William A Grobman

Northwestern University, Evanston, Illinois, United States

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Publications (337)1362.32 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery in the second stage versus cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. Thus, the appropriate clinical comparison is cesarean versus operative vaginal delivery. Objective: Our objective was to compare outcomes by the first attempted operative delivery (vacuum, forceps versus cesarean delivery) in patients needing second stage assistance at a fetal station of +2 or below. Study design: Secondary analysis of an observational obstetric cohort in 25 academically-affiliated U.S. hospitals over a three-year period. A subset of ≥37 weeks, non-anomalous, vertex, singletons, with no prior vaginal delivery who reached a station of +2 or below and underwent an attempt at an operative delivery were included. Indications included for operative delivery were: failure to descend, non-reassuring fetal status, labor dystocia or maternal exhaustion. The primary outcomes included a composite neonatal outcome (death, fracture, length of stay ≥3 days beyond mother's, low Apgar, subgaleal hemorrhage, ventilator support, hypoxic encephalopathy, brachial plexus injury, facial nerve palsy) and individual maternal outcomes (postpartum hemorrhage , third and fourth degree tears [severe lacerations], and postpartum infection). Outcomes were examined by the three attempted modes of delivery. Odds ratios were calculated for primary outcomes adjusting for confounders. Final mode of delivery was quantified. Results: 2531 women met inclusion criteria. Vacuum attempt was associated with the lowest frequency of the neonatal composite (4.2% vs. 6.1% vaginal forceps vs. 6.9% cesarean) and maternal complications (Postpartum infection 0.2% vs. 0.9% forceps vs. 5.3% cesarean, Postpartum hemmorhage 1.4% vs. 2.8% forceps vs. 3.8% cesarean), except for severe lacerations (19.1% vs. 33.8% forceps vs. 0% cesarean). When confounders were taken into account, both forceps (odds ratio 0.16, 95%CI 0.05-0.49) and vacuum (odds ratio 0.04, 95%CI 0.01-0.17) were associated with a significantly lower odds of Post partuminfection. The neonatal composite and Postpartum hemmorhage were not significantly different between modes of attempted delivery. Cesarean occurred in 6.4% and 4.4% of attempted vacuum and forceps groups (P=.04). Conclusion: In patients needing second stage delivery assistance with a station of +2 or below, attempted operative vaginal delivery was associated with a lower frequency of Postpartum infection, but higher frequency of severe lacerations.
    American journal of obstetrics and gynecology 11/2015; DOI:10.1016/j.ajog.2015.11.007 · 4.70 Impact Factor
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    ABSTRACT: Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
    American journal of obstetrics and gynecology 10/2015; DOI:10.1016/j.ajog.2015.08.035 · 4.70 Impact Factor
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    ABSTRACT: The rise in maternal morbidity and mortality has resulted in national and international attention at optimally organizing systems and teams for pregnancy care. Given that maternal morbidity and mortality can occur unpredictably in any obstetric setting, specialists in general obstetrics and gynecology along with other primary maternal care providers should be integrally involved in efforts to improve the safety of obstetric care delivery. Quality improvement initiatives remain vital to meeting this goal. The evidence-based utilization of triggers, bundles, protocols, and checklists can aid in timely diagnosis and treatment to prevent or limit the severity of morbidity as well as facilitate interdisciplinary, patient-centered care. The purpose of this document is to summarize the pertinent elements from this forum to assist primary maternal care providers in their utilization and implementation of these safety tools.
    American journal of obstetrics and gynecology 10/2015; DOI:10.1016/j.ajog.2015.10.011 · 4.70 Impact Factor
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    ABSTRACT: Objective: Fetal growth is associated with long-term health yet no appropriate standards exist for the early identification of undergrown or overgrown fetuses. We sought to develop contemporary fetal growth standards for 4 self-identified US racial/ethnic groups. Study design: We recruited for prospective follow-up 2334 healthy women with low-risk, singleton pregnancies from 12 community and perinatal centers from July 2009 through January 2013. The cohort comprised: 614 (26%) non-Hispanic whites, 611 (26%) non-Hispanic blacks, 649 (28%) Hispanics, and 460 (20%) Asians. Women were screened at 8w0d to 13w6d for maternal health status associated with presumably normal fetal growth (aged 18-40 years; body mass index 19.0-29.9 kg/m(2); healthy lifestyles and living conditions; low-risk medical and obstetrical history); 92% of recruited women completed the protocol. Women were randomized among 4 ultrasonography schedules for longitudinal fetal measurement using the Voluson E8 (GE Healthcare, Milwaukee, WI). In-person interviews and anthropometric assessments were conducted at each visit; medical records were abstracted. The fetuses of 1737 (74%) women continued to be low risk (uncomplicated pregnancy, absent anomalies) at birth, and their measurements were included in the standards. Racial/ethnic-specific fetal growth curves were estimated using linear mixed models with cubic splines. Estimated fetal weight (EFW) and biometric parameter percentiles (5th, 50th, 95th) were determined for each gestational week and comparisons made by race/ethnicity, with and without adjustment for maternal and sociodemographic factors. Results: EFW differed significantly by race/ethnicity >20 weeks. Specifically at 39 weeks, the 5th, 50th, and 95th percentiles were 2790, 3505, and 4402 g for white; 2633, 3336, and 4226 g for Hispanic; 2621, 3270, and 4078 g for Asian; and 2622, 3260, and 4053 g for black women (adjusted global P < .001). For individual parameters, racial/ethnic differences by order of detection were: humerus and femur lengths (10 weeks), abdominal circumference (16 weeks), head circumference (21 weeks), and biparietal diameter (27 weeks). The study-derived standard based solely on the white group erroneously classifies as much as 15% of non-white fetuses as growth restricted (EFW <5th percentile). Conclusion: Significant differences in fetal growth were found among the 4 groups. Racial/ethnic-specific standards improve the precision in evaluating fetal growth.
    American journal of obstetrics and gynecology 09/2015; 213(4):449.e1-449.e41. DOI:10.1016/j.ajog.2015.08.032 · 4.70 Impact Factor

  • Pediatric and Developmental Pathology 09/2015; DOI:10.2350/15-05-1646-OA.1 · 0.87 Impact Factor
  • Ashley N Battarbee · Anna Palatnik · Linda M Ernst · William A Grobman ·
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    ABSTRACT: Objective: To assess the association of an isolated single umbilical artery with small for gestational age (SGA) and preterm birth. Methods: In this retrospective cohort study, 219 consecutive women carrying a fetus with an isolated single umbilical artery diagnosed during routine second-trimester anatomic survey were compared with 219 women carrying a fetus with a three-vessel cord. Pregnancies with fetal anomalies or aneuploidy were excluded from the analysis. Outcomes included pregnancy-induced hypertension, gestational age at birth, birth weight, SGA, defined as birth weight less than the 10th percentile, and indicated or spontaneous preterm birth, defined as delivery before 37 weeks of gestation. Results: In univariable analysis, the presence of an isolated single umbilical artery was significantly associated with lower birth weight (3,146 compared with 3,430 g) and with SGA (11.9% compared with 2.7%; P<.001 for each outcome). The rates of pregnancy-induced hypertension (7.3% compared with 1.8%, P=.01) and indicated but not spontaneous preterm delivery (5.5% compared with 0.9%, P=.01 for indicated and 8.2% compared with 4.6%, P=.12 for spontaneous) were also more common in pregnancies with an isolated single umbilical artery. In multivariable analysis controlling for potential confounders, an isolated single umbilical artery remained associated with SGA, pregnancy-induced hypertension, and medically indicated preterm birth (adjusted odds ratio [OR] 3.97, confidence interval [CI] 1.55-10.12; adjusted OR 3.50, CI 1.10-11.18; adjusted OR 7.35, CI 1.60-33.77, respectively). Conclusion: Pregnancies complicated by isolated single umbilical artery are at increased risk for SGA and pregnancy-induced hypertension but not for spontaneous preterm birth. Level of evidence: II.
    Obstetrics and Gynecology 09/2015; 126(4). DOI:10.1097/AOG.0000000000001037 · 5.18 Impact Factor
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    ABSTRACT: Studies in a variety of disciplines have shown that the readability of Web-based patient education materials is above that of the sixth grade reading level recommended by the U.S. Department of Health and Human Services. The aim of this study was to evaluate the readability, content, and quality of English- and Spanish-language patient education materials addressing neuraxial labor analgesia. The websites of 122 U.S. academic medical centers with obstetric anesthesia divisions were searched for English- and Spanish-language patient education materials. Readability of English-language patient education materials was assessed with 3 validated indices: Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, and Gunning Frequency of Gobbledygook. Readability of Spanish-language patient education materials was assessed using the Spanish Lexile Measure. A 1-sample t test was used to evaluate the mean readability level against the recommended sixth grade reading level. A scoring matrix was developed to evaluate the content of patient education materials. Website quality was assessed using the Patient Education Materials Assessment Tool for Print. We identified 72 English-language and 29 Spanish-language patient education materials. The mean readability levels of all patient education materials were higher than the recommended sixth grade reading level using all indices (Flesch-Kincaid Grade Level: 9.1 ± 1.9, Simple Measure of Gobbledygook: 8.6 ± 1.4, Gunning Frequency of Gobbledygook: 11.8 ± 2.1; P < 0.001 for all). All patient education materials discussed the benefits of neuraxial analgesia. However, only 14% (upper 95% confidence interval: 24%) discussed contraindications to neuraxial anesthesia. Postdural puncture headache and hypotension were the most commonly addressed complications (92%). All other complications were addressed by less than half of patient education materials. Patient Education Materials Assessment Tool for Print scores were consistent with poor website understandability (median score, 64%; interquartile range, 64-73). The mean readability of Web-based patient education materials addressing neuraxial labor analgesia was above the recommended sixth grade reading level. Although most patient education materials explained the benefits of neuraxial analgesia, possible contraindications and complications were not consistently presented. The content, readability, and quality of patient education materials are poor and should be improved to help patients make more informed decisions about analgesic options during labor and delivery.
    Anesthesia and analgesia 08/2015; DOI:10.1213/ANE.0000000000000888 · 3.47 Impact Factor
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  • Emily A Donelan · William A Grobman · Emily S Miller ·
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    ABSTRACT: To estimate whether there is an association between second-trimester cervical length and prolonged pregnancy (defined as delivery at or beyond 41 weeks of gestation). This is a cohort study of nulliparous women with a singleton pregnancy who underwent routine cervical length measurement between 18 and 24 weeks of gestation. Women were divided into quartiles by cervical length and the association with prolonged pregnancy was evaluated in bivariable and multivariable analyses. A planned secondary analysis included only women who achieved at least 39 weeks of gestation. During the study period, a total of 9,165 women met inclusion criteria, of whom 1,481 (16.2%) had a prolonged pregnancy. Women in increasing cervical length quartiles were more likely to experience a prolonged pregnancy (12.9%, 15.8%, 17.1%, 18.6%, P<.001). This association remained significant when controlling for possible confounding variables. An analysis confined to women who achieved at least 39 weeks of gestation was consistent with the overall analysis. Increasing second-trimester cervical length is associated with an increased likelihood of having a prolonged pregnancy in nulliparous women. II.
    Obstetrics and Gynecology 07/2015; 126(3). DOI:10.1097/AOG.0000000000000976 · 5.18 Impact Factor
  • G H Falciglia · W A Grobman · K Murthy ·
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    ABSTRACT: To determine whether the frequency induction of labor (IOL) varies by day of the week based on maternal race/ethnicity. Gravid women in the US from 2007 to 2010 were stratified into <34, 34 to 36, 37 to 38 and ⩾39 weeks. Multivariable analyses estimated the association between weekend delivery, race/ethnicity (categorized as non-Hispanic white, Hispanic white, black and 'other') and their interaction with induction. After 34 weeks, induction was less likely on the weekend (P<0.01) and less likely in black, Hispanic or 'other' women relative to non-Hispanic whites (P<0.01). However, there was a significant positive interaction between race/ethnicity and weekend delivery (P<0.001). During the late preterm gestation, weekend IOL was greater in black women (odds ratio, 1.08). The difference in IOL by race/ethnicity increased with gestational age. This difference was least on the weekends.Journal of Perinatology advance online publication, 9 July 2015; doi:10.1038/jp.2015.76.
    Journal of perinatology: official journal of the California Perinatal Association 07/2015; 35(10). DOI:10.1038/jp.2015.76 · 2.07 Impact Factor
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    ABSTRACT: To describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route and type of cesarean incision. Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing 1/3 of deliveries across 25 US hospitals over 3 years (n=115,502). All women delivering non-anomalous singletons between 23 and 33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes , preterm labor, GA, and hospital of delivery. Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%CI 2.29-5.48), 12.1% of LTCD (aRR 2.59, 95%CI 1.77-3.77), and 10.3% of LVCD (aRR 2.27, 95%CI 0.68-7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR 1.37, 95%CI 0.95-1.97) or between CCD and LVCD (aRR 1.56, 95%CI 0.48-5.07). The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection and ICU admission for early preterm births requiring cesarean delivery. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 07/2015; DOI:10.1016/j.ajog.2015.06.064 · 4.70 Impact Factor
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    ABSTRACT: The objective of this study was to evaluate the readability, content, and quality of patient education materials addressing preeclampsia. Websites of U.S. obstetrics and gynecology residency programs were searched for patient education materials. Readability, content, and quality were assessed. A one-sample t-test was used to evaluate mean readability level compared with the recommended 6th grade reading level. Mean readability levels were higher using all indices (p < 0.001). Content was variable with good website understandability, but poor actionability. The mean readability was above the recommended 6th grade reading level. The content, readability, and actionability of preeclampsia patient education materials should be improved.
    Hypertension in Pregnancy 07/2015; 34(3):1-8. DOI:10.3109/10641955.2015.1053607 · 1.41 Impact Factor
  • Anna Palatnik · Nina L Gotteiner · William A Grobman · Leeber S Cohen ·
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    ABSTRACT: Prenatal diagnosis of d-transposition of the great arteries remains less frequent compared to other major congenital heart defects. In this study, we examined how often the 3-vessel and trachea view was abnormal in a large series of prenatally diagnosed cases of d-transposition of the great arteries. We found that an abnormal 3-vessel and trachea view in the shape of an "I" ("I-sign"), which represents an anteriorly displaced aorta, was present in all fetuses with d-transposition of the great arteries when a 3-vessel and trachea view was successfully obtained. Therefore we believe that the 3-vessel and trachea view can be used to reliably detect d-transposition of the great arteries during prenatal sonography. © 2015 by the American Institute of Ultrasound in Medicine.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2015; 34(7):1329-35. DOI:10.7863/ultra.34.7.1329 · 1.54 Impact Factor
  • Christian M. Pettker · William A. Grobman ·
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    ABSTRACT: Obstetric safety and quality is an emerging and important topic not only as a result of the pressures of patient and regulatory expectations, but also because of the genuine interest of caregivers to reduce harm, improve outcomes, and optimize care. Although each seeks to improve care by using scientific approaches beyond human physiology and pathophysiology, patient safety methodologies seek to avoid preventable adverse events, whereas health care quality projects aim to achieve the best possible outcomes. It is well-documented that an increasingly complex medical system controlled by human workers is a circumstance subject to recurrent failure. A safety culture encourages a proactive approach to mitigate failure before, during, and after it occurs. This article highlights the key concepts in health care safety and quality and reviews the background of the quality improvement sciences with particular emphasis on obstetric outcomes and quality measures.
    Obstetrics and Gynecology 07/2015; 126(1). DOI:10.1097/AOG.0000000000000918 · 5.18 Impact Factor
  • Emily S. Miller · Alan T. Tita · William A. Grobman ·
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    ABSTRACT: To estimate whether there are demographic or clinical characteristics that are associated with the likelihood of having a short cervix and whether these characteristics can be used to optimize cervical length screening. This is a cohort study of women with a singleton gestation without a history of spontaneous preterm birth who underwent routine transvaginal second-trimester cervical length screening. Seven risk factors for preterm birth were compared by cervical length status. A multivariable logistic regression was performed to identify independent risk factors for a short cervix (cervical length 2.5 cm or less). Different prediction models for a short cervix, based on the number of risk factors present, were developed and test characteristics for cervical length assessment for different risk-based screening approaches were calculated. Of the 18,250 women screened, 164 (0.9%) had a short cervix. Maternal age and conception by in vitro fertilization were not significantly associated with a short cervix. However, black (adjusted odds ratio [OR] 3.77, 95% confidence interval [CI] 2.42-5.87) and Hispanic (adjusted OR 1.73, 95% CI 1.10-2.74) race-ethnicity, current tobacco use (adjusted OR 3.67, 95% CI 1.56-8.62), prior indicated preterm birth (adjusted OR 2.26, 95% CI 1.26-4.05), and having a prior cervical excisional procedure (adjusted OR 2.96, 95% CI 1.86-4.70) were independent risk factors for a short cervix. If only women with any of these variables present were offered transvaginal cervical length screening, the specificity increases from 62.8% for universal screening to 96.5% with a risk-based approach. The sensitivity with one variable present to offer transvaginal scanning was 62.8% and with two factors 14%. Limiting cervical length screening to women with at least one of the identified risk factors for a short cervix substantially decreases the number of ultrasonograms for cervical length assessment. However, this strategy results in nearly 40% of women with a short cervix not being ascertained. II.
    Obstetrics and Gynecology 07/2015; 126(1). DOI:10.1097/AOG.0000000000000864 · 5.18 Impact Factor
  • Emily S Miller · Allie Sakowicz · William A Grobman ·
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    ABSTRACT: To determine whether cervical dysplasia in the absence of an excisional procedure is associated with an increased risk of preterm birth and whether that risk is independent of the presence of a short cervix. This is a cohort study including women with a singleton pregnancy who underwent routine cervical length assessment between 18 and 23 6/7 weeks of gestation, stratified according by cervical dysplasia (i.e., no prior dysplasia, prior dysplasia but no excisional procedure, or prior excisional procedure). The frequency of a short cervix (CL ≤ 2.5cm) and preterm birth were compared between groups and multivariable analyses were performed to identify whether (1) dysplasia alone or a prior excisional procedure were associated with preterm birth and (2) whether these factors remained independently associated with preterm birth after adjusting for the presence of a short cervix. Of the 18,528 women who met inclusion criteria, 3023 (16.3%) had prior dysplasia alone and 1356 (7.3%) had a prior excisional procedure. The frequency of a short cervix for women without dysplasia, with prior dysplasia alone, or with a prior excisional procedure was 0.8%, 1.0%, and 2.2%, respectively (p<0.001). The frequency of preterm birth, respectively, was 6.4%, 6.5%, and 8.4% (p<0.001). After adjusting for potential confounding factors, prior excisional procedure but not prior dysplasia alone was associated with preterm birth. Having a prior cervical excisional procedure but not dysplasia alone is associated with an increased risk of preterm birth. This association is independent of the presence of a short cervix. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 06/2015; 212(1):S165. DOI:10.1016/j.ajog.2014.10.353 · 4.70 Impact Factor
  • Anna Palatnik · William A. Grobman ·
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    ABSTRACT: In women with multiple prior cesarean deliveries (CDs), vertical skin incisions are thought by some to result in better outcomes. The objective of this study was to compare maternal and neonatal outcomes according to the type of skin incisions among women with multiple prior CDs. This was a secondary analysis of MFMU Cesarean Registry data. Women undergoing repeat CD with a viable singleton gestation and history of ≥2 prior CDs were included in this analysis. Women who had indications for urgent CD (e.g., cord prolapse) or suspected placenta accreta were excluded. Maternal and neonatal outcomes of women with 2, 3 and ≥4 prior CDs were compared by skin-incision type (transverse vs. vertical) using univariable and multivariable analyses. 5007 women met the inclusion criteria. In univariable analysis, women with 2 prior CDs who had a vertical skin incision had shorter incision-to-delivery intervals (12.9min vs. 14.1min, p<0.001) but also higher rates of endometritis and composite adverse maternal outcomes (4.9% vs. 2.7%, p=0.001, 16.1% vs. 13.4%, p=0.026, respectively). Women with 3 prior CDs also had higher rates of composite adverse maternal outcomes (21.2% vs. 15.8%, p=0.042). In women with ≥4 prior CDs, prolonged hospitalization, composite adverse maternal outcomes, NICU admission and composite adverse neonatal outcomes also were higher with vertical skin incision (23.2% vs. 9.3%, p=0.005, 32.9% vs. 13.7%, p=0.001, 32.1% vs.19.6%, p=0.045, 32.9% vs.19.4%, p=0.024, respectively). In multivariable analyses, vertical skin incision remained associated with prolonged hospitalization and composite adverse maternal outcome among women with ≥4 prior CDs (aOR 3.40, CI 1.11-10.38, aOR=2.37, CI 1.02-5.55, respectively). Vertical skin incision at the time of multiple repeat CD was not associated with better obstetric or perinatal outcomes and was associated among women with ≥4 prior CDs with a higher frequency of prolonged hospitalization and adverse maternal outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of obstetrics, gynecology, and reproductive biology 06/2015; 191. DOI:10.1016/j.ejogrb.2015.06.009 · 1.70 Impact Factor
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    ABSTRACT: Objective This study aims to evaluate whether magnesium sulfate (MgSO4) infusion at the time of delivery or magnesium cord blood concentration is associated with cerebral palsy (CP) or death diagnosed by the age of 2 years. Methods Secondary analysis of data from a randomized trial of MgSO4 versus placebo for prevention of CP or death among offspring of women with anticipated preterm delivery. This study cohort included singleton, nonanomalous fetuses, whose mothers received MgSO4 as neuroprophylaxis. The primary outcomes were CP or death diagnosed by the age of 2 years. Results A total of 936 neonates (93 with CP or death, 843 controls) were included in the analysis. Infants in the group with CP or death had MgSO4 infusing at delivery at a similar frequency to that of controls (49 [52.7%] vs. 463 [54.9%], p = 0.68). Mean concentrations of cord blood magnesium, available for 596 neonates, also were not different between the two groups (2.7 ± 0.9 vs. 2.6 ± 0.9 mEq/L, p = 0.66, respectively). Multivariable analyses did not alter these findings. Conclusion Among the offspring of women exposed to MgSO4, in utero, neither MgSO4 infusion at the time of delivery nor magnesium cord blood concentration is associated with CP or death. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Obstetrics and Gynecology 06/2015; 212(1):S302-S303. DOI:10.1016/j.ajog.2014.10.815 · 4.70 Impact Factor

  • Obstetric Anesthesia Digest 06/2015; 35(2):87. DOI:10.1097/01.aoa.0000463832.23929.4a

  • Obstetric Anesthesia Digest 06/2015; 35(2):88-89. DOI:10.1097/01.aoa.0000463834.31552.e6

Publication Stats

3k Citations
1,362.32 Total Impact Points


  • 1998-2015
    • Northwestern University
      • • Feinberg School of Medicine
      • • Department of Obstetrics and Gynecology
      • • Department of Pediatrics
      • • Division of Maternal-Fetal Medicine
      • • Division of Gastroenterology and Hepatology
      Evanston, Illinois, United States
  • 2007-2014
    • 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
  • 1998-2014
    • University of Illinois at Chicago
      • Department of Obstetrics and Gynecology (Peoria)
      Chicago, Illinois, United States
  • 2013
    • Georgetown University
      • Department of Internal Medicine
      Washington, Washington, D.C., United States
    • George Washington University
      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
  • 2011
    • Northeastern University
      Boston, Massachusetts, United States
    • Children's Memorial Hospital
      Chicago, Illinois, United States
  • 2005-2010
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
    • Society for Maternal-Fetal Medicine
      Chicago, Illinois, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 2009
    • University of Texas Medical Branch at Galveston
      • Department of Obstetrics and Gynecology
      Galveston, TX, United States
  • 2008
    • University of California, San Francisco
      San Francisco, California, United States
    • Ben-Gurion University of the Negev
      • Division of Internal Medicine
      Be'er Sheva`, Southern District, Israel
  • 2006
    • University of Iowa
      • Department of Obstetrics and Gynecology
      Iowa City, Iowa, United States
  • 1996-2005
    • Northwestern Memorial Hospital
      • Department of Obstetrics and Gynecology
      Chicago, Illinois, United States
  • 2004
    • Osaka City University
      Ōsaka, Ōsaka, Japan