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  1. Article ; Online: Telemedicine Applications in Obstetrics and Gynecology.

    Greiner, Andrea L

    Clinical obstetrics and gynecology

    2017  Volume 60, Issue 4, Page(s) 853–866

    Abstract: This article reviews principles to consider when setting up a telemedicine (TM) program to provide care to women in the field of obstetrics and gynecology. There are different types of TM encounters and clinical applications vary widely. The consensus ... ...

    Abstract This article reviews principles to consider when setting up a telemedicine (TM) program to provide care to women in the field of obstetrics and gynecology. There are different types of TM encounters and clinical applications vary widely. The consensus among patients and providers is that TM is convenient to provide needed subspecialty medical care when it is not available locally. These programs are clinically successful, but economic and cost-effectiveness data are lacking. Federal reimbursement policy is limited for TM. State policy on coverage and reimbursement varies significantly from state to state and is the main driver on whether TM programs are successful.
    MeSH term(s) Cost-Benefit Analysis ; Female ; Gynecology/economics ; Gynecology/methods ; Health Services Accessibility/economics ; Humans ; Obstetrics/economics ; Obstetrics/methods ; Pregnancy ; Prenatal Care/economics ; Prenatal Care/methods ; Telemedicine/economics ; Telemedicine/methods
    Language English
    Publishing date 2017-10-09
    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.0000000000000328
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Hemolytic disease of the fetus and newborn in the sensitizing pregnancy where anti-D was incorrectly identified as RhIG.

    Walhof, Mackenzie L / Leon, Judith / Greiner, Andrea L / Scott, James R / Knudson, Charles Michael

    Journal of clinical laboratory analysis

    2022  Volume 36, Issue 4, Page(s) e24323

    Abstract: Background: Hemolytic disease of the fetus and newborn (HDFN) is a potentially fatal complication in Rh-incompatible pregnancies and rarely occurs in the sensitizing pregnancy. Distinguishing RhIG from true anti-D identified is challenging. A case of ... ...

    Abstract Background: Hemolytic disease of the fetus and newborn (HDFN) is a potentially fatal complication in Rh-incompatible pregnancies and rarely occurs in the sensitizing pregnancy. Distinguishing RhIG from true anti-D identified is challenging. A case of severe HDFN in which a sample drawn at 28 weeks showed anti-D antibody (3+ strength) attributed to RhIG is described. RBC antibody testing early in pregnancy was negative. At birth, the infant was severely anemic and maternal anti-D titer was 1:256. This case represents a clinically significant anti-D in the sensitizing pregnancy that was missed due to confusion with RhIG.
    Methods: To determine if agglutination strength could be helpful, a retrospective chart-review using both electronic and paper medical records was performed on 348 samples identified as RhIG and 52 true anti-D samples. The agglutination strength of antibody was recorded for each sample.
    Results: For RhIG, there was an even distribution between the weak to moderate agglutination strength (w+, 1+, and 2+) results (35%, 26%, and 33%, respectively) and just 6% had a 3+ strength. Agglutination strength in patients with high titer (≥1:16) anti-D showed they often (44.4%) have 1+ or 2+ agglutination reactivity.
    Conclusions: These results show that agglutination strength alone does not provide reliable evidence to distinguish RhIG from high titer anti-D antibodies. We recommend that in cases where there is any uncertainty about whether the anti-D reactivity is due to RhIG, titers should be performed to rule out clinically significant anti-D antibody.
    MeSH term(s) Erythroblastosis, Fetal/diagnosis ; Female ; Fetus ; Humans ; Infant, Newborn ; Pregnancy ; Retrospective Studies ; Rho(D) Immune Globulin
    Chemical Substances RHO(D) antibody ; Rho(D) Immune Globulin
    Language English
    Publishing date 2022-03-03
    Publishing country United States
    Document type Case Reports
    ZDB-ID 645095-7
    ISSN 1098-2825 ; 0887-8013
    ISSN (online) 1098-2825
    ISSN 0887-8013
    DOI 10.1002/jcla.24323
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  3. Article ; Online: Breaking bad news to a pregnant woman with a fetal abnormality on ultrasound.

    Greiner, Andrea L / Conklin, Jona

    Obstetrical & gynecological survey

    2015  Volume 70, Issue 1, Page(s) 39–44

    Abstract: Ultrasound is a common procedure performed in pregnancy. Most obstetric patients have an ultrasound between 18 and 20 weeks' gestation. While there is debate regarding the utility of this ultrasound, it has become a routine part of prenatal care. ... ...

    Abstract Ultrasound is a common procedure performed in pregnancy. Most obstetric patients have an ultrasound between 18 and 20 weeks' gestation. While there is debate regarding the utility of this ultrasound, it has become a routine part of prenatal care. Discovery of a fetal anomaly on ultrasound is most commonly an unexpected, emotionally devastating event for pregnant women. Counseling these women about the ultrasound findings requires empathy and sensitivity. This task falls on the physicians caring for pregnant women: maternal-fetal medicine specialists, radiologists, generalist obstetricians, and family medicine physicians. Their training regarding breaking bad news is varied. Therefore, the purpose of this article is to provide a framework to break bad news of an anomalous fetus for physicians caring for pregnant women using the SPIKES protocol. The SPIKES acronym stands for setting, perception, invitation, knowledge, empathize, summary, and strategy.
    MeSH term(s) Adolescent ; Adult ; Clinical Protocols ; Communication Barriers ; Congenital Abnormalities/diagnostic imaging ; Congenital Abnormalities/psychology ; Counseling/methods ; Empathy ; Female ; General Practice ; Gynecology ; Humans ; Intellectual Disability ; Obstetrics ; Perception ; Pregnancy ; Pregnancy in Adolescence ; Pregnant Women/psychology ; Truth Disclosure ; Ultrasonics ; Ultrasonography, Prenatal/psychology
    Language English
    Publishing date 2015-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 391345-4
    ISSN 1533-9866 ; 0029-7828
    ISSN (online) 1533-9866
    ISSN 0029-7828
    DOI 10.1097/OGX.0000000000000149
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Early pregnancy prediction of gestational diabetes mellitus risk using prenatal screening biomarkers in nulliparous women.

    Snyder, Brittney M / Baer, Rebecca J / Oltman, Scott P / Robinson, Jennifer G / Breheny, Patrick J / Saftlas, Audrey F / Bao, Wei / Greiner, Andrea L / Carter, Knute D / Rand, Larry / Jelliffe-Pawlowski, Laura L / Ryckman, Kelli K

    Diabetes research and clinical practice

    2020  Volume 163, Page(s) 108139

    Abstract: Aims: To evaluate the clinical utility of first and second trimester prenatal screening biomarkers for early pregnancy prediction of gestational diabetes mellitus (GDM) risk in nulliparous women.: Methods: We conducted a population-based cohort study ...

    Abstract Aims: To evaluate the clinical utility of first and second trimester prenatal screening biomarkers for early pregnancy prediction of gestational diabetes mellitus (GDM) risk in nulliparous women.
    Methods: We conducted a population-based cohort study of nulliparous women participating in the California Prenatal Screening Program from 2009 to 2011 (n = 105,379). GDM was ascertained from hospital discharge records or birth certificates. Models including maternal characteristics and prenatal screening biomarkers were developed and validated. Risk stratification and reclassification were performed to assess clinical utility of the biomarkers.
    Results: Decreased levels of first trimester pregnancy-associated plasma protein A (PAPP-A) and increased levels of second trimester unconjugated estriol (uE
    Conclusions: PAPP-A, uE
    MeSH term(s) Adult ; Biomarkers/blood ; Cohort Studies ; Diabetes, Gestational/diagnosis ; Female ; Humans ; Pregnancy ; Prenatal Diagnosis/methods
    Chemical Substances Biomarkers
    Language English
    Publishing date 2020-04-06
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 632523-3
    ISSN 1872-8227 ; 0168-8227
    ISSN (online) 1872-8227
    ISSN 0168-8227
    DOI 10.1016/j.diabres.2020.108139
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    Zs.A 2047: Show issues Location:
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  5. Article ; Online: Delivery outcomes in the subsequent pregnancy following the conservative management of placenta accreta spectrum disorder: a systematic review and meta-analysis.

    Javinani, Ali / Qaderi, Shohra / Hessami, Kamran / Shainker, Scott A / Shamshirsaz, Amir A / Fox, Karin A / Mustafa, Hiba J / Subramaniam, Akila / Khandelwal, Meena / Sandlin, Adam T / Duzyj, Christina M / Lyell, Deirdre J / Zuckerwise, Lisa C / Newton, J M / Kingdom, John C / Harrison, Rachel K / Shrivastava, Vineet K / Greiner, Andrea L / Loftin, Ryan /
    Genc, Mehmet R / Atasi, Lamia K / Abdel-Razeq, Sonya S / Bennett, Kelly A / Carusi, Daniela A / Einerson, Brett D / Gilner, Jennifer B / Carver, Alissa R / Silver, Robert M / Shamshirsaz, Alireza A

    American journal of obstetrics and gynecology

    2023  Volume 230, Issue 5, Page(s) 485–492.e7

    Abstract: Objective: Cesarean hysterectomy is generally presumed to decrease maternal morbidity and mortality secondary to placenta accreta spectrum disorder. Recently, uterine-sparing techniques have been introduced in conservative management of placenta accreta ...

    Abstract Objective: Cesarean hysterectomy is generally presumed to decrease maternal morbidity and mortality secondary to placenta accreta spectrum disorder. Recently, uterine-sparing techniques have been introduced in conservative management of placenta accreta spectrum disorder to preserve fertility and potentially reduce surgical complications. However, despite patients often expressing the intention for future conception, few data are available regarding the subsequent pregnancy outcomes after conservative management of placenta accreta spectrum disorder. Thus, we aimed to perform a systematic review and meta-analysis to assess these outcomes.
    Data sources: PubMed, Scopus, and Web of Science databases were searched from inception to September 2022.
    Study eligibility criteria: We included all studies, with the exception of case studies, that reported the first subsequent pregnancy outcomes in individuals with a history of placenta accreta spectrum disorder who underwent any type of conservative management.
    Methods: The R programming language with the "meta" package was used. The random-effects model and inverse variance method were used to pool the proportion of pregnancy outcomes.
    Results: We identified 5 studies involving 1458 participants that were eligible for quantitative synthesis. The type of conservative management included placenta left in situ (n=1) and resection surgery (n=1), and was not reported in 3 studies. The rate of placenta accreta spectrum disorder recurrence in the subsequent pregnancy was 11.8% (95% confidence interval, 1.1-60.3; I
    Conclusion: Favorable pregnancy outcome is possible following successful conservation of the uterus in a placenta accreta spectrum disorder pregnancy. Approximately 1 out of 4 subsequent pregnancies following conservative management of placenta accreta spectrum disorder had considerable adverse maternal outcomes. Given such high incidence of adverse outcomes and morbidity, patient and provider preparation is vital when managing this population.
    MeSH term(s) Humans ; Placenta Accreta/therapy ; Placenta Accreta/surgery ; Female ; Pregnancy ; Conservative Treatment ; Hysterectomy ; Cesarean Section ; Pregnancy Outcome ; Organ Sparing Treatments ; Recurrence
    Language English
    Publishing date 2023-11-02
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Meta-Analysis ; Review
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2023.10.047
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  6. Article ; Online: Development and validation of a clinical model for preconception and early pregnancy risk prediction of gestational diabetes mellitus in nulliparous women.

    Donovan, Brittney M / Breheny, Patrick J / Robinson, Jennifer G / Baer, Rebecca J / Saftlas, Audrey F / Bao, Wei / Greiner, Andrea L / Carter, Knute D / Oltman, Scott P / Rand, Larry / Jelliffe-Pawlowski, Laura L / Ryckman, Kelli K

    PloS one

    2019  Volume 14, Issue 4, Page(s) e0215173

    Abstract: Implementation of dietary and lifestyle interventions prior to and early in pregnancy in high risk women has been shown to reduce the risk of gestational diabetes mellitus (GDM) development later in pregnancy. Although numerous risk factors for GDM have ... ...

    Abstract Implementation of dietary and lifestyle interventions prior to and early in pregnancy in high risk women has been shown to reduce the risk of gestational diabetes mellitus (GDM) development later in pregnancy. Although numerous risk factors for GDM have been identified, the ability to accurately identify women before or early in pregnancy who could benefit most from these interventions remains limited. As nulliparous women are an under-screened population with risk profiles that differ from their multiparous counterparts, development of a prediction model tailored to nulliparous women may facilitate timely preventive intervention and improve maternal and infant outcomes. We aimed to develop and validate a model for preconception and early pregnancy prediction of gestational diabetes mellitus based on clinical risk factors for nulliparous women. A risk prediction model was built within a large California birth cohort including singleton live birth records from 2007-2012. Model accuracy was assessed both internally and externally, within a cohort of women who delivered at University of Iowa Hospitals and Clinics between 2009-2017, using discrimination and calibration. Differences in predictive accuracy of the model were assessed within specific racial/ethnic groups. The prediction model included five risk factors: race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension. The area under the curve (AUC) for the California internal validation cohort was 0.732 (95% confidence interval (CI) 0.728, 0.735), and 0.710 (95% CI 0.672, 0.749) for the Iowa external validation cohort. The model performed particularly well in Hispanic (AUC 0.739) and Black women (AUC 0.719). Our findings suggest that estimation of a woman's risk for GDM through model-based incorporation of risk factors accurately identifies those at high risk (i.e., predicted risk >6%) who could benefit from preventive intervention encouraging prompt incorporation of this tool into preconception and prenatal care.
    MeSH term(s) Adolescent ; Adult ; Body Mass Index ; California/epidemiology ; Cohort Studies ; Continental Population Groups ; Diabetes, Gestational/epidemiology ; Diabetes, Gestational/prevention & control ; Ethnic Groups ; Female ; Humans ; Infant, Newborn ; Male ; Middle Aged ; Models, Biological ; Parity ; Preconception Care ; Pregnancy ; Pregnancy Outcome ; Risk Assessment ; Risk Factors ; Young Adult
    Language English
    Publishing date 2019-04-12
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Validation Study
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0215173
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