William A Grobman

Society for Maternal-Fetal Medicine, Chicago, Illinois, United States

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Publications (270)930.43 Total impact

  • Anna Palatnik, William A. Grobman
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    ABSTRACT: Previous studies of induction of labor in the setting of trial of labor after cesarean have compared women undergoing trial of labor after cesarean to those undergoing spontaneous labor. However, the clinically relevant comparison is to those undergoing expectant management. The objective of this study was to compare obstetric outcomes between women undergoing induction of labor and those undergoing expectant management ≥39 weeks of gestation. This was a secondary analysis of data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Cesarean Registry that included women with singleton gestations at a gestational age of ≥39 weeks and a history of 1 low transverse cesarean delivery. Outcomes of induction at 39, 40, and 41 weeks were compared to expectant management beyond each gestational age period using univariable and multivariable analyses. Women with scheduled repeat cesarean deliveries done for the indication of prior cesarean delivery were excluded from the analysis. In all, 12,676 women were eligible for analysis. The rate of vaginal birth after cesarean (VBAC) was higher among women undergoing induction of labor at 39 weeks compared to expectant management (73.8% vs 61.3%, P < .001). The risk of uterine rupture also was higher among women undergoing induction of labor at 39 weeks compared to expectant management (1.4% vs 0.5%, P = .006, respectively). In multivariable analysis, induction of labor at 39 weeks remained associated with a significantly higher chance of VBAC and uterine rupture (odds ratio, 1.31; 95% confidence interval, 1.03-1.67; and odds ratio, 2.73; 95% confidence interval, 1.22-6.12, respectively). Induction of labor at 39 weeks, when compared to expectant management, was associated with a higher chance of VBAC but also of uterine rupture. Copyright © 2015 Elsevier Inc. All rights reserved.
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    ABSTRACT: Racial differences in chronic maternal stress may contribute to disparities in pregnancy outcomes. The objective is to identify racial and ethnic differences in self-reported and biologic measures of stress between non-Hispanic black (NHB) and non-Hispanic white (NHW) pregnant women. NHB and NHW pregnant women were enrolled before 23 weeks of gestation in this prospective cohort study. Equal numbers of women were recruited with public vs private insurance in each racial group. Self-reported stress was measured and blood samples collected in the second and third trimesters were analyzed for serum Epstein-Barr virus antibody, C-reactive protein (CRP), corticotropin-releasing hormone (CRH) and adenocorticotropic hormone (ACTH). One hundred and twelve women were enrolled. NHW women reported more buffers against stress (P=0.04) and neighborhood satisfaction (P=0.02). NHB women reported more discrimination (P<0.001), food insecurity (P=0.04) and had significantly higher mean CRP levels and mean ACTH levels in the second and third trimesters. Significant differences in self-reported and biologic measures of chronic stress were identified between NHB and NHW pregnant women with similar economic characteristics. Future studies should investigate mechanisms underlying these differences and their relationship to pregnancy outcomes.Journal of Perinatology advance online publication, 19 March 2015; doi:10.1038/jp.2015.18.
    Journal of perinatology: official journal of the California Perinatal Association 03/2015; DOI:10.1038/jp.2015.18 · 1.59 Impact Factor
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    ABSTRACT: The objective of the Sleep Disordered Breathing substudy of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) is to determine whether sleep disordered breathing during pregnancy is a risk factor for adverse pregnancy outcomes. NuMoM2b is a prospective cohort study of 10,037 nulliparous women with singleton gestations that was conducted across 8 sites with a central Data Coordinating and Analysis Center. The Sleep Disordered Breathing substudy recruited 3702 women from the cohort to undergo objective, overnight in-home assessments of sleep disordered breathing. A standardized level 3 home sleep test was performed between 6(0)-15(0) weeks' gestation (visit 1) and again between 22(0)-31(0) weeks' gestation (visit 3). Scoring of tests was conducted by a central Sleep Reading Center. Participants and their health care providers were notified if test results met "urgent referral" criteria that were based on threshold levels of apnea hypopnea indices, oxygen saturation levels, or electrocardiogram abnormalities but were not notified of test results otherwise. The primary pregnancy outcomes to be analyzed in relation to maternal sleep disordered breathing are preeclampsia, gestational hypertension, gestational diabetes mellitus, fetal growth restriction, and preterm birth. Objective data were obtained at visit 1 on 3261 women, which was 88.1% of the studies that were attempted and at visit 3 on 2511 women, which was 87.6% of the studies that were attempted. Basic characteristics of the substudy cohort are reported in this methods article. The substudy was designed to address important questions regarding the relationship of sleep-disordered breathing on the risk of preeclampsia and other outcomes of relevance to maternal and child health. Copyright © 2015 Elsevier Inc. All rights reserved.
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    ABSTRACT: To describe recent maternal and neonatal delivery outcomes among women with a morbidly adherent placenta in major centers across the United States. This study reviewed a cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011 from the Assessment of Perinatal EXcellence data set. All cases of morbidly adherent placenta were identified. Maternal demographics, procedures undertaken, and maternal and neonatal outcomes were analyzed. There were 158 women with a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866). Eighteen percent of women with a morbidly adherent placenta were nulliparous and 37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a morbidly adherent placenta before delivery. Women with a prenatally suspected morbidly adherent placenta experienced large blood loss (33%), hysterectomy (92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%, respectively, in those not suspected prenatally to have a morbidly adherent placenta (P<.05 for all). Eighteen percent of women with a morbidly adherent placenta were nulliparous. Half of the morbidly adherent placenta cases were suspected before delivery and outcomes were poorer in this group, probably because the more clinically significant morbidly adherent placentas are more likely to be suspected before delivery. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 03/2015; 125(3):1. DOI:10.1097/AOG.0000000000000680 · 4.37 Impact Factor
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    ABSTRACT: A longer midtrimester cervical length (CL) is associated with an increased chance of cesarean delivery, but CL has not been used to predict the chance of successful trial of labor after cesarean delivery (TOLAC). The objective of this study was to identify whether midtrimester CL improves the prediction of vaginal birth after cesarean delivery (VBAC) among women undergoing a TOLAC. Women with 1 prior cesarean and a singleton gestation in the vertex position who had a routine CL assessment between 18 and 24 weeks and chose to undergo a TOLAC were identified. Midtrimester CL and characteristics identifiable in early prenatal care that have been used in a validated predictive model for VBAC (ie, age, body mass index, race/ethnicity, prior vaginal delivery, prior VBAC, and indication for prior cesarean delivery) were abstracted from the medical record. Multivariable regressions with VBAC as the dependent variable, with and without CL, were created and their predictive capacity compared using receiver-operating characteristic curves and reclassification tables. Of the 678 women who met inclusion criteria, 517 (76.3%) experienced a VBAC. Mean midtrimester CL was lower in women who achieved a VBAC compared with those who required a cesarean delivery in labor (4.3 ± 0.8 cm vs 4.7 ± 0.8 cm, P < .001). In a multivariable logistic regression, midtrimester CL (centimeters) was significantly associated with a reduced chance of VBAC (adjusted odds ratio [aOR], 0.60; 95% confidence interval [CI], 0.47-0.76). Although the addition of CL improved the area under the receiver-operating characteristic curve (aOR, 0.695 [95% CI, 0.648-0.743] vs aOR, 0.727 [95% CI, 0.681-0.773]; P = .03), it did not significantly enhance the clinical value of the model, as quantified by net reclassification improvement (P = .11). Shorter midtrimester CL is associated with a greater chance of vaginal birth after a TOLAC. However, midtrimester CL does not significantly improve the clinical value of a previously developed VBAC prediction model. Copyright © 2015 Elsevier Inc. All rights reserved.
  • Emily S. Miller, William A. Grobman
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    ABSTRACT: To determine whether, in the setting of induction, obstetric outcomes differ based on the number of prior cesarean deliveries (CD) and to determine whether women with two cesareans undergoing induction face increased risks of adverse outcomes compared to women undergoing a repeat CD.
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    ABSTRACT: To evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes. Cohort study of a random sample of deliveries performed at 25 hospitals over three years. Condition-specific protocols were collected from all hospitals and categorized independently by two authors. Data on maternal and neonatal outcomes, as well as data necessary for risk adjustment were collected. Risk-adjusted outcomes were compared according to whether the patient delivered in a hospital with condition-specific obstetric protocols at the time of delivery. Hemorrhage-specific protocols were not associated with a lower rate of postpartum hemorrhage or with fewer cases of EBL >1000cc. Similarly, in the presence of a shoulder dystocia protocol, there were no differences in the frequency of shoulder dystocia or number of shoulder dystocia maneuvers used. Conversely, preeclampsia-specific protocols were associated with fewer ICU admissions (OR 0.28, 95% CI 0.18-0.44) and fewer cases of severe maternal hypertension (OR 0.86, 95% CI 0.77-0.96). The presence of condition-specific obstetric protocols was not consistently shown to be associated with improved risk-adjusted outcomes. Our study would suggest that the presence or absence of a protocol does not matter and regulations to require protocols are not fruitful. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 02/2015; DOI:10.1016/j.ajog.2015.01.055 · 3.97 Impact Factor
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    ABSTRACT: The primary aim of the "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" is to determine maternal characteristics, which include genetic, physiologic response to pregnancy, and environmental factors that predict adverse pregnancy outcomes. Nulliparous women in the first trimester of pregnancy were recruited into an observational cohort study. Participants were seen at 3 study visits during pregnancy and again at delivery. We collected data from in-clinic interviews, take-home surveys, clinical measurements, ultrasound studies, and chart abstractions. Maternal biospecimens (serum, plasma, urine, cervicovaginal fluid) at antepartum study visits and delivery specimens (placenta, umbilical cord, cord blood) were collected, processed, and stored. The primary outcome of the study was defined as pregnancy ending at <37+0 weeks' gestation. Key study hypotheses involve adverse pregnancy outcomes of spontaneous preterm birth, preeclampsia, and fetal growth restriction. We recruited 10,037 women to the study. Basic characteristics of the cohort at screening are reported. The "Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be" cohort study methods and procedures can help investigators when they plan future projects. Copyright © 2015 Elsevier Inc. All rights reserved.
  • Emily S Miller, William A Grobman
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    ABSTRACT: Abstract Objective: To examine the association between interval since vaginal delivery and vaginal birth after cesarean (VBAC). Methods: Women with one prior low transverse cesarean and a prior vaginal delivery undergoing a trial of labor after cesarean at term were included in this cohort study. Multivariable analyses were performed to determine whether length of time since prior vaginal delivery was independently associated with VBAC and, if so, whether its inclusion enhanced the predictive capacity of previously published models. Results: Of the 5628 women included, 4901 (87%) achieved a VBAC. Each additional year since vaginal delivery decreased the odds of VBAC by 11% (95% CI: 10-13%). When added to an existing predictive model that included only factors available at early prenatal care, interval since vaginal delivery marginally improved the model's predictive ability (area under the curve [AUC] 0.73 versus 0.71, p < 0.01). When added to a model that included factors available proximate to the time of delivery, the addition of interval since vaginal delivery did not change the AUC (0.76 versus 0.75, p = 0.08). Conclusions: A longer interval since vaginal delivery is associated with a decreased odd of VBAC. However, the addition of this interval to VBAC prediction models does not substantively improve their predictive ability.
    Journal of Maternal-Fetal and Neonatal Medicine 01/2015; DOI:10.3109/14767058.2014.999036 · 1.21 Impact Factor
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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; DOI:10.1016/j.ajog.2014.11.007 · 3.97 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the association of duration of magnesium sulfate infusion with stillbirth or death, cerebral palsy, and select adverse maternal and neonatal outcomes. METHODS: This is a secondary cohort analysis of women randomized to receive magnesium sulfate within a previously reported Maternal-Fetal Medicine Units Network prospective clinical trial. The association of antenatal infusion of magnesium sulfate for less than 12 hours, 12-18 hours, and greater than 18 hours on maternal and perinatal outcomes was compared. The primary outcome was cerebral palsy of any severity or death. Secondary outcomes included cerebral palsy, death, and select maternal and neonatal outcomes. Stratified and logistic regression analyses were used. The models were adjusted for race, gestational age at birth, time since last magnesium sulfate, any magnesium sulfate at delivery, and eligibility criteria as appropriate. RESULTS: Of 933 women available for analysis, 356, 341, and 236 received antenatal magnesium sulfate infusion for a total of less than 12 hours, 12-18 hours, or greater than 18 hours, respectively. Any cerebral palsy or death occurred in 39 women (11.7%) who received magnesium sulfate less than 12 hours, 34 women (10.3%) who received 12-18 hours of magnesium sulfate, and 20 women (8.8%) who received greater than 18 hours of magnesium sulfate. There was no difference in death or cerebral palsy among groups (less than 12 hours as reference; adjusted odds ratio [OR] 1.03, 95% confidence interval [CI] 0.60-1.77 for 12-18 hours; adjusted OR 1.08, 95% CI 0.57-2.03 for greater than 18 hours). Select maternal adverse drug affects and neonatal morbidities were also similar across groups. CONCLUSION: The duration of antenatal magnesium sulfate infusion is not associated with risk of death or cerebral palsy. The optimal treatment duration needed for maximal neuroprotection remains unknown.
    Obstetrics and Gynecology 09/2014; 124(4). DOI:10.1097/AOG.0000000000000467 · 4.37 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; 211(3). DOI:10.1016/j.ajog.2014.03.004 · 3.97 Impact Factor
  • Alison D Cowan, Emily S Miller, William A Grobman
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    ABSTRACT: OBJECTIVE: To evaluate whether use of the B-Lynch suture is associated with subsequent adverse pregnancy outcomes. METHODS: This is a cohort study of women who experienced postpartum hemorrhage between January 2000 and June 2010 and had a subsequent pregnancy at a single university hospital. Women who had postpartum hemorrhage and B-Lynch suture were compared with those complicated by postpartum hemorrhage but no B-Lynch suture placement. The primary outcome was a composite adverse outcome related to placentation abnormalities and included placenta previa, placenta accreta, preeclampsia, preterm birth, or a small-for-gestational-age neonate. The study was powered to detect a twofold difference in the frequency of the composite outcome. RESULTS: Two hundred fifty-two patients met inclusion criteria, 63 of whom had a prior B-Lynch suture. Women with a prior B-Lynch had a higher mean estimated blood loss (1,800 mL compared with 1,200 mL, P<.001) and were more likely to have received a blood transfusion (29.2% compared with 13.3%, P=.01) in the index pregnancy. The composite outcome was not different between the groups (14.3% compared with 13.8%, P=.92). A logistic regression controlling for potential confounding factors did not show any association between exposure to a B-Lynch suture and adverse pregnancy outcome in a subsequent pregnancy (adjusted odds ratio 0.88, 95% confidence interval 0.34-2.28. CONCLUSION: Placement of a B-Lynch suture is not associated with an increased risk of future adverse pregnancy outcomes related to abnormal placentation.
    American Journal of Obstetrics and Gynecology 09/2014; 124(3):558-561. DOI:10.1097/AOG.0000000000000418 · 3.97 Impact Factor
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    ABSTRACT: Objective To evaluate the relationship between gestational age (GA) and induction of labor (IOL) and the rate of cesarean delivery (CD) in women with mild gestational diabetes (GDM). Study Design Secondary analysis of data from a multi-center RCT of mild GDM treatment. CD rate of women delivering at term (> 37 weeks) was evaluated using two complementary approaches: 1) IOL vs. spontaneous labor: women induced at each GA compared with those who spontaneously labored at the same GA, and 2) IOL vs. expectant management: women delivered after IOL at each GA compared with those delivering after spontaneous labor at the same GA or subsequently after spontaneous or induced labor (outcome at each week compared with expectant management at that week). Logistic regression adjusted for potential confounders. Results The overall CD rate was 13%. When compared to 39 weeks (either IOL or spontaneous labor) as the referent, there was no significant difference in the CD rate in women delivered at 37, 38, or 40 weeks. However, IOL was associated with a 3-fold increase in CD rate at 41 weeks and beyond as compared with IOL at 39 weeks. Similarly, there was a 3-fold increase in CD rate in women who were induced when compared to those managed expectantly at 40 completed weeks. Conclusions Induction of labor in women with mild gestational diabetes mellitus (GDM) does not increase the rate of cesarean delivery prior to 40 weeks gestation.
    American journal of obstetrics and gynecology 09/2014; 211(3). DOI:10.1016/j.ajog.2014.03.005 · 3.97 Impact Factor
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    ABSTRACT: Objective To determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care. Study Design The Assessment of Perinatal EXcellence (APEX) cohort of 115,502 women and their neonates born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and the obstetric care provided. Results 115,502 women were included in the study. For most outcomes, between 20 and 40% of hospital differences in outcomes were related to differences in patient populations. After controlling for patient-, provider- and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes, but these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, between 50 and 100% of the inter-hospital variation in outcomes was unexplained. Conclusion Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.
    American journal of obstetrics and gynecology 08/2014; 211(2). DOI:10.1016/j.ajog.2014.03.017 · 3.97 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; DOI:10.1016/j.ajog.2014.07.004 · 3.97 Impact Factor
  • William A Grobman
  • 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; 211(1). DOI:10.1016/j.ajog.2014.03.034 · 3.97 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; 30(02). DOI:10.1055/s-0034-1381320 · 1.57 Impact Factor
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    ABSTRACT: OBJECTIVE:To evaluate the association of other-than-common benign copy number variants with specific fetal abnormalities detected by ultrasonogram.METHODS:Fetuses with structural anomalies were compared with fetuses without detected abnormalities for the frequency of other-than-common benign copy number variants. This is a secondary analysis from the previously published National Institute of Child Health and Human Development microarray trial. Ultrasound reports were reviewed and details of structural anomalies were entered into a nonhierarchical web-based database. The frequency of other-than-common benign copy number variants (ie, either pathogenic or variants of uncertain significance) not detected by karyotype was calculated for each anomaly in isolation and in the presence of other anomalies and compared with the frequency in fetuses without detected abnormalities.RESULTS:Of 1,082 fetuses with anomalies detected on ultrasound scan, 752 had a normal karyotype. Other-than-common benign copy number variants were present in 61 (8.1%) of these euploid fetuses. Fetuses with anomalies in more than one system had a 13.0% frequency of other-than-common benign copy number variants, which was significantly higher (P<.001) than the frequency (3.6%) in fetuses without anomalies (n=1,966). Specific organ systems in which isolated anomalies were nominally significantly associated with other-than-common benign copy number variants were the renal (P=.036) and cardiac systems (P=.012) but did not meet significance after the adjustment.CONCLUSIONS:When a fetal anomaly is detected on ultrasonogram, chromosomal microarray offers additional information over karyotype, the degree of which depends on the organ system involved.
    Obstetrics and Gynecology 06/2014; 124(1). DOI:10.1097/AOG.0000000000000336 · 4.37 Impact Factor

Publication Stats

2k Citations
930.43 Total Impact Points

Institutions

  • 2005–2015
    • Society for Maternal-Fetal Medicine
      Chicago, Illinois, United States
  • 1996–2015
    • Northwestern University
      • • Feinberg School of Medicine
      • • Department of Obstetrics and Gynecology
      • • Department of Pediatrics
      Evanston, Illinois, United States
  • 1998–2014
    • University of Illinois at Chicago
      • Department of Obstetrics and Gynecology (Peoria)
      Chicago, Illinois, United States
  • 2013
    • George Washington University
      Washington, Washington, D.C., United States
    • Georgetown University
      • Department of Internal Medicine
      Washington, Washington, D.C., United States
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Роквилл, Maryland, United States
  • 2012–2013
    • Université de Montréal
      • Department of Obstetrics and Gynecology
      Montréal, Quebec, Canada
  • 2005–2013
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 2008–2009
    • University of Texas Medical Branch at Galveston
      • Department of Obstetrics and Gynecology
      Galveston, TX, United States
    • Ben-Gurion University of the Negev
      • Division of Internal Medicine
      Be'er Sheva`, Southern District, Israel
  • 2007–2008
    • Columbia University
      • Department of Obstetrics and Gynecology
      New York, New York, United States
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • Hospital Clínic de Barcelona
      Barcino, Catalonia, Spain
  • 2006
    • University of Iowa
      • Department of Obstetrics and Gynecology
      Iowa City, Iowa, United States
  • 1998–2005
    • Northwestern Memorial Hospital
      • Department of Obstetrics and Gynecology
      Chicago, Illinois, United States
  • 2004
    • Osaka City University
      Ōsaka, Ōsaka, Japan