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2. Prediction of Cerebral Palsy or Death among Preterm Infants Who Survive the Neonatal Period.

Author

Peaceman, Alan M., Mele, Lisa, Rouse, Dwight J., Leveno, Kenneth J., Mercer, Brian M., Varner, Michael W., Reddy, Uma M., Wapner, Ronald J., Sorokin, Yoram, Thorp, John M., Ramin, Susan M., Malone, Fergal D., O'Sullivan, Mary J., Dudley, Donald J., and Caritis, Steve N.

Subjects
CEREBRAL palsy prevention, RISK assessment, DEATH, SECONDARY analysis, MAGNESIUM sulfate, PREDICTION models, DELIVERY (Obstetrics), RECEIVER operating characteristic curves, RESEARCH funding, SEX distribution, QUESTIONNAIRES, CEREBRAL palsy, PREGNANCY outcomes, DISCHARGE planning, BRAIN diseases, DISEASES, ODDS ratio, GESTATIONAL age, APGAR score, CONFIDENCE intervals, PREGNANCY complications, CEREBRAL hemorrhage, DISEASE risk factors, DISEASE complications, CHILDREN
Abstract

Objective To assess whether neonatal morbidities evident by the time of hospital discharge are associated with subsequent cerebral palsy (CP) or death. Study Design This is a secondary analysis of data from a multicenter placebo-controlled trial of magnesium sulfate for the prevention of CP. The association between prespecified intermediate neonatal outcomes (n = 11) and demographic and clinical factors (n = 10) evident by the time of discharge among surviving infants (n = 1889) and the primary outcome of death or moderate/severe CP at age 2 (n = 73) was estimated, and a prediction model was created. Results Gestational age in weeks at delivery (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.67–0.83), grade III or IV intraventricular hemorrhage (IVH) (OR: 5.3, CI: 2.1–13.1), periventricular leukomalacia (PVL) (OR: 46.4, CI: 20.6–104.6), and male gender (OR: 2.5, CI: 1.4–4.5) were associated with death or moderate/severe CP by age 2. Outcomes not significantly associated with the primary outcome included respiratory distress syndrome, bronchopulmonary dysplasia, seizure, necrotizing enterocolitis, neonatal hypotension, 5-minute Apgar score, sepsis, and retinopathy of prematurity. Using all patients, the receiver operating characteristic curve for the final prediction model had an area under the curve of 0.84 (CI: 0.78–0.89). Using these data, the risk of death or developing CP by age 2 can be calculated for individual surviving infants. Conclusion IVH and PVL were the only neonatal complications evident at discharge that contributed to an individual infant's risk of the long-term outcomes of death or CP by age 2. A model that includes these morbidities, gestational age at delivery, and gender is predictive of subsequent neurologic sequelae. Key Points Factors known at hospital discharge are identified which are independently associated with death or CP by age 2. A model was created and validated using these findings to counsel parents. The risk of death or CP can be calculated at the time of hospital discharge. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Cord Blood Haptoglobin, Cerebral Palsy and Death in Infants of Women at Risk for Preterm Birth: A Secondary Analysis of a Randomised Controlled Trial

Author

Buhimschi, Catalin S., Jablonski, Kathleen A., Rouse, Dwight J., Varner, Michael W., Reddy, Uma M., Mercer, Brian M., Leveno, Kenneth J., Wapner, Ronald J., Sorokin, Yoram, Thorp, John M., Jr, Ramin, Susan M., Malone, Fergal D., Carpenter, Marshall W., O'Sullivan, Mary J., Peaceman, Alan M., Saade, George R., Dudley, Donald, Caritis, Steve N., and Buhimschi, Irina A.

Published
2019
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4. Episiotomy: Evolution of a Common Obstetric Practice at a Public Hospital.

Author

Dillon, Shena J., Nelson, David B., Spong, Catherine Y., McIntire, Donald D., and Leveno, Kenneth J.

Subjects
EPISIOTOMY, STATISTICS, SCIENTIFIC observation, PEARSON correlation (Statistics), PUBLIC hospitals, CHILD health services, DESCRIPTIVE statistics, CHI-squared test, DELIVERY (Obstetrics), APGAR score, PERINEUM
Abstract

Objective This study aimed to evaluate the rate and impact of episiotomy on maternal and newborn outcomes before and after restricted use of episiotomy. Study Design This population-based observational study used an obstetric database of all deliveries since 1990 that has been maintained with quality checks. Inclusion criteria were vaginal deliveries at ≥37 weeks. Exclusion criteria included fetal malformations, multifetal gestations, or fetal deaths known on arrival to Labor and Delivery. The primary outcomes of interest were episiotomy, perineal lacerations, and newborn outcomes. To evaluate the impact of restrictive episiotomy, data from 1990 to 1997 (35% overall episiotomy rate) were compared with data from 2010 to 2017 (2.5% overall episiotomy rate). Univariable analysis of maternal and infant outcomes were performed comparing the two-time epochs with the Pearson's Chi-squared test. Results Overall, 268,415 women met inclusion criteria and 49,089 (18.2%) had an episiotomy. The rate of episiotomy decreased from 37% of deliveries in 1990 to 2% in 2017. A total of 82,082 deliveries occurred in the 1990 to 1997 epoch and 57,183 in 2010 to 2017. Indicated use of episiotomy was associated with a significant decrease in third and fourth degree lacerations. Immediate newborn condition (5-minute Apgar's score ≤3 and umbilical artery pH <7.1) and neonatal outcomes (intraventricular hemorrhage [IVH] grade 3/4, positive culture sepsis, neonatal seizures, and neonatal demise) were not significantly different. Conclusion Selective, indicated use of episiotomy compared with routine was associated with lower rates of third/fourth-degree lacerations with no change in neonatal outcomes. The common obstetric practice of routinely performing episiotomy, presumably to prevent perineal trauma, proved untrue when analyzed over almost three decades. Key Points Episiotomy use decreased overtime at our institution. Decreased episiotomy use was associated with significant improvement in maternal outcomes. Neonatal outcomes were unchanged suggesting no deleterious effects with restricted episiotomy. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals

Author

Bailit, Jennifer L, Grobman, William A, Rice, Madeline Murguia, Spong, Catherine Y, Wapner, Ronald J, Varner, Michael W, Thorp, John M, Leveno, Kenneth J, Caritis, Steve N, Shubert, Phillip J, Tita, Alan T, Saade, George, Sorokin, Yoram, Rouse, Dwight J, Blackwell, Sean C, Tolosa, Jorge E, Van Dorsten, J Peter, and Network, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units

Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Good Health and Well Being, Adult, Cohort Studies, Delivery, Obstetric, Female, Hospitals, Humans, Infant, Newborn, Lacerations, Models, Statistical, Multivariate Analysis, Obstetric Labor Complications, Outcome Assessment, Health Care, Perineum, Peripartum Period, Postpartum Hemorrhage, Pregnancy, Pregnancy Complications, Cardiovascular, Pregnancy Complications, Infectious, Puerperal Infection, Quality Improvement, Risk Adjustment, United States, Venous Thromboembolism, Young Adult, obstetrics, performance improvement, quality, risk adjustment, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, Reproductive medicine
Abstract

ObjectiveRegulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take preexisting patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for 5 obstetric outcomes and assess hospital performance across these outcomes.Study designWe studied a cohort of 115,502 women and their neonates born in 25 hospitals in the United States from March 2008 through February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed.ResultsVenous thromboembolism occurred too infrequently (0.03%; 95% confidence interval [CI], 0.02-0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage, 2.29%; 95% CI, 2.20-2.38, peripartum infection, 5.06%; 95% CI, 4.93-5.19, severe perineal laceration at spontaneous vaginal delivery, 2.16%; 95% CI, 2.06-2.27, neonatal composite, 2.73%; 95% CI, 2.63-2.84). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital-adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration.ConclusionEvaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance.

Published
2013

9. Defining failed induction of labor

Author

Grobman, William A., Bailit, Jennifer, Lai, Yinglei, Reddy, Uma M., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Jr., Leveno, Kenneth J., Caritis, Steve N., Prasad, Mona, Tita, Alan T.N., Saade, George, Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., and Tolosa, Jorge E.

Published
2018
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14. Reply

Author

Nelson, David B., McIntire, Donald D., and Leveno, Kenneth J.

Published
2018
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19. Serious maternal complications after early preterm delivery (24-33 weeks’ gestation)

Author

Reddy, Uma M., Rice, Madeline Murguia, Grobman, William A., Bailit, Jennifer L., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Jr., Leveno, Kenneth J., Caritis, Steve N., Prasad, Mona, Tita, Alan T.N., Saade, George R., Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., Tolosa, Jorge E., Spong, C., Tolivaisa, S., Talucci, M., Zylfijaj, M., Reid, Z., Leed, R., Benson, J., Forester, S., Kitto, C., Davis, S., Falk, M., Perez, C., Hill, K., Sowles, A., Postma, J., Alexander, S., Andersen, G., Scott, V., Morby, V., Jolley, K., Miller, J., Berg, B., Dorman, K., Mitchell, J., Kaluta, E., Clark, K., Spicer, K., Timlin, S., Wilson, K., Moseley, L., Santillan, M., Price, J., Buentipo, K., Bludau, V., Thomas, T., Fay, L., Melton, C., Kingsbery, J., Benezue, R., Simhan, H., Bickus, M., Fischer, D., Kamon, T., DeAngelis, D., Mercer, B., Milluzzi, C., Dalton, W., Dotson, T., McDonald, P., Brezine, C., McGrail, A., Latimer, C., Guzzo, L., Johnson, F., Gerwig, L., Fyffe, S., Loux, D., Frantz, S., Cline, D., Wylie, S., Iams, J., Wallace, M., Northen, A., Grant, J., Colquitt, C., Rouse, D., Andrews, W., Mallett, G., Ramos-Brinson, M., Roy, A., Stein, L., Campbell, P., Collins, C., Jackson, N., Dinsmoor, M., Senka, J., Paychek, K., Peaceman, A., Moss, J., Salazar, A., Acosta, A., Hankins, G., Hauff, N., Palmer, L., Lockhart, P., Driscoll, D., Wynn, L., Sudz, C., Dengate, D., Girard, C., Field, S., Breault, P., Smith, F., Annunziata, N., Allard, D., Silva, J., Gamage, M., Hunt, J., Tillinghast, J., Corcoran, N., Jimenez, M., Ortiz, F., Givens, P., Rech, B., Moran, C., Hutchinson, M., Spears, Z., Carreno, C., Heaps, B., Zamora, G., Seguin, J., Rincon, M., Snyder, J., Farrar, C., Lairson, E., Bonino, C., Smith, W., Beach, K., Van Dyke, S., Butcher, S., Thom, E., Zhao, Y., McGee, P., Momirova, V., Palugod, R., Reamer, B., Larsen, M., Spangler, T., Bhandaru, V., and VanDorsten, J. P.

Published
2015
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28. Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?

Author

Bailit, Jennifer L., Grobman, William A., McGee, Paula, Reddy, Uma M., Wapner, Ronald J., Varner, Michael W., Thorp, John M., Leveno, Kenneth J., Iams, Jay D., Tita, Alan T.N., Saade, George, Sorokin, Yoram, Rouse, Dwight J., Blackwell, Sean C., Mercer, B., Milluzzi, C., Dalton, W., Dotson, T., McDonald, P., Brezine, C., McGrail, A., Mallett, G., Ramos-Brinson, M., Roy, A., Stein, L., Campbell, P., Collins, C., Jackson, N., Dinsmoor, M., Senka, J., Paychek, K., Peaceman, A., Talucci, M., Zylfijaj, M., Reid, Z., Leed, R., Benson, J., Forester, S., Kitto, C., Davis, S., Falk, M., Perez, C., Hill, K., Sowles, A., Postma, J., Alexander, S., Andersen, G., Scott, V., Morby, V., Jolley, K., Miller, J., Berg, B., Dorman, K., Mitchell, J., Kaluta, E., Clark, K., Spicer, K., Timlin, S., Wilson, K., Moseley, L., Santillan, M., Price, J., Buentipo, K., Bludau, V., Thomas, T., Fay, L., Melton, C., Kingsbery, J., Benezue, R., Caritis, S., Simhan, H., Bickus, M., Fischer, D., Kamon, T., DeAngelis, D., Shubert, P., Latimer, C., Guzzo, L., Johnson, F., Gerwig, L., Fyffe, S., Loux, D., Frantz, S., Cline, D., Wylie, S., Iams, J., Wallace, M., Northen, A., Grant, J., Colquitt, C., Moss, J., Salazar, A., Acosta, A., Hankins, G., Hauff, N., Palmer, L., Lockhart, P., Driscoll, D., Wynn, L., Sudz, C., Dengate, D., Girard, C., Field, S., Breault, P., Smith, F., Annunziata, N., Allard, D., Silva, J., Gamage, M., Hunt, J., Tillinghast, J., Corcoran, N., Jimenez, M., Ortiz, F., Givens, P., Rech, B., Moran, C., Hutchinson, M., Spears, Z., Carreno, C., Heaps, B., Zamora, G., Tolosa, J., Seguin, J., Rincon, M., Snyder, J., Farrar, C., Lairson, E., Bonino, C., Smith, W., Beach, K., Van Dyke, S., Butcher, S., Thom, E., Rice, M., Zhao, Y., McGee, P., Momirova, V., Palugod, R., Reamer, B., Larsen, M., Williams, T., Spong, C., Tolivaisa, S., and Van Dorsten, J. P.

Published
2015
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43. The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles

Author

Grobman, William A., Lai, Yinglei, Rouse, Dwight J., Spong, Catherine Y., Varner, Michael W., Mercer, Brian M., Leveno, Kenneth J., Iams, Jay D., Wapner, Ronald J., Sorokin, Yoram, Thorp, John M., Jr., Ramin, Susan M., Malone, Fergal D., OʼSullivan, Mary J., Hankins, Gary D.V., and Caritis, Steve N.

Published
2013
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49. The Association of Cord Serum Cytokines with Neurodevelopmental Outcomes

Author

Varner, Michael W., Marshall, Nicole E., Rouse, Dwight J., Jablonski, Kathleen A., Leveno, Kenneth J., Reddy, Uma M., Mercer, Brian M., Iams, Jay D., Wapner, Ronald J., Sorokin, Yoram, Thorp, John M., Malone, Fergal D., Carpenter, Marshall, OʼSullivan, Mary J., Peaceman, Alan M., Hankins, Gary D. V., Dudley, Donald J., and Caritis, Steve N.

Published
2015
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