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  1. Article: A Rare Case of Obstructive Shock due to Cardiac Tamponade in a Term Pregnancy.

    Masten, Megan / Kaliounji, Haya / Chou, Josephine / Tumolo, Alexis / Hirshberg, Jonathan S / Sayres, Lauren

    AJP reports

    2023  Volume 13, Issue 4, Page(s) e94–e97

    Abstract: ... We hypothesize that this patient's cardiac tamponade was caused by inflammatory pericarditis exacerbated ... fluid shifts in other compartments and thus is theorized to have contributed to this patient's effusion ...

    Abstract Obstructive shock due to cardiac tamponade is a rare, life-threatening occurrence in the peripartum period. Etiologies include preeclampsia, infection, autoimmune conditions, and malignancy. Early recognition of the underlying disease process allows for multidisciplinary treatment and a favorable outcome. A 33-year-old presented for cardiac tamponade identified in the peripartum period. She was diagnosed with preeclampsia with severe features immediately prior to her repeat cesarean delivery and received magnesium prophylaxis. Postoperatively, she developed hypotension, tachycardia, and shortness of breath and was found to have a pericardial effusion with tamponade physiology. She underwent pericardial drain placement which was initially successful. However, she had recurrent symptomatic tamponade and thus a pericardial window was performed resulting in improvement of her symptoms. Workup revealed pericardial inflammation possibly secondary to a viral source, and she was successfully treated with anti-inflammatory therapy. We hypothesize that this patient's cardiac tamponade was caused by inflammatory pericarditis exacerbated by severe preeclampsia. Preeclampsia is a disease characterized by cardiovascular remodeling and fluid shifts in other compartments and thus is theorized to have contributed to this patient's effusion. Cardiac tamponade should be considered in the differential for any parturient presenting with hypotension and shortness of breath.
    Language English
    Publishing date 2023-12-12
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2628074-7
    ISSN 2157-7005 ; 2157-6998
    ISSN (online) 2157-7005
    ISSN 2157-6998
    DOI 10.1055/a-2200-3497
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Pain relief: determining the safety of ibuprofen with postpartum preeclampsia.

    Hirshberg, Jonathan S / Cahill, Alison G

    American journal of obstetrics and gynecology

    2018  Volume 218, Issue 6, Page(s) 547–548

    MeSH term(s) Acetaminophen ; Analgesics, Non-Narcotic ; Double-Blind Method ; Female ; Humans ; Hypertension ; Ibuprofen ; Pain ; Postpartum Period ; Pre-Eclampsia ; Pregnancy
    Chemical Substances Analgesics, Non-Narcotic ; Acetaminophen (362O9ITL9D) ; Ibuprofen (WK2XYI10QM)
    Language English
    Publishing date 2018-10-15
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2018.04.026
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals.

    Hirshberg, Jonathan S / Stout, Molly J / Raghuraman, Nandini

    American journal of obstetrics & gynecology MFM

    2020  Volume 2, Issue 3, Page(s) 100162

    MeSH term(s) COVID-19 ; Female ; Hospitals, Urban ; Humans ; New York City/epidemiology ; Pregnancy ; Pregnant Women ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-06-22
    Publishing country Switzerland
    Document type Letter ; Comment
    ISSN 2589-9333
    ISSN (online) 2589-9333
    DOI 10.1016/j.ajogmf.2020.100162
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Gallbladder and Biliary Disease in Pregnancy.

    Brown, Kristine E / Hirshberg, Jonathan S / Conner, Shayna N

    Clinical obstetrics and gynecology

    2019  Volume 63, Issue 1, Page(s) 211–225

    Abstract: Diseases of the gallbladder and biliary tract are extremely common in developed nations. Because of the physiology of pregnancy, their incidence increases during gestation. This article represents a review of the existing literature on the entire ... ...

    Abstract Diseases of the gallbladder and biliary tract are extremely common in developed nations. Because of the physiology of pregnancy, their incidence increases during gestation. This article represents a review of the existing literature on the entire spectrum of biliary disease. The physiology, clinical presentation, and diagnostic evaluation of a variety of conditions are reviewed. Historical and contemporary data regarding pregnancy implications and treatment options are discussed.
    MeSH term(s) Female ; Gallbladder/anatomy & histology ; Gallbladder/embryology ; Gallbladder Diseases/diagnosis ; Gallbladder Diseases/epidemiology ; Gallbladder Diseases/physiopathology ; Gallbladder Diseases/therapy ; Humans ; Pancreatitis/diagnosis ; Pancreatitis/physiopathology ; Pancreatitis/therapy ; Pregnancy ; Pregnancy Complications/diagnosis ; Pregnancy Complications/physiopathology ; Pregnancy Complications/therapy
    Language English
    Publishing date 2019-12-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 391207-3
    ISSN 1532-5520 ; 0009-9201
    ISSN (online) 1532-5520
    ISSN 0009-9201
    DOI 10.1097/GRF.0000000000000496
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Monoclonal antibody treatment of symptomatic COVID-19 in pregnancy: initial report.

    Hirshberg, Jonathan S / Cooke, Emily / Oakes, Megan C / Odibo, Anthony O / Raghuraman, Nandini / Kelly, Jeannie C

    American journal of obstetrics and gynecology

    2021  Volume 225, Issue 6, Page(s) 688–689

    MeSH term(s) Adult ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antibodies, Neutralizing/therapeutic use ; COVID-19/drug therapy ; Drug Combinations ; Female ; Humans ; Pregnancy ; Pregnancy Complications, Infectious/drug therapy ; SARS-CoV-2/immunology ; Treatment Outcome
    Chemical Substances Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Antibodies, Neutralizing ; Drug Combinations ; casirivimab and imdevimab drug combination
    Language English
    Publishing date 2021-08-25
    Publishing country United States
    Document type Letter
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2021.08.025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: A Rare Case of Obstructive Shock due to Cardiac Tamponade in a Term Pregnancy

    Masten, Megan / Kaliounji, Haya / Chou, Josephine / Tumolo, Alexis / Hirshberg, Jonathan S. / Sayres, Lauren

    American Journal of Perinatology Reports

    2023  Volume 13, Issue 04, Page(s) e94–e97

    Abstract: ... We hypothesize that this patient's cardiac tamponade was caused by inflammatory pericarditis exacerbated ... fluid shifts in other compartments and thus is theorized to have contributed to this patient's effusion ...

    Abstract Obstructive shock due to cardiac tamponade is a rare, life-threatening occurrence in the peripartum period. Etiologies include preeclampsia, infection, autoimmune conditions, and malignancy. Early recognition of the underlying disease process allows for multidisciplinary treatment and a favorable outcome. A 33-year-old presented for cardiac tamponade identified in the peripartum period. She was diagnosed with preeclampsia with severe features immediately prior to her repeat cesarean delivery and received magnesium prophylaxis. Postoperatively, she developed hypotension, tachycardia, and shortness of breath and was found to have a pericardial effusion with tamponade physiology. She underwent pericardial drain placement which was initially successful. However, she had recurrent symptomatic tamponade and thus a pericardial window was performed resulting in improvement of her symptoms. Workup revealed pericardial inflammation possibly secondary to a viral source, and she was successfully treated with anti-inflammatory therapy. We hypothesize that this patient's cardiac tamponade was caused by inflammatory pericarditis exacerbated by severe preeclampsia. Preeclampsia is a disease characterized by cardiovascular remodeling and fluid shifts in other compartments and thus is theorized to have contributed to this patient's effusion. Cardiac tamponade should be considered in the differential for any parturient presenting with hypotension and shortness of breath.
    Keywords cardiac tamponade ; pericardial effusion ; pericarditis ; obstructive shock ; preeclampsia
    Language English
    Publishing date 2023-07-01
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2628074-7
    ISSN 2157-7005 ; 2157-6998
    ISSN (online) 2157-7005
    ISSN 2157-6998
    DOI 10.1055/a-2200-3497
    Database Thieme publisher's database

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  7. Article: Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals

    Hirshberg, Jonathan S / Stout, Molly J / Raghuraman, Nandini

    Am J Obstet Gynecol MFM

    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #610559
    Database COVID19

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  8. Article ; Online: Offering onsite COVID-19 vaccination to high-risk obstetrical patients: initial findings.

    Hirshberg, Jonathan S / Huysman, Bridget C / Oakes, Megan C / Cater, Ebony B / Odibo, Anthony O / Raghuraman, Nandini / Kelly, Jeannie C

    American journal of obstetrics & gynecology MFM

    2021  Volume 3, Issue 6, Page(s) 100478

    Abstract: ... counseled by providers at each visit using our institution's standardized COVID-19 vaccination discussion ...

    Abstract Objective: The COVID-19 pandemic has had a disproportionate effect on pregnant women, with higher rates of viral infection and disease severity.
    Study design: This was a quality improvement project at a single academic medical center. Onsite vaccination was available once a week at 2 high-risk obstetrical clinics staffed by obstetrical residents, maternal-fetal medicine (MFM) fellows, and MFM attendings were selected for our vaccine pilot program. Onsite vaccinations were immediately available for use in the clinic starting May 11, 2021. Data were collected over a 4-week period (April 27, 2021, to May 20, 2021), which included 4 clinic days before onsite vaccine availability (April 27, 2021 to May 10, 2021) and 4 days with onsite vaccine availability (May 11, 2021, to May 20, 2021). Patients were considered exposed to onsite vaccination if they had any clinic visits during the latter 2 weeks of the study period. All patients were counseled by providers at each visit using our institution's standardized COVID-19 vaccination discussion tool designed for pregnant and breastfeeding patients.
    Results: We reviewed data from 124 clinic visits, where a total of 93 individual patients were seen in the 4-week period; 6 had previously been vaccinated at external sites and the remaining 87 were eligible (Figure). The majority of our patient population was non-Hispanic Black women with public or no insurance (Table). Of the 32 eligible patients seen and counseled before onsite vaccination availability, 1 (3%) proceeded to receive the vaccination offsite. Of the 55 eligible patients seen and counseled after onsite vaccination availability, 2 (3%) proceeded with onsite vaccination and an additional 4 (7%) proceeded with vaccination offsite. Onsite vaccination availability did not significantly increase the vaccination rates (3% vs 11%; P=.22). Of the 55 eligible patients counseled during onsite vaccination availability, 25 were seen and counseled exclusively during the onsite vaccination pilot period and none of these patients accepted onsite vaccination or pursued vaccination offsite.
    Conclusion: Because only 3% of eligible, high-risk obstetrical patients proceeded with onsite vaccination, our experience suggests that vaccine hesitancy, not availability, is a critical driver of the low vaccination rates in this population. Although a larger sample size may have demonstrated statistical difference, the overall low vaccination uptake rate forced the closure of our pilot program over concerns for wasted vaccination doses. In a population at high risk for progression to severe COVID-19, only 14% of our study population was vaccinated, whereas Missouri reported a 41% vaccination rate during this time.
    MeSH term(s) COVID-19 ; COVID-19 Vaccines ; Female ; Humans ; Pandemics ; Pregnancy ; SARS-CoV-2 ; Vaccination
    Chemical Substances COVID-19 Vaccines ; BNT162 vaccine (N38TVC63NU)
    Language English
    Publishing date 2021-09-02
    Publishing country United States
    Document type Letter
    ISSN 2589-9333
    ISSN (online) 2589-9333
    DOI 10.1016/j.ajogmf.2021.100478
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Administration of the Coronavirus Disease 2019 (COVID-19) Vaccine to Hospitalized Postpartum Patients.

    Perez, Marta J / Paul, Rachel / Hirshberg, Jonathan S / Aibangbee, Erica / Ford, Tiana / Cooke, Emily / Carter, Ebony B / Odibo, Anthony O / Raghuraman, Nandini / Kelly, Jeannie C

    Obstetrics and gynecology

    2021  Volume 138, Issue 6, Page(s) 885–887

    MeSH term(s) Adult ; COVID-19/prevention & control ; COVID-19 Vaccines/administration & dosage ; Cohort Studies ; Female ; Hospitalization ; Humans ; Postpartum Period ; Retrospective Studies
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2021-11-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000004590
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Clinical Diagnosis of Placenta Accreta and Clinicopathological Outcomes.

    Rosenbloom, Joshua I / Hirshberg, Jonathan S / Stout, Molly J / Cahill, Alison G / Macones, George A / Tuuli, Methodius G

    American journal of perinatology

    2018  Volume 36, Issue 2, Page(s) 124–129

    Abstract: Objective: To investigate the association between the intraoperative diagnosis of placenta accreta at the time of cesarean hysterectomy and pathological diagnosis.: Study design: This is a retrospective cohort study of all patients undergoing ... ...

    Abstract Objective: To investigate the association between the intraoperative diagnosis of placenta accreta at the time of cesarean hysterectomy and pathological diagnosis.
    Study design: This is a retrospective cohort study of all patients undergoing cesarean hysterectomy for suspected placenta accreta from 2000 to 2016 at Barnes-Jewish Hospital. The primary outcome was the presence of invasive placentation on the pathology report. We estimated predictive characteristics of clinical diagnosis of placenta accreta using pathological diagnosis as the correct diagnosis.
    Results: There were 50 cesarean hysterectomies performed for suspected abnormal placentation from 2000 to 2016. Of these, 34 (68%) had a diagnosis of accreta preoperatively and 16 (32%) were diagnosed intraoperatively at the time of cesarean delivery. Two patients had no pathological evidence of invasion, corresponding to a false-positive rate of 4% (95% confidence interval [CI]: 0.5%, 13.8%) and a positive predictive value of 96% (95% CI: 86.3%, 99.5%). There were no differences in complications among patients diagnosed intraoperatively compared with those diagnosed preoperatively.
    Conclusion: Most patients undergoing cesarean hysterectomy for placenta accreta do have this diagnosis confirmed on pathology. However, since the diagnosis of placenta accreta was made intraoperatively in nearly a third of cesarean hysterectomies, intraoperative vigilance is required as the need for cesarean hysterectomy may not be anticipated preoperatively.
    MeSH term(s) Adult ; Cesarean Section ; False Positive Reactions ; Female ; Humans ; Hysterectomy ; Intraoperative Period ; Placenta/pathology ; Placenta Accreta/diagnosis ; Placenta Accreta/pathology ; Placentation ; Pregnancy ; Retrospective Studies ; Uterus/pathology
    Language English
    Publishing date 2018-09-07
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/s-0038-1670635
    Database MEDical Literature Analysis and Retrieval System OnLINE

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