Disparities in Contraception in Women with Cardiovascular Diseases in the Cardiac-Obstetrical Clinic
Laura Fiorini, Maria De Abreu Pineda, Jason K. Baxter, Rebekah J. McCurdy, Andria Jones, Indranee Rajapreyar, and Amanda Roman-Camargo
- National Survey of Family Growth 2017-19 survey reported a 65.3% contraceptive use:
- 18% tubal, 5.6% vasectomy
- 18% hormonal therapy
- 8.4% intrauterine devices (IUD)
- 8.4% condoms
- To evaluate postpartum contraception plans and use in pregnant women with cardiovascular disease (CVD) after visits to the combined cardio-obstetric clinic
Melanie Hotz, MS, MD; Cheryl Godcharles, MD, IBCLC; and Julia Switzer, MD
- Increased recognition of the importance of the ‘fourth trimester’ and the pressing need to reduce maternal morbidity and mortality, has led to a renewed focus on postpartum care.
- Advanced Milestones for The Care of the Postpartum Patient include ability to effectively counsel patients on antenatal, intrapartum and postpartum complications, collaboration with other members of the health care team in postpartum care and application of innovative approaches to the management of patients in the postpartum period.1
- The CREOG Learning objectives include several specific learning objectives regarding the diagnosis, management and counseling about normal postpartum recovery and complications of the postpartum period.2
- If specific gaps in postpartum education among OB-GYN residents are able to be identified, educational interventions can be designed to target these needs.
Rupsa Boelig, Edwin Lam, Ankit Rochani, Gagan Kaushal, Amanda Roman, and Walter K. Kraft
PK studies to guide dosing of azithromycin (AZ) for pregnancy specific conditions, such as preterm premature rupture of membranes (PPROM), and data on accumulation of AZ in fetal compartment are lacking. We aim to evaluate feasibility of non-invasive collection of amniotic fluid (AF), validate an assay for AZ in AF, and describe concentration of AZ in the amniotic cavity over one week following a single maternal dose.
Patients with PPROM treated with 1g AZ PO once and wore underwear lining pads to collect AF as it leaked. AF strained from each pad, up to 10cc collected, centrifuged and frozen.
Calibration curve established using range of 1 to 200 ng/mL, with Azithromycin-D3 as internal standard. Spiked standards and samples were extracted with plasma to ACN ratio as 1:2, and centrifuged. The clean supernatant was subjected to LCMS runs using Thermo-Orbitrap coupled with Dionex 3000 UHPLC system under +ve ion mode and sample 5µL injection volume. The chromatographic separations were done using HSS XSelect C18 reverse phase column using 50:50 water and ACN with 0.1% FA as mobile phase, flow rate of 0.250 mL/min. The linearity equation (y= 10945x, r2>0.99) established using average of 8 injections over 4 days; 2 injections per day. AZ from AF samples was quantitated in duplicate and expressed as concentration/time profile.
Five patients were enrolled. Mean gestational age on admission with PPROM was 27.5 ±2.3wk with a median latency of 7 days [IQR 4-13]. A median of 2 samples/day [IQR 1-3] were collected per participant. Azithromycin was quantified in duplicate; intra-assay coefficient of variation was 17%. Azithromycin concentration was <60ng/ml after day 3. Azithromycin concentration was positively correlated with IL-8 (r=0.38, p=0.03), IL1a (r=0.39, p=0.03), and IL-1b (r=0.36, p=0.04) in amniotic fluid.
This simple technique for noninvasive collection of AF allows for precise quantification of AZ in AF with LCMS. AZ persists in the fetal compartment for at least seven days after a single maternal dose, although not necessarily at an adequate inhibitory concentration.
Rupsa C. Boelig, MD; Mariam Wanees, BA; Vincenzo Berghella, MD; and Amanda Roman, MD
High risk women without a history of preeclampsia were less likely to be recommended aspirin for preeclampsia prevention. A simple screening tool at 1st trimester ultrasound can significantly improve aspirin utilization for preeclampsia prevention
Association Between ABO Blood Type and Postpartum Hemorrhage by Mode of Delivery: A Retrospective Cohort Study
Julia Burd, MD; Johanna Quist-Nelson, MD; Sara Edwards, MD; Anju Suhag, MD; Vincenzo Berghella, MD; and J. Biba Nijjar, MD
Patients with type O blood have been reported to have more bleeding complication than those of other pooled blood groups (OR 1.33)
Prior studies on postpartum hemorrhage by blood type
- Yielded mixed results
- Did not separate by mode of delivery
Courtney Capella, BS; Joseph Godovchik, BS; May Jean Counsilman, MD; Thenappan Chandrasekar, MD; Costas D. Lallas, MD; and Huda B. Al-Kouatly, MD
Robotic adrenalectomy is a feasible surgical alternative in the second trimester and can reverse the hypertensive disease and its associated maternal-fetal complications
The Effect of Transvaginal Ultrasound, Vaginal Examination, or Coitus on Fetal Fibronectin Results: A Systematic Review
Ariel Levy, MD; Johanna Quist-Nelson, MD; and Vincenzo Berghella, MD
Cervical manipulation via transvaginal ultrasound or sterile vaginal examination does not significantly affect fetal fibronectin results; therefore its use after these exposures is clinically acceptable. Conversely, fFN use in the setting of recent coitus should continue to be discouraged.
Meghan Gannon, LhD, MSPH
MATER is a program in the Department of Obstetrics & Gynecology at Thomas Jefferson University Hospitals, and includes the Sidney Kimmel Medical College departments of OB/GYN, Pediatrics and Psychiatry. The MATER Program includes Family Center Outpatient and Intensive Outpatient Services and My Sister’s Place Residential Program
Family Center Outpatient and Intensive Outpatient Programs
- 18 years or older
- Pregnant or parenting
- Needing treatment for any substance problems
My Sister's Place Residential Program
- 18 years or older
- Pregnant or parenting
- Needing treatment for any substance problems
- Children under 6 years old are welcome to live in the residence with their mother
Prevalence and Characterization of Adverse Childhood Experiences of Women in Substance Use Treatment
Meghan Gannon, PhD, MSPH; Vanessa Short, PhD, MPH; Marianna LaNoue, PhD; and Diane J. Abatemarco, PhD, MSW
- Rates of illicit drug use among women reproductive age significant national public health problem
- Adverse childhood experiences (ACE’s) associated with higher rates of prenatal depression and maternal childhood maltreatment
- Ace’s prevalent in those with Opioid Use Disorder (OUD)
Aims of Study:
- Determine prevalence of ACE’s in a population of pregnant and parenting women in treatment for substance use disorder
- Characterize ACE’s
- Compare our sample to Behavioral Risk Factor Surveillance System (BRFSS) Pennsylvania data
Obstetrical Providers’ Comfort and Knowledge of Screening, Brief Intervention, and Referral to Treatment
Dennis J. Hand, Aasta Mehta, Emily Rosenthal, Alice C. Fischer, Tamara Tatevosian, Carrie Malanga, Laura Hart, Debra Dalessandro, and Kristin Walker
Rates of substance use during pregnancy have continued to rise through 2017. It is likely that obstetrical providers are encountering many pregnant persons who use substances either during prenatal care or postpartum. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model that has been successfully implemented in some obstetrical settings, but its implementation has been sporadic. The objective of this study was to determine the baseline level of familiarity and use of SBIRT elements among obstetrical providers to identify needs for future SBIRT implementation efforts.
Participants were physicians, medical students, nurses, and other staff attending Grand Rounds presentations on SBIRT at six delivering academic medical centers with maternity services in Philadelphia. Throughout the Grand Rounds presentation, before each topic was discussed, the audience was asked to rate on a 5-point Likert scale their disagreement/agreement with statements like “I am comfortable managing pregnant patients with substance use disorder.” Participants responded anonymously through an online polling platform via their personal mobile device. Participants also provided demographic information anonymously. Responses and demographics were analyzed with descriptive statistics overall and at each medical center.
Less than 29% of participants reported being comfortable managing a pregnant patient with a substance use disorder. One third was familiar with substance use screening methods, 30% were comfortable providing brief interventions, and 48% were comfortable referring patients to substance use disorder treatment. 33% reported being familiar with substance use disorder treatment programs in the area. Generally, medical centers that also had substance use treatment programs were more comfortable and knowledgeable about SBIRT elements.
Very few obstetrical providers were comfortable or knowledgeable about SBIRT elements, even at medical centers with specific programs for treating substance use disorder among pregnant individuals. Efforts to implement SBIRT are sorely needed, and will require significant training given these results.
Hypertensive Disorders of Pregnancy (HDP) and Infertility Treatment: A Population-Based Survey Among U.S. Women
Brent Monseur, MD, ScM; Jerrine Morris, MD, MPH; Heather Hipp, MD; and Vincenzo Berghella, MD
To explore associations between infertility treatment and hypertensive disorders of pregnancy using a nationally representative sample of women
Rei Yamada and Abigail Wolf
- Examine contraceptive use among patients in our CenteringPregnancy® program
- Measure postpartum visit attendance among the CenteringPregnancy® patients
Impact of New “Triple I” Classification on the Incidence of Clinical Chorioamnionitis and Antibiotic Use in Neonates
Amanda Roman, Yury Cruz, Amy J. Sloane, David Carola, Dorothy McElewee, Vincenzo Berghella, and Zubair H. Aghai
To evaluate the impact of the new classification “Triple I” on the incidence of chorioamnionitis during labor, need of antibiotics and diagnosis of neonatal sepsis.
Amanda Roman, Gabriele Saccone, Yury Cruz, Giuseppe Maruotti, Mohamed Satti, Pasquale Martinelli, and Vincenzo Berghella
Objective: To identify the incidence of spontaneous preterm birth (SPTB) and indications for delivery in women with twin pregnancy stratified by chorionicity (monochorionic diamniotic and dichorionic diamniotic pregnancy).
Study Design: Multicenter retrospective cohort of all consecutive twin gestations from 2010 to 2017. They were stratified by chorionicity monochorionic diamniotic and dichorionic diamniotic pregnancy: Primary outcome was SPTB < 37 weeks. Secondary outcome was SPTB at <34, 32, and <28 weeks, gestational age at delivery and indications for delivery: maternal and fetal. Analysis: t-test, Fisher’s exact test and multivariable logistic regression.
Results: 510 women with twin pregnancies were identified. 158 (30.9%) were monochorionic diamniotic pregnancies, and 352 (69.0%) were dichorionic pregnancies. The gestational age at delivery was significantly shorter in the monochorionic compared to the dichorionic group of about 2 weeks (MD -2.20 weeks, 95% CI -2.76 to -1.64). Twins with a monochorionic pregnancy had a significantly higher risk of SPTB <37, <34 and <32 weeks. They also have higher incidence of fetal indication for delivery and increased spontaneous onset of labor at any given gestational age. Maternal complications were similar on both types of twin pregnancies
Conclusion: Twins with monochorionic pregnancy had a higher rate of SPTB <37, <34 and <32 weeks and fetal indications for preterm delivery compared with dichorionic pregnancies. This information will assist in counseling patients with twin pregnancy regarding their individual, maternal, fetal and SPTB risk at different gestational ages.
Midtrimester transvaginal ultrasound cervical length in diamniotic twin pregnancies according to chorionicity
Amanda Roman, Gabriele Saccone, Carolynn M. Dude, Danielle A. Peress, Giuseppe Maria Maruotti, Andrew Ward, Hannah Anastasio, Lorraine Dugoff, Pasquale Martinelli, and Vincenzo Berghella
To compare the mean and additional midtrimester TVCL screening cut offs in monochorionic diamniotic (MC/DA) twins and dichorionic diamniotic (DC/DA) twins and to assess the relationship between the TVCL values and spontaneous preterm birth (SPTB).
Amanda Roman, Gabriele Saccone, Sarah Pachtman, Yury Cruz, Burt Rochelson, Adiel Fleischer, Pasquale Martinelli, and Vincenzo Berghella
To evaluate the predictors of preterm birth <32 weeks in women that underwent physical exam indicated cerclage>(PEIC) in singleton pregnancy.
Maternal activity level in patients with preterm premature rupture of membranes: A Prospective Observational Cohort Study
Amanda Roman, Nathan Watters, Denise Moses, Jenny Reisner, Andrea French, Alexis Gimovsky, Caroline Pessel, Burton Rochelson, Neil Seligman, and Vincenzo Berghella
Objective: To evaluate the level of maternal physical activity effect on the perinatal outcomes of women with preterm premature rupture of membranes (PPROM)
Study Design: This is a pilot, prospective, observational multicenter cohort study. We approached patients admitted between 23 0/7 weeks to 32 0/7 weeks gestation with confirmed PPROM between January of 2014 and June of 2017 All patients received corticosteroids and latency antibiotics. Enrollment was done on third day of admission. Delivery occurred at 34 weeks per protocol via induction of labor or cesarean section as obstetrically indicated; or sooner if chorioamnionitis was diagnosed or spontaneous preterm labor occurred. Patients were provided a pedometer to wear for the duration of their antepartum course and they have maternal activity at lib and were encouraged to go to the physical therapy gymnasium.
Results: We enrolled 32 women. We stratified them in two groups: low activity as less than 500 step a day and higher maternal activity more than 500 steps a day, There were no significant differences in the demographics. Latency from PPROM to delivery were significantly prolonged in women with maternal activity > 500 steps a day: 11.0 ± 8.42 vs 21.18 ± 4.26 days p = 0.004. No maternal or fetal adverse outcomes were identified.
Conclusion: Maternal activity more than 500 steps a day showed a significant association with prolongation of latency
Obesity-induced Endoplasmic Reticulum Stress Causes Lung Endothelial Dysfunction and Promotes Acute Lung Injury
Dilip Shah, Freddy Romero, Zhi Guo, Jianxin Sun, Jonathan C. Li, Caleb Kallen, Ulhas P. Naik, and Ross Summer
- Lung endothelial dysfunction in DIO mice coincides with increased endoplasmic reticulum (ER) stress.
- Fatty acids in obese serum induce ER stress in the pulmonary endothelium leading to pulmonary endothelial cell dysfunction.
- Reducing protein load in the endoplasmic reticulum of pulmonary endothelial cells might protect against ARDS in obese individuals.
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