Scores for each identified MOEWS were derived from each set of vital sign recordings during the presentation with chorioamnionitis. The performance of these MOEWS (the primary outcome) was then analyzed and compared using their sensitivity, specificity, positive and negative predictive values, and receiver-operating characteristic curve for severe sepsis. Six MOEWS were identified. There was wide variation in design and pathophysiological thresholds used for clinical alerts. In all, 913 women with chorioamnionitis were identified from the clinical database. In all, 364 cases with complete data for all physiological indicators were included in analysis. Five women developed severe sepsis, including 1 woman who died. The sensitivities of the MOEWS in predicting the severe deterioration ranged from 40-100% and the specificities varied even more ranging from 4-97%. The positive predictive values were low for all MOEWS ranging from <2-15%. The MOEWS with simpler designs tended to be more sensitive, whereas the more complex MOEWS were more specific, but failed to identify some of the women who developed severe sepsis. Currently used MOEWS vary widely in terms of alert thresholds, format, and accuracy. Most MOEWS have not been validated. The MOEWS generally performed poorly in predicting severe sepsis in obstetric patients; in general severe sepsis was overdetected. Simple MOEWS with high sensitivity followed with more specific secondary testing is likely to be the best way forward. Further research is required to develop early warning systems for use in this setting. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology. 11/2014;
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    ABSTRACT: To evaluate the association of duration of magnesium sulfate infusion with stillbirth or death, cerebral palsy, and select adverse maternal and neonatal outcomes.
    Obstetrics and gynecology. 09/2014;
  • Alison D Cowan, Emily S Miller, William A Grobman
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    ABSTRACT: To evaluate whether use of the B-Lynch suture is associated with subsequent adverse pregnancy outcomes.
    American Journal of Obstetrics and Gynecology 09/2014; 124(3):558-561. · 3.88 Impact Factor
  • Emily S. Miller, William A. Grobman
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    ABSTRACT: Objective To determine whether a prior cervical excisional procedure (a loop electrosurgical excision procedure (LEEP) or cold knife cone (CKC)) is associated with a short midtrimester cervical length (<3cm) and whether having a short cervix explains the relationship between this procedure and preterm birth. Study Design In this cohort study of women with a singleton pregnancy who underwent routine cervical length assessment between 18 and 24 weeks of gestation, women with a history of a prior cervical excisional procedure were compared to those without such a history. Bivariable and multivariable analyses were performed to identify whether a prior cervical excisional procedure remained an independent risk factor for preterm birth after controlling for cervical length. Results Of the 6669 women who met inclusion criteria, 460 (6.9%) had a prior cervical excisional procedure. Mean cervical length was shorter [4.2±0.9cm vs. 4.5±0.9cm, p<0.001] and the proportion of women with a short cervix was higher (6.5% vs 1.5%, p<0.001) in women with a prior cervical excisional procedure. In multivariable regression, both a short cervix (aOR 6.19, 95% CI 3.85-9.95) and a prior cervical excisional procedure (aOR 1.53, 95% CI 1.04-2.25) were significantly associated with preterm birth. Conclusions Women with a prior cervical excisional procedure have shorter midtrimester cervical lengths. Both a prior cervical excisional procedure and a short cervix were independently associated with preterm birth. These data suggest that the risk of preterm birth associated with a prior LEEP or CKC is not merely due to post-surgical shortening of the cervix.
    American journal of obstetrics and gynecology 09/2014; · 3.28 Impact Factor
  • Brett D Einerson, Emily S Miller, William A Grobman
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    ABSTRACT: We sought to determine whether the introduction of a postpartum hemorrhage (PPH) safety program was associated with changes in clinical practice and outcomes, and to examine whether theses changes were sustained over time. In August 2008, a multidisciplinary PPH patient safety program was implemented at our single tertiary-care hospital. We performed a cohort study of all women with PPH from August 2007 to December 2011. Changes in clinical practice and outcomes were compared before and after the intervention. Shewhart charts were used to examine sustainability of these changes over time. During the study period 52,819 women delivered, and 3,105 (5.9%) experienced PPH. After the introduction of the program there was a significant increase in the use of uterotonic medications (p<0.001), intrauterine balloon tamponade (p=0.002), B-Lynch suture placement (p=0.042), uterine artery embolization (p=0.050), and cryoprecipitate use (p=0.0222). Concomitantly, the number of days between admissions to the ICU for PPH increased.
    American Journal of Obstetrics and Gynecology 07/2014; · 3.88 Impact Factor
  • William A Grobman
    Clinical obstetrics and gynecology. 07/2014;
  • Emily S. Miller, Priya V. Rajan, William A. Grobman
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    ABSTRACT: Objective To compare outcomes of physical exam-indicated cerclage in women with twin gestations to those with singleton gestations and to identify whether risk factors for extremely preterm birth (prior to 28 weeks) differ between these two groups. Study Design This is a single institution retrospective cohort study of women who underwent a physical exam-indicated cerclage between January 1, 1980 and August 15, 2012. Differences in characteristics and outcomes were compared between women with twin and singleton gestations. A multivariable analysis was performed to examine whether twin gestation was independently associated with delivery before 28 weeks and whether any effect modification was present between risk factors for preterm birth and the presence of a twin gestation. Results Of the 442 women who underwent a cerclage during the period of study, 104 (23.5%) had twins. Mean gestational age and digital cervical length at placement did not differ by plurality. Although twins were more likely to deliver at a slightly earlier median gestation than singletons [31.9 weeks (interquartile range 24.9-35.1) vs 32.7 weeks (interquartile range 24.6-38.3), p=0.015], the frequency of delivery before 28 weeks did not differ between these two groups (33.7% vs 35.8%, p=0.69). Greater cervical dilation and prolapsing membranes were identified as risk factors for birth < 28 weeks in both groups; digital cervical length < 2 cm appeared to be a risk factor particularly for women with twin gestations. Conclusion Women with a twin pregnancy who received a physical exam-indicated cerclage had similar risk factors for extreme preterm birth and may experience similar obstetric outcomes as women with singleton gestations.
    American journal of obstetrics and gynecology 07/2014; · 3.28 Impact Factor
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    ABSTRACT: Objective The objective of this study was to investigate the association between type of health insurance (Medicaid vs. private) and uptake of diagnostic testing for fetal aneuploidy after a positive screening test result. Methods We performed a retrospective cohort study of pregnant women who underwent aneuploidy screening in the first and/or second trimesters of pregnancy and received positive results. The characteristics of and outcomes for women with Medicaid were compared with those of women with private insurance in both univariable and multivariable analyses. Results In this study, 75 women with Medicaid and 75 with private insurance were analyzed. Those with Medicaid were younger (33.8 vs. 36.9 years, p < 0.01), and more likely to be of non-white race/ethnicity (88 vs. 27%, p < 0.01), unmarried (65 vs. 19%, p < 0.01), non-English speaking (12 vs. 0%, p < 0.01), and multiparous (76 vs. 59%, p = 0.02). They also were less likely to undergo diagnostic testing after a positive aneuploidy screen (35 vs. 57%, p < 0.01). In multivariable analysis, those with Medicaid remained significantly less likely to undergo diagnostic testing (odds ratio, 0.26; 95% confidence interval, 0.09-0.80). Conclusion Women with Medicaid are less likely than women with private insurance to undergo diagnostic testing after positive screening for aneuploidy. These results emphasize the potential importance of improved counseling for low-income women.
    American Journal of Perinatology 06/2014; · 1.57 Impact Factor
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    ABSTRACT: To evaluate the association of other-than-common benign copy number variants with specific fetal abnormalities detected by ultrasonogram.
    Obstetrics and gynecology. 06/2014;
  • Lynn M Yee, Lilly Y Liu, William A Grobman
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    ABSTRACT: To investigate the relationship between physician coping skills, need for cognition, tolerance of ambiguity, and anxiety and their patients' mode of delivery.
    American journal of obstetrics and gynecology. 06/2014;
  • Gustave H Falciglia, William A Grobman, Karna Murthy
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    ABSTRACT: Objective To quantify the variation in induction of labor (IOL) over the days of the week for gravid women in the United States. Study Design Women who delivered singletons between 24 and 42 weeks' gestation were identified using birth certificate data from 2007 to 2010. Women with pregnancy-associated hypertension, fetal anomalies, previous cesarean delivery, or incomplete records were excluded. The primary outcome was IOL. Women were stratified into four gestational age groups: < 34, 34 to 36, 37 to 38, and ≥ 39 weeks. Frequencies of IOL were determined according to day of the week. Multivariable logistic regression estimated the association between weekend delivery and IOL, adjusting for maternal characteristics and year of delivery. Results There were 11.6 million eligible women. For each gestational age stratum, the frequency of IOL was increased on weekdays compared with weekends (8.0 vs. 7.4%, 16.5 vs. 13.2%, 25.0 vs. 14.8%, and 33.2 vs. 19.3% at < 34, 34-36, 37-38, and ≥ 39 weeks, respectively; p < 0.01 for all). Multivariable analyses demonstrated that weekend IOL was inversely related to gestational age (odds ratios: 0.93, 0.77, 0.52, and 0.48, respectively; p < 0.001 for all). Conclusion The frequency of IOL varies according to the day of the week, with the odds of weekend IOL lowest at greater gestational ages.
    American Journal of Perinatology 05/2014; · 1.57 Impact Factor
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    ABSTRACT: To estimate the performance of combining cervical length measurement with fetal fibronectin testing in predicting delivery in women with symptoms of preterm labor. We conducted a prospective nationwide cohort study in all 10 perinatal centers in The Netherlands. Women with symptoms of preterm labor between 24 and 34 weeks of gestation with intact membranes were included. In all women, qualitative fibronectin testing (0.050-microgram/mL cutoff) and cervical length measurement were performed. Logistic regression was used to predict spontaneous preterm delivery within 7 days after testing. A risk less than 5%, corresponding to the risk for women with a cervical length of at least 25 mm, was considered as low risk. Between December 2009 and August 2012, 714 women were enrolled. Fibronectin results and cervical length were available for 665 women, of whom 80 (12%) delivered within 7 days. Women with a cervical length of at least 30 mm or with a cervical length between 15 and 30 mm with a negative fibronectin result were at low risk (less than 5%) of spontaneous delivery within 7 days. Fibronectin testing in case of a cervical length between 15 and 30 mm additionally classified 103 women (15% of the cohort) as low risk and 36 women (5% of the cohort) as high risk. Cervical length measurement, combined with fetal fibronectin testing in case of a cervical length between 15 and 30 mm, improves identification of women with a low risk to deliver spontaneously within 7 days. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 05/2014; · 4.80 Impact Factor
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    ABSTRACT: To evaluate whether perioperative indomethacin and antibiotic administration at the time of examination-indicated cerclage placement prolongs gestation. This is a randomized controlled trial performed at a single tertiary care hospital between March 2010 and November 2012. Women older than 18 years of age with a singleton pregnancy between 16 0/7 and 23 6/7 weeks of gestation undergoing an examination-indicated cerclage were eligible. Women were randomly assigned to receive either perioperative indomethacin and antibiotics or no perioperative prophylactic medications. The primary outcome was gestational latency after cerclage placement. Fifty women were required to be randomized to show, with 80% power, a 28-day improvement in latency assuming a latency without intervention of 50±35 days. Fifty-three patients were enrolled with three lost to follow-up. A greater proportion of pregnancies were prolonged by at least 28 days among women who received indomethacin and perioperative antibiotics (24 [92.3%] compared with 15 [62.5%], P=.01). However, gestational age at delivery and neonatal outcomes were statistically similar between groups. Among women receiving an examination-indicated cerclage in the second trimester, gestation was significantly more likely to be prolonged by 28 days among women who received perioperative indomethacin and antibiotics. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01114516. LEVEL OF EVIDENCE:: I.
    Obstetrics and Gynecology 05/2014; · 4.80 Impact Factor
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    ABSTRACT: Women have higher risk for obstetric complications as they have increasing numbers of cesarean deliveries. The objective of this study is to clarify both the likelihood of continued childbearing after cesarean deliveries and the influence of sociodemographic characteristics on that relationship. Data from the National Survey of Family Growth, 2006-2010, were used to describe the childbearing trajectory for U.S. women. Respondents with a live, singleton, first birth were included. Population-weighted bivariate and multivariable analyses were performed to test the association between route of delivery and number of cesarean deliveries with subsequent birth, up to four deliveries. The cohort included 6,526 respondents. Cesarean delivery, regardless of birth order, was associated with a lower likelihood of future birth, which decreased in a dose-response fashion as the number of cesarean deliveries increased. Among women who had three births, those with two and three cesarean deliveries were 36% and 58% less likely (P<.05), respectively, to have a fourth birth when compared with women with three vaginal deliveries adjusting for known predictors of increased parity. Income level moderated this relationship with lower-income women having a greater probability of childbirth after two or three cesarean deliveries (P<.05). U.S. women are less likely to continue childbearing as they have higher numbers of cesarean deliveries; however, this is less true for low-income women. Given the risks associated with multiple cesarean deliveries, these findings underscore the need to inform and counsel women, especially low-income women, about pregnancy planning both pre- and postcesarean delivery.
    Obstetrics and Gynecology 05/2014; 123 Suppl 1:68S. · 4.80 Impact Factor
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    ABSTRACT: Although maternal deaths have been the traditional indicator of maternal health, these events are the "tip of the iceberg" in that there are many women who have significant complications of pregnancy, labor, and delivery. Identifying women who experience severe maternal morbidity and reviewing their care can provide critical information to inform quality improvement in obstetrics. In this commentary, we review methods to identify women who experienced severe complications of pregnancy. We propose a simple validated approach based on transfusion of four or more units of blood products, admission to an intensive care unit, or both as a starting point for identification and review of severe maternal morbidity in health care settings for the purpose of understanding successes and failures in systems of care.
    Obstetrics and Gynecology 05/2014; 123(5):978-981. · 4.80 Impact Factor
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    ABSTRACT: To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.Supplemental Digital Content is Available in the Text. This was a secondary analysis of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (more than three units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity; these were used to develop a prediction model for severe maternal morbidity. Among 115,502 women who delivered during the study period, 332 (2.9/1,000 births, 95% confidence interval 2.6-3.2) experienced severe maternal morbidity. Postpartum hemorrhage was responsible for approximately half of severe maternal morbidity. Multiple patient factors were found to be independently associated with severe maternal morbidity and were used to develop a predictive model with an area under the receiver operating characteristic curve of 0.80. Severe maternal morbidity occurs in approximately 2.9 per 1,000 births, is most commonly the result of postpartum hemorrhage, and occurs more commonly in association with several identifiable patient characteristics. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 04/2014; 123(4):804-810. · 4.80 Impact Factor
  • William A Grobman
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    ABSTRACT: Multiple authors have documented that maternal outcomes differ depending on whether labor is spontaneous or electively induced. Correspondingly, there is evidence that women who are electively induced generate more costs than those in spontaneous labor. However, to determine the resource utilization of women who are electively induced, one must compare them to women who experience the actual alternative to induction, namely, expectant management. Observational studies using these comparison groups have not replicated many of the findings that lead to elective inductions being more costly. Moreover, there is little information about the contribution of outpatient costs from expectant management.
    Clinical obstetrics and gynecology 03/2014; · 2.06 Impact Factor
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    ABSTRACT: To determine whether an interactive computer program could improve patient knowledge regarding genetic screening and diagnostic concepts. In this randomized trial, women 6-26 weeks' gestation were assigned to standard care with provider-based counseling or to augmented counseling with an interactive computer program. The computer-based tool conveyed information about genetic testing options. Women were administered a 23-item test of content knowledge immediately and 2-4 weeks after exposure. Test scores were compared between groups at both points using T-tests. 150 women were randomized equally between groups. Groups were similar with regard to demographic characteristics. Women randomized to the interactive tool correctly answered a significantly greater proportion of questions than those who received standard counseling (69.4% ±14.2% vs. 46.0% ± 15.2%, p < .001) on the immediate questionnaire. One hundred and twenty-three (82%) participants participated in the follow-up test. Women randomized to the tool continued to correctly answer a significantly greater proportion of questions (60.6% ± 16% vs. 49.7% ± 18.9%, p = .001). Education, health literacy, electronic health literacy, and other discussions with providers were not associated with a differential benefit from the educational intervention. A patient-directed interactive computer program may help providers to convey relevant information about genetic screening and diagnostic concepts. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 02/2014; · 2.68 Impact Factor
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    ABSTRACT: Objective The objective of this study was to determine the prevalence and incidence of sleep disordered breathing (SDB) in pregnancy among high-risk women. Study Design This was a prospective, observational study. We recruited women with a body mass index (BMI) ≥ 30 kg/m2, chronic hypertension, pregestational diabetes, history of preeclampsia, and/or a twin gestation. Objective assessment of SDB was completed between 6 and 20 weeks and again in the third trimester. SDB was defined as an apnea-hypopnea index (AHI) ≥5, and further grouped into severity categories: mild (5-14.9), moderate (15-29.9) and severe (≥30). Subjects who had a normal AHI at the baseline (AHI < 5), but an abnormal study in the third trimester (AHI ≥5) were classified as having "new-onset" SDB. Results A total of 128 women were recruited. In early pregnancy 21, 6 and 3% had mild, moderate, or severe SDB, respectively. These frequencies increased to 35, 7, and 5% in the third trimester (p < 0.001). About 27% (n = 34) experienced a worsening of SDB during pregnancy; 26 were cases of new-onset SDB, while the other 8 had SDB in early pregnancy that worsened in severity. The incidence of new-onset SDB was 20%. The majority of these new-onset cases were mild. Conclusions SDB in early pregnancy is common in high-risk women and new-onset SDB occurs in 20% of these women.
    American Journal of Perinatology 02/2014; · 1.57 Impact Factor
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    ABSTRACT: Background: Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low-and middle-income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.

Publication Stats

2k Citations
676.09 Total Impact Points

Institutions

  • 2008–2014
    • University of Illinois at Chicago
      • • Department of Obstetrics and Gynecology (Peoria)
      • • Department of Obstetrics and Gynecology (Chicago)
      Chicago, Illinois, United States
    • Society for Maternal-Fetal Medicine
      Chicago, Illinois, United States
    • Yale University
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      New Haven, CT, United States
  • 1996–2014
    • Northwestern University
      • • Division of Maternal-Fetal Medicine
      • • Department of Obstetrics and Gynecology
      • • Department of Pediatrics
      Evanston, Illinois, United States
  • 2013
    • Magee-Womens Hospital
      Pittsburgh, Pennsylvania, United States
    • Case Western Reserve University School of Medicine
      Cleveland, Ohio, United States
    • Georgetown University
      Washington, Washington, D.C., United States
  • 2012–2013
    • Université de Montréal
      • Department of Obstetrics and Gynecology
      Montréal, Quebec, Canada
    • George Washington University
      • Biostatistics Center
      Washington, Washington, D.C., United States
    • Indiana University-Purdue University Indianapolis
      • Department of Obstetrics and Gynecology
      Indianapolis, IN, United States
  • 2006–2013
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1998–2012
    • Northwestern Memorial Hospital
      • Department of Obstetrics and Gynecology
      Chicago, Illinois, United States
  • 2011
    • University of Western Sydney
      • School of Medicine
      Penrith, New South Wales, Australia
    • Washington University in St. Louis
      • Department of Obstetrics and Gynecology
      Saint Louis, MO, United States
  • 2010
    • University of Pennsylvania
      • Department of Obstetrics and Gynecology
      Philadelphia, PA, United States
    • Massachusetts General Hospital
      • Department of Obstetrics and Gynecology
      Boston, MA, United States
    • Eastern Virginia Medical School
      • Department of Obstetrics and Gynecology
      Norfolk, VA, United States
  • 2009
    • University of Texas Medical Branch at Galveston
      • Department of Obstetrics and Gynecology
      Galveston, TX, United States
  • 2005
    • Hospital of the University of Pennsylvania
      Philadelphia, Pennsylvania, United States