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Non-adherence to labor guidelines in cesarean sections done for failed induction and arrest of dilation

Escobar, Christina M; Grünebaum, Amos; Nam, Eunice Y; Olson, Amber T; Anzai, Yuzuru; Benedetto-Anzai, Maria Teresa; Cheon, Teresa; Arslan, Alan; McClelland, W Spencer
Objectives/UNASSIGNED:In 2014, the American College of Obstetrics and Gynecology published guidelines for diagnosing failed induction of labor (FIOL) and arrest of dilation (AOD) to prevent cesarean delivery (CD). The objectives of this study were to determine the rate of adherence to these guidelines and to compare the association of guideline adherence with physician CD rates and obstetric/neonatal outcomes. Methods/UNASSIGNED:Retrospective cohort review of singleton primary cesarean deliveries for FIOL and AOD at a single academic institution from 2014 to 2016. Univariate and multivariate analyses were used to compare adherence to the guidelines with physician CD rates and obstetric/neonatal outcomes. Results/UNASSIGNED:Of the 591 cesarean deliveries in the study, 263 were for failed induction, 328 for AOD and 79% (468/591) were not adherent to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines. Of the failed inductions, 82% (215/263) and of the AODs 77% (253/328) were not adherent. There was no difference between adherent and non-adherent CDs with regard to maternal characteristics, or obstetric/neonatal outcomes. Duration of oxytocin use after rupture of membranes, dilation at time of CD, and birth weight were statistically higher in adherent CDs. On multivariate linear regression, physician CD rates were inversely correlated with adherence to ACOG/SMFM guidelines (p<0.0001), gestational age (p=0.007), and parity (p=0.003). Conclusions/UNASSIGNED:Our study shows that physician non-compliance with ACOG guidelines was high. Adherence to these guidelines was associated with lower physician CD rates, without an increase in obstetric or neonatal complications.
PMID: 33555148
ISSN: 1619-3997
CID: 4779342

Preventing the Primary Cesarean in Practice: Evaluating Temporal Trends and Adherence to ACOG/SMFM Guidelines at a Single Institution. [Meeting Abstract]

Gilmore, Emma; Escobar, Christina; Anzai, Yuzuru; Arslan, Alan; Benedetto-Anzai, Maria Teresa; Cheon, Teresa; McClelland, W. Spencer
ISI:000459610400822
ISSN: 1933-7191
CID: 4212832

Preventing the Primary Cesarean in Practice: Evaluating Adherence to ACOG/SMFM Guidelines by Provider Affiliation at a Single Institution [Meeting Abstract]

Gilmore, Emma; Escobar, Christina; Anzai, Yuzuru; Arslan, Alan; Benedetto-Anzai, Maria Teresa; Cheon, Teresa; McClelland, W. Spencer
ISI:000459610400558
ISSN: 1933-7191
CID: 4212822

Analysis of the High Preterm Birth Rate in the US [Meeting Abstract]

Olson, Amber T.; McClelland, Spencer; Benedetto-Anzai, Maria Teresa; Arslan, Alan A.; Cheon, Teresa; Anzai, Yuzuru
ISI:000459610400966
ISSN: 1933-7191
CID: 4212842

Risk Factors for Preterm Birth: A Global Analysis. [Meeting Abstract]

Olson, Amber T.; McClelland, Spencer; Benedetto-Anzai, Maria Teresa; Arslan, Alan A.; Cheon, Teresa; Anzai, Yuzuru
ISI:000459610400967
ISSN: 1933-7191
CID: 4212852

Preventing the primary cesarean in practice: evaluating adherence to ACOG/SMFM guidelines at a single institution [Meeting Abstract]

Escobar, Christina; Anzai, Yuzuru; Arslan, Alan; Benedetto-Anzai, Maria Teresa; Cheon, Teresa; McClelland, W. Spencer
ISI:000423616600331
ISSN: 0002-9378
CID: 2956272

Factors associated with cesarean delivery rates: a single-institution experience

McClelland, Spencer; Gorfinkle, Naomi; Arslan, Alan A; Benedetto-Anzai, Maria Teresa; Cheon, Teresa; Anzai, Yuzuru
BACKGROUND: The aim of this study was to identify factors associated with variability in Cesarean delivery (CD) rates amongst providers at a single institution. METHODS: A retrospective cohort analysis was carried out on all births at NYU Langone Medical Center from 2005-2013. Data was collected for subjects and linked to diagnosis codes for singleton and twin deliveries. Descriptive characteristics were generated for all deliveries, and inferential analysis was performed including multiple covariates for singleton deliveries in the 2010-2013 cohort, including both univariate and multivariate regression analyses to identify factors associated with higher CD rates. RESULTS: 37,692 deliveries were identified at our institution during the study period, performed by 88 unique providers. The mean CD rate was 29.6%, with a range for individual physicians from 9.9% to 75.6%. In multivariate regression analysis, CD rate was directly correlated with average patient age, physician male gender, proportion of high-risk deliveries, and Maternal-Fetal Medicine specialty, and it was inversely correlated with total number of deliveries by physician and forceps delivery rate. There was no significant difference in CD rates between group and solo practices. Within the same group practice, each member's CD rate was strongly correlated with the average CD rate of the group. CONCLUSION: Our study demonstrates the wide range of CD rates for providers practicing within the same institution and reiterates the association of CD rates with patient age, high-risk pregnancy, and provider volume. Among operative vaginal deliveries, forceps delivery rate was associated with lower CD rates whereas vacuum delivery rate was not. Despite these findings, practice patterns within individual practices appear to contribute significantly to the wide range of CD rates.
PMCID:5401466
PMID: 28439421
ISSN: 2054-958x
CID: 2542452

Effects of interferon-beta on steroid receptors, prostaglandins and enzymatic activities in human endometrial cancer

De Cicco Nardone, F; Rossiello, F; Iacopino, F; Benedetto, M T; Cinque, B; Dell'Acqua, S; Sica, G
Steroid receptors, prostaglandin output and enzymatic activities were determined in explants derived from human endometrium exposed to natural interferon-beta (IFN-beta). Receptors and cell metabolism were evaluated before culturing the tissue fragments and after a 3-day treatment with varying concentrations of IFN-beta. Total steroid receptor levels were unchanged when explants were set up, but there was a redistribution of both estrogen and progesterone receptors (ER and PR). A decrease in cytoplasmic receptors corresponded to an increase in receptor molecules within the nucleus. Treatment with low concentrations of IFN-beta caused a significant enhancement (p < 0.05) of ER and PR in neoplastic endometrium. In basal conditions the ratio between prostaglandin F2 alpha (Pgf2 alpha) and prostaglandin E2 (PgE2) was higher in normal than in neoplastic endometrium. The addition of low concentrations of IFN-beta to the culture medium determined a significant increase (p < 0.02) in PgF2 alpha and a parallel increase in the above ratio in neoplastic tissue, while no variation was found in normal endometrium. Analysis of the results concerning the variations in hormone-related enzymatic activities due to IFN-B revealed a significant increase (p < 0.05) in 17 beta-hydroxy-steroid-dehydrogenase (17 beta-HSD) activity. The data presented here indicate that treatment with IFN-beta modifies those biological characteristics of neoplastic cells which are involved in hormone-responsiveness
PMID: 8615603
ISSN: 0250-7005
CID: 67829

Steroid hormones and gonadotropins in a case of ovarian endometriosis associated with virilization [Case Report]

Mango D; Manna P; Liberati M; Benedetto MT; Ricci S; Olleja L; de Cicco Nardone F; Menini E
The clinical course, the hormone secretion, the testosterone receptors and the enzymatic activities related to androgen metabolism in a 56-year-old postmenopausal woman with a history of virilization and ovarian endometrioma are reported. Unexpectedly, at the time of examination, no evidence of biochemical hyperandrogenism was obtained. The uncommon association of virilization and ovarian endometrioma simulating a functioning tumor of the ovary is discussed
PMID: 1316048
ISSN: 0001-6349
CID: 43027

Isolation and analysis of the mouse genomic sequence encoding Cu(2+)-Zn2+ superoxide dismutase

Benedetto, M T; Anzai, Y; Gordon, J W
Cu(2+)-Zn2+ superoxide dismutase (SOD-1) is a ubiquitously synthesized eukaryotic enzyme with a variety of important roles in mammalian development and physiology. With the goal of better understanding the structure and regulation of this gene, we have cloned and analyzed the genomic structure of the mouse SOD-1 gene. The murine sequence has an intron:exon organization very similar to that of the human gene, though significant diversion was observed in the promoter and 3' regions. These differences account for the observation that only a single transcript for SOD-1 is seen in mouse cells, while two transcripts are derived from the human gene. The cloning of mouse SOD-1 should allow elucidation of the regulatory characteristics of this element, as well as new and informative genetic engineering experiments
PMID: 2022332
ISSN: 0378-1119
CID: 67830