Jenny Y. Mei

All Publications

• Remote blood pressure management for postpartum hypertension: a cost-effectiveness analysis. American journal of obstetrics & gynecology MFM Mei, J. Y., Hauspurg, A., Corry-Saavedra, K., Nguyen, T. A., Murphy, A., Miller, E. S. 2024; 6 (9): 101442

  Abstract

  Recognizing the importance of close follow-up after hypertensive disorders of pregnancy, many centers have initiated programs to support postpartum remote blood pressure management.This study aimed to evaluate the cost-effectiveness of remote blood pressure management to determine the scalability of these programmatic interventions.This was a cost-effectiveness analysis of using remote blood pressure management vs usual care to manage postpartum hypertension. The modeled remote blood pressure management included provision of a home blood pressure monitor, guidance on warning symptoms, instructions on blood pressure self-monitoring twice daily, and clinical staff to manage population-level blood pressures as appropriate. Usual care was defined as guidance on warning symptoms and recommendations for 1 outpatient visit for blood pressure monitoring within a week after discharge. This study designed a Markov model that ran over fourteen 1-day cycles to reflect the initial 2 weeks after delivery when most emergency department visits and readmissions occur and remote blood pressure management is clinically anticipated to be most impactful. Parameter values for the base-case scenario were derived from both internal data and literature review. Quality-adjusted life-years were calculated over the first year after delivery and reflected the short-term morbidities associated with hypertensive disorders of pregnancy that, for most birthing people, resolve by 2 weeks after delivery. Sensitivity analyses were performed to assess the strength and validity of the model. The primary outcome was the incremental cost-effectiveness ratio, which was defined as the cost needed to gain 1 quality-adjusted life-year. The secondary outcome was incremental cost per readmission averted. Analyses were performed from a societal perspective.In the base-case scenario, remote blood pressure management was the dominant strategy (ie, cost less, higher quality-adjusted life-years). In univariate sensitivity analyses, the most cost-effective strategy shifted to usual care when the cost of readmission fell below $2987.92 and the rate of reported severe range blood pressure with a response in remote blood pressure management was <1%. Assuming a willingness to pay of $100,000 per quality-adjusted life-year, using remote blood pressure management was cost-effective in 99.28% of simulations in a Monte Carlo analysis. Using readmissions averted as a secondary effectiveness outcome, the incremental cost per readmission averted was $145.00.Remote blood pressure management for postpartum hypertension is cost saving and has better outcomes than usual care. Our data can be used to inform future dissemination of and support funding for remote blood pressure management programs.

  View details for DOI 10.1016/j.ajogmf.2024.101442

  View details for PubMedID 39074606

• Standardized Clinical Assessment and Management Plan to Reduce Readmissions for Postpartum Hypertension. Obstetrics and gynecology Mei, J. Y., Corry-Saavedra, K., Nguyen, T. A., Murphy, A. 2023; 142 (2): 384-392

  Abstract

  To evaluate the effect of a postpartum hypertension standardized clinical assessment and management plan on postpartum readmissions and emergency department (ED) visits.We conducted a prospective cohort study of patients with postpartum hypertension (either chronic hypertension or hypertensive disorders of pregnancy) who delivered at a single tertiary care center for 6 months after enacting an institution-wide standardized clinical assessment and management plan (postintervention group). Patients in the postintervention group were compared with patients in a historical control group. The standardized clinical assessment and management plan included 1) initiation or uptitration of medication for any blood pressure (BP) higher than 150/100 mm Hg or any two BPs higher than 140/90 mm Hg within a 24-hour period, with the goal of achieving normotension (BP lower than 140/90 mm Hg) in the 12 hours before discharge; and 2) enrollment in a remote BP monitoring system on discharge. The primary outcome was postpartum readmission or ED visit for hypertension. Multivariable logistic regression was used to evaluate the association between standardized clinical assessment and management plan and the selected outcomes. A sensitivity analysis was performed with propensity score weighting. A planned subanalysis in the postintervention cohort identified risk factors associated with requiring antihypertensive uptitration after discharge. For all analyses, the level of statistical significance was set at P <.05.Overall, 390 patients in the postintervention cohort were compared with 390 patients in a historical control group. Baseline demographics were similar between groups with the exception of lower prevalence of chronic hypertension in the postintervention cohort (23.1% vs 32.1%, P =.005). The primary outcome occurred in 2.8% of patients in the postintervention group and in 11.0% of patients in the historical control group (adjusted odds ratio [aOR] 0.24, 95% CI 0.12-0.49, P <.001). A matched propensity score analysis controlling for chronic hypertension similarly demonstrated a significant reduction in the incidence of the primary outcome. Of the 255 patients (65.4%) who were compliant with outpatient remote BP monitoring, 53 (20.8%) had medication adjustments made per protocol at a median of 6 days (interquartile range 5-8 days) from delivery. Non-Hispanic Black race (aOR 3.42, 95% CI 1.68-6.97), chronic hypertension (aOR 2.09, 95% CI 1.13-3.89), having private insurance (aOR 3.04, 95% CI 1.06-8.72), and discharge on antihypertensive medications (aOR 2.39, 95% CI 1.33-4.30) were associated with requiring outpatient adjustments.A standardized clinical assessment and management plan significantly reduced postpartum readmissions and ED visits for patients with hypertension. Close outpatient follow-up to ensure appropriate medication titration after discharge may be especially important in groups at high risk for readmission.

  View details for DOI 10.1097/AOG.0000000000005248

  View details for PubMedID 37411026

• Reproductive genetic carrier screening in pregnancy: improving health outcomes and expanding access. Journal of perinatal medicine Mei, J. Y., Platt, L. D. 2024; 52 (7): 688-695

  Abstract

  Reproductive genetic carrier screening (RGCS) serves to screen couples for their risk of having children affected by monogenic conditions. The included conditions are mostly autosomal recessive or X-linked with infantile or early-childhood onset. Cystic fibrosis, spinal muscular atrophy, and hemoglobinopathies are now recommended by the American College of Obstetricians and Gynecologists (ACOG) for universal screening. Recommendations for further RGCS remain ethnicity based. The American College of Medical Genetics and Genomics and the National Society of Genetic Counselors in recent years have recommended universal expanded-panel RGCS and moving towards a more equitable approach. ACOG guidelines state that offering RGCS is an acceptable option, however it has not provided clear guidance on standard of care. Positive results on RGCS can significantly impact reproductive plans for couples, including pursuing in vitro fertilization with preimplantation genetic testing, prenatal genetic testing, specific fetal or neonatal treatment, or adoption. RGCS is a superior approach compared to ethnicity-based carrier screening and moves away from single race-based medical practice. We urge the obstetrics and gynecology societies to adopt the guidelines for RGCS put forward by multiple societies and help reduce systemic inequalities in medicine in our new genetic age. Having national societies such as ACOG and the Society for Maternal-Fetal Medicine officially recommend and endorse RGCS would bolster insurance coverage and financial support by employers for RGCS. The future of comprehensive reproductive care in the age of genomic medicine entails expanding access so patients and families can make the reproductive options that best fit their needs.

  View details for DOI 10.1515/jpm-2024-0059

  View details for PubMedID 38924780

• Fetal and neonatal outcomes after "atypical findings" on cell-free fetal DNA screening. American journal of obstetrics & gynecology MFM Mei, J. Y., Murali, A., Nitka, A., Kang, S. H., Saitta, S. C., Han, C. S. 2024; 6 (8): 101410

  View details for DOI 10.1016/j.ajogmf.2024.101410

  View details for PubMedID 38878968

• Primary achalasia diagnosed during pregnancy: rare cause of nausea and vomiting. BMJ case reports Mei, J. Y., Mendoza, D., Gutierrez, M., Rao, R. 2024; 17 (6)

  Abstract

  Nausea and vomiting during pregnancy are very common; however, when persistent symptoms lead to severe malnutrition, other conditions should be considered. We present a patient with severe postprandial nausea and vomiting resulting in 120 lb weight loss. She was treated for presumed hyperemesis gravidarum but diagnosed with achalasia type 1 upon further work-up. The pregnancy was further complicated by fetal growth restriction, shortened cervix and preterm premature rupture of membranes, and resulted in delivery at 26 weeks of gestation. Postpartum, she underwent a peroral endoscopic myotomy procedure and has returned to normal body mass index.The differential for nausea/vomiting is broad, and major medical conditions can manifest for the first time during pregnancy. Severe malnutrition adversely affects maternal and fetal health. Further work-up should be pursued when symptoms cannot otherwise be explained.

  View details for DOI 10.1136/bcr-2023-258792

  View details for PubMedID 38914522

• Triple-blind peer review in scientific publishing: a systematic review. American journal of obstetrics & gynecology MFM Polnaszek, B. E., Mei, J., Cheng, C., Punjala-Patel, A., Sawyer, K., Manuck, T. A., Bennett, T. A., Miller, E. S., Berghella, V. 2024; 6 (4): 101320

  View details for DOI 10.1016/j.ajogmf.2024.101320

  View details for PubMedID 38492638

• Smartwatch detection of new-onset monomorphic ventricular tachycardia in pregnancy. BMJ case reports Mei, J. Y., Xu, L., Nguyen, T. A. 2024; 17 (2)

  Abstract

  Smartwatches provide health tracking in various ways and there has been a recent rise in reporting cardiac arrhythmias. While original studies focused on atrial fibrillation, fewer reports have been made on other arrhythmias especially in pregnancy. We report a pregnant patient who presented at 34 weeks' gestation with palpitations. An ECG recorded through her Apple Watch showed ventricular tachycardia. Hospital ECG confirmed monomorphic ventricular tachycardia likely caused by increased sympathetic tone from the gravid state. She was admitted to the cardiac intensive care unit for close monitoring with intravenous anti-arrhythmic agents; however, the rhythm persisted. She underwent a caesarean delivery and the arrhythmia resolved post partum. She later underwent a catheter ablation, after which she discontinued all anti-arrhythmic medications with no recurrence. This case highlights the importance of requesting relevant digital health information, if available, from patients in our modern era. Controlled clinical studies are needed to validate such practices.

  View details for DOI 10.1136/bcr-2023-258807

  View details for PubMedID 38373812

  View details for PubMedCentralID PMC10882298

• Evaluating Standard of Care and Obstetrical Outcomes in a Reduced Contact Prenatal Care Model in the COVID-19 Pandemic. Maternal and child health journal Mei, J. Y., Bernstein, M. E., Patton, E., Duong, H. L., Negi, M. 2024; 28 (2): 287-293

  Abstract

  We aimed to investigate the impact of reduced contact prenatal care necessitated by the COVID-19 pandemic on meeting standards of care and perinatal outcomes.This was a retrospective case-control study of patients in low-risk obstetrics clinic at a tertiary care county facility serving solely publicly insured patients comparing reduced in-person prenatal care (R) over 12 weeks with a control group (C) receiving traditional prenatal care who delivered prior.Total 90 patients in reduced contact (R) cohort were matched with controls (C). There were similar rates of standard prenatal care metrics between groups. Gestational age (GA) of anatomy ultrasound was later in R (p = 0.017). Triage visits and missed appointments were similar, though total number of visits (in-person and telehealth) was higher in R (p = 0.043). R group had higher GA at delivery (p = 0.001). Composite neonatal morbidity and length of stay were lower in R (p = 0.017, p = 0.048). Maternal and neonatal outcomes did not otherwise differ between groups. Using Kotelchuck Adequacy of Prenatal Care Utilization index, R had higher rates of adequate prenatal care (45.6% R vs. 24.4% C, p = 0.005).Our study demonstrates the non-inferiority of a hybrid, reduced schedule prenatal schedule to traditional prenatal scheduling. In a reduced contact prenatal care model, more patients met criteria for adequate prenatal care, likely due to higher attendance of telehealth visits. These findings raise the question of revising the prenatal care model to mitigate disparities in disadvantaged populations.

  View details for DOI 10.1007/s10995-023-03812-3

  View details for PubMedID 37957413

  View details for PubMedCentralID PMC10901916

• Hypertensive complications of pregnancy: Hepatic consequences of preeclampsia through HELLP syndrome. Clinical liver disease Mei, J. Y., Afshar, Y. 2023; 22 (6): 195-199

  View details for DOI 10.1097/CLD.0000000000000088

  View details for PubMedID 38143815

  View details for PubMedCentralID PMC10745250

• Can prenatal ultrasound predict adverse neonatal outcomes in SARS-CoV-2-affected pregnancies? American journal of obstetrics & gynecology MFM Mei, J. Y., Mok, T., Cambou, M. C., Fuller, T., Fajardo, V. M., Kerin, T., Han, C. S., Nielsen-Saines, K., Rao, R. 2023; 5 (9): 101028

  Abstract

  On the basis of available data, at least 1 ultrasound assessment of pregnancies recovering from SARS-CoV-2 infection is recommended. However, reports on prenatal imaging findings and potential associations with neonatal outcomes following SARS-CoV-2 infection in pregnancy have been inconclusive.This study aimed to describe the sonographic characteristics of pregnancies after confirmed SARS-CoV-2 infection and assess the association of prenatal ultrasound findings with adverse neonatal outcomes.This was an observational prospective cohort study of pregnancies diagnosed with SARS-CoV-2 by reverse transcription polymerase chain reaction between March 2020 and May 2021. Prenatal ultrasound evaluation was performed at least once after diagnosis of infection, with the following parameters measured: standard fetal biometric measurements, umbilical and middle cerebral artery Dopplers, placental thickness, amniotic fluid volume, and anatomic survey for infection-associated findings. The primary outcome was the composite adverse neonatal outcome, defined as ≥1 of the following: preterm birth, neonatal intensive care unit admission, small for gestational age, respiratory distress, intrauterine fetal demise, neonatal demise, or other neonatal complications. Secondary outcomes were sonographic findings stratified by trimester of infection and severity of SARS-CoV-2 infection. Prenatal ultrasound findings were compared with neonatal outcomes, severity of infection, and trimester of infection.A total of 103 SARS-CoV-2-affected mother-infant pairs with prenatal ultrasound evaluation were identified; 3 cases were excluded because of known major fetal anomalies. Of the 100 included cases, neonatal outcomes were available in 92 pregnancies (97 infants); of these, 28 (29%) had the composite adverse neonatal outcome, and 23 (23%) had at least 1 abnormal prenatal ultrasound finding. The most common abnormalities seen on ultrasound were placentomegaly (11/23; 47.8%) and fetal growth restriction (8/23; 34.8%). The latter was associated with a higher rate of the composite adverse neonatal outcome (25% vs 1.5%; adjusted odds ratio, 22.67; 95% confidence interval, 2.63-194.91; P<.001), even when small for gestational age was removed from this composite outcome. The Cochran Mantel-Haenszel test controlling for possible fetal growth restriction confounders continued to show this association (relative risk, 3.7; 95% confidence interval, 2.6-5.9; P<.001). Median estimated fetal weight and birthweight were lower in patients with the composite adverse neonatal outcome (P<.001). Infection in the third trimester was associated with lower median percentile of estimated fetal weight (P=.019). An association between placentomegaly and third-trimester SARS-CoV-2 infection was noted (P=.045).In our study of SARS-CoV-2-affected maternal-infant pairs, rates of fetal growth restriction were comparable to those found in the general population. However, composite adverse neonatal outcome rates were high. Pregnancies with fetal growth restriction after SARS-CoV-2 infection were associated with an increased risk for the adverse neonatal outcome and may require close surveillance.

  View details for DOI 10.1016/j.ajogmf.2023.101028

  View details for PubMedID 37295718

  View details for PubMedCentralID PMC10247147

• Group B Streptococcus in Pregnancy. Obstetrics and gynecology clinics of North America Mei, J. Y., Silverman, N. S. 2023; 50 (2): 375-387

  Abstract

  To decrease risk of early-onset neonatal sepsis from group B streptococcus (GBS), pregnant patients should undergo screening between 36 0/7 and 37 6/7 weeks' gestation. Patients with a positive vaginal-rectal culture, GBS bacteriuria , or history of newborn with GBS disease should receive intrapartum antibiotic prophylaxis (IAP) with an agent targeting GBS. If GBS status is unknown at time of labor, IAP should be administered in cases of preterm birth, rupture of membranes for >18 hours, or intrapartum fever. The antibiotic of choice is intravenous penicillin; alternatives should be considered in cases of penicillin allergy depending on allergy severity.

  View details for DOI 10.1016/j.ogc.2023.02.009

  View details for PubMedID 37149317

• Twin Vaginal Deliveries in Labor Rooms: A Cost-Effectiveness Analysis. American journal of perinatology Mei, J. Y., Mallampati, D., Pluym, I. D., Han, C. S., Afshar, Y. 2023; 40 (3): 290-296

  Abstract

  Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the theoretical risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to evaluate the cost-effectiveness of performing VDs for twin gestations in the labor and delivery room (LDR) versus OR.We conducted a cost-effectiveness analysis using a decision-analysis model that compared the costs and effectiveness of two strategies of twin deliveries undergoing a trial of labor: (1) intended delivery in the LDR and 2) delivery in the OR. Sensitivity analyses were performed to assess strength and validity of the model. Primary outcome was incremental cost-effectiveness ratio (ICER) defined as cost needed to gain 1 quality-adjusted life year (QALY).In the base-case scenario, where 7% of deliveries resulted in conversion to CD for twin B, attempting to deliver twins in the LDR was the most cost-effective strategy. For every QALY gained by delivering in the OR, 243,335 USD would need to be spent (ICER). In univariate sensitivity analyses, the most cost-effective strategy shifted to delivering in the OR when the following was true: (1) probability of successful VD was less than 86%, (2) probability of neonatal morbidity after emergent CD exceeded 3.5%, (3) cost of VD in an LDR exceeded 10,500 USD, (4) cost of CD was less than 10,000 USD, or (5) probability of neonatal death from emergent CD exceeded 2.8%. Assuming a willingness to pay of 100,000 USD per neonatal QALY gained, attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis.Twin VDs in the LDR are cost effective based on current neonatal outcome data, taking into account gestational age and associated morbidity. Further investigation is needed to elucidate impact of cost and outcomes on optimal utilization of resources.· Cost effectiveness of twin VDs in the LDR versus OR was assessed.. · Twin VDs in the LDR are cost effective based on current neonatal outcome data.. · Attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis..

  View details for DOI 10.1055/s-0041-1727213

  View details for PubMedID 33878770

• Pregnancy and Pulmonary Hypertension: From Preconception and Risk Stratification Through Pregnancy and Postpartum. Heart failure clinics Mei, J. Y., Channick, R. N., Afshar, Y. 2023; 19 (1): 75-87

  Abstract

  Pulmonary hypertension is one of the highest risk medical conditions in pregnancy and carries significant maternal morbidity and mortality as well as neonatal morbidity. Diagnosis is commonly delayed due to the nonspecific nature of early symptoms. Disease progression can lead to right ventricular failure, which carries mortality rates as high as 25% to 56%. Pregnancy-related complications arise from cardiac inability to accommodate increased plasma volume and cardiac output, decreased systemic vascular resistance, and hypercoagulability. Patients in this high-risk cohort necessitate preconception risk stratification and multidisciplinary care throughout their pregnancy and delivery planning.

  View details for DOI 10.1016/j.hfc.2022.08.019

  View details for PubMedID 36435575

• Preferences and comfort of maternal fetal medicine fellows in the United States with operative vaginal deliveries. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Rose, K., Mei, J., Kwan, L., Pluym, I. D., Han, C. S., Afshar, Y. 2022; 35 (17): 3238-3243

  Abstract

  The objective of this study was to determine the current landscape of vacuum and forceps-assisted vaginal delivery (FAVD) preferences and comfort across maternal fetal medicine (MFM) fellows in the United States (U.S.).A survey was sent to MFM fellowship program directors for distribution to current MFM fellows across U.S. Geographic regions, as determined using Census Bureau-designated regions. The survey looked at comfort and experience with FAVDs and vacuum-assisted vaginal deliveries (VAVD) throughout their post-graduate training. Descriptive statistics were used to analyze survey responses. Respondents were compared by post-graduate year (PGY) and region.One hundred six MFM fellows (32%) completed the survey. 22.6% of MFM fellows had performed greater than 30 FAVDs, with 33% having performed ≤10 FAVDs. In comparison, 35.8% of fellows had performed more than 30 VAVDs. While 95.2% of fellows feel prepared to perform a VAVD independently, only 59.4% feel prepared to do FAVDs independently. Never the less, 53% of MFM fellows favor performing a FAVD. While some regional differences were seen, there was no significant difference in the percent of fellows by geographic region who have performed >30 FAVD (p = .87). MFM fellows in the West are most likely to have performed >30 FAVD at 57.8%, compared to 42.3, 35, and 11.4% in the Midwest, South, and Northeast, respectively.MFM fellows are more confident with VAVD compared to FAVD. Despite feeling less confident performing FAVD (versus VAVD), the majority of MFM fellows feel comfortable performing FAVDs independently. Region of training fellowship training does not significantly affect one's confidence in FAVDs. A coordinated nationwide effort to increase exposure to and confidence for FAVDs should be considered.

  View details for DOI 10.1080/14767058.2020.1817894

  View details for PubMedID 32912038

• Pregnancy care in solid organ transplant recipients. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics Kallapur, A., Jang, C., Yin, O., Mei, J. Y., Afshar, Y. 2022; 157 (3): 502-513

  Abstract

  Recipients of solid organ transplants who become pregnant represent an obstetrically high-risk population. Preconception planning and effective contraception tailored to the individual patient are critical in this group. Planned pregnancies improve both maternal and neonatal outcomes and provide a window of opportunity to mitigate risk and improve lifelong health. Optimal management of these pregnancies is not well defined. Common pregnancy complications after transplantation include hypertension, preterm birth, infection, and metabolic disease. Multidisciplinary preconception and prepartum management, and counseling decrease complications and benefit the maternal-neonatal dyad.

  View details for DOI 10.1002/ijgo.13819

  View details for PubMedID 34245162

• Extracorporeal membrane oxygenation in pregnancy: a bridge to delivery and pulmonary recovery for COVID-19-related severe respiratory failure. American journal of obstetrics and gynecology Yin, O., Richley, M., Hadaya, J., Mei, J., Mok, T., Fahim, M., Pluym, I. D., Rao, R., Martin, C., Han, C. S., Benharash, P., Afshar, Y. 2022; 226 (4): 571-576.e5

  View details for DOI 10.1016/j.ajog.2021.12.024

  View details for PubMedID 34922925

  View details for PubMedCentralID PMC8675182

• Rates of Cesarean Conversion and Associated Predictors and Outcomes in Planned Vaginal Twin Deliveries. American journal of perinatology Mei, J. Y., Muñoz, H. E., Kim, J. S., Szlachta-McGinn, A., Blat, C., Rao, R., Han, C. S., Irani, R. A., Afshar, Y. 2022; 39 (6): 601-608

  Abstract

  Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to investigate the rates of conversion to CD for planned twin VDs and identify predictors and outcomes of conversion.A retrospective cohort study of all women who underwent a planned twin VD at two large academic medical centers over 4 years. Demographic and outcome data were chart abstracted. Various statistical tests were used to evaluate the influence of perinatal variables on mode of delivery and identify possible predictors of conversion.Eight hundred and eighty-five twin deliveries were identified, of which 725 (81.9%) were possible candidates for VD. Of those, 237 (32.7%) underwent successful VD of twin A. Ninety-five (40.1%) had a nonvertex second twin at time of delivery. Conversion to CD occurred in 10 planned VDs (4.2%). Conversions were higher with spontaneous labor (relative risk [RR]: 2.1; 95% confidence interval [CI] 1.6-2.7; p = 0.003), and having an intertwin delivery interval greater than 60 minutes (RR: 5.1; 95% CI: 2.5-10.8; p < 0.001). Nonvertex presentation of twin B, type of delivery provider, or years out in practice of delivery provider were not significantly different between groups. There were no significant differences in neonatal outcomes between VD and conversion groups. There was a significant association between use of forceps for twin B and successful VD (p = 0.02), with 84.6% in the setting of a nonvertex twin B.Successful VD was achieved in planned VD of twins in 95.8% of cases, and there were no significant differences in maternal and fetal outcomes between successful VD and conversion to CD for twin B. With the optimal clinical scenario and shared decision-making, performing vaginal twin deliveries in labor and delivery rooms should be discussed.· There is a propensity to perform twin vaginal deliveries in the operating room.. · Rates of conversion to cesarean section are very low.. · There are no significant differences in perinatal outcomes with conversion..

  View details for DOI 10.1055/s-0040-1718368

  View details for PubMedID 33032326

• Neutralizing Monoclonal Antibodies for Coronavirus Disease 2019 (COVID-19) in Pregnancy: A Case Series. Obstetrics and gynecology Richley, M., Rao, R. R., Afshar, Y., Mei, J., Mok, T., Vijayan, T., Weinstein, S., Pham, C. U., Madamba, J., Shin, C. S., Suda, D., Han, C. S. 2022; 139 (3): 368-372

  Abstract

  To describe outcomes associated with monoclonal antibody use in pregnant persons with mild-to-moderate coronavirus disease 2019 (COVID-19).We present a retrospective case series of pregnant patients who received anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibody infusions at a single center from April 1, 2021, through October 16, 2021. Pregnant patients who had a positive SARS-CoV-2 polymerase chain reaction (PCR) test result and mild-to-moderate COVID-19 symptoms were eligible for monoclonal antibody infusion. Exclusion criteria for administration included need for supplemental oxygen, hospitalization due to COVID-19, and positive SARS-CoV-2 PCR test result more than 7 days before screening. All patients received either bamlanivimab plus etesevimab or casirivimab plus imdevimab based on availability and dosing instructions of the product and emerging resistance patterns in the community.During the study period, monoclonal antibody infusions were administered to 450 individuals at our institution, of whom 15 were pregnant. Of the 15 pregnant persons receiving monoclonal antibody, six (40%) had full-vaccination status at the time of infusion. Two individuals (13%, CI 0-31%) experienced systemic reactions during the infusion, both resulting in temporary changes in the fetal heart rate tracing that recovered with maternal and intrauterine resuscitative efforts. One patient delivered after infusion for worsening maternal and fetal status; the remainder of the patients did not require admission for COVID-19.In this case series, pregnant persons who received anti-SARS-CoV-2 monoclonal antibody infusions had generally favorable outcomes.

  View details for DOI 10.1097/AOG.0000000000004689

  View details for PubMedID 35115451

  View details for PubMedCentralID PMC8843364

• The systemic inflammatory landscape of COVID-19 in pregnancy: Extensive serum proteomic profiling of mother-infant dyads with in utero SARS-CoV-2. Cell reports. Medicine Foo, S. S., Cambou, M. C., Mok, T., Fajardo, V. M., Jung, K. L., Fuller, T., Chen, W., Kerin, T., Mei, J., Bhattacharya, D., Choi, Y., Wu, X., Xia, T., Shin, W. J., Cranston, J., Aldrovandi, G., Tobin, N., Contreras, D., Ibarrondo, F. J., Yang, O., Yang, S., Garner, O., Cortado, R., Bryson, Y., Janzen, C., Ghosh, S., Devaskar, S., Asilnejad, B., Moreira, M. E., Vasconcelos, Z., Soni, P. R., Gibson, L. C., Brasil, P., Comhair, S. A., Arumugaswami, V., Erzurum, S. C., Rao, R., Jung, J. U., Nielsen-Saines, K. 2021; 2 (11): 100453

  Abstract

  While pregnancy increases the risk for severe COVID-19, the clinical and immunological implications of COVID-19 on maternal-fetal health remain unknown. Here, we present the clinical and immunological landscapes of 93 COVID-19 mothers and 45 of their SARS-CoV-2-exposed infants through comprehensive serum proteomics profiling for >1,400 cytokines of their peripheral and cord blood specimens. Prenatal SARS-CoV-2 infection triggers NF-κB-dependent proinflammatory immune activation. Pregnant women with severe COVID-19 show increased inflammation and unique IFN-λ antiviral signaling, with elevated levels of IFNL1 and IFNLR1. Furthermore, SARS-CoV-2 infection re-shapes maternal immunity at delivery, altering the expression of pregnancy complication-associated cytokines, inducing MMP7, MDK, and ESM1 and reducing BGN and CD209. Finally, COVID-19-exposed infants exhibit induction of T cell-associated cytokines (IL33, NFATC3, and CCL21), while some undergo IL-1β/IL-18/CASP1 axis-driven neonatal respiratory distress despite birth at term. Our findings demonstrate COVID-19-induced immune rewiring in both mothers and neonates, warranting long-term clinical follow-up to mitigate potential health risks.

  View details for DOI 10.1016/j.xcrm.2021.100453

  View details for PubMedID 34723226

  View details for PubMedCentralID PMC8549189

• Ultrasound for the Pregnant Person With Diabesity. Clinical obstetrics and gynecology Mei, J. Y., Han, C. S. 2021; 64 (1): 144-158

  Abstract

  Diabetes and obesity increase the risk of congenital anomalies, but the putative mechanisms of this increased risk are not fully elucidated. In this chapter, we delve into sonographic characteristics associated with diabetes and obesity, including fetal structural anomalies, functional cardiac alterations, and growth abnormalities. We will also discuss the technical challenges of imaging in the patient with diabesity and propose methodologies for optimizing imaging. Lastly, we will address the prevention of workplace-associated musculoskeletal disorders injury for sonographers.

  View details for DOI 10.1097/GRF.0000000000000600

  View details for PubMedID 33394705

• May-Thurner syndrome in pregnancy: a multi-institutional case series and review of the literature. American journal of obstetrics & gynecology MFM Mei, J. Y., Deshmukh, U., Negi, M., Campbell, K., Paidas, M. J., Platt, L. D., Silverman, N. S., Han, C. S. 2020; 2 (4): 100240

  View details for DOI 10.1016/j.ajogmf.2020.100240

  View details for PubMedID 33345939

• Gender representation of speakers at the Society for Maternal-Fetal Medicine postgraduate courses: a 20-year review. American journal of obstetrics & gynecology MFM Mei, J. Y., Negi, M., Han, C. S., Rao, R., Krakow, D., Afshar, Y. 2020; 2 (3): 100131

  Abstract

  The percentage of female physicians has grown significantly in past decades, with women currently making up 56% of the Society for Maternal-Fetal Medicine's board-certified membership.We aimed to describe trends in the gender of invited speakers at postgraduate courses, panels, and debates at the annual meetings of the Society for Maternal-Fetal Medicine over the last 2 decades.We performed a retrospective observational study examining annual meetings of the Society for Maternal-Fetal Medicine in 1999, 2009, and 2015-2019. Invited speakers were identified through publicly available programs and examined by gender, degree, and the session of involvement. Postgraduate lectures (including courses, workshops, and forums), panels, and debates were examined. Speakers with Medicinae Doctor (or equivalent) degrees and obstetrics and gynecology training were included.Among the 3 time points 1999, 2009, and 2019, there were 330 speaker slots. There was a significant difference in gender representation in the 3 time points; female representation was 25% in 1999, 21.5% in 2009, and 55.7% in 2019 (P<.001). There were significantly higher odds of having a female speaker in 2019 than in 2009 (odds ratio, 4.58; 95% confidence interval, 2.40-8.72; P<.001). Between 2015 and 2019, 813 speaker slots were identified, with a significant positive correlation between increasing year and increasing female representation (correlation coefficient=0.099; P=.005). When controlling for type of session, there were higher odds of having a female speaker with a later year (adjusted odds ratio, 1.16; 95% confidence interval, 1.05-1.28; P=.003). There was a significant difference in gender representation among different sessions (P=.028), with females listed in 51.2% of lecture slots but only 42.4% of panels and 38.0% of debates. Male moderators resulted in an average female representation of 29.8%±23.7% in a given session, whereas female moderators and a combination of both genders as moderators had average female representations of 71.6%±25.0% and 43.3%±19.4%, respectively, in a given session (P<.001). There was no correlation between the gender of the postgraduate course chair and either moderator or speaker gender.There was a significant increase in the percentage of speaker slots allocated to females over the past 2 decades, a trend that moves toward reflecting the gender composition of the Society for Maternal-Fetal Medicine membership.

  View details for DOI 10.1016/j.ajogmf.2020.100131

  View details for PubMedID 33345873

• Vaginal birth after cesarean: Does accuracy of predicted success change from prenatal intake to admission? American journal of obstetrics & gynecology MFM Ha, T. K., Rao, R. R., Maykin, M. M., Mei, J. Y., Havard, A. L., Gaw, S. L. 2020; 2 (2): 100094

  Abstract

  There are 2 prediction nomograms for vaginal birth after cesarean delivery. The first is based on variables that are available at the first prenatal visit, and the second includes variables at the time of admission.The purpose of this study was to compare the accuracy of prediction scores that are calculated by the intake and admission prediction nomograms in a modern cohort of racially and ethnically diverse women.This is a retrospective cohort study that analyzed the data for women with at least 1 previous cesarean delivery who attempted a trial of labor from 2007-2016 at a tertiary medical center. Participants were stratified into 3 probability-of-success groups: low (<35%), moderate (35-65%), and high (>65%). The primary outcome was the difference between the intake- and admission-predicted success scores in the 3 groups. Secondary outcomes were characteristics that were associated with successful vaginal birth after cesarean delivery .Of the 614 women included in the analysis, 444 (72.3%) had a successful vaginal birth after cesarean delivery . Predicted vaginal birth after cesarean delivery success rate ranged from 14.4-96.2%. Patients were stratified into 3 groups by intake predicted success rates: low (<35%; n=21), moderate (35-65%; n=136), and high (>65%; n=457). The change in predicted success rates was compared between the intake and admission nomograms. Women in the low and moderate groups improved their prediction score by approximately 7-8% when variables at the time of admission were included. As a result, more than one-half of these women (172/307; 56%) shifted to a higher predicted success group. The admission nomogram, as compared with the intake nomogram, more accurately predicted vaginal birth after cesarean delivery success in all groups. Analysis of admission variables showed that cervical dilation >2 cm compared with a closed cervix was the strongest predictor of successful vaginal birth after cesarean delivery (relative risk, 1.79; 95% confidence interval, 1.11-2.89).The admission prediction nomogram was more accurate and showed higher predicted success compared with the intake nomogram for the same cohort. Because prediction scores may improve at the time of admission, additional counseling on the risks and benefits of trial of labor may be helpful at that time.

  View details for DOI 10.1016/j.ajogmf.2020.100094

  View details for PubMedID 33345960

• Transverse versus vertical skin incision for planned cesarean hysterectomy: does it matter? BMC pregnancy and childbirth Szlachta-McGinn, A., Mei, J., Tabsh, K., Afshar, Y. 2020; 20 (1): 65

  Abstract

  To investigate differences in perioperative outcomes by type of skin incision, transverse versus vertical, for planned cesarean hysterectomy for placenta accreta spectrum (PAS).A retrospective cohort study of all women who underwent a planned cesarean hysterectomy for abnormal placentation at a single academic medical center over 5 years. The Student's t-test was used for continuous variables and Fisher's exact test compared categorical variables. Continuous data were presented as median and compared using the Wilcoxon-rank sum test.Forty-two planned cesarean hysterectomies were identified. A transverse skin incision was made in 43% (n = 18); a vertical skin incision was made in 57% (n = 24). Skin incision was independent of BMI (30.3 vs 30.8 kg/m2, p = 0.37), placental location (p = 0.82), and PAS-subtype (p = 0.26). Mean estimated blood loss (EBL) was 2.73 l (L) (range 0.5-20) and was not significantly different between transverse and vertical skin incision (2.6 L vs 2.8 L, p = 0.8). There was significantly shorter operative time with transverse skin incision (180 vs 238 min, p = 0.03), with no difference in intraoperative complications, including cystotomy (p = 0.22) and ureteral injury (p = 0.73). Postoperatively, there was no difference in maternal length of stay (4.8 vs 4.4 days, p = 0.74) or post-operative opioid use (117 vs 180 morphine equivalents, p = 0.31).Transverse skin incision is associated with shorter operative time for patients undergoing planned cesarean hysterectomy. There was no difference in EBL, intraoperative complications, postoperative length of stay, or opioid use. Given an increasing rate of cesarean hysterectomy, we should consider variables that optimize maternal outcomes and resource utilization.

  View details for DOI 10.1186/s12884-020-2768-7

  View details for PubMedID 32005190

  View details for PubMedCentralID PMC6995109

• First-Trimester Ultrasound. Obstetrics and gynecology clinics of North America Mei, J. Y., Afshar, Y., Platt, L. D. 2019; 46 (4): 829-852

  Abstract

  Since the 1980s, development of high-resolution transvaginal ultrasound transducers has significantly improved ultrasound evaluation at earlier gestational ages. Although many indications exist for first-trimester ultrasound in pregnancy, more emphasis has been placed on assessment of fetal anatomy recently. In turn, congenital diagnoses can also be made earlier in pregnancy, raising the question of whether anatomic assessment in the first trimester is one of choice or obligation. Combining transvaginal and transabdominal approach yields the highest detection rate overall. Some studies have shown that more than half of all anomalies and almost all severe anomalies can be detected on early scans.

  View details for DOI 10.1016/j.ogc.2019.07.011

  View details for PubMedID 31677757

• Impact of obesity class on trial of labor after cesarean success: does pre-pregnancy or at-delivery obesity status matter? Journal of perinatology : official journal of the California Perinatal Association Mei, J. Y., Havard, A. L., Mularz, A. J., Maykin, M. M., Gaw, S. L. 2019; 39 (8): 1042-1049

  Abstract

  To investigate whether pre-pregnancy versus at delivery obesity status impacts TOLAC success rates in a modern cohort.A retrospective cohort study of women undergoing TOLAC at a single institution from May 2007 to April 2016. Women were divided into four groups (not obese; class I, II, and III obesity) by pre-pregnancy and at delivery weight class. We investigated associations between obesity status at both time points and TOLAC success rates.Six hundred and fourteen women underwent TOLAC; 444 (72.3%) had successful VBACs. We found no difference in rate of VBAC success across the four groups, both prior to pregnancy (p = 0.91) and at delivery (p = 0.75). We found no differences in secondary perinatal morbidity outcomes.We found no difference in TOLAC success rates stratified by obesity class. Properly counseling patients on TOLACs can lower rates of morbidity in women with high-risk conditions and comorbidities.

  View details for DOI 10.1038/s41372-019-0386-x

  View details for PubMedID 31092887

• Birth Plans and Childbirth Education: What Are Provider Attitudes, Beliefs, and Practices? The Journal of perinatal education Afshar, Y., Mei, J., Fahey, J., Gregory, K. D. 2019; 28 (1): 10-18

  Abstract

  We describe the perception and practices of obstetric providers on birth plans and childbirth education (CBE) classes. Using a national online survey, we collected provider and patient demographics, practice settings, and perceptions. Of 567 surveys, 77% were physicians and 22% were midwives. This cohort believed prenatal care and CBE were predictors of patient satisfaction, while they had unfavorable views of birth plans. Most providers routinely recommended (69.7%) and had favorable views on CBE (84%). Most providers (66.5%) did not recommend birth plans and 31% felt they were predictors of poor obstetrical outcomes. Further research is needed to bridge the gap between provider beliefs and patient desires about their birth experience as well as to understand how to improve childbirth-related patient satisfaction.

  View details for DOI 10.1891/1058-1243.28.1.10

  View details for PubMedID 31086471

  View details for PubMedCentralID PMC6491153

• Impact of Gestational Weight Gain on Trial of Labor after Cesarean Success. American journal of perinatology Mei, J. Y., Havard, A. L., Mularz, A. J., Maykin, M. M., Gaw, S. L. 2018

  Abstract

   Excessive gestational weight gain (GWG) has been associated with adverse pregnancy outcomes, including increased risk of cesarean delivery (CD). Data are limited on associations between GWG and outcomes in women undergoing trial of labor after cesarean (TOLAC). We aimed to investigate whether appropriate GWG impacts TOLAC outcomes. We performed a retrospective cohort study of women undergoing TOLAC at a single institution from May 2007 to April 2016. Women were divided into three groups based on GWG as compared with the Institute of Medicine recommendations. The primary outcome was successful vaginal birth after cesarean (VBAC). Secondary outcomes included various perinatal morbidity markers. A total of 614 women underwent TOLAC, of whom 444 (72.3%) had successful VBACs. When grouped by GWG in accordance with the Institute of Medicine guidelines, 149 (24.3%) women had GWG below guidelines, 224 (36.5%) met guidelines, and 241(39.3%) exceeded guidelines. There was no difference in the rate of VBAC success among the three groups. We also found no differences in secondary perinatal morbidity markers. We found no difference in TOLAC success rates with excess GWG. Providers should not consider excess GWG a risk factor for failed TOLAC, even in obese patients.

  View details for DOI 10.1055/s-0038-1675624

  View details for PubMedID 30500964

• Female Caudal Duplication Syndrome: A Surgical Case Report With 10-Year Follow-up and Review of the Literature. Female pelvic medicine & reconstructive surgery Mei, J. Y., Nguyen, M. T., Raz, S. 2018; 24 (4): e16-e20

  Abstract

  Caudal duplication syndrome is an exceedingly rare condition that manifests as duplicative anomalies of the gastrointestinal and genitourinary systems. We present a case of an adult patient born with multiple congenital anomalies including duplicated reproductive and urinary systems. She presented to our center for initial evaluation 11 years ago largely experiencing right-sided pelvic organ prolapse and bilateral urinary tract voiding dysfunction. She underwent successful surgical management and presented several years later for recurrent symptoms. We describe her presentation and our surgical experience, including complications and outcomes, for this case. We also review caudal duplication syndrome-its etiology, clinical presentation, diagnostic workup, surgical intervention (if any), and recommendations.

  View details for DOI 10.1097/SPV.0000000000000576

  View details for PubMedID 29698366

• Birth plans-Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study. Birth (Berkeley, Calif.) Afshar, Y., Mei, J. Y., Gregory, K. D., Kilpatrick, S. J., Esakoff, T. F. 2018; 45 (1): 43-49

  Abstract

  To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction.This was a prospective cohort study of singleton pregnancies greater than 34 weeks' gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi-squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables.Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth-related patient satisfaction.

  View details for DOI 10.1111/birt.12320

  View details for PubMedID 29094374

• A Case of Fulminant Endophthalmitis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Mei, J. Y., Nomura, J., Eichorn, K., Novak-Weekley, S. 2017; 65 (3): 527-528

  View details for DOI 10.1093/cid/cix273

  View details for PubMedID 30052832

• Influence of graft source and configuration on revision rate and patient-reported outcomes after MPFL reconstruction: a systematic review and meta-analysis. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Weinberger, J. M., Fabricant, P. D., Taylor, S. A., Mei, J. Y., Jones, K. J. 2017; 25 (8): 2511-2519

  Abstract

  The purpose of this systematic review and meta-analysis was to determine the influence of graft source (allograft vs. autograft) and configuration (single-limbed vs. double-limbed) on failure rate and disease-specific patient-reported outcome (Kujala score) after medial patellofemoral ligament (MPFL) reconstruction for patellar instability.A systematic review of PubMed, Scopus, and the Cochrane Library was performed. A total of 31 studies met inclusion/exclusion criteria and were used to extract cohorts of patients who underwent ligament reconstruction with various allograft, autograft, single-limbed, and double-limbed constructs. Failure rates and postoperative improvements in Kujala scores were compared between cohorts using inverse-variance weighting in a random-effects analysis model and appropriate comparative statistical analyses (Chi-squared and independent samples t tests).A total of 1065 MPFL reconstructions were identified in 31 studies. Autograft reconstructions were associated with greater postoperative improvements in Kujala scores when compared to allograft (32.2 vs. 22.5, p < 0.001), but there was no difference in recurrent instability (5.7 vs. 6.7 %, p = 0.74). Double-limbed reconstructions were associated with both improved postoperative Kujala scores (37.8 vs. 31.6, p < 0.001) and lower failure rate (10.6 vs. 5.5 %, p = 0.030).MPFL reconstructions should be performed using double-limbed graft configurations. While autograft tendon may be associated with higher patient-reported outcomes in the absence of associated connective tissue disorders or ligamentous laxity, patient factors and allograft processing techniques should be carefully considered when selecting an MPFL graft source, as revision rates were no different between graft sources.IV.

  View details for DOI 10.1007/s00167-016-4006-4

  View details for PubMedID 26856314

• Implications of intrapartum azithromycin on neonatal microbiota. The Lancet. Infectious diseases Mei, J., Harter, K., Danhaive, O., Seidman, D., Vargas, J. 2017; 17 (3): 253-254

  View details for DOI 10.1016/S1473-3099(17)30058-0

  View details for PubMedID 28244378

• Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery. Birth (Berkeley, Calif.) Afshar, Y., Wang, E. T., Mei, J., Esakoff, T. F., Pisarska, M. D., Gregory, K. D. 2017; 44 (1): 29-34

  Abstract

  To determine whether the mode of delivery was different between women who attended childbirth education (CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan.This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed.In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls.Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.

  View details for DOI 10.1111/birt.12263

  View details for PubMedID 27859592

• The Relationship of Anterior Vaginal and Apical Position to Postvoid Residual Urine. Female pelvic medicine & reconstructive surgery Wong, K. S., Mei, J. Y., Wieslander, C. K., Tarnay, C. M. 2017; 23 (5): 310-314

  Abstract

  The aim of the study was to investigate the association between severity of anterior vaginal or apical prolapse and postvoid residual volume (PVR).The charts of all women who presented to Urogynecology Clinic at Olive View-UCLA Medical Center for a 2-year period were reviewed. Demographic data, the degree of prolapse pelvic organ prolapse quantification points Aa, Ba, and C, and PVR were recorded. Patients with incomplete pelvic organ prolapse quantification assessment or improperly measured PVR were excluded.Three hundred fifty-two patients were included. Median age was 54 years (range, 26-80). Mean gravidity and parity were 4.4 and 3.7, respectively. Mean body mass index was 29.9 kg/m. One hundred forty-nine women had previous pelvic surgery. Median PVR was 25 mL, and 40 patients (11.4%) had a PVR of 100 mL or greater.Considering 15 potential PVR predictors, we found that the position of apex/cervix (point C) significantly correlated with an increase in PVR and also after controlling for the other significant covariates (rate of change b = 4.7% increase in PVR/cm, P = 0.0007). The other significant (P < 0.05) covariates were gravidity (5.7% per pregnancy), postmenopausal status (32.4%), and vaginal surgical history (61.4%). This was not true, however, for the anterior vaginal position (points Aa, Ba; P > 0.15). There was no difference in mean PVR in patients with versus without a hysterectomy (P = 0.236).Elevated PVR values have long been linked with prolapse of the anterior vaginal wall. We found that there is a linear association between PVR and the anatomic position of the apex. There was no association of PVR with the position of the anterior vaginal wall.

  View details for DOI 10.1097/SPV.0000000000000390

  View details for PubMedID 28145915

• Birth Plans: What Matters for Birth Experience Satisfaction. Birth (Berkeley, Calif.) Mei, J. Y., Afshar, Y., Gregory, K. D., Kilpatrick, S. J., Esakoff, T. F. 2016; 43 (2): 144-50

  Abstract

  To categorize individual birth plan requests and determine if number of requests and request fulfillment is associated with birth experience satisfaction.This is a sub-analysis of a prospective cohort study of 302 women with singleton pregnancies with and without birth plans. Women with a hard copy of their birth plans who completed a postdelivery satisfaction survey were included in this study. We described the number and type of birth plan requests and associated the number of requests and request fulfillment with overall satisfaction, expectations met, and sense of control. Differences between groups were analyzed using chi-square, Spearman rank correlation, and logistic regression.One hundred and nine women presented to Labor and Delivery with a hard copy of their prewritten birth plan. We identified 23 unique requests. The most common requests were no intravenous analgesia (82%) and exclusive breastfeeding (74%). The requests most fulfilled were avoidance of episiotomy (100%) and no operative vaginal delivery (89%). Having a higher number of requests fulfilled correlated with greater overall satisfaction (p = 0.03), higher chance of expectations being met (p < 0.01), and feeling more in control (p < 0.01). Having a high number of requests was associated with an 80 percent reduction in overall satisfaction with the birth experience (p < 0.01).Having a higher number of requests fulfilled was positively associated with birth experience satisfaction, while having a high number of requests was inversely associated with birth experience satisfaction. Further research is needed to understand how to improve birth plan-related birth experience satisfaction.

  View details for DOI 10.1111/birt.12226

  View details for PubMedID 26915304