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Melissa Gilliam

Publications and source records attributed to Melissa Gilliam.

6 recordsLinked to original sources
PubMed2006

Barriers to obtaining a desired postpartum tubal sterilization.

OBJECTIVE: To determine why women do not undergo postpartum sterilization despite expressing desire during antepartum care. METHODS: In a retrospective chart review, we identified all women between March 2002 and November 2003 who requested postpartum sterilization during antepartum care but did not undergo the procedure. We report the reasons why sterilizations were not performed. RESULTS: We reviewed 6,589 prenatal care and delivery records identifying 324 women meeting inclusion criteria. One hundred and four women changed their mind. Of women still desiring sterilization at discharge, the most common reasons for not undergoing the procedure were lack of valid Medicaid sterilization consent forms [n=121; 37.3%, 95% confidence interval (CI) 32.0-42.6%]; a medical condition precluding the procedure (n=47; 14.5%, 95% CI 10.7-18.3%); lack of availability of an operating room (n=2; 6.5%, 95% CI 3.8-9.2%). CONCLUSION: We found that the Medicaid consent process, medical conditions and insufficient operating room space prevented women from having the desired surgery.

Adult↗
PubMed2006

Cesarean delivery on request: reproductive consequences.

OBJECTIVE: The objective of this review is to examine the long term reproductive health consequences of cesarean delivery on maternal request. FINDINGS: In the first delivery, cesarean delivery appears to hold small risk of reproductive complications compared to vaginal delivery. Primary cesarean delivery can affect subsequent pregnancies. The most serious reproductive health consequences of prior cesarean delivery occur in subsequent pregnancies. These complications include: unexplained fetal death apparent from 34 weeks gestation onward; abnormalities of placentation which increase with a greater number of cesarean deliveries; risk of uterine rupture and uterine scar dehiscence. CONCLUSIONS: Primary cesarean delivery carries risk for subsequent pregnancies. While the studies reviewed do not specifically refer to cesarean delivery on request, it is likely that the results would be similar. Overall, in considering the specific question of long term reproductive health, the risks of maternal request cesarean delivery outweigh the benefits.

Cesarean Section↗
PubMed2005

Failure to obtain desired postpartum sterilization: risk and predictors.

OBJECTIVE: The aim of this study was to assess the rate of and risk factors for not obtaining postpartum sterilization among women who expressed a desire for sterilization during antepartum care. METHODS: In this retrospective study, we identified a cohort of women who expressed desire for postpartum sterilization at our center between March 2002 and November 2003. We compared women who did and those who did not undergo the procedure, based on demographic, antenatal, and intrapartum factors. RESULTS: Of the 712 women who expressed desire for postpartum sterilization during antepartum care, 327 (46%) did not undergo the procedure. In multivariable analysis, women who were between the ages of 21 and 25 years (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.89), were African American (OR 0.68, 95% CI 0.47-1.00), requested sterilization in the second trimester (OR 0.50, 95% CI 0.29-0.86)), and had a vaginal delivery (OR 0.21, 95% CI 0.14-0.32) rather than cesarean delivery were least likely to undergo postpartum sterilization. CONCLUSION: Despite their initial request, only 54% of women in our sample underwent sterilization. Young age, African-American race, request in the second trimester, and vaginal delivery were significantly associated with not undergoing sterilization. Our data suggest that providers should counsel all women who desire postpartum sterilization about the wide array of contraceptive methods available, with the understanding that approximately half of all women may not undergo the sterilization procedure. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2004

Success with oral contraceptives: a pilot study.

The objective of this pilot study was to examine the effectiveness of a postpartum educational intervention aimed at increasing compliance with oral contraception (OCs) and decreasing repeat pregnancies in young, African American women in the year following an unplanned pregnancy. In this longitudinal study, 43 young, pregnant women attending Prentice Ambulatory Care, Northwestern Hospital, were enrolled and 33 were randomized to receive an antepartum, multicomponent intervention consisting of counseling, a videotape about OCs and written material or resident-physician counseling (usual care). Questionnaire data were collected at enrollment, immediately following the intervention, at 6 weeks, 6 months and 12 months. At 1 year, 25 women remained in the study. More women in the intervention group were not pregnant and still using contraception, and were able to successfully switch contraceptive methods compared to women in the control group. There was no decrease in repeat pregnancy in the intervention group at 1 year compared to the control group. Our intervention resulted in a sustained increase in knowledge of OCs throughout the study period. However, more is needed to promote postpartum contraceptive compliance and decrease repeat pregnancies in young, low-income African Americans with unintended pregnancies.

Adolescent↗
PubMed2002

The likelihood of placenta previa with greater number of cesarean deliveries and higher parity.

OBJECTIVE: To examine the relationship between prior cesarean delivery and placenta previa. METHODS: A hospital-based, case-control study was conducted in which 316 multiparous women with placenta previa were identified. Controls consisted of 2051 multiparous women with spontaneous vaginal deliveries. Information on prior cesarean delivery was examined in three forms: as a dichotomous variable, as an ordinal variable, and as a set of three indicator variables for one, two, and three or more cesarean deliveries. Multivariable logistic regression modeling was used to obtain an adjusted estimate of this association. RESULTS: Women with a prior cesarean delivery were more likely to have a placenta previa than those without (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.21, 2.08). The likelihood of placenta previa increased as both parity and number of cesarean deliveries increased. Thus, the adjusted OR for a primiparous woman with one cesarean delivery was 1.28 (95% CI 0.82, 1.99). For a woman who has four or more deliveries with only a single cesarean delivery, the OR increases to 1.72 (95% CI 1.12, 2.64). This trend continues with greater parity and a greater number of cesarean deliveries such that the likelihood of placenta previa for a woman with parity greater than four and greater than four cesarean deliveries was OR 8.76 (95% CI 1.58, 48.53). CONCLUSION: This study supports the association between prior cesarean delivery and placenta previa and demonstrates that the joint effect of parity and prior cesarean delivery is greater than that of either variable alone.

Adult↗