We appraised the compliance of randomized clinical trials (RCTs) cited for level A recommendation... more We appraised the compliance of randomized clinical trials (RCTs) cited for level A recommendations in obstetric practice bulletins (OPBs) and published after the CONSORT (Consolidated Standards of Reporting Trials, published 1996) statement. From the CONSORT checklist, we identified 50 separate items the RCTs should describe in the article and assigned 1 point if present; 0, if absent. The CONSORT score was the total points, expressed as a percentage. From 1998 to 2006, American College of Obstetricians and Gynecologists published 68 level A obstetric recommendations, and 20 (29%) are supported by > or = 1 RCT published after 1997. The median CONSORT score for the 32 RCTs published after the statement was 73% (range 30 to 100%). Only four RCTs complied with 90% of the CONSORT statement. RCTs supporting level A recommendations in OPB have variable compliance with CONSORT. Recommendations that lack quality RCTs should prompt further studies into the topic.
Objective The factors associated with persistent neonatal brachial plexus palsy
(PNBPP) are unkno... more Objective The factors associated with persistent neonatal brachial plexus palsy (PNBPP) are unknown. Our objectives are to compare PNBPP at 1 and 2 years in children delivered via vaginal delivery (VD) versus cesarean delivery (CD) and in children delivered via VD with or without reported shoulder dystocia (SD). Study Design Retrospective cohort of children diagnosed with neonatal brachial plexus palsy (NBPP). Maternally reported delivery history and presence of SD were recorded with Student t-test, chi-square test, and odds ratio (OR) with 95% confidence intervals (CI) calculated for comparisons. Results Of 387 cases of NBPP, 8% (30) delivered via CD. Rates of PNBPP were higher in the VD group at 1 and 2 years (60% of CD and 85% of VD; OR, 0.26; 95% CI, 0.11–0.62 at 1 year; 33% of CD and 73% of VD; OR, 0.15; 95% CI, 0.05–0.39 at 2 years). There was no difference in PNBPP in women with VD with or without maternally reported SD (87 vs. 85%, p ¼ 0.68 at 1 year; 64 vs. 61%, p ¼ 0.61 at 2 years). Conclusion PNBPP is possible with CD, and there is no difference in PNBPP in VD with or without maternally reported SD. A prospective study is warranted to ascertain associative factors.
OBJECTIVE: The objective of the study was to compare national guidelines
regarding small for gest... more OBJECTIVE: The objective of the study was to compare national guidelines regarding small for gestational age (SGA). STUDY DESIGN: Along with American College of Obstetricians and Gynecologists (ACOG) practice bulletin on abnormal growth, guidelines from England, Canada, Australia, and New Zealand were reviewed. RESULTS: There are no guidelines on SGA from Canada, Australia, and New Zealand. The Royal College of Obstetricians and Gynaecologists (RCOG) guideline agrees with ACOG’s definition of abnormal growth, but there are noticeable variances in the diagnosis and management of SGA. RCOG has more recommendations than ACOG (18 vs 4, respectively). The articles referenced varied, with only 13 similar articles being cited by the both committees. CONCLUSION: The differences in the 2 guidelines suggest that there is variance in how 2 committees synthesize the literature and issue recommendations.
Objective The objective of this study was to determine the morbidity of preterm small for gestati... more Objective The objective of this study was to determine the morbidity of preterm small for gestational age (SGA) infants compared with appropriate for GA (AGA). Study Design This is a secondary analysis of the randomized trial evaluating magnesium sulfate for the prevention of cerebral palsy (CP). We compared outcomes of preterm (< 37 weeks) nonanomalous infants who were SGA (birth weight < 10% for GA) versus AGA (birth weight 10-89% for GA). We compared (1) the parent trial primary outcome, a composite of stillbirth, infant death by 1 year of age, or moderate to severe CP at 2 years of age and (2) composite neonatal morbidity (CNM). Results Of the 1,948 infants who met inclusion criteria, 95% were AGA and 5% were SGA. The primary outcome was similar (10 and 15%, p = 0.08), as was the CNM (24 and 25%, p = 0.89). Sample size calculations indicate that detection of a one-third higher rate of CNM among SGA compared with AGA infants requires more than 93,900 preterm births; for a o...
American journal of obstetrics and gynecology, 2015
Nonimmune hydrops is the presence of ≥2 abnormal fetal fluid collections in the absence of red ce... more Nonimmune hydrops is the presence of ≥2 abnormal fetal fluid collections in the absence of red cell alloimmunization. The most common etiologies include cardiovascular, chromosomal, and hematologic abnormalities, followed by structural fetal anomalies, complications of monochorionic twinning, infection, and placental abnormalities. We sought to provide evidence-based guidelines for the evaluation and management of nonimmune hydrops fetalis. A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and Cochrane Library. The search was restricted to English-language articles published from 1966 through June 2014. Priority was given to articles reporting original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Evidence reports and guidelines published by organizations or institutions such as the National Institute...
To ascertain the influence and utilization of the American College Obstetricians and Gynecologist... more To ascertain the influence and utilization of the American College Obstetricians and Gynecologists practice bulletins (PBs) by measuring their citations in three different search tools. PBs in obstetrics (OB-PBs) and gynecology (GYN-PBs) published from September 1998 to December 2009 were identified. PubMed, Ovid MEDLINE, and Web of Science were utilized to determine how often PBs were cited. The citations were quantified by three parameters, most citations, highest citation rate, and highest impact factor. The OB-PB with the most citations (125) was PB no. 33 (Diagnosis and Management of Preeclampsia and Eclampsia), highest citation rate (44) was PB no. 101 (Ultrasonography in Pregnancy), highest OBGYN impact factor (4.39) was PB no. 71 (Episiotomy), and highest non-OBGYN impact factor (53.49) was PB no. 38 (Perinatal Care at Threshold of Viability). The GYN-PB with the highest citation rate (103) was PB no. 109 (Cervical Cytology Screening), highest OBGYN impact factor (3.85) was ...
American journal of obstetrics and gynecology, 2005
The purpose of this study was to survey members of the Central Association of Obstetricians and G... more The purpose of this study was to survey members of the Central Association of Obstetricians and Gynecologists about professional liability claims. A survey was mailed to Central Association of Obstetricians and Gynecologists members regarding medical liability experience. Of the 897 surveys mailed, 73% were completed. The responding 658 clinicians had been in practice for 17,136 years and had 1507 closed claims. The respondents had a claim every 11 years of practice and a trial every 69 years. Matched for years of practice, a case control comparison indicated that the litigation is significantly lower for female physicians (1.5 +/- 1.8) than for male physicians (2.2 +/- 2.0; P = .019) although the mean cases that were dropped or dismissed were higher for men (1.3 +/- 1.7 vs 0.8 +/- 1.4; P = .022). However, the mean number of trials, defense trial verdicts, and the settlement amounts were similar for both genders. We found that professional liability claims are uncommon and that the ...
American journal of obstetrics and gynecology, 2005
The purpose of this study was to analyze the data on brachial plexus injury and its relationship ... more The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period. A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center. During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (> or =1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed > or =4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants without injury (odds ratio, 6.55; 95% CI, 2.30, 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups. A case of brachial plexus injury occurs 1 time in every 1000 ...
Objective: An association between maternal hypoglycemia during pregnancy with fetal growth restri... more Objective: An association between maternal hypoglycemia during pregnancy with fetal growth restriction and overall perinatal mortality has been reported. In a retrospective pilot study we found that hypoglycemia was linked with a greater number of special care/neonatal intensive care unit admissions and approached significance in the number of women who developed preeclampsia. That study was limited by its retrospective design, a narrow patient population and the inability to perform multivariate analysis because of the limitations in the data points collected. This study was undertaken to compare the perinatal outcome in pregnancies with hyoglycemia following a glucose challenge test (GCT) to pregnancies with a normal GCT.
American journal of obstetrics and gynecology, 2014
We sought to determine the extent to which reviewers' recommendations influence the final edi... more We sought to determine the extent to which reviewers' recommendations influence the final editorial disposition of manuscripts submitted for publication. Five reviewers retrieved their electronic databases of obstetrical manuscripts that they had reviewed for Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology. The recommendations of each reviewer were grouped in 1 of 3 categories: rejection (or not acceptance), acceptance with major revisions, and acceptance with minor or no revisions. These recommendations were contrasted in the final editorial disposition of the manuscript, which was recorded as "accepted" or "rejected." The quality of the reviews was assessed in a random sample of 10% of the reviews, stratified by reviewer and journal. A total of 635 reviews were analyzed. Overall, the most influential reviewers' recommendation was rejection, which was accompanied by 93% rejection rate. Recommendation for acceptance with mi...
To review the English-language literature from 1990 to 2000 on cesarean delivery for "fetal ... more To review the English-language literature from 1990 to 2000 on cesarean delivery for "fetal distress" and assess compliance with American College of Obstetricians and Gynecologists (ACOG) guidelines. A PubMed search with the search items cesarean, fetal distress, cesarean, nonreassuring fetal heart rate, cesarean, neonatal acidosis and cesarean, umbilical arterial pH was undertaken. Excluded from the search were case reports, letters to the editor, focus on fetal anomaly, combinations with other reasons for operative delivery (either abdominally or vaginally) or absence of pertinent information. Among 392 articles from the search, 169 met the inclusion criteria. Three reports provided detailed information on use of scalp pH; use occurred in 5% (60/1,128) of emergency cesareans. Three reports provided data on the use of tocolytics for intrauterine resuscitation; the combined result was 16% (201/1,261). Five reports assessed the decision-to-incision interval within 30 minute...
American journal of obstetrics and gynecology, 2015
Although major international guidelines recommend venous thromboembolism (VTE) prophylaxis during... more Although major international guidelines recommend venous thromboembolism (VTE) prophylaxis during vaginal delivery hospitalization for women with additional risk factors, US guidelines recommend prophylaxis for a very small number of women who are at particularly high risk for an event. The purpose of this study was to characterize practice patterns of VTE prophylaxis in the United States during vaginal delivery hospitalizations and to determine VTE incidence in this population. A population-level database was used to analyze VTE incidence and use of VTE prophylaxis during vaginal delivery hospitalizations in the United States between 2006 and 2012 (n = 2,673,986). We evaluated whether patients received either pharmacologic or mechanical prophylaxis. Hospital-level factors and patient characteristics were included in multivariable regression analysis that evaluated prophylaxis administration. We identified 2,673,986 women who underwent vaginal delivery. Incidence of VTE increased du...
Objective This study aims to compare two management protocols in pregnancies diagnosed with fetal... more Objective This study aims to compare two management protocols in pregnancies diagnosed with fetal growth restriction (FGR). Study Design All singleton pregnancies diagnosed and managed with FGR at our institution during two protocol periods were analyzed. The early term protocol (January 2008-February 2010) specified delivery at 37(0/7) weeks if antenatal testing was reassuring, but did not specify the timing of delivery if umbilical artery (UA) Doppler systolic:diastolic (S:D) ratios were elevated (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;95th percentile for gestational age [GA]). The term protocol (March 2010-July 2012) specified delivery at 39(0/7) weeks with normal S:D ratios and 37(0/7) weeks with elevated S:D ratios when antenatal testing was reassuring. Results There were 228 and 312 women in the early term and term protocol, respectively, who met inclusion criteria. Compared with the early term group, the term group had an increased median GA at delivery (37.1 vs. 38.6%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), decreased deliveries less than 37(0/7) weeks (37 vs. 24%, p = 0.01) and decreased neonatal intensive care unit (NICU) admissions (38 vs. 28%, p = 0.02). Conclusion A protocol specifying delivery at 39(0/7) weeks when UA S:D ratios are normal and delivery at 37(0/7) weeks when UA S:D ratios are elevated when other antenatal testing is reassuring in FGR: (1) prolonged gestation, (2) decreased preterm births, and (3) decreased NICU admissions.
The Journal of Obstetrics and Gynecology of India, 2011
Abstract Introduction There are more deliveries in India than any country in the world, according... more Abstract Introduction There are more deliveries in India than any country in the world, according to World Health Report. Review of seven articles published in The Journal of Obstetrics and Gynecology of India suggests that the perinatal mortality (PNM) in the ...
Objective To compare the obstetric recommendations in American Congress of Obstetricians and Gyne... more Objective To compare the obstetric recommendations in American Congress of Obstetricians and Gynecologists (ACOG) practice bulletins (PB) with similar topics in UpToDate (UTD). Study Design We accessed all obstetric PB and cross-searched UTD (May 1999-May 2013). We analyzed only the PB which had corresponding UTD chapter with graded recommendations (level A-C). To assess comparability of recommendations for each obstetric topic, two maternal-fetal medicine (MFM) subspecialists categorized the statement as similar, dissimilar, or incomparable. Simple and weighted kappa statistics were calculated to assess agreement between the two raters. Results We identified 46 ACOG obstetric PB and 86 UTD chapters. There were 50% fewer recommendations in UTD than in PB (181 vs. 365). The recommendations being categorized as level A, B, or C was significantly different (p < 0.001) for the two guidelines. While the overall concordance rate between the two MFM subspecialists was 83% regarding the ...
Objectives Substance abuse in pregnancy remains a major public health problem. Fetal teratogenici... more Objectives Substance abuse in pregnancy remains a major public health problem. Fetal teratogenicity results from the effect of these substances during fetal development, particularly when used in combination. This review will focus on and attempt to clarify the existing literature regarding the association of substance abuse on the development of congenital anomalies and the long-term implications in exposed offspring. Methods Systematic review of available English literature using the PubMed database of all peer-reviewed articles on the subject. Results A total of 128 articles were included in this review. Alcohol was the most common substance associated with fetal anomalies, particularly facial dysmorphisms and alterations in the central nervous system development. Adverse maternal environments associated with risky behaviors and lack of adequate prenatal care precludes the timely detection of fetal anomalies, confounding most studies linking causality. In addition, although metho...
Australian & New Zealand Journal of Obstetrics & Gynaecology, 1993
Four hundred and fifty-four gravid women were identified with the HELLP syndrome from January, 19... more Four hundred and fifty-four gravid women were identified with the HELLP syndrome from January, 1980 to May, 1992. The peak systolic and diastolic blood pressures, proteinuria, and uric acid were recorded for each patient during the peripartal course. Patients were classified according to disease severity with, in addition to elevated lactate dehydrogenase (LDH) values, laboratory evidence of haemolysis and hepatic dysfunction, a peripartal platelet count &lt; or = 50,000/microliters was depicted Class I, Class II as a platelet count &gt; 50,000 and &lt; or = 100,000/microliters and Class III as &gt; 100,000 and &lt; or = 150,000/microliters. Patients with Class I HELLP syndrome had peak antepartum systolic blood pressures &lt; 150 mm Hg significantly more often than the Class II (p &lt; 0.0091) or Class III (p &lt; 0.04) HELLP syndrome. Class I HELLP syndrome had significantly more patients with 1+ to 2+ proteinuria than Class II (p &lt; 0.02) and Class III HELLP syndrome (p &lt; 0.009). Uric acid levels were not different among nor proportionately related to increasing severity of the HELLP syndrome.
To define the normal range of amniotic fluid (AF) volume in third-trimester diamniotic twin gesta... more To define the normal range of amniotic fluid (AF) volume in third-trimester diamniotic twin gestations. The AF volume of third-trimester diamniotic twin pregnancies was measured prospectively. An AF sample was drawn from both amniotic cavities of diamniotic twins either for diagnosis of subclinical chorioamnionitis with preterm labor and/or assessment of fetal lung maturity. Actual AF volume was determined in each amniotic cavity by a dye-dilution technique. The AF volume of 45 diamniotic twin pregnancies of 27-38 weeks&#39; gestation was assessed. The AF volume per amniotic sac ranged from 155-5430 mL, with a mean (+/- standard deviation) of 877 +/- 860 mL. The AF volume in individual amniotic cavities and the total of both cavities in a diamniotic twin pregnancy were unchanged across the entire gestational age range (27-38 weeks). Neither fetal positioning within the uterus (lower twin versus upper twin) nor fetal weight were determining factors in the AF volume variability (P = .846 and P = .726, respectively). Based on absolute volumetric differences between the larger- and smaller-sac AF volume, we observed that as the AF volume of the larger sacs increased proportionately (P &lt; .001), the AF volume of the smaller sacs remained relatively constant across the entire range of differences (P = .687) between 27-38 weeks. The average AF volume of 877 mL for each diamniotic twin is similar to the AF volume reported for third-trimester singletons. The AF volumes of diamniotic twin gestations relate neither to fetal position nor fetal weight, but instead develop independently without relation to the other amniotic cavity. Ninety percent of the AF volumes were 215-2500 mL.
We appraised the compliance of randomized clinical trials (RCTs) cited for level A recommendation... more We appraised the compliance of randomized clinical trials (RCTs) cited for level A recommendations in obstetric practice bulletins (OPBs) and published after the CONSORT (Consolidated Standards of Reporting Trials, published 1996) statement. From the CONSORT checklist, we identified 50 separate items the RCTs should describe in the article and assigned 1 point if present; 0, if absent. The CONSORT score was the total points, expressed as a percentage. From 1998 to 2006, American College of Obstetricians and Gynecologists published 68 level A obstetric recommendations, and 20 (29%) are supported by &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 1 RCT published after 1997. The median CONSORT score for the 32 RCTs published after the statement was 73% (range 30 to 100%). Only four RCTs complied with 90% of the CONSORT statement. RCTs supporting level A recommendations in OPB have variable compliance with CONSORT. Recommendations that lack quality RCTs should prompt further studies into the topic.
Objective The factors associated with persistent neonatal brachial plexus palsy
(PNBPP) are unkno... more Objective The factors associated with persistent neonatal brachial plexus palsy (PNBPP) are unknown. Our objectives are to compare PNBPP at 1 and 2 years in children delivered via vaginal delivery (VD) versus cesarean delivery (CD) and in children delivered via VD with or without reported shoulder dystocia (SD). Study Design Retrospective cohort of children diagnosed with neonatal brachial plexus palsy (NBPP). Maternally reported delivery history and presence of SD were recorded with Student t-test, chi-square test, and odds ratio (OR) with 95% confidence intervals (CI) calculated for comparisons. Results Of 387 cases of NBPP, 8% (30) delivered via CD. Rates of PNBPP were higher in the VD group at 1 and 2 years (60% of CD and 85% of VD; OR, 0.26; 95% CI, 0.11–0.62 at 1 year; 33% of CD and 73% of VD; OR, 0.15; 95% CI, 0.05–0.39 at 2 years). There was no difference in PNBPP in women with VD with or without maternally reported SD (87 vs. 85%, p ¼ 0.68 at 1 year; 64 vs. 61%, p ¼ 0.61 at 2 years). Conclusion PNBPP is possible with CD, and there is no difference in PNBPP in VD with or without maternally reported SD. A prospective study is warranted to ascertain associative factors.
OBJECTIVE: The objective of the study was to compare national guidelines
regarding small for gest... more OBJECTIVE: The objective of the study was to compare national guidelines regarding small for gestational age (SGA). STUDY DESIGN: Along with American College of Obstetricians and Gynecologists (ACOG) practice bulletin on abnormal growth, guidelines from England, Canada, Australia, and New Zealand were reviewed. RESULTS: There are no guidelines on SGA from Canada, Australia, and New Zealand. The Royal College of Obstetricians and Gynaecologists (RCOG) guideline agrees with ACOG’s definition of abnormal growth, but there are noticeable variances in the diagnosis and management of SGA. RCOG has more recommendations than ACOG (18 vs 4, respectively). The articles referenced varied, with only 13 similar articles being cited by the both committees. CONCLUSION: The differences in the 2 guidelines suggest that there is variance in how 2 committees synthesize the literature and issue recommendations.
Objective The objective of this study was to determine the morbidity of preterm small for gestati... more Objective The objective of this study was to determine the morbidity of preterm small for gestational age (SGA) infants compared with appropriate for GA (AGA). Study Design This is a secondary analysis of the randomized trial evaluating magnesium sulfate for the prevention of cerebral palsy (CP). We compared outcomes of preterm (< 37 weeks) nonanomalous infants who were SGA (birth weight < 10% for GA) versus AGA (birth weight 10-89% for GA). We compared (1) the parent trial primary outcome, a composite of stillbirth, infant death by 1 year of age, or moderate to severe CP at 2 years of age and (2) composite neonatal morbidity (CNM). Results Of the 1,948 infants who met inclusion criteria, 95% were AGA and 5% were SGA. The primary outcome was similar (10 and 15%, p = 0.08), as was the CNM (24 and 25%, p = 0.89). Sample size calculations indicate that detection of a one-third higher rate of CNM among SGA compared with AGA infants requires more than 93,900 preterm births; for a o...
American journal of obstetrics and gynecology, 2015
Nonimmune hydrops is the presence of ≥2 abnormal fetal fluid collections in the absence of red ce... more Nonimmune hydrops is the presence of ≥2 abnormal fetal fluid collections in the absence of red cell alloimmunization. The most common etiologies include cardiovascular, chromosomal, and hematologic abnormalities, followed by structural fetal anomalies, complications of monochorionic twinning, infection, and placental abnormalities. We sought to provide evidence-based guidelines for the evaluation and management of nonimmune hydrops fetalis. A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and Cochrane Library. The search was restricted to English-language articles published from 1966 through June 2014. Priority was given to articles reporting original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Evidence reports and guidelines published by organizations or institutions such as the National Institute...
To ascertain the influence and utilization of the American College Obstetricians and Gynecologist... more To ascertain the influence and utilization of the American College Obstetricians and Gynecologists practice bulletins (PBs) by measuring their citations in three different search tools. PBs in obstetrics (OB-PBs) and gynecology (GYN-PBs) published from September 1998 to December 2009 were identified. PubMed, Ovid MEDLINE, and Web of Science were utilized to determine how often PBs were cited. The citations were quantified by three parameters, most citations, highest citation rate, and highest impact factor. The OB-PB with the most citations (125) was PB no. 33 (Diagnosis and Management of Preeclampsia and Eclampsia), highest citation rate (44) was PB no. 101 (Ultrasonography in Pregnancy), highest OBGYN impact factor (4.39) was PB no. 71 (Episiotomy), and highest non-OBGYN impact factor (53.49) was PB no. 38 (Perinatal Care at Threshold of Viability). The GYN-PB with the highest citation rate (103) was PB no. 109 (Cervical Cytology Screening), highest OBGYN impact factor (3.85) was ...
American journal of obstetrics and gynecology, 2005
The purpose of this study was to survey members of the Central Association of Obstetricians and G... more The purpose of this study was to survey members of the Central Association of Obstetricians and Gynecologists about professional liability claims. A survey was mailed to Central Association of Obstetricians and Gynecologists members regarding medical liability experience. Of the 897 surveys mailed, 73% were completed. The responding 658 clinicians had been in practice for 17,136 years and had 1507 closed claims. The respondents had a claim every 11 years of practice and a trial every 69 years. Matched for years of practice, a case control comparison indicated that the litigation is significantly lower for female physicians (1.5 +/- 1.8) than for male physicians (2.2 +/- 2.0; P = .019) although the mean cases that were dropped or dismissed were higher for men (1.3 +/- 1.7 vs 0.8 +/- 1.4; P = .022). However, the mean number of trials, defense trial verdicts, and the settlement amounts were similar for both genders. We found that professional liability claims are uncommon and that the ...
American journal of obstetrics and gynecology, 2005
The purpose of this study was to analyze the data on brachial plexus injury and its relationship ... more The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period. A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center. During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (> or =1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed > or =4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants without injury (odds ratio, 6.55; 95% CI, 2.30, 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups. A case of brachial plexus injury occurs 1 time in every 1000 ...
Objective: An association between maternal hypoglycemia during pregnancy with fetal growth restri... more Objective: An association between maternal hypoglycemia during pregnancy with fetal growth restriction and overall perinatal mortality has been reported. In a retrospective pilot study we found that hypoglycemia was linked with a greater number of special care/neonatal intensive care unit admissions and approached significance in the number of women who developed preeclampsia. That study was limited by its retrospective design, a narrow patient population and the inability to perform multivariate analysis because of the limitations in the data points collected. This study was undertaken to compare the perinatal outcome in pregnancies with hyoglycemia following a glucose challenge test (GCT) to pregnancies with a normal GCT.
American journal of obstetrics and gynecology, 2014
We sought to determine the extent to which reviewers' recommendations influence the final edi... more We sought to determine the extent to which reviewers' recommendations influence the final editorial disposition of manuscripts submitted for publication. Five reviewers retrieved their electronic databases of obstetrical manuscripts that they had reviewed for Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology. The recommendations of each reviewer were grouped in 1 of 3 categories: rejection (or not acceptance), acceptance with major revisions, and acceptance with minor or no revisions. These recommendations were contrasted in the final editorial disposition of the manuscript, which was recorded as "accepted" or "rejected." The quality of the reviews was assessed in a random sample of 10% of the reviews, stratified by reviewer and journal. A total of 635 reviews were analyzed. Overall, the most influential reviewers' recommendation was rejection, which was accompanied by 93% rejection rate. Recommendation for acceptance with mi...
To review the English-language literature from 1990 to 2000 on cesarean delivery for "fetal ... more To review the English-language literature from 1990 to 2000 on cesarean delivery for "fetal distress" and assess compliance with American College of Obstetricians and Gynecologists (ACOG) guidelines. A PubMed search with the search items cesarean, fetal distress, cesarean, nonreassuring fetal heart rate, cesarean, neonatal acidosis and cesarean, umbilical arterial pH was undertaken. Excluded from the search were case reports, letters to the editor, focus on fetal anomaly, combinations with other reasons for operative delivery (either abdominally or vaginally) or absence of pertinent information. Among 392 articles from the search, 169 met the inclusion criteria. Three reports provided detailed information on use of scalp pH; use occurred in 5% (60/1,128) of emergency cesareans. Three reports provided data on the use of tocolytics for intrauterine resuscitation; the combined result was 16% (201/1,261). Five reports assessed the decision-to-incision interval within 30 minute...
American journal of obstetrics and gynecology, 2015
Although major international guidelines recommend venous thromboembolism (VTE) prophylaxis during... more Although major international guidelines recommend venous thromboembolism (VTE) prophylaxis during vaginal delivery hospitalization for women with additional risk factors, US guidelines recommend prophylaxis for a very small number of women who are at particularly high risk for an event. The purpose of this study was to characterize practice patterns of VTE prophylaxis in the United States during vaginal delivery hospitalizations and to determine VTE incidence in this population. A population-level database was used to analyze VTE incidence and use of VTE prophylaxis during vaginal delivery hospitalizations in the United States between 2006 and 2012 (n = 2,673,986). We evaluated whether patients received either pharmacologic or mechanical prophylaxis. Hospital-level factors and patient characteristics were included in multivariable regression analysis that evaluated prophylaxis administration. We identified 2,673,986 women who underwent vaginal delivery. Incidence of VTE increased du...
Objective This study aims to compare two management protocols in pregnancies diagnosed with fetal... more Objective This study aims to compare two management protocols in pregnancies diagnosed with fetal growth restriction (FGR). Study Design All singleton pregnancies diagnosed and managed with FGR at our institution during two protocol periods were analyzed. The early term protocol (January 2008-February 2010) specified delivery at 37(0/7) weeks if antenatal testing was reassuring, but did not specify the timing of delivery if umbilical artery (UA) Doppler systolic:diastolic (S:D) ratios were elevated (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;95th percentile for gestational age [GA]). The term protocol (March 2010-July 2012) specified delivery at 39(0/7) weeks with normal S:D ratios and 37(0/7) weeks with elevated S:D ratios when antenatal testing was reassuring. Results There were 228 and 312 women in the early term and term protocol, respectively, who met inclusion criteria. Compared with the early term group, the term group had an increased median GA at delivery (37.1 vs. 38.6%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), decreased deliveries less than 37(0/7) weeks (37 vs. 24%, p = 0.01) and decreased neonatal intensive care unit (NICU) admissions (38 vs. 28%, p = 0.02). Conclusion A protocol specifying delivery at 39(0/7) weeks when UA S:D ratios are normal and delivery at 37(0/7) weeks when UA S:D ratios are elevated when other antenatal testing is reassuring in FGR: (1) prolonged gestation, (2) decreased preterm births, and (3) decreased NICU admissions.
The Journal of Obstetrics and Gynecology of India, 2011
Abstract Introduction There are more deliveries in India than any country in the world, according... more Abstract Introduction There are more deliveries in India than any country in the world, according to World Health Report. Review of seven articles published in The Journal of Obstetrics and Gynecology of India suggests that the perinatal mortality (PNM) in the ...
Objective To compare the obstetric recommendations in American Congress of Obstetricians and Gyne... more Objective To compare the obstetric recommendations in American Congress of Obstetricians and Gynecologists (ACOG) practice bulletins (PB) with similar topics in UpToDate (UTD). Study Design We accessed all obstetric PB and cross-searched UTD (May 1999-May 2013). We analyzed only the PB which had corresponding UTD chapter with graded recommendations (level A-C). To assess comparability of recommendations for each obstetric topic, two maternal-fetal medicine (MFM) subspecialists categorized the statement as similar, dissimilar, or incomparable. Simple and weighted kappa statistics were calculated to assess agreement between the two raters. Results We identified 46 ACOG obstetric PB and 86 UTD chapters. There were 50% fewer recommendations in UTD than in PB (181 vs. 365). The recommendations being categorized as level A, B, or C was significantly different (p < 0.001) for the two guidelines. While the overall concordance rate between the two MFM subspecialists was 83% regarding the ...
Objectives Substance abuse in pregnancy remains a major public health problem. Fetal teratogenici... more Objectives Substance abuse in pregnancy remains a major public health problem. Fetal teratogenicity results from the effect of these substances during fetal development, particularly when used in combination. This review will focus on and attempt to clarify the existing literature regarding the association of substance abuse on the development of congenital anomalies and the long-term implications in exposed offspring. Methods Systematic review of available English literature using the PubMed database of all peer-reviewed articles on the subject. Results A total of 128 articles were included in this review. Alcohol was the most common substance associated with fetal anomalies, particularly facial dysmorphisms and alterations in the central nervous system development. Adverse maternal environments associated with risky behaviors and lack of adequate prenatal care precludes the timely detection of fetal anomalies, confounding most studies linking causality. In addition, although metho...
Australian & New Zealand Journal of Obstetrics & Gynaecology, 1993
Four hundred and fifty-four gravid women were identified with the HELLP syndrome from January, 19... more Four hundred and fifty-four gravid women were identified with the HELLP syndrome from January, 1980 to May, 1992. The peak systolic and diastolic blood pressures, proteinuria, and uric acid were recorded for each patient during the peripartal course. Patients were classified according to disease severity with, in addition to elevated lactate dehydrogenase (LDH) values, laboratory evidence of haemolysis and hepatic dysfunction, a peripartal platelet count &lt; or = 50,000/microliters was depicted Class I, Class II as a platelet count &gt; 50,000 and &lt; or = 100,000/microliters and Class III as &gt; 100,000 and &lt; or = 150,000/microliters. Patients with Class I HELLP syndrome had peak antepartum systolic blood pressures &lt; 150 mm Hg significantly more often than the Class II (p &lt; 0.0091) or Class III (p &lt; 0.04) HELLP syndrome. Class I HELLP syndrome had significantly more patients with 1+ to 2+ proteinuria than Class II (p &lt; 0.02) and Class III HELLP syndrome (p &lt; 0.009). Uric acid levels were not different among nor proportionately related to increasing severity of the HELLP syndrome.
To define the normal range of amniotic fluid (AF) volume in third-trimester diamniotic twin gesta... more To define the normal range of amniotic fluid (AF) volume in third-trimester diamniotic twin gestations. The AF volume of third-trimester diamniotic twin pregnancies was measured prospectively. An AF sample was drawn from both amniotic cavities of diamniotic twins either for diagnosis of subclinical chorioamnionitis with preterm labor and/or assessment of fetal lung maturity. Actual AF volume was determined in each amniotic cavity by a dye-dilution technique. The AF volume of 45 diamniotic twin pregnancies of 27-38 weeks&#39; gestation was assessed. The AF volume per amniotic sac ranged from 155-5430 mL, with a mean (+/- standard deviation) of 877 +/- 860 mL. The AF volume in individual amniotic cavities and the total of both cavities in a diamniotic twin pregnancy were unchanged across the entire gestational age range (27-38 weeks). Neither fetal positioning within the uterus (lower twin versus upper twin) nor fetal weight were determining factors in the AF volume variability (P = .846 and P = .726, respectively). Based on absolute volumetric differences between the larger- and smaller-sac AF volume, we observed that as the AF volume of the larger sacs increased proportionately (P &lt; .001), the AF volume of the smaller sacs remained relatively constant across the entire range of differences (P = .687) between 27-38 weeks. The average AF volume of 877 mL for each diamniotic twin is similar to the AF volume reported for third-trimester singletons. The AF volumes of diamniotic twin gestations relate neither to fetal position nor fetal weight, but instead develop independently without relation to the other amniotic cavity. Ninety percent of the AF volumes were 215-2500 mL.
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Papers by Suneet Chauhan
(PNBPP) are unknown. Our objectives are to compare PNBPP at 1 and 2 years in children
delivered via vaginal delivery (VD) versus cesarean delivery (CD) and in children
delivered via VD with or without reported shoulder dystocia (SD).
Study Design Retrospective cohort of children diagnosed with neonatal brachial
plexus palsy (NBPP). Maternally reported delivery history and presence of SD were
recorded with Student t-test, chi-square test, and odds ratio (OR) with 95% confidence
intervals (CI) calculated for comparisons.
Results Of 387 cases of NBPP, 8% (30) delivered via CD. Rates of PNBPP were higher in
the VD group at 1 and 2 years (60% of CD and 85% of VD; OR, 0.26; 95% CI, 0.11–0.62 at
1 year; 33% of CD and 73% of VD; OR, 0.15; 95% CI, 0.05–0.39 at 2 years). There was no
difference in PNBPP in women with VD with or without maternally reported SD (87 vs.
85%, p ¼ 0.68 at 1 year; 64 vs. 61%, p ¼ 0.61 at 2 years).
Conclusion PNBPP is possible with CD, and there is no difference in PNBPP in VD with
or without maternally reported SD. A prospective study is warranted to ascertain
associative factors.
regarding small for gestational age (SGA).
STUDY DESIGN: Along with American College of Obstetricians and
Gynecologists (ACOG) practice bulletin on abnormal growth, guidelines
from England, Canada, Australia, and New Zealand were
reviewed.
RESULTS: There are no guidelines on SGA from Canada, Australia,
and New Zealand. The Royal College of Obstetricians and Gynaecologists
(RCOG) guideline agrees with ACOG’s definition of abnormal
growth, but there are noticeable variances in the diagnosis and management
of SGA. RCOG has more recommendations than ACOG (18 vs
4, respectively). The articles referenced varied, with only 13 similar
articles being cited by the both committees.
CONCLUSION: The differences in the 2 guidelines suggest that there is
variance in how 2 committees synthesize the literature and issue
recommendations.
(PNBPP) are unknown. Our objectives are to compare PNBPP at 1 and 2 years in children
delivered via vaginal delivery (VD) versus cesarean delivery (CD) and in children
delivered via VD with or without reported shoulder dystocia (SD).
Study Design Retrospective cohort of children diagnosed with neonatal brachial
plexus palsy (NBPP). Maternally reported delivery history and presence of SD were
recorded with Student t-test, chi-square test, and odds ratio (OR) with 95% confidence
intervals (CI) calculated for comparisons.
Results Of 387 cases of NBPP, 8% (30) delivered via CD. Rates of PNBPP were higher in
the VD group at 1 and 2 years (60% of CD and 85% of VD; OR, 0.26; 95% CI, 0.11–0.62 at
1 year; 33% of CD and 73% of VD; OR, 0.15; 95% CI, 0.05–0.39 at 2 years). There was no
difference in PNBPP in women with VD with or without maternally reported SD (87 vs.
85%, p ¼ 0.68 at 1 year; 64 vs. 61%, p ¼ 0.61 at 2 years).
Conclusion PNBPP is possible with CD, and there is no difference in PNBPP in VD with
or without maternally reported SD. A prospective study is warranted to ascertain
associative factors.
regarding small for gestational age (SGA).
STUDY DESIGN: Along with American College of Obstetricians and
Gynecologists (ACOG) practice bulletin on abnormal growth, guidelines
from England, Canada, Australia, and New Zealand were
reviewed.
RESULTS: There are no guidelines on SGA from Canada, Australia,
and New Zealand. The Royal College of Obstetricians and Gynaecologists
(RCOG) guideline agrees with ACOG’s definition of abnormal
growth, but there are noticeable variances in the diagnosis and management
of SGA. RCOG has more recommendations than ACOG (18 vs
4, respectively). The articles referenced varied, with only 13 similar
articles being cited by the both committees.
CONCLUSION: The differences in the 2 guidelines suggest that there is
variance in how 2 committees synthesize the literature and issue
recommendations.