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  1. Article ; Online: In Reply.

    Heyborne, Kent

    Obstetrics and gynecology

    2024  Volume 143, Issue 2, Page(s) e22–e23

    Language English
    Publishing date 2024-01-18
    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.0000000000005484
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  2. Article ; Online: Reassessing Preterm Birth Prevention After the Withdrawal of 17-α Hydroxyprogesterone Caproate.

    Heyborne, Kent

    Obstetrics and gynecology

    2023  Volume 142, Issue 3, Page(s) 493–501

    Abstract: The U.S. Food and Drug Administration has recently withdrawn approval for 17-α hydroxyprogesterone caproate for prevention of recurrent preterm birth, and recent studies have called into question benefits of the pessary in the setting of a short cervix. ... ...

    Abstract The U.S. Food and Drug Administration has recently withdrawn approval for 17-α hydroxyprogesterone caproate for prevention of recurrent preterm birth, and recent studies have called into question benefits of the pessary in the setting of a short cervix. Obstetric health care professionals are once again left with limited remaining options for preterm birth prevention. This narrative review summarizes the best current evidence on the use of vaginal progesterone, low-dose aspirin, and cerclage for the prevention of preterm birth; attempts to distill possible lessons learned from studies of progesterone and pessary, as well as their implementation into practice; and highlights areas where inroads into preterm birth prevention may be possible outside of the progesterone-aspirin-cerclage paradigm.
    MeSH term(s) Pregnancy ; Female ; Infant, Newborn ; Humans ; 17 alpha-Hydroxyprogesterone Caproate ; Progesterone ; Premature Birth/prevention & control ; Administration, Intravaginal
    Chemical Substances 17 alpha-Hydroxyprogesterone Caproate (276F2O42F5) ; Progesterone (4G7DS2Q64Y)
    Language English
    Publishing date 2023-07-13
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005290
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  3. Article ; Online: Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa: A Systematic Review.

    Heyborne, Kent

    Obstetrics and gynecology

    2023  Volume 142, Issue 3, Page(s) 519–528

    Abstract: Objective: To determine the causes and potential preventability of perinatal deaths in prenatally identified cases of vasa previa.: Data sources: Reports of prenatally identified cases of vasa previa published in the English language literature since ...

    Abstract Objective: To determine the causes and potential preventability of perinatal deaths in prenatally identified cases of vasa previa.
    Data sources: Reports of prenatally identified cases of vasa previa published in the English language literature since 2000 were identified in Medline and ClinicalTrials.gov with the search terms "vasa previa," "abnormal cord insertion," "velamentous cord," "marginal cord," "bilobed placenta," and "succenturiate lobe."
    Methods of study selection: All cases from the above search with an antenatally diagnosed vasa previa present at delivery in singleton or twin gestations with perinatal mortality information were included.
    Tabulation, integration, and results: Cases meeting inclusion criteria were manually abstracted, and multiple antenatal, intrapartum, and outcome variables were recorded. Deaths and cases requiring neonatal transfusion were analyzed in relation to plurality, routine hospitalization, and cervical length monitoring. A total of 1,109 prenatally diagnosed cases (1,000 singletons, 109 twins) were identified with a perinatal mortality rate attributable to vasa previa of 1.1% (95% CI 0.6-1.9%). All perinatal deaths occurred with unscheduled deliveries. The perinatal mortality rate in twin pregnancies was markedly higher than that in singleton pregnancies (9.2% vs 0.2%, P <.001), accounting for 80% of overall mortality despite encompassing only 9.8% of births. Compared with individuals with singleton pregnancies, those with twin pregnancies are more likely to undergo unscheduled delivery (56.4% vs 35.1%, P =.01) despite delivering 2 weeks earlier (33.2 weeks vs 35.1 weeks, P =.006). An institutional policy of routine hospitalization is associated with a reduced need for neonatal transfusion (0.9% vs 6.0%, P <.001) and a reduction in the perinatal mortality rate in twin pregnancies (0% vs 25%, P =.002) but not in singleton pregnancies (0% vs 0.5%, P =.31).
    Conclusion: Routine hospitalization and earlier delivery of twins may result in a reduction in the perinatal mortality rate. A smaller benefit from routine admission of individuals with singleton pregnancies cannot be excluded. There is currently insufficient evidence to recommend the routine use of cervical length measurements to guide clinical management.
    MeSH term(s) Infant, Newborn ; Pregnancy ; Female ; Humans ; Vasa Previa/diagnostic imaging ; Vasa Previa/epidemiology ; Perinatal Death ; Perinatal Mortality ; Retrospective Studies ; Prenatal Diagnosis ; Pregnancy, Twin ; Ultrasonography, Prenatal
    Language English
    Publishing date 2023-08-02
    Publishing country United States
    Document type Systematic Review ; Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005296
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  4. Article ; Online: Intrapartum head compression does not equate to increased intracranial pressure.

    Heyborne, Kent D

    American journal of obstetrics and gynecology

    2023  Volume 229, Issue 6, Page(s) 702

    MeSH term(s) Pregnancy ; Female ; Humans ; Intracranial Pressure ; Parturition ; Pressure
    Language English
    Publishing date 2023-07-10
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2023.07.007
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  5. Article ; Online: Risk of Adverse Pregnancy Outcomes Among US Individuals With Gestational Diabetes by Race and Ethnicity.

    Heyborne, Kent / Barbour, Linda

    JAMA

    2022  Volume 328, Issue 4, Page(s) 396–397

    MeSH term(s) Diabetes, Gestational/epidemiology ; Diabetes, Gestational/ethnology ; Ethnicity/statistics & numerical data ; Female ; Hispanic or Latino/statistics & numerical data ; Humans ; Pregnancy/statistics & numerical data ; Pregnancy Outcome/epidemiology ; Pregnancy Outcome/ethnology ; Racial Groups/statistics & numerical data ; Risk ; United States/epidemiology ; Whites/statistics & numerical data
    Language English
    Publishing date 2022-05-20
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2022.9409
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  6. Article ; Online: Changes in metabolic acidosis following birth in intensive care unit neonates.

    Simon, Natalie T / Hagan, Patricia M / Rockhill, Karilynn M / Heyborne, Kent D

    European journal of obstetrics, gynecology, and reproductive biology

    2024  Volume 297, Page(s) 161–168

    Abstract: Background: Little is known about how and why metabolic acidosis changes within the first six hours of life in intensive care unit neonates.: Objective: To determine changes in pH and base excess between paired umbilical cord arterial and neonatal ... ...

    Abstract Background: Little is known about how and why metabolic acidosis changes within the first six hours of life in intensive care unit neonates.
    Objective: To determine changes in pH and base excess between paired umbilical cord arterial and neonatal arterial blood samples during the first 6 h of life, to identify factors associated with the direction and magnitude of change, and to examine morbidity and mortality in newborns with acidosis at birth or as neonates.
    Study design: Retrospective cohort study of all deliveries from a single institution between 2016-2020 with paired umbilical cord arterial and neonatal arterial samples obtained within 6 h of life meeting rigorous criteria to ensure sample integrity. The primary outcomes were the direction and magnitude of change of pH and base excess. Multiple factors were assessed for possible correlation with pH and base excess change. The secondary outcome was the association between a composite outcome of death or cerebral palsy and pathologic acidosis (pH ≤ 7.1) at birth or as a neonate.
    Results: 102 patients met inclusion criteria. Newborn arterial gasses were obtained at a median of 1.5 h (74 % < 2 h). pH improved in 71 % of cases and worsened in 29 %, and base excess improved in 52 % and worsened in 48 %, with wide observed ranges in both parameters. The paired pH and base excess values were moderately (r = 0.38) and strongly (r = 0.63) positively correlated, respectively, but were not correlated with time since birth (r = 0.14). Low birth weight, prematurity or respiratory failure were associated with worsening or less improvement, while worse initial acidosis was associated with greater improvement. Death or survival with cerebral palsy was more common with pathologic acidosis in either cord or newborn sample as compared with those without acidosis (27.3 % vs 3.7 %, p = 0.003), and was more common in those with isolated neonatal acidosis as compared to those without acidosis (50 % vs 3.7 %, p = 0.016).
    Conclusions: Changes in pH and base excess occurred over a wide range between delivery and the first newborn blood gas in the first 6 h of life, and we identified several factors associated with direction of change. Metabolic acidosis at birth cannot reliably be inferred from neonatal arterial values. Neonatal acidosis, including acidosis following a normal pH and base excess at birth, was associated with morbidity and mortality.
    MeSH term(s) Humans ; Infant, Newborn ; Acidosis/blood ; Acidosis/epidemiology ; Retrospective Studies ; Female ; Intensive Care Units, Neonatal/statistics & numerical data ; Male ; Hydrogen-Ion Concentration ; Fetal Blood/chemistry ; Umbilical Arteries
    Language English
    Publishing date 2024-04-20
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 190605-7
    ISSN 1872-7654 ; 0301-2115 ; 0028-2243
    ISSN (online) 1872-7654
    ISSN 0301-2115 ; 0028-2243
    DOI 10.1016/j.ejogrb.2024.04.025
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  7. Article: A Systematic Review of Intrapartum Fetal Head Compression: What Is the Impact on the Fetal Brain?

    Heyborne, Kent D

    AJP reports

    2017  Volume 7, Issue 2, Page(s) e79–e85

    Abstract: ... ...

    Abstract Objective
    Language English
    Publishing date 2017-04-18
    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/s-0037-1602658
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  8. Article ; Online: Fetal fibronectin testing in threatened preterm labor: time for more study!

    Heyborne, Kent D

    American journal of obstetrics and gynecology

    2017  Volume 217, Issue 1, Page(s) 94

    Language English
    Publishing date 2017-07
    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.2017.03.026
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  9. Article ; Online: Repeat anatomic surveys performed for an initial incomplete study: the sonographer and physician factors.

    Lendrum, Taylor L / Shaffer, Robyn K / Heyborne, Kent D

    American journal of obstetrics & gynecology MFM

    2022  Volume 4, Issue 3, Page(s) 100567

    Abstract: Background: Repeat obstetrical anatomic surveys are often performed because of incomplete initial studies despite conflicting evidence on their utility.: Objective: To determine the frequency and yield of repeat obstetrical anatomic surveys performed ...

    Abstract Background: Repeat obstetrical anatomic surveys are often performed because of incomplete initial studies despite conflicting evidence on their utility.
    Objective: To determine the frequency and yield of repeat obstetrical anatomic surveys performed because of incomplete initial studies and to determine patient and provider factors associated with the recommendation for a second study.
    Study design: A 10-year retrospective cohort study of women having an initial anatomic survey at 18 weeks to 21 weeks and 6/7 days of gestation at a single nonreferral county hospital. We identified the number of patients needed to scan to detect an anatomic abnormality for the overall cohort and for women having a repeat study. Select patient, sonographer, and reading physician factors were compared between the repeat-ultrasound and no-repeat-ultrasound groups by the 2-sample t test, chi-squared analysis, or analysis of variance, as appropriate. Multivariate logistic regression was used to assess the significance of multiple factors contributing to the recommendation for repeat ultrasounds.
    Results: A total of 18,911 women had an initial anatomic survey between 18 weeks and 21 weeks and 6/7 days of gestation, and 2310 (12.2%) had a repeat ultrasound because of an incomplete initial study. For the overall cohort, there were 642 structural anomalies detected, with the number of patients needed to scan being 29. Among the 2310 repeat ultrasounds, only 7 structural anomalies were detected, whereas the number of patients needed to scan was 330, representing only 1.1% of all prenatally-identified anomalies. The frequency of recommended repeat ultrasounds varied by performing sonographer (4.5%-45.8%) and reading physician (7.1%-21.6%), both with P<.001 by 1-way analysis of variance. Clinical factors significantly impacting the odds of repeat ultrasounds included body mass index, gestational age, and previous cesarean delivery, but were less impactful than the sonographer and physician.
    Conclusion: The primary determinants of the perceived need for a repeat ultrasound are the sonographer and physician reader, with clinical factors having less but still significant importance. Repeat anatomic surveys account for a significant fraction of our total anatomic surveys and are of limited diagnostic utility. Recommendation of repeat anatomic surveys should be considered within the context of these findings.
    MeSH term(s) Body Mass Index ; Female ; Gestational Age ; Humans ; Male ; Physicians ; Pregnancy ; Retrospective Studies ; Ultrasonography, Prenatal
    Language English
    Publishing date 2022-01-25
    Publishing country United States
    Document type Journal Article
    ISSN 2589-9333
    ISSN (online) 2589-9333
    DOI 10.1016/j.ajogmf.2022.100567
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  10. Article ; Online: 17-α Hydroxyprogesterone Caproate for the Prevention of Recurrent Preterm Birth: One Size May Not Fit All.

    Heyborne, Kent D

    Obstetrics and gynecology

    2016  Volume 128, Issue 4, Page(s) 899–903

    Abstract: Spontaneous preterm birth is a syndrome with many causes and thus unresponsive to a single intervention. It logically follows that patients with a prior spontaneous preterm birth are a heterogeneous group unlikely to respond equally to a single ... ...

    Abstract Spontaneous preterm birth is a syndrome with many causes and thus unresponsive to a single intervention. It logically follows that patients with a prior spontaneous preterm birth are a heterogeneous group unlikely to respond equally to a single preventive intervention such as 17-α hydroxyprogesterone caproate. Further confounding this issue is our fundamental lack of knowledge about the mechanism(s) by which 17-α hydroxyprogesterone caproate reduces preterm birth. Recently, studies demonstrating that responders and nonresponders can be identified based on obstetric history, genotype, physical characteristics, and behavioral factors have begun to provide clues into both 17-α hydroxyprogesterone caproate's mechanism and the pathophysiology of recurrent preterm birth and may allow for more targeted therapy. These studies lend support to speculation that inflammation or nitric oxide metabolism may be common threads between 17-α hydroxyprogesterone caproate's mechanism and preterm birth prevention. It will remain critically important to avoid the temptation to regard prior spontaneous preterm birth as a single disease entity amenable to a single treatment.
    MeSH term(s) 17 alpha-Hydroxyprogesterone Caproate ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Humans ; Hydroxyprogesterones/administration & dosage ; Hydroxyprogesterones/therapeutic use ; Obstetrics ; Practice Patterns, Physicians' ; Pregnancy ; Pregnancy Trimester, Second ; Premature Birth/prevention & control ; Prenatal Care ; United States
    Chemical Substances Hydroxyprogesterones ; 17 alpha-Hydroxyprogesterone Caproate (276F2O42F5)
    Language English
    Publishing date 2016-05-20
    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.0000000000001618
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