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Zelivianskaia A, Arcaz A, Robinson J, Hazen N. Cost savings analysis of routine hysteroscopy for early detection and treatment of intrauterine adhesions. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.068] [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: 03/10/2023]
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Zelivianskaia A, Arcaz A, Kolm P, Robinson JK, Hazen N. Cost-Savings Analysis of Routine Hysteroscopy for Early Detection and Treatment of Intrauterine Adhesions. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0106] [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] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna Zelivianskaia
- Department of Obstetrics and Gynecology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Arthur Arcaz
- Student, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Paul Kolm
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - James K. Robinson
- National Center for Advanced Pelvic Surgery, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Nicholas Hazen
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Zelivianskaia A, Hazen N, Morozov V, Robinson JK. Prospective Study Investigating Change in Carboxyhemoglobin Blood Level During Operative Hysteroscopy. J Minim Invasive Gynecol 2022; 29:1260-1267. [PMID: 36108914 DOI: 10.1016/j.jmig.2022.09.002] [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: 05/19/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVES To evaluate whether the use of radiofrequency energy during resectoscopy leads to increases in patient blood levels of carboxyhemoglobin (COHb) and investigate procedural variables associated with these elevations. DESIGN A prospective cross-sectional study of 40 subjects undergoing a hysteroscopic procedure using bipolar radiofrequency energy. SETTING, PATIENTS, AND INTERVENTIONS The study was conducted at an ambulatory surgery center. Procedures for uterine leiomyoma, septa, products of conception, or a combination of these pathologies were included. We measured blood COHb levels before and immediately after the surgery. Abnormal postoperative COHb level was defined as an increase of plasma COHb ≥3.0%. All patients with abnormal postoperative levels were contacted and screened for carbon monoxide toxicity symptoms. Summary statistics included frequency for categorical variables and averages for continuous variables. p values were reported without modification. MEASUREMENTS AND MAIN RESULTS A total of 17.5% of subjects met the criteria for abnormal postoperative COHb levels. None of these subjects reported symptoms of carbon monoxide toxicity. One subject with an elevated postoperative COHb level had intraoperative hemodynamic changes possibly related to COHb elevation. An abnormal postoperative COHb level was associated with a higher fluid deficit (p = .024) and greater myoma volume (p = .04). CONCLUSION This study demonstrates that systemic absorption of carbon monoxide is a reproducible phenomenon in hysteroscopic resections using bipolar diathermy. Greater absorption is associated with a higher fluid deficit and greater myoma volume. Although none of the subjects with an abnormal increase screened positive for symptoms in the postoperative setting and only 1 experienced hemodynamic changes intraoperatively, our study looked at a healthy and young patient population. More research is needed on the safety of this COHb exposure in patients with medical comorbidities. Special consideration should be given to the possibility of carbon monoxide absorption and the uncertain long-term effects when planning extensive hysteroscopic resections.
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Affiliation(s)
- Anna Zelivianskaia
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center; Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia.
| | - Nicholas Hazen
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia
| | - Vadim Morozov
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center; Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia
| | - James K Robinson
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center
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Kwok S, Pan M, Hazen N, Pan X, Liu J. Mechanical Deformation of Peripapillary Retina in Response to Acute Intraocular Pressure Elevation. J Biomech Eng 2022; 144:1131131. [PMID: 35001106 DOI: 10.1115/1.4053450] [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] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 11/08/2022]
Abstract
Elevated intraocular pressure (IOP) may cause mechanical injuries to the optic nerve head (ONH) and the peripapillary tissues in glaucoma. Previous studies have reported the mechanical deformation of the ONH and the peripapillary sclera (PPS) at elevated IOP. The deformation of the peripapillary retina (PPR) has not been well-characterized. Here we applied high-frequency ultrasound elastography to map and quantify PPR deformation, and compared PPR, PPS and ONH deformation in the same eye. Whole globe inflation was performed in ten human donor eyes. High-frequency ultrasound scans of the posterior eye were acquired while IOP was raised from 5 to 30 mmHg. A correlation-based ultrasound speckle tracking algorithm was used to compute pressure-induced displacements within the scanned tissue cross-sections. Radial, tangential, and shear strains were calculated for the PPR, PPS, and ONH regions. In PPR, shear was significantly larger in magnitude than radial and tangential strains. Strain maps showed localized high shear and high tangential strains in PPR. In comparison to PPS and ONH, PPR had greater shear and a similar level of tangential strain. Surprisingly, PPR radial compression was minimal and significantly smaller than that in PPS. These results provide new insights into PPR deformation in response of IOP elevation, suggesting that shear rather than compression was likely the primary mode of IOP-induced mechanical insult in PPR. High shear, especially localized high shear, may contribute to the mechanical damage of this tissue in glaucoma.
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Affiliation(s)
- Sunny Kwok
- Department of Biomedical Engineering, Ohio State University, 140 W 19th Ave, Columbus, OH 43210
| | - Manqi Pan
- Department of Biomedical Engineering, Ohio State University, 140 W 19th Ave, Columbus, OH 43210
| | - Nicholas Hazen
- Biophysics Interdisciplinary Group, Ohio State University, 140 W 19th Ave, Columbus, OH 43210
| | - Xueliang Pan
- Department of Biomedical Informatics, Ohio State University, 1800 Cannon Drive, Columbus, OH 43210
| | - Jun Liu
- Department of Biomedical Engineering, Ohio State University, 140 W 19th Ave, Columbus, OH 43210
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Brunn E, Cheney M, Hazen N, Morozov V, Robinson JK. Virtual-Reality Effects on Acute Pain During Office Hysteroscopy: A Randomized Controlled Trial. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0121] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elizabeth Brunn
- Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Megan Cheney
- Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Nicholas Hazen
- Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Vadim Morozov
- Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, DC, USA
| | - James K. Robinson
- Department of Obstetrics and Gynecology, Medstar Washington Hospital Center, Washington, DC, USA
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Kwok S, Hazen N, Clayson K, Pan X, Liu J. Regional variation of corneal stromal deformation measured by high-frequency ultrasound elastography. Exp Biol Med (Maywood) 2021; 246:2184-2191. [PMID: 34315279 DOI: 10.1177/15353702211029283] [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: 12/28/2022] Open
Abstract
The cornea's mechanical response to intraocular pressure elevations may alter in ectatic diseases such as keratoconus. Regional variations of mechanical deformation in normal and keratoconus eyes during intraocular pressure elevation have not been well-characterized. We applied a high-frequency ultrasound elastography technique to characterize the regional deformation of normal and keratoconus human corneas through the full thickness of corneal stroma. A cross-section centered at the corneal apex in 11 normal and 2 keratoconus human donor eyes was imaged with high-frequency ultrasound during whole globe inflation from 5 to 30 mmHg. An ultrasound speckle tracking algorithm was used to compute local tissue displacements. Radial, tangential, and shear strains were mapped across the imaged cross-section. Strains in the central (1 mm surrounding apex) and paracentral (1 to 4 mm from apex) regions were analyzed in both normal and keratoconus eyes. Additional regional analysis was performed in the eye with severe keratoconus presenting significant thinning and scarring. Our results showed that in normal corneas, the central region had significantly smaller tangential stretch than the paracentral region, and that within the central region, the magnitudes of radial and shear strains were significantly larger than that of tangential strain. The eye with mild keratoconus had similar shear strain but substantially larger radial strains than normal corneas, while the eye with severe keratoconus had similar overall strains as in normal eyes but marked regional heterogeneity and large strains in the cone region. These findings suggested regional variation of mechanical responses to intraocular pressure elevation in both normal and keratoconus corneas, and keratoconus appeared to be associated with mechanical weakening in the cone region, especially in resisting radial compression. Comprehensive characterization of radial, tangential, and shear strains through corneal stroma may provide new insights to understand the biomechanical alterations in keratoconus.
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Affiliation(s)
- Sunny Kwok
- Department of Biomedical Engineering, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA
| | - Nicholas Hazen
- Department of Biomedical Engineering, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA.,Biophysics Interdisciplinary Group, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA
| | - Keyton Clayson
- Department of Biomedical Engineering, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA.,Biophysics Interdisciplinary Group, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA
| | - Xueliang Pan
- Department of Biomedical Informatics, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA
| | - Jun Liu
- Department of Biomedical Engineering, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA.,Biophysics Interdisciplinary Group, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA.,Department of Ophthalmology and Visual Sciences, 2647The Ohio State University, The Ohio State University, Columbus, OH 43210-1110, USA
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Davenport A, Hoang E, Brunn E, Hazen N, Jallad K, Iglesia C. 114 #MIGS tag ontology project. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.139] [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: 10/21/2022]
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Davenport A, Hoang E, Hazen N, Brunn E, Kho R, Truong MD, Iglesia CB. #MIGS: Minimally Invasive Gynecologic Surgery Tag Ontology Project. J Minim Invasive Gynecol 2021; 28:2025-2027. [PMID: 34029744 DOI: 10.1016/j.jmig.2021.05.012] [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: 03/26/2021] [Revised: 05/02/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE The creation of an ontology may enable providers to more definitively engage the public in evidence-based and meaningful discussions about women's health. The goal of this study is to review and analyze the current social media status of minimally invasive gynecologic surgery (MIGS) on Twitter and create a tag ontology. DESIGN Tag ontologies are lists of hashtags used to standardize searches within a social media platform. We examined trending terms and influencers on Twitter on the basis of the keyword "MIGS." We then compiled a list of top hashtags on the basis of the number of tweets from January 2018 to August 2020. Terms were identified with manual Twitter queries and Symplur Signals and selected for inclusion in the ontology on the basis of frequency of use and clinical relevance. The ontology was then categorized by pelvic disease and intervention and reviewed/supplemented by key social media influencers for inclusivity. SETTING N/A PATIENTS: N/A INTERVENTIONS: N/A MEASUREMENTS AND MAIN RESULTS: We identified 4550 tweets and 1836 users while searching #MIGS in August 2020. Twenty-nine terms were included in our ontology, which were then subcategorized into 6 groups (uterine pathology, adnexal pathology, menstruation, pelvic pathology, pelvic pain, and other). CONCLUSION Our study has created an ontology specific to the MIGS on the basis of Twitter usage over the last 2 years that may facilitate more effective social media communication.
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Affiliation(s)
- Abigail Davenport
- MedStar Health/Georgetown University School of Medicine; Washington, District of Columbia (Drs. Davenport, Hoang, Hazen, Brunn, and Iglesia).
| | - Elizabeth Hoang
- MedStar Health/Georgetown University School of Medicine; Washington, District of Columbia (Drs. Davenport, Hoang, Hazen, Brunn, and Iglesia)
| | - Nicholas Hazen
- MedStar Health/Georgetown University School of Medicine; Washington, District of Columbia (Drs. Davenport, Hoang, Hazen, Brunn, and Iglesia)
| | - Elizabeth Brunn
- MedStar Health/Georgetown University School of Medicine; Washington, District of Columbia (Drs. Davenport, Hoang, Hazen, Brunn, and Iglesia)
| | - Rosanne Kho
- Cleveland Clinic Foundation, Cleveland, Ohio (Dr. Kho)
| | | | - Cheryl B Iglesia
- MedStar Health/Georgetown University School of Medicine; Washington, District of Columbia (Drs. Davenport, Hoang, Hazen, Brunn, and Iglesia)
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Kwok S, Clayson K, Hazen N, Pan X, Ma Y, Hendershot AJ, Liu J. Heartbeat-Induced Corneal Axial Displacement and Strain Measured by High Frequency Ultrasound Elastography in Human Volunteers. Transl Vis Sci Technol 2021; 9:33. [PMID: 33384887 PMCID: PMC7757631 DOI: 10.1167/tvst.9.13.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to establish in vivo data acquisition and processing protocols for repeatable measurements of heartbeat-induced corneal displacements and strains in human eyes, using a high-frequency ultrasound elastography method, termed ocular pulse elastography (OPE). Methods Twenty-four volunteers with no known ocular diseases were recruited for this study. Intraocular pressure (IOP) and ocular pulse amplitude (OPA) were measured using a PASCAL Dynamic Contour Tonometer (DCT). An in vivo OPE protocol was developed to measure heartbeat-induced corneal displacements. Videos of the central 5.7 mm of the cornea were acquired using a 50-MHz ultrasound probe at 128 frames per second. The radiofrequency data of 1000 frames were analyzed using an ultrasound speckle tracking algorithm to calculate corneal displacements and quantify spectral and temporal characteristics. The intrasession and intersession repeatability of OPE- and DCT-measured parameters were also analyzed. Results The in vivo OPE protocol and setup were successful in tracking heartbeat-induced corneal motion using high-frequency ultrasound. Corneal axial displacements showed a strong cardiac rhythm, with good intrasession and intersession repeatability, and high interocular symmetry. Corneal strain was calculated in two eyes of two subjects, showing substantially different responses. Conclusions We demonstrated the feasibility of high-frequency ultrasound elastography for noninvasive in vivo measurement of the cornea's biomechanical responses to the intrinsic ocular pulse. The high intrasession and intersession repeatability suggested a robust implementation of this technique to the in vivo setting. Translational Relevance OPE may offer a useful tool for clinical biomechanical evaluation of the cornea by quantifying its response to the intrinsic pulsation.
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Affiliation(s)
- Sunny Kwok
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Keyton Clayson
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.,Biophysics Interdisciplinary Group, The Ohio State University, Columbus, OH, USA
| | - Nicholas Hazen
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.,Biophysics Interdisciplinary Group, The Ohio State University, Columbus, OH, USA
| | - Xueliang Pan
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Yanhui Ma
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.,Department of Ophthalmology and Visual Science, The Ohio State University, Columbus, OH, USA
| | - Andrew J Hendershot
- Department of Ophthalmology and Visual Science, The Ohio State University, Columbus, OH, USA
| | - Jun Liu
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.,Biophysics Interdisciplinary Group, The Ohio State University, Columbus, OH, USA.,Department of Ophthalmology and Visual Science, The Ohio State University, Columbus, OH, USA
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Ma Y, Kwok S, Sun J, Pan X, Pavlatos E, Clayson K, Hazen N, Liu J. IOP-induced regional displacements in the optic nerve head and correlation with peripapillary sclera thickness. Exp Eye Res 2020; 200:108202. [PMID: 32861767 PMCID: PMC7655654 DOI: 10.1016/j.exer.2020.108202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
Mechanical insult induced by intraocular pressure (IOP) is likely a driving force in the disease process of glaucoma. This study aimed to evaluate regional displacements in human optic nerve head (ONH) and peripapillary tissue (PPT) in response to acute IOP elevations, and their correlations with morphological characteristics of the posterior eye. Cross-sectional (2D) images of the ONH and PPT in 14 globes of 14 human donors were acquired with high-frequency ultrasound during whole globe inflation from 5 to 30 mm Hg. High-frequency ultrasound has a spatial resolution of tens of micrometers and is capable of imaging through the ONH and PPT thickness. Tissue displacements were calculated using a correlation-based speckle tracking algorithm for a dense matrix of kernels covering the 2D imaging plane. The ONH was manually segmented in the ultrasound B-mode images acquired at 5 mmHg based on echogenicity. The lamina cribrosa (LC) boundaries were visible in eight of the fourteen eyes and the LC region was segmented using a semi-automated superpixel-based method. The ONH had larger radial displacement than the PPT in all tested eyes and the difference increased with increasing IOP. A significant negative correlation was found between ONH-PPT displacement difference and PPT thickness (p < 0.05), while no significant correlations were found between ONH-PPT displacement difference and other morphological parameters including PPT radius of curvature, scleral canal size, LC thickness and anterior LC surface depth. Within the ONH, the radial displacement decreased in the region anterior to and across LC but not in the region posterior to LC. Finite element models using simplified geometry and material properties confirmed the role of LC in reducing the overall ONH radial displacements, but did not predict the displacement gradient change observed experimentally. These results suggested that a thinner PPT may be associated with a larger relative posterior motion of the ONH with respect to the surrounding PPT and the LC may play a major role in preventing excessive posterior displacement of ONH during acute IOP elevations.
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Affiliation(s)
- Yanhui Ma
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, USA
| | - Sunny Kwok
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, USA
| | - Jiajun Sun
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, USA
| | - Xueliang Pan
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Elias Pavlatos
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, USA
| | - Keyton Clayson
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, USA; Biophysics Interdisciplinary Group, Ohio State University, Columbus, OH, USA
| | - Nicholas Hazen
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, USA; Biophysics Interdisciplinary Group, Ohio State University, Columbus, OH, USA
| | - Jun Liu
- Department of Biomedical Engineering, Ohio State University, Columbus, OH, USA; Biophysics Interdisciplinary Group, Ohio State University, Columbus, OH, USA; Department of Ophthalmology and Visual Science, Ohio State University, Columbus, OH, USA.
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Zelivianskaia A, Hazen N, Brunn E, Robinson J, Morozov V. 23: How to salvage an air knot. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.171] [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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