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Publications (523)
Objective
To compare the accuracy of four published reference standards for the umbilical artery pulsatility index (UA‐PI) in predicting small‐for‐gestational age (SGA), adverse neonatal outcomes and obstetric complications in pregnancies at risk for fetal growth restriction.
Methods
This was a secondary analysis of a prospective study of singleto...
Objective
Untreated opioid use disorder (OUD) is associated with significant morbidity in pregnancy. Recent reports have highlighted the rise of xylazine in the nonprescribed fentanyl supply. The frequency with which pregnant people with OUD are exposed to xylazine has not been characterized. We sought to describe the rate of xylazine detection in...
Objective The American College of Obstetricians and Gynecologists recommends speculum exams, rather than digital exams, for evaluation of the cervix after preterm prelabor rupture of membranes (PPROM). However, in clinical practice, digital exams may be necessary. We examined whether increasing numbers of digital exams were associated with adverse...
Objective We sought to assess the impact of a prolonged latent phase (PLP) on maternal and neonatal morbidity.
Study Design This is a secondary analysis of a prospective cohort study conducted 2010 to 2015 that included all term gravidas who reached active labor (6 cm). Primary outcomes were composite maternal morbidity (maternal fever, postpartum...
Objectives
Estimated fetal weight (EFW) is an important metric at delivery as neonates with abnormal birthweight and their mothers are at higher risk of birth complications. Data regarding optimal EFW assessment in gravidas with obesity is inconsistent, and with the increasing incidence of obesity, clarification of this question is crucial. We aime...
OBJECTIVE
Although hydrocephalus rates have decreased with intrauterine surgery for myelomeningocele (MMC), 40%–85% of children with MMC still go on to develop hydrocephalus. Prenatal ventricle size is known to be associated with later development of hydrocephalus; however, it is not known how prediction measures or timing of hydrocephalus treatmen...
( Am J Obstet Gynecol. 2022;227:265.e1–8)
Fetal acidemia at delivery is a predictor of neonatal morbidity and mortality. Testing fetal umbilical artery (UA) blood gases at delivery can help identify neonates with acidemia who should receive additional surveillance and interventions to prevent long-term adverse outcomes. There is debate over which l...
( Am J Obstet Gynecol . 2022;227:513.e1–513.e8)
Infection- or noninfection-mediated intrapartum maternal fever (≥38 °C) is a frequent complication of childbirth, affecting 1 in 15 deliveries. Associations with increased risk for neonatal morbidity include low Apgar score, sepsis, encephalopathy, seizures, respiratory distress, meconium aspiration,...
Objective:
There is evidence to suggest that early amniotomy during induction of labor is advantageous. However, following cervical ripening balloon removal the cervix remains less effaced and the utility of amniotomy in this setting is less clear. We investigated whether cervical effacement at the time of amniotomy impacts outcomes among nullipar...
Background:
Electronic fetal monitoring is widely used to identify and intervene on suspected fetal hypoxia and/or acidemia. Category II fetal heart rate tracings (FHTs) are the most common class of fetal monitoring in labor, and intrauterine resuscitation is recommended given the association of Category II FHTs with fetal acidemia. However, minim...
Introduction:
To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) on management fetal growth restriction (FGR).
Content:
Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR.
Summary:
Diagnostic criteria of FGR, recommended gr...
Background:
The second stage of labor requires active patient engagement. Prior studies suggest that coaching can influence second stage duration. However, a standardized education tool has not been established and patients face many barriers to accessing childbirth education before delivery OBJECTIVE: We investigated the effect of an intrapartum...
Up to 30% of term labor deliveries experience fetal acidemia, a condition usually caused by hypoxia that is associated with adverse neonatal outcomes. The American College of Obstetricians and Gynecologists and American Academy of Pediatrics recommend assessing fetal umbilical artery (UA) blood gases at delivery when fetal metabolic status is in qu...
Background
Existing evidence on the effects of race and ethnicity on pregnancy outcomes is restricted to individual studies done within specific countries and health systems. We aimed to assess the impact of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries, and to ascertain whether the magnitude of dispariti...
Background
Iron deficiency anemia (IDA) is common during pregnancy and associated with adverse maternal and neonatal outcomes. Treatment with iron supplementation is recommended during pregnancy, but the optimal delivery route is unclear. Oral iron risks has high risk of gastrointestinal side effects and low absorption. Intravenous iron is infused...
Objective:
To estimate short-term maternal and neonatal outcomes with one-compared with two-step testing for gestational diabetes mellitus (GDM).
Data sources:
A systematic review of randomized controlled trials (RCTs) and observational studies comparing one-step and two-step GDM testing strategies before September 2021 was conducted. We searche...
Background
Clinical trials of the mRNA COVID-19 vaccines excluded individuals with active reproductive needs (attempting to conceive, currently pregnant, and/or lactating). Women comprise three-quarters of healthcare workers in the United States, an occupational field among the first to receive the vaccine. Professional medical and government organ...
(Abstracted from J Ultrasound Med 2022;41:157–162)
Screening for fetal growth restriction (FGR) to identify those fetuses at increased risk of adverse neonatal outcomes has been difficult. Investigators have defined FGR in different ways, which has complicated efforts to validate results.
Among several interleukin (IL)-6 family members, only IL-6 and IL-11 require a gp130 protein homodimer for intracellular signaling due to lack of intracellular signaling domain in the IL-6 receptor (IL-6R) and IL-11R. We previously reported enhanced decidual IL-6 and IL-11 levels at the maternal-fetal interface with significantly higher peri-membra...
Objective To evaluate the hypothesis that patients with opioid use disorder (OUD), who receive prenatal care in a multidisciplinary, prenatal OUD clinic, have comparable postpartum breastfeeding rates, prenatal and postpartum visit compliance, and postpartum contraceptive use when compared with matched controls without a diagnosis of OUD.
Study Des...
Diabetes and pregnancy are independently associated with increased risk of severe COVID-infection. However, little is known about the relationship between severe COVID-and diabetes in pregnancy. We sought to determine whether diabetes in pregnancy was associated with increased risk of COVID-infection and severity. We conducted a case-control study...
Background
Umbilical artery absent end-diastolic velocity (AEDV) indicates increased placental resistance and is associated with increased risk of perinatal demise and neonatal morbidity in fetal growth restriction (FGR). However, the clinical implications of intermittent (iAEDV) versus persistent (pAEDV) absent end-diastolic velocity are unclear....
Objective:
To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) for the management of SARS-CoV-2 infection in pregnancy.
Background
The few studies that have addressed the relationship between severity of intrapartum fever and neonatal and maternal morbidity have mixed results. The impact of the duration between maximum intrapartum temperature and delivery on neonatal outcomes remains unknown.
Objective
To test the association between severity of intrapartum fever a...
Background:
Fetal acidemia at the time of scheduled cesarean delivery (CD) is generally unexpected. In the setting of reassuring preoperative monitoring, the duration of fetal acidemia in this scenario is presumably brief. The neonatal sequelae and risks of brief fetal acidemia in this setting are unknown.
Objective:
We assessed whether fetal ac...
Introduction:
The methodological quality of fetal brain charts has not been critically appraised yet.
Material and methods:
MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to December 31, 2020. The primary outcome was to evaluate the methodology of the studies assessing the growth of fetal brain structure...
Objective:
To compare the maternal and neonatal complications of periviable birth by delivery route.
Study design:
A retrospective cohort study of periviable deliveries (22w0d-25w6d) from 2013-2020 at a tertiary teaching institution was conducted. Deliveries were grouped by mode of delivery. Excluded deliveries included pregnancy termination, an...
Background
Healthcare workers were prioritized for COVID-19 vaccination roll-out due to high occupational risk. Vaccine trials excluded individuals who were trying to conceive, pregnant, and lactating necessitating vaccine decision-making in the absence of data specific to this population.
Objective
To determine initial attitudes about COVID-19 va...
OBJECTIVE
The COVID-19 pandemic has had a disproportionate effect on pregnant women, with higher rates of viral infection and disease severity.¹ The development of highly effective vaccines has significantly reduced SARS-CoV-2 transmission and clinical disease.² However, vaccine uptake has been low in the pregnant population.³ The Centers for Disea...
Objectives:
To evaluate the methodology of studies reporting reference charts of fetal brain structures at magnetic resonance imaging (MRI).
Methods:
MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to December 31, 2020. The primary outcome was to evaluate the methodology of the studies investigating the b...
Objective:
Superb microvascular imaging (SMI) has been shown in many systems to improve visualization of small vessels by suppressing global motions while preserving low-flow components such as the micro-vessels in the placenta. We sought to determine if SMI-aided visualization of flow velocities in spiral artery (SA) and fetal arterioles in intra...
Objective
To determine the role of progesterone, pessary and cervical cerclage in reducing the risk of (preterm birth) PTB in twin pregnancies and compare these interventions using pairwise and network meta-analysis.
Study design
Medline, Embase, CINAHL and Cochrane databases were explored. The inclusion criteria were studies in which twin pregnan...
( JAMA . 2020;324:1180–1189)
Maternal obesity is associated with greater likelihood of cesarean delivery and higher risk of surgical-site infection. While prophylactic negative pressure wound therapy using portable, single-use systems has been increasingly used following cesarean delivery, larger studies are needed to evaluate its ability to decrea...
Objective:
The cerebroplacental ratio (CPR) has shown utility as a surrogate marker for fetal growth restriction and can be used to stratify the risk for adverse perinatal outcomes in affected pregnancies. However, recent studies suggest that its inverse, the umbilico-cerebral ratio (UCR), may be a better predictor of such outcomes. The aim of thi...
Objective
The recent international guidelines by the Society for Maternal–Fetal Medicine (SMFM) and the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) differ in their definitions of fetal growth restriction (FGR). Our aim was to compare the performance of the two definitions in predicting neonatal small‐for‐gestational age...
SARS‐CoV‐2 is a zoonotic Coronavirus that crossed species to infect humans, causing a disease called COVID‐19. Despite a potentially higher risk of acquiring SARS‐CoV‐2 infection compared to the non‐pregnant population, no additional specific recommendations to avoid exposure are needed in pregnancy. Fever, cough, lymphopenia and raised C reactive...
Objective
Society for Maternal‐Fetal Medicine guidelines for diagnosing fetal growth restriction (FGR) have broadened the definition to include abdominal circumference (AC) <10th percentile for gestational age (GA) regardless of estimated fetal weight (EFW). We aimed to compare the ability of three definitions of FGR to predict small for gestationa...
(Abstracted from JAMA 2020;324:1180–1189)
Surgical-site infection is a significant cause of morbidity, lengthening hospital stays and contributing to health care costs. Cesarean delivery increases the risk of surgical site infection, and obesity contributes to this risk because obese pregnant women are more likely to have cesarean deliveries.
Objective
Growth velocities derived from fetal biometrics have been proposed to improve prediction of small for gestational age (SGA) neonates. We sought to determine if ultrasound growth velocities for abdominal circumference (AC) and estimated fetal weight (EFW) improve the prediction of SGA infants when compared to using EFW alone.
Study design...
Importance:
Obesity increases the risk of both cesarean delivery and surgical-site infection. Despite widespread use, it is unclear whether prophylactic negative pressure wound therapy reduces surgical-site infection after cesarean delivery in obese women.
Objective:
To evaluate whether prophylactic negative pressure wound therapy, initiated imm...
Objective
Compare the accuracy of the Hadlock, the NICHD, and the Fetal Medicine Foundation (FMF) charts to detect large for gestational age (LGA) and adverse neonatal outcomes (as a secondary outcome).
Methods
This is a secondary analysis from a prospective study that included singleton non‐anomalous gestations with growth ultrasound at 26–36 wee...
Objective
To investigate the outcome of pregnancies with small baby, including both small for gestational age (SGA) and late fetal growth restriction (FGR) fetuses, undergoing induction of labor (IOL) with Dinoprostone, Misoprostol or mechanical methods.
Study design
Medline, Embase and Cochrane databases were searched. Inclusion criteria were non...
Objective: The use of growth velocities derived from fetal biometrics have been suggested to improve prediction of large for gestational age (LGA). Our objective was to determine if ultrasonographic growth velocities (GV) for abdominal circumference (AC) and estimated fetal weight (EFW) improve the prediction of LGA infants when compared to Hadlock...
INTRODUCTION
The risks of inadequate gestational weight gain (IWG) remain controversial, especially among obese women. We aim to compare pregnancy outcomes in this population.
METHODS
This is a secondary analysis from a prospective study of pregnant women undergoing fetal growth assessment. Obese participants were sorted into cohorts of adequate g...
INTRODUCTION
The objective of this study is to compare the risks for small for gestational age (SGA) neonates and composite adverse neonatal outcomes (CANO) in patients with inadequate gestational weight gain (IWG) versus adequate gestational weight gain (AWG).
METHODS
This is a secondary analysis of a prospective study of women undergoing fetal g...
INTRODUCTION
Excessive gestational weight gain (EWG) increases risk of large for gestational age (LGA) neonates, hypertensive disorders of pregnancy and cesarean delivery. There is limited data on EWG in the obese population. We aim to compare pregnancy outcomes among obesity classes in women with EWG.
METHODS
This is a secondary analysis from a p...