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Article ; Online: Complications of lymphangioleiomyomatosis in pregnancy: a case report and review of the literature.

Wang-Koehler, Eileen / Kern-Goldberger, Adina R / Srinivas, Sindhu K

AJOG global reports

2024 Volume 4, Issue 1, Page(s) 100309

Abstract: Lymphangioleiomyomatosis is a rare cystic lung disease primarily affecting premenopausal females and may be exacerbated by pregnancy. We conducted a literature review of lymphangioleiomyomatosis during pregnancy with a specific focus on related maternal ... ...

Abstract	Lymphangioleiomyomatosis is a rare cystic lung disease primarily affecting premenopausal females and may be exacerbated by pregnancy. We conducted a literature review of lymphangioleiomyomatosis during pregnancy with a specific focus on related maternal morbidity and obstetrical outcomes. We also report a case of lymphangioleiomyomatosis that presented as an acute spontaneous pneumothorax in the third trimester of pregnancy, followed by significant maternal morbidity. A 37-year-old primigravid woman who presented at 29 weeks 5 days gestation with chest pain was diagnosed with spontaneous pneumothorax. Further imaging demonstrated cystic lung lesions and renal angiomyolipomas. She developed severe abdominal pain concerning for placental abruption that led to an urgent cesarean delivery at 30 weeks 2 days gestation. Her course was complicated by recurrent pneumothorax, superimposed preeclampsia, and significant ileus and bowel dilation complicated by bowel perforation. For patients with a clinical suspicion of lymphangioleiomyomatosis in pregnancy, prompt recognition, diagnosis, and referral to appropriate multidisciplinary subspecialists is critical to mitigate complications and optimize outcomes both during and after pregnancy.
Language	English
Publishing date	2024-01-10
Publishing country	United States
Document type	Case Reports
ISSN	2666-5778
ISSN (online)	2666-5778
DOI	10.1016/j.xagr.2024.100309
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Variation as Evidence of Preventability: Research and Policy Implications of State Differences in Severe Maternal Morbidity Rates.

Kern-Goldberger, Adina R / Srinivas, Sindhu K

Obstetrics and gynecology

2023 Volume 141, Issue 5, Page(s) 875–876

MeSH term(s)	Pregnancy ; Humans ; Female ; Pregnancy Complications/epidemiology ; Pregnancy Complications/prevention & control ; Morbidity ; Maternal Mortality
Language	English
Publishing date	2023-04-05
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000005162
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Article ; Online: Society for Maternal-Fetal Medicine Special Statement: Utilizing telemedicine to address disparities in maternal-fetal medicine: a call to policy action.

Kern-Goldberger, Adina R / Malhotra, Tani / Zera, Chloe A

American journal of obstetrics and gynecology

2023 Volume 230, Issue 5, Page(s) B6–B11

Abstract: The combination of deserts in maternal-fetal medicine coverage across the United States and the COVID-19 pandemic accelerated the implementation of telemedicine programs for maternal-fetal medicine care delivery. Although telemedicine-based care has the ... ...

Abstract	The combination of deserts in maternal-fetal medicine coverage across the United States and the COVID-19 pandemic accelerated the implementation of telemedicine programs for maternal-fetal medicine care delivery. Although telemedicine-based care has the potential to facilitate timely access to maternal-fetal medicine services, which can improve maternal and neonatal outcomes, telemedicine is a relatively novel healthcare modality that needs to be implemented strategically. As with any medical service, telemedicine care requires rigorous evaluation to assess outcomes and ensure quality. Important health policy considerations, including access to services and insurance coverage, have substantial implications for equity in the implementation of telemedicine, particularly for reproductive healthcare following the 2022 United States Supreme Court decision in Dobbs v Jackson Women's Health Organization that overturned the constitutional right to an abortion. Investing resources and advocating for a rigorous, widely accessible telemedicine infrastructure at this crucial moment will establish an important foundation for more equitable pregnancy care. Key advocacy priorities for maternal-fetal medicine telemedicine include (1) expanding insurance coverage of telemedicine across payers, regardless of geographic location; (2) advocating for interstate licensure parity; (3) increasing access to affordable Internet and digital literacy training; and (4) ensuring access to reproductive healthcare, including abortion care, delivered via telemedicine.
MeSH term(s)	Humans ; Telemedicine/legislation & jurisprudence ; Female ; Pregnancy ; Healthcare Disparities ; United States ; Health Services Accessibility ; Health Policy ; COVID-19/epidemiology ; Obstetrics ; Insurance Coverage ; Societies, Medical ; SARS-CoV-2 ; Maternal Health Services
Language	English
Publishing date	2023-11-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2023.11.001
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Article: Maternal and Neonatal Morbidities by Race in College-Educated Women.

Kern-Goldberger, Adina R / Madden, Nigel / Baptiste, Caitlin / Friedman, Alexander / Gyamfi-Bannerman, Cynthia

AJP reports

2024 Volume 14, Issue 1, Page(s) e57–e61

Abstract: ... ...

Abstract	Objective
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2628074-7
ISSN	2157-7005 ; 2157-6998
ISSN (online)	2157-7005
ISSN	2157-6998
DOI	10.1055/s-0043-1778000
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Article ; Online: Risk Factors and Risk for Severe Maternal Morbidity in Severe Preeclampsia Complicated by Pulmonary Edema: A Case-Control Study.

Amin, Bushra Z / Kern-Goldberger, Adina R / Srinivas, Sindhu K

American journal of perinatology

2023

Abstract: Objective: The objective of this study is to examine risk factors and adverse outcomes related to preeclampsia with severe features complicated by pulmonary edema.: Study design: This is a nested case-control study of all patients with preeclampsia ...

Abstract	Objective: The objective of this study is to examine risk factors and adverse outcomes related to preeclampsia with severe features complicated by pulmonary edema. Study design: This is a nested case-control study of all patients with preeclampsia with severe features who delivered in a tertiary, urban, academic medical center over a 1-year period. The primary exposure was pulmonary edema and the primary outcome was a composite of severe maternal morbidity (SMM), defined according to the Centers for Disease Control and Prevention and based on International Classification of Diseases, 10th revision, Clinical Modification codes. Secondary outcomes included postpartum length of stay, maternal intensive care unit admission, 30-day readmission, and discharge on antihypertensive medication. A multivariable logistic regression model adjusting for clinical characteristics related to the primary outcome was used to determine adjusted odds ratios (aOR) as measures of effect. Results: Of 340 patients with severe preeclampsia, there were seven cases of pulmonary edema (2.1%). Pulmonary edema was associated with lower parity, autoimmune disease, earlier gestational age at diagnosis of preeclampsia and at delivery, and cesarean section. Patients with pulmonary edema demonstrated increased odds of SMM (aOR: 10.11, 95% confidence interval [CI]: 2.13-47.90), extended postpartum length of stay (aOR: 32.56, 95% CI: 3.95-268.45), and intensive care unit admission (aOR: 102.85, 95% CI: 7.43-1422.92) compared with those without pulmonary edema. Conclusion: Pulmonary edema is associated with adverse maternal outcomes among patients with severe preeclampsia, and is more likely to affect patients who are nulliparous, have an autoimmune disease, and are diagnosed preterm. Key points: · Pulmonary edema increases odds of severe maternal morbidity in preeclamptics.. · Pulmonary edema prolongs postpartum and intensive care unit stay in preeclamptics.. · Risk factors for pulmonary edema include nulliparity and autoimmune disease.. · Earlier diagnosis of severe preeclampsia increases risk of pulmonary edema..
Language	English
Publishing date	2023-06-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/a-2097-1212
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Article ; Online: Obstetrical Telehealth and Virtual Care Practices During the COVID-19 Pandemic.

Kern-Goldberger, Adina R / Srinivas, Sindhu K

Clinical obstetrics and gynecology

2022 Volume 65, Issue 1, Page(s) 148–160

Abstract: The coincidence of a global pandemic with 21st-century telecommunication technology has led to rapid deployment of virtual obstetric care beginning in March of 2020. Pregnancy involves uniquely time-sensitive health care that may be amenable to ... ...

Abstract	The coincidence of a global pandemic with 21st-century telecommunication technology has led to rapid deployment of virtual obstetric care beginning in March of 2020. Pregnancy involves uniquely time-sensitive health care that may be amenable to restructuring into a hybrid of telemedicine and traditional visits to optimize accessibility and outcomes. The coronavirus disease 2019 pandemic has provided an unprecedented natural laboratory to explore how virtual obstetric care programs can be developed, implemented, and maintained, both as a contingency model for the pandemic and potentially for the future. Here, we discuss the role of telehealth and virtual care for pregnancy management in the coronavirus disease 2019 pandemic, as well as anticipated barriers, challenges, and strategies for success for obstetric telemedicine.
MeSH term(s)	COVID-19 ; Delivery of Health Care ; Humans ; Pandemics/prevention & control ; SARS-CoV-2 ; Telemedicine
Language	English
Publishing date	2022-02-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	391207-3
ISSN	1532-5520 ; 0009-9201
ISSN (online)	1532-5520
ISSN	0009-9201
DOI	10.1097/GRF.0000000000000671
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Article ; Online: The impact of an intervention to improve intrapartum maternal vital sign monitoring and reduce alarm fatigue.

Kern-Goldberger, Adina R / Nicholls, Erika M / Plastino, Natalie / Srinivas, Sindhu K

American journal of obstetrics & gynecology MFM

2023 Volume 5, Issue 5, Page(s) 100893

Abstract: Background: The infrastructure of many labor and delivery units in the United States may dispose clinicians to overuse continuous and automated maternal physiological monitors. Overmonitoring low-risk patients can negatively affect patient care, ... ...

Abstract	Background: The infrastructure of many labor and delivery units in the United States may dispose clinicians to overuse continuous and automated maternal physiological monitors. Overmonitoring low-risk patients can negatively affect patient care, primarily through generating alarm fatigue. Objective: Given the national attention to reducing alarm fatigue across healthcare settings and the concern for vital sign monitoring overuse on our labor and delivery unit, this quality improvement study aimed to evaluate vital sign monitoring patterns and alarm rates, and nursing experiences of alarm fatigue, before and after implementing a vital sign monitoring guideline for low-risk obstetrical patients. Study design: This was a quality improvement study conducted on the labor and delivery unit of an urban, academic, tertiary hospital. The lack of guidance for maternal vital sign assessment in low-risk patients was identified as a potential safety challenge. A vital sign guideline was developed with multidisciplinary input, followed by a pre-post-implementation study evaluating vital sign volume and alarm rates. Total vital signs and alarm rates for all patients delivered during designated calendar days were assessed as a rate of vital signs per patient and compared across baseline, peri-intervention, and follow-up periods. Data were examined in p-type statistical process control charts and with time-series analysis. Patient characteristics and severe maternal morbidity, as a balancing metric, were compared across periods. Nursing perceptions of vital sign monitoring and experience of alarm fatigue were assessed via survey before and after implementation of the guideline. Results: A total of 35 individual 24-hour periods were evaluated with regard to vital sign and alarm volume. There was a decrease in vital signs per patient from a mean of 208.34 to 135.46 (incidence rate ratio, 0.65) and in alarms per patient from a mean of 14.31 to 10.51 (incidence rate ratio, 0.73) after implementation, with no difference in severe maternal morbidity. There were 85 total respondents to the nursing surveys, and comparison of modified task-load index scores before and after implementation demonstrated overall lower scores in the postperiod, although these were not statistically significant. Conclusion: Introducing a maternal vital sign guideline for low-risk patients on the labor and delivery unit decreased vital signs measured as well as alarms, which may ultimately reduce alarm fatigue. This strategy should be considered on labor and delivery units widely to improve patient safety and optimize outcomes.
MeSH term(s)	Humans ; Monitoring, Physiologic ; Clinical Alarms ; Vital Signs ; Patient Safety ; Quality Improvement
Language	English
Publishing date	2023-02-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2023.100893
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Article ; Online: What we talk about when we talk about severe maternal morbidity: a call to action to critically review severe maternal morbidity as an outcome measure.

Kern-Goldberger, Adina R / Howell, Elizabeth A / Srinivas, Sindhu K / Levine, Lisa D

American journal of obstetrics & gynecology MFM

2023 Volume 5, Issue 5, Page(s) 100882

Abstract: Severe maternal morbidity has historically functioned as an umbrella term to define major, potentially life-threatening obstetrical, medical, and surgical complications of pregnancy. There is no overarching or consensus definition of the constellation of ...

Abstract	Severe maternal morbidity has historically functioned as an umbrella term to define major, potentially life-threatening obstetrical, medical, and surgical complications of pregnancy. There is no overarching or consensus definition of the constellation of conditions that have been used variably to define severe maternal morbidity, although it is clear that having a well-honed definition of severe maternal morbidity is important for research, quality improvement, and health policy purposes. Although severe maternal morbidity may ultimately elude a single unifying definition because different features may be relevant depending on context and modality of data acquisition, it is valuable to explore the intellectual frameworks and various applications of severe maternal morbidity in current practice, and to consider the potential benefit of more consolidated terminology for maternal morbidity.
MeSH term(s)	Pregnancy ; Female ; Humans ; Quality Improvement ; Outcome Assessment, Health Care
Language	English
Publishing date	2023-02-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2023.100882
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Article ; Online: The impact of double-blind peer review on gender bias in scientific publishing: a systematic review.

Kern-Goldberger, Adina R / James, Richard / Berghella, Vincenzo / Miller, Emily S

American journal of obstetrics and gynecology

2022 Volume 227, Issue 1, Page(s) 43–50.e4

Abstract: Objective: Gender-based bias during journal peer review can lead to publication biases and perpetuate gender inequality in science. Double-blind peer review, in which the names of authors and reviewers are masked, may present an opportunity for ... ...

Abstract	Objective: Gender-based bias during journal peer review can lead to publication biases and perpetuate gender inequality in science. Double-blind peer review, in which the names of authors and reviewers are masked, may present an opportunity for scientific literature to increase equity and reduce gender-based biases. This systematic review of studies evaluates the impact of double-blind vs single-blind peer review on the publication rates by perceived author gender. Data sources: The PubMed, Embase, Web of Science, and Scopus electronic databases were searched using the terms "blind," "peer review," "gender," "woman," and "author." All published literature in the English language from database inception through 2020 was queried. Study eligibility criteria: Prospective experimental and observational studies comparing double-blind to single-blind peer review strategies examining impact on publication decisions by author gender were included. Study appraisal and synthesis methods: The extracted data were primarily descriptive and included information on study design, sample size, primary outcome, major findings, and scientific discipline. The studies were characterized on the basis of design and whether the results demonstrated an impact of double-blind peer review on review scores and publication decision by perceived author gender. This study was registered with the International Prospective Register of Systematic Reviews or PROSPERO. Results: In total, 1717 articles were identified, 123 were reviewed, and 8 were included, encompassing 5 prospective experimental studies and 3 observational studies. Four studies demonstrated a difference in the acceptance rate or review score on the basis of perceived author gender, whereas the other 4 studies demonstrated no differences when the author gender was anonymized. Conclusion: Studies evaluating the impact of double-blind peer review on author gender demonstrate mixed results, but there is reasonable evidence that gender bias may exist in scientific publishing and that double-blinding can mitigate its impact. Further evaluation of the processes in place to create the body of evidence that clinicians and researchers rely on is essential to reduce bias, particularly in female-majority fields such as obstetrics and gynecology.
MeSH term(s)	Female ; Humans ; Male ; Double-Blind Method ; Peer Review ; Publishing ; Sexism ; Single-Blind Method
Language	English
Publishing date	2022-02-01
Publishing country	United States
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2022.01.030
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Article: Maternal and Neonatal Morbidities by Race in College-Educated Women

Kern-Goldberger, Adina R. / Madden, Nigel / Baptiste, Caitlin / Friedman, Alexander / Gyamfi-Bannerman, Cynthia

American Journal of Perinatology Reports

2024 Volume 14, Issue 01, Page(s) e57–e61

Abstract: Objective: Non-Hispanic black and Hispanic women experience significantly higher adverse maternal and neonatal outcomes compared with non-Hispanic white women. The purpose of this study is to explore whether disparities in obstetric outcomes exist by ... ...

Abstract	Objective: Non-Hispanic black and Hispanic women experience significantly higher adverse maternal and neonatal outcomes compared with non-Hispanic white women. The purpose of this study is to explore whether disparities in obstetric outcomes exist by race among women who are college-educated. Study Design: This is a retrospective cohort study from a multicenter observational cohort of women undergoing cesarean delivery. Women were defined as “college-educated” if they reported completion of a 4-year college degree. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian, Native American, or unknown. The primary outcome was a composite of maternal morbidity, and a composite of neonatal morbidity was evaluated as a secondary outcome. A multivariable logistic regression model was then utilized to assess associations of race with the primary and secondary outcomes. Results: A total of 2,540 women were included in the study. After adjusting for potential confounding variables, maternal morbidity was found to be significantly higher for college-educated non-Hispanic black women compared with non-Hispanic white women (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.12–2.80). The incidence of neonatal morbidity was significantly higher for non-Hispanic black (OR 1.91, 95% CI 1.31–2.79) and Hispanic (OR 3.34, 95% CI 2.23–5.01) women. Conclusion: In this cohort, the odds of cesarean-related maternal and neonatal morbidities were significantly higher for college-educated non-Hispanic black women, compared with their non-Hispanic white counterparts. This demonstrates that even among women with higher level education, racial and ethnic disparities persist in obstetric outcomes.
Keywords	racial disparities ; maternal morbidity ; neonatal morbidity ; education
Language	English
Publishing date	2024-01-01
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/s-0043-1778000
Database	Thieme publisher's database

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