Amanda C. Zofkie’s research while affiliated with Washington University in St. Louis and other places

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Publications (31)


Hepatitis C and obstetric morbidity in a substance use disorder clinic: A role for telemedicine?
  • Article

November 2023

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5 Reads

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1 Citation

American Journal of Obstetrics & Gynecology MFM

Cassandra J. TRAMMEL

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Shannon BEERMAN

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Bree GOODMAN

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[...]

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Jeannie C. KELLY

Expanded Clinician Offering of Expectant Management of PPROM 34 Weeks 0 Days–36 Weeks 6 Days After Introduction of Shared Decision-Making Aid [ID: 1364841]

May 2023

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9 Reads

Obstetrics and Gynecology

INTRODUCTION In March 2020, the American College of Obstetricians and Gynecologists updated recommendations for prelabor preterm rupture of membranes (PPROM) at 34 weeks 0 days–36 weeks 6 days to include shared decision-making (SDM) for expectant management (EM) versus immediate delivery (ID). We sought to compare the patient populations offered EM before and after a SDM aid. METHODS This is a retrospective cohort study from March 2020 to February 2022 of patients presenting with PPROM 34 weeks 0 days–36 weeks 6 days. On October 25, 2022, a SDM aid was introduced to help clinicians discuss the benefits and risks to EM versus ID of PPROM. Patients offered EM were compared before and after the SDM aid using Fisher exact, χ ² , and t tests. RESULTS Eighty-six patients presented with PPROM during the study period, 26 before the SDM aid and 60 afterwards. Populations were similar, with the exception of more publicly insured patients post-SDM aid. Significantly more patients were offered EM of PPROM post-SDM aid than pre-SDM aid (48% versus 11%, P =.001). The proportion of Caucasian and privately insured patients offered EM significantly increased after the SDM aid; more African American and publicly insured patients were offered EM as well, but this was not statistically significant. No patients accepted EM prior to the SDM aid compared to 41% who chose EM after the SDM aid. CONCLUSION A SDM aid significantly increased the number of patients offered EM of PPROM. Still, while more patients elected for EM after the SDM aid, the majority elected for ID. A standardized approach to SDM may improve provider awareness of management options and provide patients with necessary information to make informed decisions.







The Effect of the COVID-19 Pandemic on EPDS Scores and Maternal Quality of Life [A239]

May 2022

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21 Reads

Obstetrics and Gynecology

INTRODUCTION The COVID-19 pandemic has impacted mental health. We evaluated the impact on pregnant women and compared the Edinburgh Postpartum Depression Scale (EPDS) and a Maternal Postpartum Quality of Life Questionnaire (mPQOL) before and during the pandemic to evaluate the effect of the pandemic on maternal mental health and quality of life. METHODS After institutional review board approval, EPDS screening exams and mPQOL surveys were collected postpartum on all pregnant women during six 12-week epochs prior to and during the pandemic (Epoch 1: December 16, 2019, to March 8, 2020; Epoch 2: March 9, 2020, to May 31, 2020; Epoch 3: June 1, 2020, to August 23, 2020; Epoch 4: August 24, 2020, to November 15, 2020; Epoch 5: November 16, 2020, to January 31, 2021; Epoch 6: February 1, 2021, to May 2, 2021). Scores were compared among the epochs. A score of 13 or higher indicated screening positive for depression. The mPQOL survey was evaluated by sub-categories: Psychological/Baby, Socioeconomic, Relational/Partner, Relationships/Family, and Health/Functioning. Satisfaction was ranked on a scale from 1 to 6 (1=very dissatisfied, 6=very satisfied). EPDS scores and mPQOL scores were compared among the epochs to determine contributors that impacted quality of life during the pandemic. RESULTS Out of 2,011 women, an EPDS score of 13 or higher increased from 3% to 9% from Epoch 1 to Epoch 2 and peaked at 11% in Epoch 5 ( P =0.007). mPQOL Socioeconomic and Relational/Partner sub-category scores decreased significantly from 5.8 to 5.5 ( P =0.014) and 5.5 to 5.4 ( P =0.041), respectively, from Epoch 2 to Epoch 3. CONCLUSION There was a significant increase in positive EPDS screens in pregnant women during the COVID-19 pandemic. Sub-scores obtained from the mPQOL survey suggest that increasing socioeconomic concerns and relational partner issues may have driven these trends.


Flow diagram of anemia cohort distribution
Maternal demographics and obstetric outcomes
Average hemoglobin/hematocrit per antepartum epoch
Comparison of fifth percentile estimates between cohorts by antepartum epoch
Anemia defined, fifth percentile values of a normal, uncomplicated population
An evidence-based definition of anemia for singleton, uncomplicated pregnancies
  • Article
  • Full-text available

January 2022

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48 Reads

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11 Citations

Background The definition for anemia in pregnancy is outdated, derived from Scandinavian studies in the 1970’s to 1980’s. To identity women at risk of blood transfusion, a common cause of Severe Maternal Morbidity, a standard definition of anemia in pregnancy in a modern, healthy United States cohort is needed. Objective To define anemia in pregnancy in a United States population including a large county vs. private hospital population using uncomplicated patients. Materials and methods Inclusion criteria were healthy women with the first prenatal visit before 20 weeks. Exclusion criteria included preterm birth, preeclampsia, hypertension, diabetes, short interval pregnancy (<18 months), multiple gestation, abruption, and fetal demise. All women had iron fortification (Ferrous sulfate 325 mg daily) recommended. The presentation to care and pre-delivery hematocrits were obtained, and the percentiles determined. A total of 2000 patients were included, 1000 from the public county hospital and 1000 from the private hospital. Each cohort had 250 patients in each 2011, 2013, 2015, and 2018. The cohorts were compared for differences in the fifth percentile for each antepartum epoch. Student’s t-test and chi-squared statistical tests were used for analysis, p-value of ≤0.05 was considered significant. Results In the public and private populations, 777 and 785 women presented in the first trimester while 223 and 215 presented in the second. The women at the private hospital were more likely to be older, Caucasian race, nulliparous, and present earlier to care. The fifth percentile was compared between the women in the private and public hospitals and were clinically indistinguishable. When combining the cohorts, the fifth percentile for hemoglobin/hematocrit was 11 g/dL/32.8% in the first trimester, 10.3 g/dL/30.6% in the second trimester, and 10.0 g/dL/30.2% pre-delivery. Conclusions Fifth percentile determinations were made from a combined cohort of normal, uncomplicated pregnancies to define anemia in pregnancy. Comparison of two different cohorts confirms that the same definition for anemia is appropriate regardless of demographics or patient mix.

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Citations (5)


... Telehealth technology can be categorized into four main groups: (i) telemedicine services, which utilize videoconferencing or audio-only communication for consultations, diagnostics, and treatment; (ii) the transfer of medical information, such as digital images, through store-and-forward imaging systems; (iii) the electronic gathering and transmission of health and medical data for remote patient monitoring; and (iv) the support of healthcare and medical operations [43][44][45]. Telehealth technology has the capability to provide a diverse range of services pertaining to pregnancy [46][47][48][49][50]. Continued telehealth application aims to provide equitable access to perinatal care [51]. ...

Reference:

Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis
Hepatitis C and obstetric morbidity in a substance use disorder clinic: A role for telemedicine?
  • Citing Article
  • November 2023

American Journal of Obstetrics & Gynecology MFM

... Anemia was de ned as a hemoglobin value of less than 11 g/dL [9]. Hemoglobin responses to IFA supplementation were categorized as either adequate or inadequate [5,10]. ...

An evidence-based definition of anemia for singleton, uncomplicated pregnancies

... There may be benefit for "expedited" partner treatment as was attempted to be demonstrated for another STI (i.e. chlamydia), for which medication was given to the patient for her to provide it to her sexual partner [18]. Borrowing from that same concept, a known sexual contact who is presumed to have syphilis according to the acquired serologic record, could be offered parenteral penicillin treatment by an appropriate primary care physician (PCP). ...

Effectiveness of Chlamydia Trachomatis expedited partner therapy in pregnancy
  • Citing Article
  • April 2021

American Journal of Obstetrics and Gynecology

... Раннее вмешательство связано с лучшими результатами, так как оперативное лечение может замедлить прогрессирование заболевания и снизить риск серьёзных осложнений, таких как острый респираторный дистресс-синдром (ОРДС) и необходимость в ИВЛ [9]. Напротив, задержки в обращении за помощью связаны с худшими исходами, включая более высокие показатели госпитализации в отделение интенсивной терапии и неблагоприятные неонатальные исходы [11]. ...

Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection

JAMA Network Open

... However, false-negatives can occur with TPPA because of the defects in coating and antigen selection, and the subjective judgment of results [5]. It has also been reported that a certain percentage of biological false positives can be detected with TPPA [5][6][7]. In this study, samples with inconsistent results of preliminary screening of anti-TP antibodies by ELISA and retest by TPPA were taken as experiment subjects for other WB tests. ...

Syphilis Immunoassay Signal Strength Correlates with Active Infection in Pregnant Women
  • Citing Article
  • January 2020

American Journal of Perinatology