George Macones

Washington University in St. Louis | WUSTL , Wash U · Department of Obstetrics and Gynecology

Objective: To evaluate whether preterm birth rates changed in relation to the onset of the coronavirus disease 2019 (COVID-19) pandemic and whether any change depended on socioeconomic status. Methods: This is an observational cohort study of pregnant individuals with a singleton gestation who delivered in the years 2019 and 2020 at 1 of 16 U.S....

Background: Prophylactic use of tranexamic acid at the time of cesarean delivery has been shown to decrease the calculated blood loss, but the effect on the need for blood transfusions is unclear. Methods: We randomly assigned patients undergoing cesarean delivery at 31 U.S. hospitals to receive either tranexamic acid or placebo after umbilical-...

Electromyometrial imaging (EMMI) was recently developed to image the three-dimensional (3D) uterine electrical activation during contractions noninvasively and accurately in sheep. Herein we describe the development and application of a human EMMI system to image and evaluate 3D uterine electrical activation patterns at high spatial and temporal re...

Objective: To assess whether immediate or delayed pushing in the second-stage results in higher risk of pelvic floor morbidity. Methods: This study was a planned secondary aim of a multicenter randomized clinical trial that included nulliparous patients at 37 weeks of gestation or greater in labor with neuraxial analgesia. Participants were rand...

(JAMA. 2022;327:748–759) While pregnant patients with COVID-19 are at an increased risk of severe maternal morbidity related to the virus, it is not clear whether SARS-CoV-2 also increases the risk of maternal morbidity related to obstetric complications. The most common causes of obstetric morbidity in the United States are hypertensive disorders...

Objective: To evaluate whether delivering during the early the coronavirus disease 2019 (COVID-19) pandemic was associated with increased risk of maternal death or serious morbidity from common obstetric complications compared with a historical control period. Methods: This was a multicenter retrospective cohort study with manual medical-record...

Background Worldwide, 10% of babies are born preterm, defined as a live birth before 37 weeks of gestation. Preterm birth is the leading cause of neonatal death, and survivors face lifelong risks of adverse outcomes. New approaches with large sample sizes are needed to identify strategies to predict and prevent preterm birth. The primary aims of th...

(Abstracted from JAMA 2022;327:748–759) It is well known that pregnant individuals with COVID-19 have increased risks such as admission to the intensive care unit (ICU), mechanical ventilation, and death when compared with both nonpregnant adults with SARS-CoV-2 infection and pregnant adults without SARS-CoV-2 infection. However, although COVID-19...

Background SARS-CoV2 infection during pregnancy is associated with adverse pregnancy outcomes including fetal death and preterm birth. It is not known whether that risk occurs only during the time of acute infection or whether risk persists later in pregnancy. Objective The goal of this analysis was to evaluate whether the risk of SARS-CoV-2 infec...

Background : Pregnancy and childbirth are known risk factors associated with the development of pelvic organ prolapse; specific intrapartum risk factors are not well characterized. Objective : To determine intrapartum factors associated with increased risk of pelvic organ prolapse identified postpartum. Study Design : A planned secondary analysis...

Background Congenital cytomegalovirus infection following maternal primary cytomegalovirus infection affects approximately 0.4% of newborns in the United States but may be hard to diagnose prenatally. Objective To evaluate the current sensitivity and specificity of amniocentesis in detecting congenital CMV infection. Study Design Secondary analysis...

Importance: It remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity. Objective: To evaluate the association of SARS-CoV-2 infection with serious maternal morbidity or mortality from common obstetric complications. Design, setting, and participants: Retrospective cohort study of 14 104 preg...

Objective: To develop and internally validate a noninvasive method for the prediction of congenital cytomegalovirus (CMV) infection after primary maternal CMV infection. Methods: We conducted a secondary analysis of a multicenter randomized placebo-controlled trial of CMV hyperimmune globulin to prevent congenital infection. Women were eligible...

(Abstracted from N Engl J Med 2021;385:436–444) Congenital cytomegalovirus (CMV) infections are associated with stillbirth, neonatal death, deafness, and cognitive and motor delay. Small observational studies have evaluated CMV hyperimmune globulin to prevent congenital infection in women with primary CMV infection during pregnancy; however, the re...

Background Worldwide, 10% of babies are born preterm, defined as a live birth before 37 weeks of gestation. Preterm birth is the leading cause of neonatal death, and survivors face lifelong risks of adverse outcomes. New approaches with large sample sizes are needed to identify strategies to predict and prevent preterm birth. The primary aims of th...

Objective: We tested the hypothesis that administration of vaginal progesterone in women with arrested preterm labor would result in lower rates of preterm birth <37 weeks compared to placebo. Study design: We performed a randomized, placebo-controlled trial comparing vaginal progesterone to placebo in women with arrested preterm labor. Our tria...

Background Primary cytomegalovirus (CMV) infection during pregnancy carries a risk of congenital infection and possible severe sequelae. There is no established intervention for preventing congenital CMV infection. Methods In this multicenter, double-blind trial, pregnant women with primary CMV infection diagnosed before 24 weeks’ gestation were r...

Background The safest mode of delivery for very preterm infants is an ongoing topic of debate. There are many reasons for cesarean delivery (CD) in extremely preterm and very preterm infants, including labor, fetal distress, maternal indications, and malpresentation. Objectives This study aimed to determine whether CD is associated with significan...

Background: Low-income women are less likely to breastfeed than high-income women. Technology-based interventions demonstrate promise in decreasing health disparities. We assessed whether increased use of breastfeeding smartphone applications (apps) impacts breastfeeding rates for low-income women. Materials and Methods: This is a secondary analys...

Objective: To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes. Methods: We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus...

Objective: To compare risks of maternal and perinatal outcomes by completed week of gestation from 39 weeks in low-risk nulliparous patients undergoing expectant management. Methods: We conducted a secondary analysis of a multicenter randomized trial of elective induction of labor at 39 weeks of gestation compared with expectant management in lo...

Objectives: While percutaneous umbilical cord blood sampling (PUBS) and intrauterine transfusion (IUT) are the standards of care for the management of significant fetal anemia, the neonatal complications resultant from these procedures remain poorly understood. Thus, we aimed to compare neonatal outcomes of the patients undergoing percutaneous umbi...

Background The maternal habitus in the setting of obesity makes external monitoring of the fetal heart rate and contractions suboptimal, and internal monitors may be utilized more often in this population. Obesity is a risk factor for obstetrical infectious complications, but it is unknown whether the use of internal monitors in this population is...

Objective: To examine the effect of a novel smartphone application (app)-BreastFeeding Friend (BFF)-on breastfeeding rates among low-income first-time mothers planning exclusive breastfeeding. Methods: A recent randomized controlled trial (RCT) randomized low-income first-time mothers to BFF or control app. BFF contained breastfeeding education an...

Background Anemia is one of the most commonly diagnosed comorbidities in pregnancy and is known to increase the risk of obstetrical complications. However, little is known about the effect of anemia on placental oxygen transfer and fetal oxygenation. Objective This study examined the relationship between maternal anemia and fetal oxygenation statu...

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...

Background: Having twins is associated with more depressive symptoms compared to having singletons. However, the association between having twins and psychiatric morbidity requiring Emergency Department (ED) visit or inpatient hospitalization is less well-known. Objectives: To determine whether women have higher risk of having a psychiatric diag...

Objective: To develop models to predict vaginal delivery in low-risk, nulliparous women contemplating elective induction of labor or expectant management at 39 weeks of gestation. Methods: We conducted a secondary analysis of a randomized controlled trial of planned elective induction of labor at 39 weeks of gestation compared with expectant man...

Objective: To evaluate characteristics associated with adverse outcomes in low-risk nulliparous women randomized to elective labor induction at 39 weeks of gestation or expectant management. Methods: We conducted a secondary analysis of women randomized during the 38th week to induction at 39 weeks of gestation or expectant management. Deliverie...

Background Contemporary guidelines for labor management do not characterize abnormal labor on the basis of maternal and/or neonatal morbidity. Objective In this study, we aimed to evaluate the association of abnormal duration of the first stage of term labor and the risk of maternal and neonatal morbidity. Study Design We conducted a retrospectiv...

Background Despite expectant management, preeclampsia remote from term usually results in preterm delivery. Antithrombin displays anti-inflammatory and anticoagulant properties and thus may have a therapeutic role treating preterm preeclampsia, a disorder characterized by endothelial dysfunction, inflammation and activation of the coagulation syste...

Objective This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities. Study Design A pilot randomized controlled trial was conducted at two sites. Inclusion criteria were English or Spanish speaking, type 2 or gestational diabetes, 22 to 34 weeks of...

Objective We examined rates of spontaneous and indicated preterm births (S-PTB and I-PTB, respectively) and clinical risk factors for PTB in adolescents. Study Design This is a population-based, retrospective cohort using 2012 U.S. natality data of nulliparous women who delivered a nonanomalous singleton birth between 20 and 42 weeks' gestation. Ma...

Objective We tested the hypothesis that a longer duration of supplemental oxygen (O2) exposure in labor is associated with higher umbilical cord O2 content. Study Design This is a planned secondary analysis of a randomized noninferiority trial comparing O2 to room air (RA) in laboring patients. Patients were randomized to 10 L/min O2 or RA at any...

OBJECTIVE Maternal oxygen (O2) administration for Category II electronic fetal monitoring (EFM) is a widely used intrauterine resuscitation technique, despite a paucity of evidence on its ability to improve EFM patterns. We investigated the effect of intrapartum O2 administration on Category II EFM patterns. STUDY DESIGN This is a secondary analys...

Objective Low-income women are less likely to exclusively breastfeed on postpartum day two compared to high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day two. Smartphone applications (apps) provide on-demand vid...

Objective The aim of this study is to determine the association between mild acidemia (umbilical artery [UA] pH: 7.11–7.19) and neonatal morbidity in neonates at term. Study Design This is a secondary analysis of a prospective cohort of women admitted for labor at ≥37 weeks of gestation within a single institution from 2010 to 2015. Universal umbil...

In 2019, a total of 25 abortions bans were signed into law by states in the Southeast and Midwest. As of May 2019, 33 states had passed laws restricting or limiting abortion services, including “trigger laws” that make abortion illegal in the event that Roe v. Wade is overturned. In addition, nine states have passed extreme abortion laws, such as m...

Objective: To describe the prevalence of hepatitis C virus (HCV) antibody, evaluate current risk factors associated with HCV antibody positivity, and identify novel composite risk factors for identification of groups most likely to demonstrate HCV antibody seropositivity in an obstetric population from 2012 to 2015. Methods: The Eunice Kennedy S...

Background: Although induction of labor (IOL) of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains given that this intervention historically has been thought to incur greater resource utilization. Objective: To determine...

The dataset presented in this paper is related to the recent work "Accuracy of electromyometrial imaging of uterine contractions in clinical environment" [1]. The dataset including body-uterus geometry obtained from magnetic resonance imaging (MRI), uterine electrograms and isochrone maps reconstructed using Electromyometrial imaging (EMMI) under v...

Investigate marked variability in fetal heart rate (FHR) patterns before delivery and its association with neonatal morbidity and abnormal arterial cord gases. Prospective cohort of laboring patients at term. Composite neonatal morbidity (respiratory distress, mechanical ventilation, suspected sepsis, meconium aspiration syndrome, therapeutic hypot...

Objective: To test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery. Methods: This is a retrospective cohort study based in the New York State Inpatient Database. The first delivery for all pa...

Objective: To compare the utility of maximum vertical pocket versus amniotic fluid index for predicting adverse perinatal outcomes. Methods: Systematic review of randomized clinical studies comparing these two ultrasound techniques and random-effects meta-analysis to quantify a range of perinatal outcomes. Result: Six studies with 4278 women were e...

Clinically, uterine contractions are monitored with tocodynamometers or intrauterine pressure catheters. In the research setting, electromyography (EMG), which detects electrical activity of the uterus from a few electrodes on the abdomen, is feasible, can provide more accurate data than these other methods, and may be useful for predicting preterm...

Objective: To estimate whether stillbirth at 23 weeks of gestation or more is associated with increased risk of severe maternal morbidity compared with live birth, when stratified by maternal comorbidities. Methods: This retrospective cohort study used International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagn...

Objective To estimate second stage duration and its effects on labor outcomes in obese versus nonobese nulliparous women. Study Design This was a secondary analysis of a cohort of nulliparous women who presented for labor at term and reached complete cervical dilation. Adjusted relative risks (aRR) were used to estimate the association between obes...

Objective: Determine whether gestational age of 17-hydroxyprogesterone caproate (17-OHPC) initiation is associated with preterm birth (PTB) risk. Study design: We performed a retrospective cohort study using MarketScan® data. The primary outcome was PTB < 37 weeks. Rates of PTB were compared between medication initiation at 16-21 weeks versus 21...

Objective: To estimate whether severe maternal morbidity is associated with increased risk of psychiatric illness in the year