Try a new search

Format these results:

Searched for:

person:reb2

Total Results:

12


Characteristics of Category II Tracings during Last Hour of Second Stage Labor in Predicting Fetal Acidosis [Meeting Abstract]

Hoskins, I A; Berg, R E
INTRODUCTION: Intrapartum fetal heart rate (FHR) monitoring although sensitive, lacks specificity for predicting fetal acidosis. Category II tracings, within the last hour of labor, occur in >/=96% of uncomplicated, term, laboring patients. Most result in delivery of well oxygenated neonates. Neonatal acidosis occurs in <3% of term neonates and may result in neonatal encephalopathy. Currently, there is no standard approach to management of Category II tracings.
METHOD(S): We retrospectively reviewed Category II tracings in singleton, uncomplicated, term patients, during the last hour prior to delivery, in women who delivered neonates with cord blood pH /=8 (Group 1) and pH >= 7.20, base excess.
RESULT(S): In Group 1 (n=414), 91% of tracings exhibited good/moderate variability, 17.5% demonstrated minimal/absent variability, 13% had accelerations (>=15 bpm, lasting >=15 secs). In Group 2 (n = 913), 97% showed moderate/good variability, 9% minimal/absent variability, 92% demonstrated accelerations (P<0.05). Duration of second stage labor was comparable in both Groups, (Group 1 = 3.5 hours, Group 2 = 3.1 hours), as were rates of chorioamnionitis, Pitocin use. Apgar scores and rates of NICU interventions were also similar in the two Groups.
CONCLUSION(S): Minimal/decreased variability and the absence of accelerations, in Category II tracings, reliably predict fetal acidosis. Thus, expedited delivery should be considered in this clinical setting
EMBASE:633844265
ISSN: 1873-233x
CID: 4749432

Impact of decision to delivery times upon maternal and neonatal outcomes [Meeting Abstract]

Hoskins, I A; Berg, R
Introduction: Category III tracings occur in 1-2% of labors and require rapid interventions to avoid serious fetal compromise or death. ACOG states that a "stat" or emergency delivery should occur within 30 minutes after the decision has been made. The purpose of this study was to review the outcomes of a performance improvement initiative whereby a Labor Response Team (LRT) consisting of Obstetrics, Pediatrics, Anesthesia and Nursing is initiated for expeditiously managing Category III tracings.
Method(s): A retrospective chart review from January 2013 to August 2018, identified patients with Category III tracings in whom an LRT alert was initiated. The decision to delivery times were divided into 3 groups of 15 minute segments. Group 1 was delivery within 15 minutes, Group 2 was delivery between 16 to 30 minutes, Group 3 was delivery after 31 minutes. Neonatal outcomes in each of the 3 groups were reviewed.
Result(s): There were 6632 patients with Category 3 tracings. Of these, 6035 (91%) were delivered by Cesarean section (C/S), 597 (9%) by operative vaginal delivery. There were 2851 (43%) patients in Group 1, 3449 (52%) in Group 2, 332 (5%) in Group 3. Cord pH values Conclusion(s): Fetal compromise (low cord pH, 5 minute Apgar scores) were least likely to occur when decision to delivery time was
EMBASE:626672053
ISSN: 1933-7205
CID: 3751332

Correlation of Blood Lactate Levels as a Predictor for Blood Transfusion in Postpartum Hemorrhage [Meeting Abstract]

Hoskins, Iffath; Berg, Robert
ISI:000402705800077
ISSN: 0029-7844
CID: 2615592

Higher Order (>/=3) Repeat Cesarean Sections: Complications and Outcomes in the Setting of a Unique OB Safety Officer Program in an Urban Academic Medical Center [Meeting Abstract]

Hoskins, Iffath A; Schweizer, William E; Berg, Robert E; Pertab, Dorothy
ISI:000372879200199
ISSN: 1933-7205
CID: 2128002

Heterotopic Gestation with Twin Intrauterine Implantation Following Transfer of Three Developmentally-delayed Embryos from Cryopreserved Oocytes: A Case Report [Case Report]

Goldman, Kara N; Keltz, Julia; Berg, Robert E; Noyes, Nicole L
BACKGROUND: In vitro fertilization (IVF) data suggest improved live birth rates for embryos transferred at the blastocyst versus the cleavage stage. Embryos that have not reached the blastocyst stage by day 5 postthaw have diminished potential for implantation and live birth. Few data exist regarding embryogenesis and optimal timing of transfer for embryos derived from previously cryopreserved oocytes, but we report the case of 100% implantation following transfer of 3 developmentally-delayed embryos derived from cryopreserved oocytes. CASE: A 38-year-old woman cryopreserved 20 oocytes for the purpose of future childbearing. At age 42 she returned to thaw and fertilize 8 oocytes using donor sperm. Embryos were cultured to day 5 postthaw, at which time 1 morula and 2 cleavage-stage embryos were available for transfer. Three-embryo transfer resulted in a heterotopic tubal pregnancy and twin intrauterine gestation. Laparoscopic salpingectomy was performed for the ectopic gestation. The twin intrauterine pregnancy spontaneously reduced to singleton, and the patient delivered a live-born infant. CONCLUSION: While heterotopic and multifetal pregnancy are known risks of multiembryo transfer, 3 lesser-quality embryos derived from cryopreserved oocytes would be unlikely to have high implantation potential. Future studies are needed to delineate timing of embryogenesis events in previously cryopreserved oocytes.
PMID: 26592072
ISSN: 0024-7758
CID: 1906802

Foley balloon catheter to prevent or manage bleeding during treatment for cervical and Cesarean scar pregnancy

Timor-Tritsch, I E; Cali, G; Monteagudo, A; Khatib, N; Berg, R E; Forlani, F; Avizova, E
OBJECTIVE: To demonstrate the efficacy of placement and inflation of Foley balloon catheters prophylactically to prevent, or as an adjuvant therapy to control, bleeding in women undergoing treatment for Cesarean scar pregnancy (CSP) or cervical pregnancy (CxP). METHODS: This was a retrospective study of 18 women with either CSP (n = 16) or CxP (n = 2), who underwent Foley balloon catheter placement under continuous transvaginal or transabdominal ultrasound guidance to prevent or manage bleeding following treatment, which in most cases comprised local (intragestational sac) and intramuscular (IM) methotrexate (MTX) injections. In eight cases, the balloon catheter was placed immediately following local and/or IM MTX treatment, either because of bleeding or prophylactically; in eight cases, the catheter was placed as part of a two-step protocol, with patients first treated with local and IM MTX injection, then suction aspiration on Day 4 or 5, followed by planned insertion of a balloon catheter; in one patient the balloon was placed on Day 21 after local and IM MTX treatment, due to sudden bleeding; and in one case of a heterotopic pregnancy, one intrauterine and one cervical, the balloon was placed due to severe bleeding. Human chorionic gonadotropin (hCG) levels were evaluated weekly following MTX injection. RESULTS: Gestational ages at balloon placement ranged between 5 and 12 + 2 weeks. All embryos/fetuses, with the exception of the cervical heterotopic one, had heart activity and catheter placement was well-tolerated by all women. The balloon tamponade effectively reduced or prevented maternal vaginal bleeding in all except one patient; this woman had a heterotopic CxP and required abdominal robotic cerclage to control the bleeding. Catheters were kept in place for a mean of 3.6 (range, 1-6) days. hCG levels returned to low or zero levels within 19-82 days following MTX injection. Fifteen women required antibiotic treatment following the procedure. One woman with CSP developed an arteriovenous malformation requiring uterine artery embolization. CONCLUSION: Ultrasound-guided placement and inflation of Foley balloon catheters was easy to perform and well-tolerated by patients undergoing treatment for CSP or CxP, and successfully prevented or helped in the management of bleeding complications. Based on our experience and previous publications we suggest having the option of balloon catheter insertion available when local treatment of CSP or CxP is undertaken
PMID: 25346492
ISSN: 1469-0705
CID: 1663302

Cesarean scar pregnancies: experience of 60 cases

Timor-Tritsch, Ilan E; Khatib, Nizar; Monteagudo, Ana; Ramos, Joanne; Berg, Robert; Kovacs, Sandor
OBJECTIVES: To evaluate the management, clinical courses, and outcomes of cesarean scar pregnancies diagnosed in the first trimester. METHODS: We identified 60 cases of cesarean scar pregnancies diagnosed between 5 and 14 weeks. Group A contained 48 patients with fetal/embryonic cardiac activity; group B comprised 12 patients without cardiac activity; and group C included 11 patients with cardiac activity who chose expectant management. RESULTS: Five of the 48 patients (10.4%) in group A were successfully treated for vaginal bleeding. Thirty-three (68.7%) received methotrexate injections, and all had full resolution. Three (6.3%) required uterine artery embolization for late-developing arteriovenous malformations. Ten of the 12 patients (83.3%) in group B were managed expectantly and had full recovery. Two of the 10 (20.0%) had arteriovenous malformations; 1 had unsuccessful uterine artery embolization followed by a hysterectomy, and the second requested a hysterectomy. Ten of the 11 patients (90.9%) in group C continued the pregnancies. One declined local injection. Four of the 10 (40.0%) delivered live offspring by successive elective cesarean deliveries. Three (30.0%) had hysterectomies for placenta percreta, and 1 did not have a hysterectomy after delivery. Five (50%) had second-trimester complications, all leading to hysterectomies. Of the 60 patients, 20 (33.3%) had serious complications: 5 had arteriovenous malformations; 4 had uterine artery embolization; and 11 had hysterectomies. CONCLUSIONS: A cesarean scar pregnancy is a serious complication for patients who have had cesarean deliveries. Counseling, treatment, and follow-up are challenging for patients and caregivers. However, emerging data from different management approaches confirm that a cesarean scar pregnancy may progress and result in a live neonate at the expense of further fertility. This study confirmed that expectant management of a cesarean scar pregnancy is associated with a high risk of hysterectomy due to morbidly adherent placenta.
PMID: 25792575
ISSN: 0278-4297
CID: 1506462

Massive ovarian edema associated with a broad ligament leiomyoma: a case report and review

Harrison, Beth T; Berg, Robert E; Mittal, Khush
Massive ovarian edema is a rare disorder in which there is marked accumulation of interstitial fluid in the stroma of the ovary. Grossly, the involved ovary is an enlarged solid mass with a smooth tan-white surface, easily confused with a neoplasm. Microscopically, it features diffuse interstitial edema sparing follicles and outer cortex, dilated lymphatic vessels, thick-walled veins, fibromatosis, and luteinized stromal cells. It is believed that massive ovarian edema arises from interference in lymphatic drainage and venous return of the ovary secondary to partial torsion among other etiologies. Herein we provide the first description of unilateral ovarian edema in association with a large leiomyoma in the ipsilateral broad ligament. It is important to recognize the various presentations of this benign entity and to consider it in the differential diagnosis of an adnexal mass in a reproductive age woman.
PMID: 24901402
ISSN: 0277-1691
CID: 1042262

Term singleton pregnancy after conservative management of a complicated triplet gestation including a heterotopic cornual monochorionic twin pair [Letter]

Bornstein, Eran; Berg, Robert; Santos, Rosalba; Monteagudo, Ana; Timor-Tritsch, Ilan E
PMID: 21633005
ISSN: 1550-9613
CID: 140491

Case report: MRI appearance of isolated fallopian tube torsion in an adolescent with a congenital Mullerian duct anomaly and ispilateral renal agenesis [Case Report]

Kopec, M; Rosenkrantz, A B; Rivera, R; Wells, J L; Berg, R E; Milla, S S
PMID: 20103428
ISSN: 1365-229x
CID: 106378