Julia Burd’s research while affiliated with Washington University in St. Louis and other places

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Publications (28)


“Inpatient pharmacological thromboprophylaxis in the antepartum period: an argument for universal thromboprophylaxis”
  • Literature Review

November 2024

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1 Read

American Journal of Obstetrics & Gynecology MFM

Julia Burd

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Amanda Zofkie

Perinatal outcomes based on number of digital exams in patients with PPROM

October 2024

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16 Reads

American Journal of Perinatology

Julia Burd

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Evaline Xie

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Jeannie C. Kelly

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[...]

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Nandini Raghuraman

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 outcomes in PPROM. Study Design This was a single-center retrospective cohort study of patients admitted between 2019 and 2021 with PPROM at 24 to 34 weeks of gestation. The primary outcome was intra-amniotic infection and inflammation (triple I), compared between patients who had ≤1 or ≥2 digital exams during expectant management of PPROM. Secondary outcomes included latency, antepartum events, and other maternal and neonatal morbidities. Groups were compared using univariate analysis and Cox proportional hazards model to account for time between admission and delivery and potential confounders. Results Of 125 patients included in the analysis, 46 (36.8%) had ≤ 1 and 79 (63.2%) had ≥2 digital exams. There was no significant difference in triple I between groups (adjusted hazard ratio [aHR]: 1.03, 95% confidence interval [CI]: 0.47, 2.26). There were no significant differences in composite maternal or neonatal morbidities or latency from admission to delivery between groups (8 days [interquartile range (IQR): 3, 14] vs. 6 days [IQR: 3, 12]). There was a higher rate of spontaneous labor as the indication for delivery in the group with ≥2 exams (aHR: 2.07, 95% CI: 1.04, 4.11). Conclusion In this retrospective cohort study, ≥2 digital exams during expectant management of PPROM was not associated with change in infectious morbidity or pregnancy latency. There was an increase in spontaneous labor in the group with more digital exams; this may be due to confounding by indication, as patients who are in prodromal labor are more likely to receive digital exams. These results suggest equipoise in exam type in the management of PPROM. Key Points


Risks Associated with Prolonged Latent Phase of Labor

September 2024

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11 Reads

American Journal of Perinatology

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 hemorrhage, transfusion, endometritis, and severe perineal lacerations) and composite neonatal morbidity (respiratory distress syndrome, mechanical ventilation, birth injury, seizures, hypoxic ischemic encephalopathy, therapeutic hypothermia, or umbilical artery pH ≤ 7.1). Outcomes were compared between patients with and without PLP, defined as ≥90th percentile of labor duration between admission and active phase. Results were stratified by induction of labor (IOL) versus spontaneous labor. A stratified analysis was performed by mode of delivery. Multivariable logistic regression was used to adjust for confounders. Results In this cohort of 6,509 patients, 51% underwent IOL. A total of 650 patients had a PLP with a median length of 8.5 hours in spontaneous labor and 18.8 hours in IOL. Among patients with PLP, there was a significant increase in composite maternal morbidity with both IOL (adjusted odds ratio [aOR]: 1.36, 95% confidence interval [CI]: 1.01, 1.84) and spontaneous labor (aOR: 1.49, 95% CI: 1.09, 2.04) and an increase in composite neonatal morbidity with spontaneous labor only (aOR: 1.57, 95% CI: 1.01, 2.45). Cesarean delivery occurred more often in PLP group (14.0 vs. 25.1%). Among patients who underwent cesarean delivery, PLP remained associated with increased odds of maternal morbidity compared with those with normal latent phase. Conclusion PLP at or above the 90th percentile in patients who reach active labor is associated with increased risk of maternal morbidity that is not mediated by cesarean delivery. PLP in spontaneous labor is associated with increased neonatal morbidity. These data suggest that further research is needed to establish latent phase cutoffs that may be incorporated into labor management guidelines. Key Points







Intrapartum Oxygen for Fetal Resuscitation: State of the Science
  • Literature Review
  • Publisher preview available

May 2023

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36 Reads

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4 Citations

Current Obstetrics and Gynecology Reports

Purpose of Review This review aims to summarize the current evidence regarding maternal oxygen supplementation for Category II fetal heart tracings (FHT) in labor. We aim to evaluate the theoretical rationale for oxygen administration, the clinical efficacy of supplemental oxygen, and the potential risks. Recent Findings Maternal oxygen supplementation is an intrauterine resuscitation technique rooted in the theoretic rationale that hyperoxygenating the mother results in increased oxygen transfer to the fetus. However, recent data suggest otherwise. Randomized controlled trials on the efficacy of oxygen supplementation in labor suggest no improvement in umbilical cord gases or other adverse maternal and neonatal outcomes compared to room air. Two meta-analyses demonstrated that oxygen supplementation is not associated with an improvement in umbilical artery pH or reduction in cesarean delivery. Although we lack data on definitive clinical neonatal outcomes with this practice, there is some suggestion of adverse neonatal outcomes with excess in utero oxygen exposure, including lower umbilical artery pH. Summary Despite historic data suggesting the benefit of maternal oxygen supplementation in increasing fetal oxygenation, recent randomized trials and meta-analyses have demonstrated a lack of efficacy of this practice and some suggestion of harm. This has led to conflicting national guidelines. Further research is needed on short- and long-term neonatal clinical outcomes following prolonged intrauterine oxygen exposure.

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Citations (10)


... Interventions such as lateral tilt, intravenous fluid boluses, cessation of oxytocin infusions where present are standard and important ways of improving placental perfusion during labour and delivery whilst awaiting emergency treatments such as Caesarean section or vacuum delivery. We recognise that the world literature has not confirmed the value or unlikely potential harm from additional maternal inspired oxygen treatment for fetal distress [19,20] but it remains in practice in Ukraine even though not supported by the National Protocol. This means that these practices still have strong traditions and need more attention and effort to stop their use in Ukraine. ...

Reference:

A descriptive analysis of a medical humanitarian aid initiative for quality perinatal management in war-torn Ukraine
Intrapartum Oxygen for Fetal Resuscitation: State of the Science

Current Obstetrics and Gynecology Reports

... Several methods are available, including continuous barbed suture, double-layer closure, inverted-U closure, locking stitch technique, single-layer closure, single-layer closure using inverting Lembert or Cushing stitches, two-layer closure with an interlocking layer, two-layer closure with distinct suture materials, and uterosacral ligament suspension. Each of these techniques has its own advantages and disadvantages, contributing to the ongoing debate about the most effective approach for uterine closure [15][16][17]. ...

Suture type for hysterotomy closure: a systematic review and meta-analysis of randomized controlled trials
  • Citing Article
  • August 2022

American Journal of Obstetrics & Gynecology MFM

... Consequently, the COVID-19 epidemic may have significant risks for pregnant women [3]. Recent research indicates that pregnant women with severe or critical cases of COVID-19 are at a higher risk for complications, including mechanical ventilation) compared to nonpregnant women of reproductive age [4]. ...

Pregnant Women With Severe or Critical Coronavirus Disease 2019 have Increased Composite Morbidity Compared With Nonpregnant Matched Controls
  • Citing Article
  • March 2022

Obstetric Anesthesia Digest

... (Barrowclough et al., 2022;Levy et al., 2021) Side lateral position Based on the studies included in the review, use of this position may have little or no effect on reducing rates of CS, instrumental births and maternal satisfaction, but this evidence is uncertain and further research is needed. (Barrowclough et al., 2022) Manual internal rotation A review by Burd et al. (2022) shows that prophylactic manual rotation of the fetus from the occipitoposterior (OP) or occipitotransverse (OT) position, confirmed by ultrasound (USS), did not increase the rate of spontaneous vaginal labour compared with no manual rotation. Manual vertex rotation from a OP position during the early second stage of labour was associated with a significant 12.8-minute reduction in length, without changes in maternal and fetal outcome. ...

Prophylactic rotation for malposition in the second stage of labor: a systematic review and meta-analysis of randomized controlled trials
  • Citing Article
  • February 2022

American Journal of Obstetrics & Gynecology MFM

... identifier NCT03764696. KEYWORDS prolonged oxygen exposure, umbilical cord arterial metabolites, fetal heart rate tracings, pregnancy, childbirth Background Maternal oxygen (O 2 ) administration was approved for use in preventing or treating fetal hypoxia and acidemia in many parts of the world (1)(2)(3). Obstetricians and midwives hoped that the supplemental O 2 could be transferred to fetal circulation to improve fetal metabolic status and alleviate non-reassuring fetal status, as a mass of animal and human data have shown that maternal O 2 improves fetal oxygenation and other neonatal outcomes (1)(2)(3). It is estimated that more than half of women during labor receive supplemental O 2 , even though they are well oxygenated (1). ...

Evaluation of an Initiative to Decrease the Use of Oxygen Supplementation for Category II Fetal Heart Rate Tracings
  • Citing Article
  • September 2021

Obstetrics and Gynecology

... A significantly lower cesarean delivery rate in our study is contrary to a recent meta-analysis. 33 Nevertheless, all included studies in this meta-analysis, such as ours, did not assess the cesarean delivery rate as a primary outcome measure. The duration of oxygen supplementation did not affect most cord blood parameters in women with category II FHR tracing. ...

Effect of intrapartum oxygen on the rate of cesarean delivery: a meta-analysis
  • Citing Article
  • April 2021

American Journal of Obstetrics & Gynecology MFM

... As the first human genetic markers known, the ABO blood group system remains one of the most interesting, both clinically and scientifically, systematically dividing people into four groups [11]. Many studies have demonstrated the relationship between various ABO blood types and certain diseases including cancers, cardiovascular diseases, infections, and pregnancy complications, such as preeclampsia, gestational diabetes mellitus, and postpartum hemorrhage [11][12][13][14][15][16][17]. Previous studies have shown there is an association with ABO blood type and adverse pregnancy outcomes, but still, the results are conflicting. ...

Blood type and postpartum hemorrhage by mode of delivery: A retrospective cohort study
  • Citing Article
  • January 2021

European Journal of Obstetrics & Gynecology and Reproductive Biology

... Unvaccinated pregnant women are at a heightened risk of ICU admission, mechanical ventilation, and mortality from COVID-19 in comparison to appropriately matched nonpregnant women [22][23][24]. Rasmussen and Jamieson [25] have posited that COVID-19 during pregnancy is a "two for the price of one deal". In the current investigation, we have demonstrated that the advantages of administering the COVID-19 vaccination before pregnancy are noteworthy for neonates postpartum. ...

Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls
  • Citing Article
  • November 2020

American Journal of Obstetrics and Gynecology

... A study involving 438,548 pregnant women suggested that compared with uninfected women, pregnant women infected with SARS-CoV-2 have an increased risk of experiencing PTB, LBW and stillbirth to varying degrees [15]. Collectively, evidence indicates a significant increase in certain adverse birth outcomes, such as stillbirth during the COVID-19 pandemic; however, a decrease in PTBs was observed in high-income countries such as the United States, the Netherlands and Japan [16][17][18]. Conversely, mid-or low-income countries, including Nepal [19], Turkey [20] and India [21], have experienced a significant rise in stillbirth rates due to the relatively inadequate healthcare services and limited capacity to respond effectively to the challenges posed by the COVID-19 pandemic. Furthermore, the impact of the COVID-19 pandemic on foetal health may have enduring intergenerational effects and exacerbate social demographic disparities in birth outcomes [22]. ...

Decreased incidence of preterm birth during coronavirus disease 2019 pandemic
  • Citing Article
  • November 2020

American Journal of Obstetrics & Gynecology MFM

... Adverse perinatal outcomes such as stillbirth, fetal distress, or prematurity were similar in both infected and uninfected groups after adjustment for vaccination, comorbidities, gestational trimester, and periods of time. However, we found a higher proportion of prematurity among participants who tested positive for SARS-CoV-2, as in prior research studies from the U.S. and Europe [57][58][59][60][61]. In addition, the sensitivity analysis indicated a possible association between SARS-CoV-2 infection and the risk of prematurity. ...

Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study
  • Citing Article
  • May 2020

American Journal of Obstetrics & Gynecology MFM