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Berger DS, Garg B, Penfield CA, Caughey AB. Respiratory Distress Syndrome is Associated with Increased Morbidity and Mortality in Late Preterm Births. Am J Obstet Gynecol MFM 2024:101374. [PMID: 38583712 DOI: 10.1016/j.ajogmf.2024.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Respiratory Distress Syndrome (RDS) is strongly associated with prematurity, including late preterm births. RDS has been shown to be associated with certain neonatal morbidities and mortality, but these associations are not well described among late preterm births. OBJECTIVE We sought to determine the association between RDS and adverse neonatal outcomes among late preterm (34-36 weeks) born singleton neonates. STUDY DESIGN This is a retrospective cohort study using California's linked vital statistics-patient discharge data (2008-2019). We included singleton, non-anomalous births with gestational age of 34-36 weeks. Outcomes of interest were interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), neonatal sepsis, length of hospital stay, neonatal death and infant death. Chi-square and multivariable Poisson regression analyses were used to examine the association of RDS with outcomes at each gestational age. Adjusted risk ratios (aRR) and 95% confidence intervals (CI) were estimated. RESULTS A total of 242,827 births were included, of which 11,312 (4.7%) had RDS. We found that among neonates with RDS, NEC was higher at 35 weeks (aRR= 3.97; 95% CI: 1.88, 8.41) and 36 weeks (aRR= 4.53; 95% CI: 1.45, 14.13). IVH, ROP, neonatal sepsis and length of hospital stay were significantly higher at 34-36 weeks' gestation in neonates with RDS. Neonatal death was significantly higher among neonates with RDS at 35 weeks (aRR=3.04; 95% CI: 1.58, 5.85) and 36 weeks (aRR=3.25; 95% CI: 1.59, 6.68). Infant death was also significantly higher at 35 weeks (aRR=2.27; 95% CI: 1.43, 3.61) and 36 weeks (aRR=2.60; 95% CI: 1.58, 4.28). CONCLUSION We found that RDS was associated with IVH, ROP and sepsis at 34-36 weeks' gestation; while RDS was associated with neonatal death, infant death and NEC at 35 and 36 weeks. Clinicians should keep these outcomes in mind when making decisions about delivery timing and the potential benefits of antenatal steroids in pregnancies in the late preterm period as well as management of RDS in late preterm neonates.
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Affiliation(s)
- Dana S Berger
- NYU Langone Medical Center, New York, New York; Department of Obstetrics and Gynecology.
| | - Bharti Garg
- Oregon Health & Science University, Portland, Oregon; Department of Obstetrics and Gynecology
| | - Christina A Penfield
- NYU Langone Medical Center, New York, New York; Department of Obstetrics and Gynecology
| | - Aaron B Caughey
- Oregon Health & Science University, Portland, Oregon; Department of Obstetrics and Gynecology
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Trostle ME, Grossman TB, Penfield CA, Phoon CKL, Raabe VN, Sloane MF, Roman AS. A Pregnant Adolescent with COVID-19 and Multisystem Inflammatory Syndrome in Children. AJP Rep 2024; 14:e66-e68. [PMID: 38370327 PMCID: PMC10874691 DOI: 10.1055/s-0044-1779032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/22/2023] [Indexed: 02/20/2024] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C), a new condition related to coronavirus disease 2019 (COVID-19) in the pediatric population, was recognized by physicians in the United Kingdom in April 2020. Given those up to the age of 21 years can be affected, pregnant adolescents and young adults are susceptible. However, there is scant information on how MIS-C may affect pregnancy and whether the presentation differs in the pregnant population. We report a case of a pregnant adolescent with COVID-19 and MIS-C with a favorable outcome. This case highlights the considerations in managing a critically ill pregnant patient with a novel illness and the importance of a multidisciplinary team in coordinating care.
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Affiliation(s)
- Megan E. Trostle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York, New York
| | - Tracy B. Grossman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York, New York
| | - Christina A. Penfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York, New York
| | - Colin K. L. Phoon
- Division of Pediatric Cardiology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone Medical Center, New York, New York
| | - Vanessa N. Raabe
- Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine and NYU Langone Vaccine Center, New York, New York
| | - Mark F. Sloane
- Division of Pulmonary and Critical Care Medicine, NYU Langone Medical Center, New York, New York
| | - Ashley S. Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York, New York
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Perelman AD, Trostle ME, Pecoriello J, Quinn GP, Roman AS, Penfield CA. Acceptance of Routine Vaccines in Pregnancy during the COVID-19 Pandemic. Am J Perinatol 2023. [PMID: 37816391 DOI: 10.1055/a-2188-8511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
OBJECTIVE This study aimed to evaluate the rates of vaccination against infectious diseases (Tetanus, Diphtheria, and Pertussis [Tdap] and influenza) in pregnancy during the coronavirus disease 2019 (COVID-19) pandemic compared to contemporary historical controls. STUDY DESIGN This was a retrospective cohort study comparing rates of Tdap and influenza vaccination in pregnant people who received care at NYU Langone Health and delivered from September 1, 2020, to January 31, 2021 ("COVID cohort") to the same period the prior year ("2019 cohort"). Demographic information, trimester of initiation of prenatal care, insurance status, and medical comorbidities were evaluated. Outcomes were analyzed using chi-square, Fisher's exact test, and multivariable logistic regression, with significance of p < 0.05. RESULTS In total, 1,713 pregnant people were included. Compared to historical controls, the COVID cohort differed in age, race, timing of initiation of prenatal care, insurance status, and medical comorbidities. After adjusting for these covariates, pregnant people were significantly more likely to accept influenza vaccine in the COVID cohort (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.27-2.29) and had similar Tdap acceptance (aOR 1.5, 95% CI 0.99-2.17). However, this trend was not observed for the entire obstetric population; public insurance status and medical comorbidities were associated with lower vaccine rates during the pandemic. For those who had public insurance, rates of influenza vaccination decreased from 83% in 2019 to 40% during COVID (aOR 0.16, 95% CI 0.10-0.24) and for Tdap rates decreased from 93 to 54% (aOR 0.13, 95% CI 0.08-0.21). CONCLUSION During the COVID-19 pandemic era, pregnant people at large were more likely to accept the influenza vaccine. However, this trend did not apply to Tdap, and high-risk groups with public insurance and medical comorbidities. This study highlights potential disparities in vaccination rates, which need to be accounted for when evaluating national vaccine trends. These data support increased efforts in vaccine counseling for high-risk populations. KEY POINTS · Antenatal flu vaccination increased during the pandemic.. · Antenatal Tdap vaccination was unchanged during the pandemic.. · High-risk pregnant patients had decreased vaccine uptake.. · High-risk subgroups were not included in overarching vaccination trends..
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Affiliation(s)
- Allison D Perelman
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, New York
| | - Megan E Trostle
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, NYU Langone Health, New York, New York
| | - Jillian Pecoriello
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, New York
| | - Gwendolyn P Quinn
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, New York
| | - Ashley S Roman
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, NYU Langone Health, New York, New York
| | - Christina A Penfield
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, NYU Langone Health, New York, New York
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Griffin MM, Mehta-Lee SS, Penfield CA, Roman AS. Comparing outcomes of fetal growth restriction defined by estimated fetal weight versus isolated abdominal circumference. Arch Gynecol Obstet 2023:10.1007/s00404-023-07241-z. [PMID: 37891409 DOI: 10.1007/s00404-023-07241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE The objective of this study was to compare maternal and neonatal outcomes when the diagnosis of FGR was based on isolated abdominal circumference < 10th percentile for gestational age (GA) (iAC group) versus overall estimated fetal weight < 10th percentile (EFW group). METHODS This was a retrospective cohort study of singleton gestations who underwent growth ultrasounds and delivered at a single health system from 1/1/19-9/4/20. The study group was comprised of patients with AC < 10th percentile and EFW ≥ than the 10th percentile (iAC group). The control group included patients with overall EFW < 10th percentile (EFW group). Outcomes evaluated included GA at delivery, mode of delivery, fetal and neonatal outcomes. Data was analyzed using Mann Whitney U, X2, and Fisher exact tests with significance defined as p < 0.05. RESULTS 635 women met the inclusion criteria, 259 women in the iAC group and 376 women in the EFW group. The iAC group was noted to have a later GA at diagnosis and delivery. iAC was associated with lower rates of preterm birth (PTB), NICU admission, SGA at delivery and umbilical artery cord gas < 7.0. CONCLUSION Using iAC as a definition of FGR increased the number of FGR cases by 1.69-fold over EFW criteria alone. However, obstetrical and neonatal outcomes for the iAC group appear to be significantly better than those in the EFW group, with low rates of PTB, NICU admission, and umbilical artery cord gas < 7.0.
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Affiliation(s)
- Myah M Griffin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, 550 First Ave., NBV 9N2, New York, NY, 10016, USA.
| | - Shilpi S Mehta-Lee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, 550 First Ave., NBV 9N2, New York, NY, 10016, USA
| | - Christina A Penfield
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, 550 First Ave., NBV 9N2, New York, NY, 10016, USA
| | - Ashley S Roman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, 550 First Ave., NBV 9N2, New York, NY, 10016, USA
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Lin BX, Smith M, Sutter M, Penfield CA, Proudfit C. Association between Peripartum Mean Arterial Pressure and Postpartum Readmission for Preeclampsia with Severe Features. Am J Perinatol 2023. [PMID: 37385293 DOI: 10.1055/s-0043-1770705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the relationship between peripartum mean arterial pressure (MAP) and postpartum readmission for preeclampsia with severe features. STUDY DESIGN This is a retrospective case-control study comparing adult parturients readmitted for preeclampsia with severe features to matched nonreadmitted controls. Our primary objective was to evaluate the association between MAP at three time points during the index hospitalization (admission, 24-hour postpartum, and discharge) and readmission risk. We also evaluated readmission risk by age, race, body mass index, and comorbidities. Our secondary aim was to establish MAP thresholds to identify the population at highest risk of readmission. Multivariate logistic regression and chi-squared tests were used to determine the adjusted odds of readmission based on MAP. Receiver operating characteristic analyses were performed to evaluate risk of readmission relative to MAP; optimal MAP thresholds were established to identify those at highest risk of readmission. Pairwise comparisons were made between subgroups after stratifying for history of hypertension, with a focus on readmitted patients with new-onset postpartum preeclampsia. RESULTS A total of 348 subjects met inclusion criteria, including 174 controls and 174 cases. We found that elevated MAP at both admission (adjusted odds ratio [OR]: 1.37 per 10 mm Hg, p < 0.0001) and 24-hour postpartum (adjusted OR: 1.61 per 10 mm Hg, p = 0.0018) were associated with increased risk of readmission. African American race and hypertensive disorder of pregnancy were independently associated with increased risk of readmission. Subjects with MAP > 99.5 mm Hg at admission or >91.5 mm Hg at 24-hour postpartum had a risk of at least 46% of requiring postpartum readmission for preeclampsia with severe features. CONCLUSION Admission and 24-hour postpartum MAP correlate with risk of postpartum readmission for preeclampsia with severe features. Evaluating MAP at these time points may be useful for identifying women at higher risk for postpartum readmission. These women may otherwise be missed based on standard clinical approaches and may benefit from heightened surveillance. KEY POINTS · Existing literature focuses on management of antenatal hypertensive disorders of pregnancy.. · Elevated peripartum MAP is associated with increased odds of readmission for preeclampsia.. · Peripartum MAP may predict readmission risk for de novo postpartum preeclampsia..
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Affiliation(s)
- Bing-Xue Lin
- Franciscan Women's Health Associates, Tacoma, Washington
| | - Maria Smith
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Megan Sutter
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Christina A Penfield
- Department of Obstetrics & Gynecology, New York University Langone Health,, New York, New York
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Halpern DG, Penfield CA, Feinberg JL, Small AJ. Reproductive Health in Congenital Heart Disease: Preconception, Pregnancy, and Postpartum. J Cardiovasc Dev Dis 2023; 10:jcdd10050186. [PMID: 37233153 DOI: 10.3390/jcdd10050186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
The prevalence of congenital heart disease (CHD) in pregnancy is rising due to the improved survival of patients with CHD into childbearing age. The profound physiological changes that occur during pregnancy may worsen or unmask CHD, affecting both mother and fetus. Successful management of CHD during pregnancy requires knowledge of both the physiological changes of pregnancy and the potential complications of congenital heart lesions. Care of the CHD patient should be based on a multidisciplinary team approach beginning with preconception counseling and continuing into conception, pregnancy, and postpartum periods. This review summarizes the published data, available guidelines and recommendations for the care of CHD during pregnancy.
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Affiliation(s)
- Dan G Halpern
- NYU Adult Congenital Heart Disease Program, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| | - Christina A Penfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| | - Jodi L Feinberg
- NYU Adult Congenital Heart Disease Program, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
| | - Adam J Small
- NYU Adult Congenital Heart Disease Program, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
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Meyer JA, Quinn GP, Penfield CA. Apples, Oranges, and Ectopic Pregnancies. Fertil Steril 2023; 119:813-814. [PMID: 36858166 DOI: 10.1016/j.fertnstert.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Jessica A Meyer
- Department of Obstetrics & Gynecology, NYU Langone Health; Division of Maternal Fetal Medicine, NYU Langone Health
| | - Gwendolyn P Quinn
- Department of Obstetrics & Gynecology, NYU Langone Health; Division of Medical Ethics, Department of Population Health, NYU Langone Health.
| | - Christina A Penfield
- Department of Obstetrics & Gynecology, NYU Langone Health; Division of Maternal Fetal Medicine, NYU Langone Health
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Hawks RJM, Ades V, Roman AS, Penfield CA, Goddard B. COVID-19 transmissibility during labor and vaginal delivery. Am J Obstet Gynecol MFM 2023; 5:100770. [PMID: 36240987 PMCID: PMC9554218 DOI: 10.1016/j.ajogmf.2022.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Rebecca J Mahn Hawks
- Jacobi Medical Center, Department of Obstetrics and Gynecology, Bronx, New York.
| | - Veronica Ades
- Jacobi Medical Center, Department of Obstetrics and Gynecology, Bronx, New York
| | - Ashley S Roman
- NYU Langone Health, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York NY
| | - Christina A Penfield
- NYU Langone Health, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York NY
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Griffin MM, Black M, Deeb J, Penfield CA, Hoskins IA. Postpartum Readmissions for Hypertensive Disorders in Pregnancy During the COVID-19 Pandemic. AJOG Global Reports 2022; 2:100108. [PMID: 36164558 PMCID: PMC9493139 DOI: 10.1016/j.xagr.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy are one of the most common causes of readmission in the postpartum period. Because of the COVID-19 pandemic, early hospital discharge was encouraged for patients who were medically stable, because hospitalization rates among SARS-CoV-2–infected patients steadily increased in 2020. The impact of an early discharge policy on postpartum readmission rates among patients with hypertensive disorders in pregnancy is unknown. OBJECTIVE This study aimed to compare the postpartum readmission rates of patients with hypertensive disorders in pregnancy before and after implementation of an early discharge policy owing to the COVID-19 pandemic. STUDY DESIGN This was a quality improvement, retrospective cohort study of postpartum patients with antenatal hypertensive disorders in pregnancy who delivered and were readmitted because of hypertensive disorders in pregnancy at the New York University Langone Health medical center from March 1, 2019 to February 29, 2020 (control cohort) and from April 1, 2020 to March 31, 2021 (COVID-19 cohort). During the pandemic, our institution introduced an early discharge policy for all postpartum patients to be discharged no later than 2 days postpartum during the delivery admission if deemed medically appropriate. The reduction in postpartum length of stay was accompanied by the continuation of patient education, home blood pressure monitoring, and outpatient follow-up. The primary outcome was the comparison of the readmission rates for patients with postpartum hypertensive disorders in pregnancy. Data were analyzed using Fisher's Exact tests, chi-square tests, and Wilcoxon rank-sum tests with significance defined as P<.05. RESULTS There was no statistical difference in the readmission rates for patients with postpartum hypertensive disorders in pregnancy before vs after implementation of an early discharge policy (1.08% for the control cohort vs 0.59% for the COVID-19 cohort). The demographics in each group were similar, as were the median times to readmission (5.0 days; interquartile range, 4.0–6.0 days vs 6.0 days; interquartile range, 5.0–6.0 days; P=.13) and the median readmission length of stay (3.0 days; interquartile range, 2.0–4.0 days vs 3.0 days; interquartile range, 2.0–4.0 days; P=.45). There was 1 intensive care unit readmission in the COVID-19 cohort and none in the control cohort (P=.35). There were no severe maternal morbidities or maternal deaths. CONCLUSION These findings suggest that policies calling for a reduced postpartum length of stay, which includes patients with hypertensive disorders in pregnancy, can be implemented without impacting the hospital readmission rate for patients with hypertensive disorders in pregnancy. Continuation of patient education and outpatient surveillance during the pandemic was instrumental for the outpatient postpartum management of the study cohort. Further investigation into best practices to support early discharges is warranted.
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Affiliation(s)
- Myah M. Griffin
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health Medical Center, New York, NY
- Corresponding author: Myah M. Griffin, MD.
| | - Mara Black
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY
| | - Jessica Deeb
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY
| | - Christina A. Penfield
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY
| | - Iffath A. Hoskins
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY
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Perelman A, Trostle ME, Pecoriello J, Roman AS, Penfield CA. Acceptance of vaccines during pregnancy during the COVID-19 pandemic. Am J Obstet Gynecol 2022. [PMCID: PMC8696628 DOI: 10.1016/j.ajog.2021.11.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Perelman A, Marty L, Hirschberg CI, Pass AR, Quinn G, Roman AS, Penfield CA. Progression of hypertensive disorders of pregnancy during induction of labor at term. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trostle ME, Penfield CA, Roman AS. Adjustment of the spontaneous abortion rate following COVID-19 vaccination. Am J Obstet Gynecol MFM 2021; 4:100511. [PMID: 34656732 PMCID: PMC8516146 DOI: 10.1016/j.ajogmf.2021.100511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Megan E Trostle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, 550 First Ave., NBV 9N2, New York, NY 10016.
| | - Christina A Penfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, 550 First Ave., NBV 9N2, New York, NY 10016
| | - Ashley S Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, 550 First Ave., NBV 9N2, New York, NY 10016
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Meyer JA, Roman AS, Limaye M, Grossman TB, Flaifel A, Vaz MJ, Thomas KM, Penfield CA. Association of SARS-CoV-2 placental histopathology findings with maternal-fetal comorbidities and severity of COVID-19 hypoxia. J Matern Fetal Neonatal Med 2021; 35:8412-8418. [PMID: 34542385 DOI: 10.1080/14767058.2021.1977791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE SARS-CoV-2 is known to impact multiple organ systems, with growing data to suggest the potential for placental infection and resultant pathology. Understanding how maternal COVID-19 disease can affect placental histopathology has been limited by small study cohorts with mild disease, review by multiple pathologists, and potential confounding by maternal-fetal comorbidities that can also influence placental findings. This study aims to identify pathologic placental findings associated with COVID-19 disease and severity, as well as to distinguish them from changes related to coexisting maternal-fetal comorbidities. METHODS This is an observational study of 61 pregnant women with confirmed SARS-CoV-2 infection who delivered and had a placental histological evaluation at NYU Langone Health between March 19, 2020 and June 30, 2020. Primary outcomes were the prevalence of placental histopathologic features and their association with maternal-fetal comorbidities and severity of COVID-19 related hypoxia. Analysis was performed using Fisher's exact test and t-test with p < 0.05 considered significant. RESULTS Sixty-one placentas were included in the study cohort, 71% from pregnancies complicated by at least one maternal-fetal comorbidity. Twenty-five percent of placentas were small for gestational age and 77% exhibited at least one feature of maternal vascular malperfusion. None of the histopathologic features in the examined placentas were associated with the presence of any specific maternal-fetal comorbidity. Thirteen percent of the cohort required maternal respiratory support for COVID-19 related hypoxia. Villous trophoblast necrosis was associated with maternal supplemental oxygen requirement (67 vs. 33%, p = 0.04) and intubation (67 vs. 33%, p = 0.01). CONCLUSION In pregnancies complicated by COVID-19 disease, there was a high prevalence of placental histopathologic changes identified, particularly features of maternal vascular malperfusion, which could not be attributed solely to the presence of maternal-fetal comorbidities. The significantly increased prevalence of villous trophoblast necrosis in women needing respiratory support suggests a connection to the severity of COVID-19 illness.
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Affiliation(s)
- Jessica A Meyer
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Ashley S Roman
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Meghana Limaye
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Tracy B Grossman
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Abdallah Flaifel
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Michelle J Vaz
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Kristen M Thomas
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Christina A Penfield
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
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Limaye MA, Roman AS, Trostle ME, Venkatesh P, Lantigua Martinez M, Brubaker SG, Chervenak J, Wei LS, Sahani P, Grossman TB, Meyer JA, Penfield CA. Predictors of severe and critical disease in pregnant women with SARS-CoV-2. J Matern Fetal Neonatal Med 2021; 35:7536-7540. [PMID: 34470122 PMCID: PMC8425435 DOI: 10.1080/14767058.2021.1951216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVE SARS-CoV-2 continues to spread widely in the US and worldwide. Pregnant women are more likely to develop severe or critical illness than their non-pregnant counterparts. Known risk factors for severe and critical disease outside of pregnancy, such as asthma, diabetes, and obesity have not been well-studied in pregnancy. We aimed to determine which clinical and pregnancy-related factors were associated with severe and critical COVID illness in pregnancy. STUDY DESIGN This was a retrospective cohort study of women with confirmed intrauterine pregnancy and positive nasopharyngeal swab for SARS-CoV-2 who presented to an academic medical center in New York City from 1 March 2020 to 1 July 2020. Severe and critical COVID-19 disease was defined by World Health Organization criteria. Women with severe/critical disease were compared to women with asymptomatic/mild disease. Continuous variables were compared with Mann-Whitney or t-test and categorical variables were compared using chi-square and Fisher's exact. Statistical significance was set at p < .05. Multivariable logistic regression was performed including variables that were significantly different between groups. RESULTS Two hundred and thirty-three patients were included, 186 (79.8%) with asymptomatic/mild disease and 47 (20.2%) with severe/critical disease. Women with asymptomatic/mild disease were compared to those with severe/critical disease. Women with severe/critical disease were more likely to have a history of current or former smoking (19.6 vs. 5.4%, p = .004), COVID-19 diagnosis in the 2nd trimester (42.6 vs. 11.8%, p = .001), and asthma or other respiratory condition (21.3 vs. 7.0%, p = .01). Women with severe/critical disease were more likely to have cesarean delivery (35.5 vs. 15.6%, p < .01) and preterm delivery <37 weeks (25.8 vs. 3.8%, p < .01). After adjustment, history of smoking remained significantly predictive of severe/critical disease [aOR 3.84 (95% CI, 1.25-11.82)]. CONCLUSION Pregnant women with a history of smoking, asthma, or other respiratory condition, and COVID-19 diagnosis in the second trimester of pregnancy were more likely to develop severe/critical disease. These findings may be useful in counseling women on their individual risk of developing the severe or critical disease in pregnancy and may help determine which women are good candidates for vaccination during pregnancy.
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Affiliation(s)
- Meghana A Limaye
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ashley S Roman
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Megan E Trostle
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Pooja Venkatesh
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Meralis Lantigua Martinez
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sara G Brubaker
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Judith Chervenak
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lili S Wei
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Parita Sahani
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Tracy B Grossman
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Jessica A Meyer
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Christina A Penfield
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
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DeBolt CA, Bianco A, Limaye MA, Silverstein J, Penfield CA, Roman AS, Rosenberg HM, Ferrara L, Lambert C, Khoury R, Bernstein PS, Burd J, Berghella V, Kaplowitz E, Overbey JR, Stone J. Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls. Am J Obstet Gynecol 2021; 224:510.e1-510.e12. [PMID: 33221292 PMCID: PMC7677036 DOI: 10.1016/j.ajog.2020.11.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
Background In March 2020, as community spread of severe acute respiratory syndrome coronavirus 2 became increasingly prevalent, pregnant women seemed to be equally susceptible to developing coronavirus disease 2019. Although the disease course usually appears mild, severe and critical cases of coronavirus disease 2019 seem to lead to substantial morbidity, including intensive care unit admission with prolonged hospital stay, intubation, mechanical ventilation, and even death. Although there are recent reports regarding the impact of coronavirus disease 2019 on pregnancy, there is a lack of information regarding the severity of coronavirus disease 2019 in pregnant vs nonpregnant women. Objective We aimed to describe the outcomes of severe and critical cases of coronavirus disease 2019 in pregnant vs nonpregnant, reproductive-aged women. Study Design This is a multicenter, retrospective, case-control study of women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection hospitalized with severe or critical coronavirus disease 2019 in 4 academic medical centers in New York City and 1 in Philadelphia between March 12, 2020, and May 5, 2020. The cases consisted of pregnant women admitted specifically for severe or critical coronavirus disease 2019 and not for obstetrical indications. The controls consisted of reproductive-aged, nonpregnant women admitted for severe or critical coronavirus disease 2019. The primary outcome was a composite morbidity that includes the following: death, a need for intubation, extracorporeal membrane oxygenation, noninvasive positive pressure ventilation, or a need for high-flow nasal cannula O2 supplementation. The secondary outcomes included intensive care unit admission, length of stay, a need for discharge to long-term acute care facilities, and discharge with a home O2 requirement. Results A total of 38 pregnant women with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction-confirmed infections were admitted to 5 institutions specifically for coronavirus disease 2019, 29 (76.3%) meeting the criteria for severe disease status and 9 (23.7%) meeting the criteria for critical disease status. The mean age and body mass index were markedly higher in the nonpregnant control group. The nonpregnant cohort also had an increased frequency of preexisting medical comorbidities, including diabetes, hypertension, and coronary artery disease. The pregnant women were more likely to experience the primary outcome when compared with the nonpregnant control group (34.2% vs 14.9%; P=.03; adjusted odds ratio, 4.6; 95% confidence interval, 1.2–18.2). The pregnant patients experienced higher rates of intensive care unit admission (39.5% vs 17.0%; P<.01; adjusted odds ratio, 5.2; 95% confidence interval, 1.5–17.5). Among the pregnant women who underwent delivery, 72.7% occurred through cesarean delivery and the mean gestational age at delivery was 33.8±5.5 weeks in patients with severe disease status and 35±3.5 weeks in patients with critical coronavirus disease 2019 status. Conclusion Pregnant women with severe and critical coronavirus disease 2019 are at an increased risk for certain morbidities when compared with nonpregnant controls. Despite the higher comorbidities of diabetes and hypertension in the nonpregnant controls, the pregnant cases were at an increased risk for composite morbidity, intubation, mechanical ventilation, and intensive care unit admission. These findings suggest that pregnancy may be associated with a worse outcome in women with severe and critical cases of coronavirus disease 2019. Our study suggests that similar to other viral infections such as severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, pregnant women may be at risk for greater morbidity and disease severity.
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Lin B, Smith M, Sutter M, Penfield CA, Proudfit C. 790 Association between mean arterial pressure and postpartum readmission for preeclampsia with severe features. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hirschberg CI, Pass AR, Roman AS, Penfield CA. 562 Delivery outcomes in women with hypertensive disorders of pregnancy: comparing induction versus immediate cesarean delivery. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Limaye MA, Lantigua-Martinez M, Trostle ME, Penfield CA, Conroy EM, Roman AS, Mehta-Lee SS. Differential Uptake of Telehealth for Prenatal Care in a Large New York City Academic Obstetrical Practice during the COVID-19 Pandemic. Am J Perinatol 2021; 38:304-306. [PMID: 33302308 DOI: 10.1055/s-0040-1721510] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic in New York City, telehealth was rapidly implemented for obstetric patients. Though telehealth for prenatal care is safe and effective, significant concerns exist regarding equity in access among low-income populations. We performed a retrospective cohort study evaluating utilization of telehealth for prenatal care in a large academic practice in New York City, comparing women with public and private insurance. We found that patients with public insurance were less likely to have at least one telehealth visit than women with private insurance (60.9 vs. 87.3%, p < 0.001). After stratifying by borough, this difference remained significant in Brooklyn, one of the boroughs hardest hit by the pandemic. As COVID-19 continues to spread around the country, obstetric providers must work to ensure that all patients, particularly those with public insurance, have equal access to telehealth. KEY POINTS: · Telehealth for prenatal care is frequently utilized during the COVID-19 pandemic.. · Significant concerns exist regarding equity in access among lower-income populations.. · Women with public insurance in New York City were less likely to access telehealth for prenatal care..
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Affiliation(s)
- Meghana A Limaye
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, New York
| | - Meralis Lantigua-Martinez
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, New York
| | - Megan E Trostle
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, New York
| | - Christina A Penfield
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, New York
| | - Erin M Conroy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, New York
| | - Ashley S Roman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, New York
| | - Shilpi S Mehta-Lee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, New York
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Affiliation(s)
- Christina A Penfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 150 E 32 St., NYU Langone Health, New York, NY 10016
| | - Jennifer Lighter
- Division of Pediatric Infectious Diseases, Department of Infection Prevention and Control and Pediatrics, NYU Langone Health, New York, NY
| | - Ashley S Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY
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Pierce-Williams RA, Burd J, Felder L, Khoury R, Bernstein PS, Avila K, Penfield CA, Roman AS, DeBolt CA, Stone JL, Bianco A, Kern-Goldberger AR, Hirshberg A, Srinivas SK, Jayakumaran JS, Brandt JS, Anastasio H, Birsner M, O’Brien DS, Sedev HM, Dolin CD, Schnettler WT, Suhag A, Ahluwalia S, Navathe RS, Khalifeh A, Anderson K, Berghella V. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM 2020; 2:100134. [PMID: 32391519 PMCID: PMC7205698 DOI: 10.1016/j.ajogmf.2020.100134] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
Background The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited. Objective This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2. Study Design This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation ≤93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24-48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported. Results Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m2. Gestational age was at a mean of 29±6 weeks at symptom onset and a mean of 30±6 weeks at hospital admission, with a median disease day 7 since first symptoms. Most women (81%) were treated with hydroxychloroquine; 7% of women with severe disease and 65% of women with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation during their admission. The median duration of hospital stay was 6 days (6 days [severe group] and 10.5 days [critical group]; P=.01). Intubation was usually performed around day 9 on patients who required it, and peak respiratory support for women with severe disease was performed on day 8. In women with critical disease, prone positioning was required in 20% of cases, the rate of acute respiratory distress syndrome was 70%, and reintubation was necessary in 20%. There was 1 case of maternal cardiac arrest, but there were no cases of cardiomyopathy or maternal death. Thirty-two of 64 (50%) women with coronavirus disease 2019 in this cohort delivered during their hospitalization (34% [severe group] and 85% [critical group]). Furthermore, 15 of 17 (88%) pregnant women with critical coronavirus disease 2019 delivered preterm during their disease course, with 16 of 17 (94%) pregnant women giving birth through cesarean delivery; overall, 15 of 20 (75%) women with critical disease delivered preterm. There were no stillbirths or neonatal deaths or cases of vertical transmission. Conclusion In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.
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Affiliation(s)
- Rebecca A.M. Pierce-Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Julia Burd
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Laura Felder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Rasha Khoury
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Peter S. Bernstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Karina Avila
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY
| | - Christina A. Penfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY
| | - Ashley S. Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY
| | - Chelsea A. DeBolt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Joanne L. Stone
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Angela Bianco
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Adina R. Kern-Goldberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adi Hirshberg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sindhu K. Srinivas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jenani S. Jayakumaran
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Justin S. Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hannah Anastasio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke’s University Health Network, Bethlehem, PA
| | - Meredith Birsner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke’s University Health Network, Bethlehem, PA
| | - Devon S. O’Brien
- Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, NJ
| | - Harish M. Sedev
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cara D. Dolin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William T. Schnettler
- Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH
| | - Anju Suhag
- Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH
| | - Shabani Ahluwalia
- Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA
| | - Reshama S. Navathe
- Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA
| | - Adeeb Khalifeh
- Department of Obstetrics and Gynecology, Einstein Healthcare Network, Philadelphia, PA
| | - Kathryn Anderson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
- Corresponding author: Vincenzo Berghella, MD.
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Silverstein JS, Limaye MA, Brubaker SG, Roman AS, Bautista J, Chervenak J, Ratner AJ, Sommer PM, Roselli NM, Gibson CD, Ellenberg D, Penfield CA. Acute Respiratory Decompensation Requiring Intubation in Pregnant Women with SARS-CoV-2 (COVID-19). AJP Rep 2020; 10:e169-e175. [PMID: 32509416 PMCID: PMC7272216 DOI: 10.1055/s-0040-1712925] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022] Open
Abstract
There is a current paucity of information about the obstetric and perinatal outcomes of pregnant novel coronavirus disease 2019 (COVID-19) patients in North America. Data from China suggest that pregnant women with COVID-19 have favorable maternal and neonatal outcomes, with rare cases of critical illness or respiratory compromise. However, we report two cases of pregnant women diagnosed with COVID-19 in the late preterm period admitted to tertiary care hospitals in New York City for respiratory indications. After presenting with mild symptoms, both quickly developed worsening respiratory distress requiring intubation, and both delivered preterm via caesarean delivery. These cases highlight the potential for rapid respiratory decompensation in pregnant COVID-19 patients and the maternal-fetal considerations in managing these cases.
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Affiliation(s)
- Jenna S. Silverstein
- Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
- Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
| | - Meghana A. Limaye
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
| | - Sara G. Brubaker
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
| | - Ashley S. Roman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
| | - Judita Bautista
- Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
- Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
| | - Judith Chervenak
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
| | - Adam J. Ratner
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Hassenfeld Children's Hospital at New York University Langone Medical Center, New York, New York
| | - Philip M. Sommer
- Department of Anesthesiology and Critical Care Medicine, New York University Langone Medical Center, New York, New York
| | - Nicole M. Roselli
- Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
- Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
| | - Charlisa D. Gibson
- Division of Pulmonary and Critical Care, Department of Internal Medicine, New York University Langone Medical Center, New York, New York
| | - David Ellenberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine, New York University Langone Medical Center, New York, New York
| | - Christina A. Penfield
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, New York
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York, New York
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Penfield CA, McNulty JA, Oakes MC, Nageotte MP. Ibuprofen and Postpartum Blood Pressure in Women With Hypertensive Disorders of Pregnancy: A Randomized Controlled Trial. Obstet Gynecol 2019; 134:1219-1226. [PMID: 31764732 DOI: 10.1097/aog.0000000000003553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effect of ibuprofen on blood pressure in women with a diagnosis of hypertensive disorders of pregnancy and mild hypertension during the immediate postpartum period. METHODS In this double-blind controlled trial, we randomly assigned women with a diagnosis of hypertensive disorders of pregnancy and mild hypertension to receive a postpartum analgesic regimen with either ibuprofen or acetaminophen. The primary outcome was average mean arterial pressure during the postpartum hospital stay. Prespecified secondary outcomes included use of breakthrough opioid pain medications, length of hospital stay, and postpartum diuresis, defined as urine output of at least 200 mL/hour for 4 hours. A sample size of 56 participants was needed to detect a difference of 6 mm Hg in average mean arterial pressure between the study groups. RESULTS From January 17, 2017, to February 24, 2018, 61 participants were randomized and completed the trial, 31 participants in the ibuprofen group and 30 in the control group. Baseline characteristics were similar between groups. Postpartum average arterial pressure did not differ between study groups (93±8 mm Hg for those in the ibuprofen group vs 93±7 mm Hg in the control group, P=.93). Breakthrough opioid medications were requested by 24% of the participants in the ibuprofen group compared with 30% in the control group (P=.62). The ibuprofen group did not have a longer length of stay (48 hours vs 43 hours in the control group) or decreased rate of postpartum diuresis (61% in ibuprofen group vs 77% in the control group, P=.2). CONCLUSION In women with hypertensive disorders of pregnancy and mild hypertension, ibuprofen did not increase postpartum blood pressure compared with women not receiving nonsteroidal antiinflammatory drugs. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT03011567.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Irvine, and the Department of Obstetrics and Gynecology, Miller Children's and Women's Hospital/Long Beach Memorial Medical Center, Long Beach, California
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Abstract
OBJECTIVE To evaluate the prevalence of cesarean delivery in women with hypertensive disorders of pregnancy (HDP), and explore whether maternal, sociodemographic, or obstetric comorbidities contribute to cesarean delivery rates. STUDY DESIGN This is a retrospective cohort study of nulliparous, term, singleton, vertex women using the 2013 U.S. National Vital Statistics Report. We compared prevalence of risk factors for cesarean delivery between women with and without HDP, and then calculated probabilities of cesarean delivery after controlling for these risk factors. RESULTS In this cohort of 1,439,977 women, the unadjusted probability of cesarean delivery in women with HDP was 39.5 versus 26.8% in those without the diagnosis (p < 0.01). Hypertensive women had more risk factors for cesarean delivery, most notably morbid obesity (9.0 vs. 3.1%, p < 0.01), diabetes (9.9 vs. 4.4%, p < 0.01), and induction of labor (59.2 vs. 26.9%, p < 0.01). Despite this, after controlling for these risk factors, hypertensive women remained significantly more likely to undergo cesarean delivery (35.1 vs. 26.4%, p < 0.01). CONCLUSION Even after controlling for multiple comorbidities, hypertension remained a significant risk factor for cesarean delivery in nulliparous women at term. Hypertensive women may therefore represent an important target population in efforts aimed at reduction of cesarean rates.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, California.,Department of Obstetrics and Gynecology, Miller Children's and Women's Hospital/Long Beach Memorial Medical Center, Long Beach, California
| | - Michael P Nageotte
- Department of Obstetrics and Gynecology, Miller Children's and Women's Hospital/Long Beach Memorial Medical Center, Long Beach, California
| | - Deborah A Wing
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, California
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Penfield CA, Oakes MC, McNulty JA, Nageotte MP. 90: A randomized controlled trial of ibuprofen on postpartum blood pressure in hypertensive disorders of pregnancy. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Induction of labor is a common procedure undertaken whenever the benefits of prompt delivery outweigh the risks of expectant management. Cervical assessment is essential to determine the optimal approach. Indication for induction, clinical presentation and history, safety, cost, and patient preference may factor into the selection of methods. For the unfavorable cervix, several pharmacologic and mechanical methods are available, each with associated advantages and disadvantages. In women with a favorable cervix, combined use of amniotomy and intravenous oxytocin is generally the most effective approach. The goal of labor induction is to ensure the best possible outcome for mother and newborn.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA.
| | - Deborah A Wing
- Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
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Penfield CA, Nageotte MP, Wing DA. 346: Disparate rates of cesarean delivery in term nulliparous women with hypertensive disorders of pregnancy. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Penfield CA, Lahiff M, Pies C, Caughey AB. Adolescent Pregnancies in the United States: How Obstetric and Sociodemographic Factors Influence Risk of Cesarean Delivery. Am J Perinatol 2017; 34:123-129. [PMID: 27322668 DOI: 10.1055/s-0036-1584580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective To determine how an adolescent's risk of cesarean varies by maternal age and race/ethnicity, and evaluate the contribution of obstetric and sociodemographic factors to mode of delivery. Study Design This is a retrospective cohort study of 604,287 births to women aged 13 to 23 years. Regression techniques were used to determine maternal ages at lowest risk of primary cesarean in each major racial/ethnic group before and after adjustment for various cesarean risk factors. Results Adolescent age was associated with lower risk of cesarean compared with young adults (17.2% at age 13 years vs 24.8% at age 23 years, p < 0.05). After stratification by race/ethnicity, Non-Hispanic Black women had the highest probability of cesarean, while Asian/Pacific Islanders had the lowest probability across all ages. When compared with young adults of the same race/ethnicity, young adolescents continued to have a lower risk of cesarean, decreased by at least 30% until age 18 years (White) and 17 years (other racial/ethnic groups). These associations persisted after adjustment for obstetric and sociodemographic risk factors. Conclusion Young maternal age is protective against cesarean delivery in all racial/ethnic groups. Adolescents also experience racial/ethnic disparities in mode of delivery similar to those observed in adults, which were unexplained by either obstetric or sociodemographic factors.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Berkeley, California
| | - Maureen Lahiff
- University of California, Berkeley, School of Public Health, Berkeley, California
| | - Cheri Pies
- University of California, Berkeley, School of Public Health, Berkeley, California
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
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Penfield CA, Pilliod RA, Esakoff TA, Valent A, Caughey AB. 599: Adolescent maternal age is associated with increased risk of perinatal complications in diabetic gravidas. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Objective To evaluate whether a subcategory system for category II tracings can improve team communication and perinatal outcomes. Study Design We collected data prospectively for 15 months, first using the NICHD system, followed by the ABC system, which divides category II tracings into subcategories A, B, and C, each representing increased risk for metabolic acidemia. We surveyed providers about communication effectiveness and agreement on tracing interpretation for each system. In cases where the communication system was used to alert an off-site physician about a category II tracing, we compared arrival to L&D and NICU admissions. Results The ABC system was preferred (69%, n = 152) and considered a more effective tool for communicating concerning fetal status (80% vs. 43%, p < 0.01). Participants also reported greater agreement on tracing interpretation (79% for ABC vs. 64% for NICHD, p = 0.046). When an off-site physician was contacted about a category II tracing (n = 95), they were more likely to arrive to L&D (44% vs. 20%, p < 0.01) and have fewer NICU admissions (0% vs. 6%, p < 0.01) with the ABC system. Conclusion The ABC system resulted in improved team communication, increased physician response, and decreased NICU admissions. Using standardized communication may offer a useful strategy for identifying and expediting care.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
| | - Connie Hong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samia El Haj Ibrahim
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sarah J Kilpatrick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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Penfield CA, Pilliod RA, Esakoff TF, Valent AM, Caughey AB. 607: Adolescent maternal age is associated with increased risk of perinatal complications in gravidas with gestational diabetes. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Penfield CA, Pilliod RA, Esakoff TF, Valent AM, Caughey AB. 330: Maternal age and risk of perinatal complications in gravidas with chronic hypertension. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To examine obstetric outcomes for adolescents among the major US racial/ethnic groups. METHODS This is a retrospective cohort study of singleton births to nulliparous women aged 12 to 19 years from 1988 to 2008. The prevalence of preterm delivery, cesarean delivery, preeclampsia, gestational diabetes, low birth weight and low Apgar score were compared across African-American, Asian, Latina and White adolescents. RESULTS 1865 adolescents were included in the analysis. Differences between racial/ethnic groups for rates of preterm delivery, cesarean delivery and gestational diabetes were statistically significant at p < 0.05. African Americans had lower odds of preterm delivery (OR = 0.58, 95% CI [0.38-0.90]) and gestational diabetes (OR = 0.17, 95% CI [0.05-0.55]) than White adolescents. White adolescents had increased odds of cesarean delivery compared to African-American (OR = 0.69, 95% CI [0.48-0.98]), Latina (OR = 0.62, 95% CI [0.41-0.94]) and Asian adolescents (OR = 0.41, 95% CI [0.25-0.68]). Although not statistically significant, White adolescents also had higher odds of low Apgar score. In the multivariate analysis, non-White adolescents continued to have improved outcomes, except in the case of low birth weight. CONCLUSIONS African-American, Asian and Latina adolescents may have similar or decreased risk of obstetric complications compared to White adolescents.
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Affiliation(s)
- Christina A Penfield
- Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Yeaton-Massey A, Ottaviano G, Penfield CA, Handler SJ, Granados JM, Caughey AB. 542: Exclusive breastfeeding promotes postpartum weight loss. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Penfield CA, Cheng YW, Caughey AB. 546: Preterm birth in adolescent pregnancies: The interaction of age and race/ethnicity. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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