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Change in shock index as a predictor of transfusion requirement [Meeting Abstract]

Schmidt, A; Wells, M; Hoffman, E; Ramani, S; Kunzier, N; Vintzileos, A
INTRODUCTION: Early identification of PPH is difficult. Shock index (SI) (SI=HR/SBP) of (.0.9) has demonstrated good prediction of PPH, and identify identification of patients requiring massive transfusion. Our objective is to determine if there is a change in SI on admission to postpartum or at time of transfusion after which there is an increased transfusion requirement or morbidity.
METHOD(S): IRB approved, retrospective cohort of patients who received blood transfusion at a University based hospital, 2017-2018. SI calculated; at time of admission, after delivery, and prior to transfusion. Patients with invasive carcinoma, with fetus of non-viable gestational age, and incomplete charts were excluded. Spearman correlate coefficient, univariable logistic regression, and ROC analyses were performed.
RESULT(S): 160 patients; 117/160 (73%) delivered by cesarean, 37/ 160 (23%) vaginally, and 6/160 (4%) operative vaginal delivery. Mean admission hemoglobin was 10.8 (6 1.5). Median EBL was 1320 mL (250-6000 mL). 77/160 (48%) of patients received 2 units of PRBC, 26/ 160 (17%) received 3 units of PRBC, 24/160 (15%) received 4 units of PRBC and 33/160 (20%) received >=5 units of PRBC. Change in SI from admission to postpartum had a correlation coefficient of 0.022 and a P value of .78. Change in SI from admission to pre-transfusion had a correlation coefficient of 0.128 and a P value of .11.
CONCLUSION(S): Changes in SI from admission to immediately postpartum or pre-transfusion do not show any correlation or predictive value for increasing morbidity, or transfusion requirements. This demonstrates change in SI is a poor predictor of morbidity and transfusion requirements
ISSN: 1873-233x
CID: 4721122

Does cervical cerclage decrease preterm birth in twin pregnancies with a short cervix?

Adams, Tracy M; Rafael, Timothy J; Kunzier, Nadia B; Mishra, Supriya; Calixte, Rose; Vintzileos, Anthony M
PURPOSE: To determine if use of cerclage in twin gestations with mid-trimester short cervix is associated with decreased preterm birth rate. STUDY DESIGN: This is a retrospective cohort of twin gestations identified with cervical length of
PMID: 28320233
ISSN: 1476-4954
CID: 2801832

Reply [Letter]

Kunzier, Nadia B; Brand, Donald A; Vintzileos, Anthony M
PMID: 27443815
ISSN: 1097-6868
CID: 2801872

Counseling and Management of a Conservatively Managed Second Trimester Cesarean Scar Pregnancy: A Case Report [Case Report]

Kunzier, Nadia B; Sharma, Shefali; Chavez, Martin R; Vintzileos, Anthony M
Background:Cesarean scar ectopic pregnancies (CSPs) are becoming more prevalent and can have an extremely poor prognosis, with high morbidity and mortality. Management guidelines for patients desiring conservative treatment should be established to improve outcomes. Case:A 33-year-old woman with a conservatively managed CSP now in the second trimester presented from an outside institution. After thorough counseling regarding potential maternal morbidity and extreme prematurity in the newborn based on clinical findings of progressive cervical shortening and vaginal spotting with a significant drop in hemoglobin, she abandoned conservative therapy and underwent a hysterectomy with the previable fetus in situ. Conclusion:As pregnancy progresses, danger to the mother and fetus can become severe and imminent. Progressive cervical shortening may be associated with much more significant bleeding than evidenced by spotting, indicating the importance of using cervical shortening in abandonment of conservative management to reduce impending morbidity and mortality.
PMID: 30226733
ISSN: 0024-7758
CID: 3442932

Does cervical cerclage decrease preterm birth in twin pregnancies with a short cervix? [Meeting Abstract]

Adams, Tracy; Rafael, Timothy; Kunzier, Nadia; Calixte, Rose; Vintzileos, Anthony
ISSN: 1097-6868
CID: 2800472

A comparison of obstetrical outcomes and costs between misoprostol and dinoprostone [Meeting Abstract]

Kunzier, Nadia; Park, Hyein; Cioffi, Joseph; Vintzileos, Anthony
ISSN: 0002-9378
CID: 3441172

Long-term maternal morbidity and mortality associated with ischemic placental disease

Adams, Tracy; Yeh, Corinne; Bennett-Kunzier, Nadia; Kinzler, Wendy L
Ischemic placental disease can have long-term maternal health implications. In this article, we discuss the three conditions of ischemic placental disease (preeclampsia, fetal growth restriction, and abruption placenta) and its associated long-term maternal morbidity. Retrospective observational studies comparing pregnancies complicated by ischemic placental disease to uncomplicated pregnancies suggest an increased long-term risk of hypertension, cardiovascular death, metabolic syndrome, and cerebrovascular disease. This association is much stronger in women who had an indicated-preterm delivery due to ischemic placental disease. It is important to adequately counsel women who are diagnosed with these conditions about their future health risks. Increased awareness of the potential health risks and multidisciplinary collaboration remains paramount to instituting the appropriate screening and preventative strategies (i.e., behavior modification) for affected women.
PMID: 24836826
ISSN: 1558-075x
CID: 2801842

The use of cervical sonography to differentiate true versus false labor in term gestations [Meeting Abstract]

Kunzier, Nadia; Kinzler, Wendy; Muscat, Jolene; Chavez, Martin; Vintzileos, Anthony
ISSN: 0002-9378
CID: 3444492