William A Grobman

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

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Publications (302)1066.23 Total impact

  • Anna Palatnik, William A. Grobman
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    ABSTRACT: To evaluate the association between a sonographically diagnosed subchorionic hematoma (SCH) in the first trimester, and subsequent mid-trimester cervical length and preterm birth. In this cohort study, 512 women with a SCH on their first trimester ultrasound were compared with 1024 women without a first-trimester SCH. All women underwent routine transvaginal cervical length measurement between 18 and 22 weeks. Women with multifetal gestation, cerclage or a uterine anomaly were excluded. Multivariable linear regression was performed to assess the independent association of SCH with cervical length and logistic regression was done to determine whether the presence of SCH was associated with preterm birth independent of the cervical length. In univariable analysis, the presence of a SCH was significantly associated with a shorter mean cervical length as well as a cervical length < 10(th) percentile (4.27 cm vs. 4.36cm, p=0.038; 1.9% vs. 0.5%, p=0.006 respectively). Preterm birth also was more common in women with a SCH (12.5% vs. 7.3%, p=0.001). Even after adjusting for potentially confounding factors, a significant negative association existed between the presence of a SCH and cervical length (cm) (Linear regression coefficient = - 0.08, CI -0.17- -0.005). In multivariable regression, SCH remained associated with preterm birth even with cervical length entered into the equation as a covariate (aOR=1.58, CI 1.09 -2.32). First-trimester SCH is associated with both a shorter cervical length and preterm birth. Our data suggest however, that mechanisms other than cervical shortening may be involved in preterm birth among women with SCH. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 05/2015; 212(1):S64. DOI:10.1016/j.ajog.2014.10.137 · 3.97 Impact Factor
  • Lynn M. Yee, Lilly Y. Liu, William A. Grobman
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    ABSTRACT: To investigate the relationship between obstetricians' cognitive traits and delivery outcomes among women with a prior cesarean delivery (CD). 94 obstetricians completed 5 standardized psychometric scales: Reflective Coping (RC), Proactive Coping (PC), Multiple Stimulus Types Ambiguity Tolerance (MSTAT), Need for Cognition (NFC) and State-Trait Anxiety Inventory (STAI). Scores were analyzed by quartile. Delivery data were collected for primiparas with one prior low transverse CD and a term, cephalic singleton. Chi-square tests and random-effects logistic regression were used to examine the relationship between obstetricians' cognitive traits and their patients' frequency of trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC). Of 1502 eligible patients, 22.6% underwent TOLAC. Women were more likely to undergo TOLAC when cared for by physicians with scores in the highest quartile of the PC (33.6% vs 19.6%, p<0.001), MSTAT (29.2% vs 21.0%, p=0.002), and NFC (27.9% vs 21.5%, p=0.02) assessments, or in the lowest quartile for anxiety assessment (28.0% vs 20.6%, p=0.001). Similarly, those with high PC (18.0% vs 11.3%, p=0.001), high MSTAT (16.6% vs 11.8%, p=0.03), and low anxiety (19.2% vs 10.4%, p<0.001) had greater VBAC rates. Random-effects regression analyses revealed physicians with high proactive coping remained significantly more likely to have patients undergo TOLAC (aOR 1.86, 95% CI 1.10-3.14) and those with low anxiety remained significantly more likely to have patients experience VBAC (aOR 2.08, 95% CI 1.28-3.37). There is an increased likelihood of TOLAC and VBAC for women delivered by physicians with more proactive coping and less anxiety. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 05/2015; DOI:10.1016/j.ajog.2015.05.023 · 3.97 Impact Factor
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    ABSTRACT: To evaluate whether racial and ethnic disparities exist in obstetric care and adverse outcomes. We analyzed data from a cohort of women who delivered at 25 hospitals across the United States over a 3-year period. Race and ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, or Asian. Associations between race and ethnicity and severe postpartum hemorrhage, peripartum infection, and severe perineal laceration at spontaneous vaginal delivery as well as between race and ethnicity and obstetric care (eg, episiotomy) relevant to the adverse outcomes were estimated by univariable analysis and multivariable logistic regression. Of 115,502 studied women, 95% were classified by one of the race and ethnicity categories. Non-Hispanic white women were significantly less likely to experience severe postpartum hemorrhage (1.6% non-Hispanic white compared with 3.0% non-Hispanic black compared with 3.1% Hispanic compared with 2.2% Asian) and peripartum infection (4.1% non-Hispanic white compared with 4.9% non-Hispanic black compared with 6.4% Hispanic compared with 6.2% Asian) than others (P<.001 for both). Severe perineal laceration at spontaneous vaginal delivery was significantly more likely in Asian women (2.5% non-Hispanic white compared with 1.2% non-Hispanic black compared with 1.5% Hispanic compared with 5.5% Asian; P<.001). These disparities persisted in multivariable analysis. Many types of obstetric care examined also were significantly different according to race and ethnicity in both univariable and multivariable analysis. There were no significant interactions between race and ethnicity and hospital of delivery. Racial and ethnic disparities exist for multiple adverse obstetric outcomes and types of obstetric care and do not appear to be explained by differences in patient characteristics or by delivery hospital. II.
    Obstetrics and Gynecology 05/2015; 125(6):1. DOI:10.1097/AOG.0000000000000735 · 4.37 Impact Factor
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    ABSTRACT: To stratify the risk of spontaneous preterm delivery using cervical length (CL) and fetal fibronectin (fFN) in women with threatened preterm labor who remained pregnant after seven days. Prospective observational study. Nationwide cohort of women with threatened preterm labor from the Netherlands. Women with threatened preterm labor between 24 and 34 weeks with a valid CL and fFN measurement and remaining pregnant 7 days after admission. Kaplan Meier and Cox proportional hazards models were used to estimate cumulative percentages and hazard ratios (HR) for spontaneous delivery. Spontaneous delivery between seven and 14 days after initial presentation and spontaneous preterm delivery before 34 weeks. The risk of delivery between seven and 14 days was significantly increased for women with a CL <15 mm or a CL ≥15 - <30 mm and a positive fFN, compared to women with a CL ≥30 mm (HR 22.3 (95%CI 2.6 - 191) and 14 (95%CI 1.8 - 118), respectively. For spontaneous preterm delivery before 34 weeks the risk was increased for women with a CL <15 mm (HR 6.3 (95%CI 2.6-15)) or with a CL ≥15 - <30 mm with either positive fFN (HR 3.6 (95%CI 1.5-8.7)) or negative fFN (HR 3.0 (95%CI 1.2-7.1)) compared to women with a CL ≥ 30mm. In women remaining pregnant seven days after threatened preterm labor, CL and fetal fibronection results can be used in risk stratification for spontaneous delivery. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Acta Obstetricia Et Gynecologica Scandinavica 04/2015; DOI:10.1111/aogs.12643 · 1.99 Impact Factor
  • Ashley Battarbee, Anna Palatnik, William Grobman
    American Journal of Obstetrics and Gynecology 04/2015; 212(1):S375. DOI:10.1016/j.ajog.2014.10.979 · 3.97 Impact Factor
  • Ultrasound in Medicine & Biology 04/2015; 41(4):S140. DOI:10.1016/j.ultrasmedbio.2014.12.547 · 2.10 Impact Factor
  • Ultrasound in Medicine & Biology 04/2015; 41(4):S111. DOI:10.1016/j.ultrasmedbio.2014.12.452 · 2.10 Impact Factor
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    ABSTRACT: Microparticles (MPs) bearing tissue factor (TF) are potent activators of the coagulation system. To investigate whether MPs originating from platelets or trophoblast cells contribute to coagulation changes in pregnancy, we aimed to characterize whether pregnancy, labor, and delivery are associated with changes in the origin and composition of circulating maternal MPs. We performed a prospective cohort study. Blood samples were collected in 20 non-pregnant women, 20 term pregnant women not in labor, and 20 term pregnant women in labor. Two samples were collected in the pregnant groups, the first prior to delivery and the second 1 h after delivery. MPs from platelets and trophoblasts and MPs expressing TF were identified using flow cytometry. Comparisons were made among the non-pregnant and pregnant groups, non-laboring and laboring groups, and predelivery and postdelivery values within the pregnant groups. Pregnancy was not associated with changes in MP origin or number of TF-expressing MPs. Neither labor nor delivery was associated with changes in the percentage of trophoblast-derived MPs in the pregnant groups. The percentage of platelet-derived MPs among laboring women increased after delivery (8.5 vs. 20.5 %, p = 0.02), although there was no difference with delivery in the non-laboring group. TF expression was not associated with delivery in either laboring or non-laboring women. In conclusion, pregnancy was not associated with changes in cell origin of circulating maternal MPs or in the number of TF-expressing MPs. However, labor and delivery appear to be associated with an increase in the number of platelet-derived MPs.
    Annals of Hematology 04/2015; DOI:10.1007/s00277-015-2355-6 · 2.40 Impact Factor
  • 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.
    American Journal of Obstetrics and Gynecology 03/2015; 212(3). DOI:10.1016/j.ajog.2015.01.026 · 3.97 Impact Factor
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    ABSTRACT: Objectives To estimate the interhospital differences in induction of labor (IOL) from 34(0/7) to 38(6/7) weeks' gestation by race/ethnicity. Methods Women between 34 and 42 weeks' gestation during 1995 and 2009 in three states were identified using linked maternal and infant records. Women with prior cesarean delivery, premature rupture of membranes, gestational hypertension, who delivered at hospitals with < 100 annual births, or who had missing data were excluded. The outcomes were inductions at early-term (ETI: between 37(0/7) and 38(6/7) weeks') and late preterm (LPI: from 34(0/7)-36(6/7) weeks') gestations. Cox proportional hazard ratios (HR) were used to estimate the independent associations between race/ethnicity and hospital of delivery on ETI and LPI. Results A total of 6.98 million eligible women delivered at 469 hospitals. ETI and LPI occurred in 3.20 and 0.40% of women, respectively. Non-Hispanic white women (3.99%) received ETI most commonly; conversely, LPI was highest among non-Hispanic black women (0.50%). In multivariable analyses, non-Hispanic black race was protective for ETI (HR = 0.89; p < 0.01) and was a risk factor for LPI (HR = 1.26; p < 0.01) after adjusting for patient factors and the delivery hospital. Conclusion Racial differences in ETI and LPI appear to be pervasive. Much of the unaccounted racial/ethnic variation remains seems secondary to within-hospital differences in selecting women for IOL. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    American Journal of Perinatology 03/2015; DOI:10.1055/s-0035-1544191 · 1.60 Impact Factor
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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 · 2.35 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.
    American Journal of Obstetrics and Gynecology 03/2015; 212(4). DOI:10.1016/j.ajog.2015.01.021 · 3.97 Impact Factor
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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.
    American Journal of Obstetrics and Gynecology 02/2015; 212(1). DOI:10.1016/j.ajog.2015.01.025 · 3.97 Impact Factor
  • 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.
    American Journal of Obstetrics and Gynecology 02/2015; DOI:10.1016/j.ajog.2015.02.003 · 3.97 Impact Factor
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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.
    American Journal of Obstetrics and Gynecology 01/2015; 212(4). DOI:10.1016/j.ajog.2015.01.019 · 3.97 Impact Factor
  • 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
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S141. DOI:10.1016/j.ajog.2014.10.302 · 3.97 Impact Factor
  • Anna Palatnik, William Grobman
    American Journal of Obstetrics and Gynecology 01/2015; 212(1):S26. DOI:10.1016/j.ajog.2014.10.083 · 3.97 Impact Factor

Publication Stats

2k Citations
1,066.23 Total Impact Points

Institutions

  • 2005–2015
    • Society for Maternal-Fetal Medicine
      Chicago, Illinois, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 1996–2015
    • Northwestern University
      • • Feinberg School of Medicine
      • • Department of Obstetrics and Gynecology
      • • Department of Pediatrics
      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
  • 2009
    • University of Texas Medical Branch at Galveston
      • Department of Obstetrics and Gynecology
      Galveston, TX, United States
  • 2008
    • Ben-Gurion University of the Negev
      • Division of Internal Medicine
      Be'er Sheva`, Southern District, Israel
  • 2006–2008
    • University of California, San Francisco
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      San Francisco, California, United States
    • 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