Michael O Gardner

University of Oklahoma, Norman, Oklahoma, United States

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Publications (44)150.92 Total impact

  • Nora Doyle · Jessica Pullen · Mindy Holliday · Michael Gardner ·

    American Journal of Obstetrics and Gynecology 01/2015; 212(1):S72. DOI:10.1016/j.ajog.2014.10.154 · 4.70 Impact Factor
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    ABSTRACT: Background and Objectives: The increasing use and acceptance of robotic platforms calls for the need to train not only established surgeons but also residents and fellow trainees within the context of the traditional residency and fellowship program. Our study aimed to clarify the current status of robotic training in gynecologic fellowship programs in the United States. Methods: This was a Web-based survey of four gynecology fellowship programs in the United States from November 2010 to March 2011. Programs were selected based on their geographic areas. A questionnaire with 43 questions inquiring about robotic surgery performance and training was sent to the programs and either a fellow or the fellowship director was asked to complete. Participation was voluntary. Results: We had 102 responders (18% respond rate) with an almost equal response rate from all four gynecologic fellowships, with a median response rate of 25% (range 21–29%). Minimally Invasive Surgery (MIS) and Gynecologic Oncology (Gyn Onc) fellowships had the highest rate of robotic training in their fellowship curriculum—95% and 83%, respectively. Simulator training was used as a training tool in 74% of Female Pelvic Medicine and Reconstructive Surgery (FPMRS); however, just 22% of Reproductive Endocrinology and Infertility fellowships had simulator training. Eighty-seven percent of Gyn Onc fellows graduate with >50 robotic cases, but this was 0% for Reproductive Endocrinology Infertility fellows. Conclusion: Our study showed that the use of a robotic system was built into fellowship curriculum of >80% of MIS and Gyn Onc fellowship programs that were entered in our study. Simulator training has been used widely in Ob&Gyn fellowship programs as part of their robotic training curriculum.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 07/2014; 2014(Jul-Sep; 18(3):):e2014.00402.. DOI:10.4293/JSLS.2014.00402 · 0.91 Impact Factor
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    ABSTRACT: Placenta accreta is an unyielding pregnancy complication with increased morbidity and mortality. Optimal management requires prenatal diagnosis. Currently, ultrasonography and magnetic resonance imaging (MRI) are used for screening. We pursued if a risk assessment tool incorporating both clinical risk factors and screening radiography would give a more accurate prediction. We secondarily calculated ultrasound and MRI sensitivity, specificity, and positive and negative predictive values. We performed an institutional review board-approved retrospective cohort analysis from January 2008 to April 2013. Using electronic and ultrasound information systems, women diagnosed with placenta accrete or cesarean hysterectomy were identified. Maternal demographics and operative characteristics and complications obtained. Ultrasonography, MRI, and pathology findings compared. Using our unique screening tool incorporating clinic and radiographic study findings, each woman was given a priori risk number (0-44). Statistical analyses performed using NCSS software. Forty-six underwent cesarean hysterectomy for abnormal placentation. Pathology confirmed 32 of these cases. Ultrasound sensitivity was 89%, specificity was 52%, positive predictive value was 74%, and negative predictive value was 28%. Magnetic resonance imaging sensitivity was 85%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 40%. Using our risk assessment tool, our patients mean scores was 18 with a standard deviation of 4.3. A score of 20+ correlated with proven abnormal placentation by pathology. Prenatal diagnosis of abnormal placental invasion decreases maternal and fetal morbidities and mortalities. Radiographic screening tools of ultrasonography and MRI are useful but frequently unsatisfying when used in isolation. Combining clinical risk factors with radiographic evidence using our risk assessment instrument may prove useful in designing a more predictable approach for prenatal diagnosis of abnormal placentation.
    Obstetrics and Gynecology 05/2014; 123 Suppl 1:166S. DOI:10.1097/01.AOG.0000447171.60522.8e · 5.18 Impact Factor
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    ABSTRACT: Hysterectomy is the most common major operation for women in the United States and an integral component of resident training. Recently, robotic-assisted hysterectomy has been introduced. We sought to measure the effect of robotic surgery on obstetrics-gynecology resident surgical experience. After institutional review board approval, a retrospective cohort of all graduating residents during the time period 2009-2012 was analyzed for total number of surgical cases and resident role as primary surgeon using data from Accreditation Council for Graduate Medical Education Oplogs and electronic medical records and billing codes. Sixteen residents were identified and stratified by year of graduation, 2009-2010-2011-2012 and compared knowing robot introduction occurred in approximately 2011. Statistical analyses performed using NCSS software with P<.05 considered significant. Total number of hysterectomies with the resident as primary surgeon decreased over the study period 1,171-1,426-1,407-781 (P=.02). A decrease in abdominal approach was seen: 1,152-892-834-385 (P=.001). Vaginal numbers remained stable. Other laparotomy cases decreased 1,035-905-562-388 (P=.001). A trend increase for laparoscopic cases coincided with the laparotomy decrease. The introduction of the robotic-assisted hysterectomy has changed the resident surgical experience, arguably for the worse. Laparotomy experience at our institution reflects national decreasing trends. Resident as primary surgeon may decrease with robot use as attending surgeons are learning the skill set. The decrease in total numbers, coupled with the increase in the variety of hysterectomies, may affect resident surgical skills. Along with the limitations of resident work hours, these changes may require a more rigorous assessment of surgical competency before graduation.
    Obstetrics and Gynecology 05/2014; 123 Suppl 1(6):118S. DOI:10.1097/01.AOG.0000447070.70824.09 · 5.18 Impact Factor
  • Ryan Gholson · Jessica Pullen · Amanda Miles · Michael O Gardner · Nora M Doyle ·
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    ABSTRACT: Adnexal mass in pregnancy is a common finding with now routine ultrasound use. Incidence of adnexal mass=1-2% with malignancy complicating is reported in 2-3% of cases. We sought to determine if the size of persistent adnexal mass can be used as a predictor of patients requiring surgical intervention. We performed an institutional review board-approved retrospective cohort analysis of all women with persistent adnexal mass found on ultrasonography during pregnancy at our institution over the 5-year period, January 2008 to March 2013. Charts reviewed for maternal demographics, operative characteristics, and neonatal outcomes. Ultrasound mass size, septae, echogenicity, wall thickness, and papillary projections were evaluated. Statistical analyses were then performed using NCSS software. Thirteen thousand six hundred seventy-seven births occurred over the study period. Forty-one women were identified with persistent adnexal mass. Twenty-five of these adnexal masses were 5 cm or greater and 14 adnexal masses less than 5 cm. A significant higher body mass index in the large mass group (34.5 compared with 26.5 kg/m, P=.01) was found. Patients with large masses were more likely to undergo surgery. Average cyst volume was 769 cc (range 220-9,216 cc). The large adnexal mass group was more likely to deliver preterm (36.6 compared with 38.2 weeks of gestation, P=.01) with significant lower birth weight neonates (2,944 compared with 3,169 g, P=.01). Routine ultrasonography has increased detection of adnexal masses during pregnancy. Large-sized masses may be predictors of preterm birth. Ultrasound characteristics, including size, may help differentiate need for surgical intervention. Risk factors and symptomatology dictate the need for operative intervention.
    Obstetrics and Gynecology 05/2014; 123 Suppl 1:192S-3S. DOI:10.1097/01.AOG.0000447221.83324.5d · 5.18 Impact Factor
  • Soorena Fatehchehr · Michael O. Gardner · Elisa Ramunno · Nora M. Doyle ·

    Journal of Minimally Invasive Gynecology 11/2013; 20(6):104-105. DOI:10.1016/j.jmig.2013.08.350 · 1.83 Impact Factor
  • Michael Gardner · Nora Doyle · Lori Johnson · Elisa Ramunno · Michael Baxter ·

    American Journal of Obstetrics and Gynecology 01/2012; 206(1):S301. DOI:10.1016/j.ajog.2011.10.695 · 4.70 Impact Factor
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    ABSTRACT: Thrombophilias have been implicated in complications related to ischemic placental disease including recurrent pregnancy loss, intrauterine fetal demise, preeclampsia, fetal growth restriction, placental abruption, and preterm delivery. Maternal screening and treatment may lower the recurrence of these outcomes. Our objective was to estimate if antenatal screening for thrombophilias with the intention to offer treatment among women with a prior adverse pregnancy outcome (APO) is preferable to no screening. A decision-analytical model was constructed for pregnant women with prior APO, comparing screening for thrombophilia with intention to treat with no screening. Values obtained from previously published studies include probability of positive test: 0.3 (0.1 to 0.6); good outcome with treatment: 0.9 (0.3 to 0.99); no thrombophilia, good outcome: 0.75 (0.5 to 0.9); test negative, thrombophilia positive: 0.05 (0.01 to 0.1); test negative, thrombophilia positive, good outcome: 0.75 (0.5 to 0.9); thrombophilia/test negative, good outcome: 0.98 (0.5 to 0.99). Sensitivity analyses were run over a wide range of assumptions. Thrombophilia screening with intention to treat in women with prior APO associated with ischemic placental disease is the strategy of choice compared with no testing over a wide range of assumptions. Sensitivity analyses support this to be robust. Women with poor pregnancy history related to placental ischemic disease may benefit from thrombophilia screening and treatment in a subsequent pregnancy.
    American Journal of Perinatology 03/2011; 28(6):495-500. DOI:10.1055/s-0031-1272964 · 1.91 Impact Factor
  • Anna Gonzalez · Michael Gardner · Nora Doyle ·

    American Journal of Obstetrics and Gynecology 12/2009; 201(6). DOI:10.1016/j.ajog.2009.10.271 · 4.70 Impact Factor
  • Michael Gardner · Nora Doyle ·

    American Journal of Obstetrics and Gynecology 12/2007; 197(6). DOI:10.1016/j.ajog.2007.10.636 · 4.70 Impact Factor
  • NM Doyle · M Gardner ·

    American Journal of Obstetrics and Gynecology 12/2005; 193(6):2178-2178. DOI:10.1016/j.ajog.2005.05.030 · 4.70 Impact Factor
  • Nora M Doyle · Judy E Levison · Michael O Gardner ·
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    ABSTRACT: Mother-to-child transmission of human immunodeficiency virus is the most common cause of pediatric human immunodeficiency virus in the United States; the Centers for Disease Control and Prevention recommendations endorse rapid human immunodeficiency virus testing for women with unknown viral status to quicken antiretroviral therapy. We compared the cost-effectiveness of Oraquick (Orasure Technologies, Bethlehem, Pa) rapid testing versus enzyme-linked immunosorbent assay testing for a low-risk population of Mexican American women who are in labor. Using decision analysis techniques, we tested 2 strategies: (1) testing with enzyme-linked immunosorbent assay that was confirmed by Western blot and (2) testing with Oraquick rapid testing that was confirmed by Western blot. All seropositive parturients received zidovudine treatment in labor. The baseline assumptions were the incidence of human immunodeficiency virus in Mexican American mothers (0.05%), mother-to-child transmission with no treatment (25%), with treatment in labor (10%), sensitivity of enzyme-linked immunosorbent assay (98%), positive predictive value of enzyme-linked immunosorbent assay (10%), sensitivity/specificity of Oraquick rapid testing (99%/100%), positive predictive value of Oraquick rapid testing (83%-100%), sensitivity/specificity of Western blot (97%/99%), costs (enzyme-linked immunosorbent assay [dollar 5], Oraquick rapid testing [dollar 15], Western blot [dollar 25], zidovudine treatment [dollar 76] for 12 hours labor, neonatal treatment [dollar 2.50], lifetime treatment of human immunodeficiency virus-affected child [dollar 194,250]). Sensitivity analyses were done over a wide range of assumptions that included the costs of tests, the sensitivity of Oraquick rapid testing, the positive predictive value of enzyme-linked immunosorbent assay and Oraquick rapid testing, and the costs of treatments. Oraquick rapid testing was the preferred strategy at dollar 98 spent per human immunodeficiency virus-negative child versus dollar 491 for enzyme-linked immunosorbent assay testing. Much of the cost of the enzyme-linked immunosorbent assay strategy was due to the treatment of women and infants with false-positive tests. Sensitivity analysis over test costs, test sensitivity, and other variables found the analysis results to be robust. Threshold analysis revealed that, if the cost remained < dollar 409.90, Oraquick rapid testing was the dominant test. In a low prevalence population, the universal use of Oraquick rapid testing is cost-effective because of the low rate of false-positive results, thus preventing the emotional and economic costs of unnecessary treatment for human immunodeficiency virus to the new mother and her family.
    American Journal of Obstetrics and Gynecology 10/2005; 193(3 Pt 2):1280-5. DOI:10.1016/j.ajog.2005.07.001 · 4.70 Impact Factor
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    Nora M Doyle · Michael O Gardner · Lorraine Wells · Clifford Qualls · Lu-Ann Papile ·
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    ABSTRACT: Beginning in October 1995, and for several years thereafter, our institution used indomethacin as a first-line tocolytic drug. Our purpose is to compare the outcomes of very low birth weight infants who were exposed to antenatal indomethacin with those who were not exposed to this therapy. We used our center's component of the NICHD Neonatal Research Network's Generic Data Base which recorded the outcomes of all live born infants weighing less than 1500 g over a 5-year period. We abstracted data concerning neonatal morbidity (death, Grades III to IV intraventricular hemorrhage (IVH), necrotizing enterocolitis and patent ductus arteriosus), as well as other factors including gestational age, birth weight, antenatal corticosteroid treatment and maternal hypertension or pre-eclampsia. Univariate analysis was performed using Fisher's exact test. Multivariate analysis using logistic regression was performed to control for confounding factors. A total of 85 infants who were exposed to antenatal indomethacin were compared to 464 infants who were not exposed to the drug. In the univariate analysis, antenatal indomethacin exposure was not associated with a significant increase in the incidence of necrotizing enterocolitis or patent ductus arteriosus. The incidence of Grades III to IV IVH was 17.9% in those infants exposed to antenatal indomethacin compared to 7.1% in the nonexposed infants (p=0.008). The incidence of neonatal death in the exposed infants was 27.7 versus 16.4 in the nonexposed infants (p=0.02). After controlling for antenatal corticosteroids, maternal pre-eclampsia, gestational age and birth weight, antenatal indomethacin was significantly associated with an increased incidence of IVH, but not neonatal death. Antenatal indomethacin was associated with significantly higher rates of IVH. Additional studies assessing the potential risks of indomethacin tocolysis are needed before it is used as a first-line tocolytic therapy.
    Journal of Perinatology 06/2005; 25(5):336-40. DOI:10.1038/sj.jp.7211256 · 2.07 Impact Factor
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    ABSTRACT: To identify the characteristics of the gravidas delivering at our birthing center that place them at risk for false-positive human immunodeficiency virus (HIV) enzyme-linked immunosorbent assay (ELISA). The medical records of all rapid HIV-ELISA-positive gravidas that delivered at our hospital between January 2000 and October 2001 were retrieved, and information was gathered regarding maternal demographics. The results of the Western blot tests were also retrieved and correlated to the ELISA results, across varying maternal characteristics. chi(2), Student's t-test and multivariate analysis were performed, as appropriate, using the SAS software; statistical significance was denoted by p<0.05. A total of 69 patients had a positive rapid HIV-ELISA out of 9,781 deliveries. Of those, 26 were confirmed as HIV infected by Western blot (overall HIV prevalence: 0.27%, ELISA-positive predictive value: 37.7%). The subgroup prevalence of HIV and positive predictive value of ELISA were 1.53 and 75% among Caucasians; 2.43 and 82.6% among African-Americans; and 0.05 and 9.8% among Hispanics, respectively (p<0.05 for the comparisons between Hispanics and non-Hispanics only). A history of multiple (> or =5 lifetime) sexual partners was elicited in the majority of HIV-infected patients. The positive predictive value of rapid HIV-ELISA during pregnancy varies widely, depending on maternal race/ethnicity and sexual behavior. The routine disclosure of rapid intrapartum HIV serum screening results prior to Western blot confirmation should be avoided in very low-risk populations.
    Journal of Perinatology 01/2005; 24(12):743-7. DOI:10.1038/sj.jp.7211184 · 2.07 Impact Factor
  • Nora Doyle · Judy Levison · Michael Gardner ·

    American Journal of Obstetrics and Gynecology 12/2004; 191(6). DOI:10.1016/j.ajog.2004.10.082 · 4.70 Impact Factor

  • American Journal of Obstetrics and Gynecology 12/2004; 191(6). DOI:10.1016/j.ajog.2004.10.548 · 4.70 Impact Factor
  • Nora Doyle · Michael Gardner ·

    American Journal of Obstetrics and Gynecology 12/2004; 191(6). DOI:10.1016/j.ajog.2004.10.083 · 4.70 Impact Factor
  • Antara Mallampalli · David J Powner · Michael O Gardner ·
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    ABSTRACT: Cardiopulmonary arrest during pregnancy is a rare event that critical care clinicians must be prepared to manage. The causes of cardiopulmonary arrest during pregnancy, recommended modifications to cardiopulmonary resuscitation protocols that are specific to pregnancy, indications for and timing of perimortem cesarean delivery, and the expected fetal outcomes are reviewed. Rarely, brain death of a pregnant patient may occur in which continued support of the mother is possible to prolong the pregnancy and improve fetal outcome. Prolonged somatic support of pregnant patients who are brain dead presents specific management challenges, but has been accomplished. The physiologic changes that occur after brain death and recommendations for somatic support of the brain dead pregnant patient also are reviewed.
    Critical Care Clinics 11/2004; 20(4):747-61, x. DOI:10.1016/j.ccc.2004.05.005 · 2.16 Impact Factor
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    ABSTRACT: Mother-to-child transmission of HIV (MTCT) is a major contributor to Zambia's HIV burden. Based on our experience in Zambia, we felt that provider perceptions, knowledge base, and practice patterns toward HIV-positive mothers may pose as significant obstacles to preventing MTCT. Two hundred and twenty-five health care providers throughout Zambia were surveyed in 2002. Providers reported widespread stigma associated with HIV. Physicians (OR = 1.9), providers with research affiliations (OR = 2.3), and those located in Lusaka (OR = 9.0) were more likely to offer HIV testing. Only 30% routinely prescribed antiretroviral treatment (ART) to reduce MTCT. Practitioners from district facilities, those from Lusaka, and those employed at research facilities were more likely to prescribe ART routinely (OR = 2.8, 10.1 and 3.4 respectively). Among those never prescribing ART, most cited a lack of availability (83%). Our results highlight the need for further provider education, critical appraisal of the current system for HIV testing, and widespread distribution of ART.
    International Journal of STD & AIDS 11/2004; 15(10):685-90. DOI:10.1258/0956462041944295 · 1.05 Impact Factor
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    ABSTRACT: Pulmonary embolism is a major cause of maternal death. The work up for suspected pulmonary embolism is complex, with many potential diagnostic options. We performed a cost analysis to evaluate which of several diagnostic strategies was the most cost-effective with the least number of deaths from pulmonary embolism. We created a decision tree to evaluate the following strategies: (1) Compression ultrasonography followed by anticoagulation (if there is a positive result) or secondary tests, ventilation perfusion scans or spiral computed tomography (if there is a negative result); high probability ventilation perfusion scans (a positive test result) resulted in anticoagulation; low probability ventilation perfusion scans (a negative test) resulted in no treatment; intermediate tests that resulted in a second test (computed tomography or pulmonary angiography). (2) Ventilation perfusion scans as a primary test followed by anticoagulation. (3) Computed tomography followed by anticoagulation (if there is a positive result). The following assumptions were made: The incidence of pulmonary embolism in pregnant women with suspected pulmonary embolism is 5%; 40% of documented pulmonary embolisms have a positive compression ultrasound result; 10% of ventilation perfusion scans for suspected pulmonary embolism are high probability, 60% are indeterminate, and 30% are low probability for pulmonary embolism; the sensitivity of computed tomography is 95%; the sensitivity of angiography is 98%. The assumed mortality rate of treated pulmonary embolism is 0.7% and of untreated pulmonary embolism in pregnancy is 15% (range, 10%-50%). The angiography-associated mortality rate is 0.5%, and the anticoagulation associated mortality rate is 0.2%. The following costs were used for the model: compression ultrasonography, 200.00 dollars; ventilation perfusion scans, 400.00 dollars; angiography, 1000.00 dollars; computed tomography, 500.00 dollars; and anticoagulation, 5982.00 dollars. With baseline assumptions, spiral computed tomography as the initial diagnostic regimen was found to be the most cost-effective at 17,208 dollars per life saved. Sensitivity analyses were performed over a wide range of assumptions that included alteration of the probability of pulmonary embolism, the sensitivity of computed tomography, ventilation perfusion scans, and compression ultrasonography, the cost of computed tomography, and the mortality rate of untreated pulmonary embolism. Our findings remained robust over a wide range of assumptions. Suspected pulmonary embolism remains a diagnostic quandary. Our analysis indicated that spiral computed tomography offers the most cost-effective method for diagnosing this potentially fatal condition.
    American Journal of Obstetrics and Gynecology 10/2004; 191(3):1019-23. DOI:10.1016/j.ajog.2004.06.048 · 4.70 Impact Factor

Publication Stats

540 Citations
150.92 Total Impact Points


  • 2015
    • University of Oklahoma
      Norman, Oklahoma, United States
  • 2014
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
  • 2011
    • Oklahoma State University - Tulsa
      Tulsa, Oklahoma, United States
  • 2007
    • Emory University
      • Department of Gynecology and Obstetrics
      Atlanta, Georgia, United States
  • 2005
    • University of Houston
      Houston, Texas, United States
  • 2003-2005
    • Baylor College of Medicine
      • Department of Obstetrics and Gynecology
      Houston, Texas, United States
  • 1997
    • University of New Mexico Hospitals
      Albuquerque, New Mexico, United States
    • University of Miami Miller School of Medicine
      Miami, Florida, United States
    • University of New Mexico
      • Department of Obstetrics & Gynecology
      Albuquerque, New Mexico, United States
  • 1995-1997
    • University of Alabama at Birmingham
      • • Department of Obstetrics and Gynecology
      • • Division of Maternal-Fetal Medicine
      Birmingham, AL, United States
    • Society for Maternal-Fetal Medicine
      Birmingham, Alabama, United States