Biomedical subjects

Michelle Pagano

Publications and source records attributed to Michelle Pagano.

4 recordsLinked to original sources

PubMed2006

Is routine prophylactic cervical cerclage associated with significant prolongation of triplet gestation?

OBJECTIVE: The purpose of this study was to determine if routine prophylactic cervical cerclage was associated with a significant prolongation of triplet pregnancy. STUDY DESIGN: A retrospective study of all women carrying triplet pregnancies at a single institution during a four-year period was carried out. Selected maternal characteristics and obstetric outcome measures in women who received prophylactic cerclage (PC) were compared to women who did not receive PC (no cerclage placed and emergency cerclage). Statistical comparison was done using the Mann-Whitney test for continuous variables and Fisher's exact test for categorical variables. RESULTS: Fifty-five women had PC and 40 had no PC. There was no significant difference between these two groups in mean maternal age or weight, nulliparity, history of or current sexually transmitted disease, cigarette smoking, history of cervical insufficiency, prior dilation and curettage, prior cervical surgery, prior preterm labor/prolonged preterm rupture of membranes (PTL/PPROM), medical complications in pregnancy, current PTL/PPROM, gestational age at delivery, delivery prior to 28 weeks, delivery prior to 32 weeks, or delivery of an infant weighing less than 1000 or 1500 grams. Thirteen women in the no PC group (32.5%) required emergency cerclage. CONCLUSION: PC was not associated with significant prolongation of triplet pregnancy.

Adult↗

PubMed2005

Previous preterm cesarean delivery: identification of a new risk factor for uterine rupture in VBAC candidates.

OBJECTIVE: A major risk of trials of labor in patients with prior cesarean delivery is uterine rupture. We evaluated the question of whether a previous cesarean delivery at an early gestational age predisposes the patient to subsequent uterine rupture. METHODS: This was a retrospective chart review of patients delivering at North Shore University Hospital with a trial of labor after previous cesarean delivery to ascertain all cases of uterine rupture. Patients who had had a previous cesarean delivery at our institution who did not suffer uterine rupture during a trial of labor served as controls. RESULTS: Twenty-five patients suffered a uterine rupture. The incidence of prior preterm cesarean delivery (PPCD) in this group was 40%, compared to 10.9% of 691 laboring vaginal birth after cesarean (VBAC) patients without rupture (p < 0.001). Patients in the rupture group with a PPCD were less likely to have experienced labor in the index pregnancy and more likely to have had an interdelivery interval of less than two years. CONCLUSIONS: An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.

Birth Intervals↗

PubMed2003

Low prepregnancy ideal weight:height ratio in women with hyperemesis gravidarum.

OBJECTIVE: To determine if a low prepregnancy weight:height ratio is a risk factor for hyperemesis. STUDY DESIGN: A retrospective chart review was conducted on 38 patients admitted to North Shore University Hospital for hyperemesis over a 5-year period. Prepregnancy weight, body mass index and percent ideal weight:height ratio in this group were compared to findings on 79 randomly selected control patients not admitted for hyperemesis. RESULTS: There was a significantly higher incidence of prepregnancy underweight women (low percent ideal weight for height) in patients admitted for hyperemesis as compared to controls (P < .01). Thyroid-stimulating hormone was low in 19% of patients tested. CONCLUSION: A low prepregnancy percent ideal weight:height ratio may predispose women to the development of hyperemesis.

Adult↗

PubMedDate not supplied

Sustaining a diabetes in pregnancy program: a continuous quality improvement process.

Education regarding diabetes management is of utmost importance, especially during pregnancy when there are 2 patients being managed at the same time, a mother and a fetus. The level of education the mother receives affects both patients. The constant reevaluation and change in treatment plans based on those evaluations positively affects the outcomes for each of them. There are a number of complications associated with having uncontrolled diabetes during pregnancy. A diabetes in pregnancy management program can offer education, provide continuous evaluation of management options, decrease hospitalizations for glucose control, and decrease complications associated with uncontrolled diabetes. All programs must have a goal, a benchmark by which to measure themselves. Plans must be formulated using current and acceptable standards of care. Once implemented, there must be ongoing evaluation of outcomes to determine whether goals are being met. With implementation of the appropriate quality tools, programs can learn to formulate their plans, implement them, measure the results, improve outcomes, and sustain themselves.

Diabetes Complications↗