Publications by authors named "Byron Calhoun"

41 Publications

Abdominal cerclage in a patient with a neocervix with planned cesarean hysterectomy at delivery.

J Obstet Gynaecol Res 2021 Jan 20;47(1):416-419. Epub 2020 Oct 20.

Department of Obstetrics and Gynecology, Charleston Area Medical Center, Charleston, West Virginia, USA.

Pregnancies complicated by congenital uterine anomalies (CUA) with a neocervix present a variety of challenges for the obstetrician. Abdominal cerclage can be utilized to help prevent preterm delivery in a patient with a neocervix. A 14-year-old female presented with right adnexal pain and was found to have a complex uterine anomaly resembling a noncommunicating unicornuate uterus with a cervix embedded in the rudimentary horn. A neocervix was created during surgical removal of the rudimentary horn. The patient became pregnant at age 24, and a transabdominal cerclage served an important role in the prevention of preterm delivery. Although limited data exists regarding the outcomes for the use of abdominal cerclage after the creation of a neocervix, term delivery is possible with said intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jog.14525DOI Listing
January 2021

Ecological study of effects of industrial watershed on Müllerian anomalies in an obstetric population.

Ecotoxicol Environ Saf 2020 Oct 23;202:110819. Epub 2020 Jun 23.

West Virginia University/Charleston Area Medical Center Women and Children's Hospital, 800 Pennsylvania Ave, Charleston, WV, 25302, United States. Electronic address:

Objective: To ascertain the prevalence of Müllerian anomalies within an obstetrical population in relation to official hazardous waste sites designated by the Environmental Protection Agency (EPA) in West Virginia.

Methods: Observational study of obstetric patients in a tertiary care center with uterine ultrasounds from January 2006 to June 2017. An Optimized Hot Spot analysis and Ripley's K- Function was constructed to ascertain if there is an association with environmental exposures.

Results: The prevalence of Müllerian anomalies in our obstetric study sample was 0.9% (118/13,040). The most common were septate (47; 39.8%) and bicornuate (46; 39.0%). The distribution of Müllerian anomalies was non-random illustrated by Optimized Hot Spot Analysis locating several statistically significant zip codes of Müllerian anomalies in relation to zip codes that include EPA facilities.

Conclusion: The distribution of Müllerian anomalies was clustered in watershed areas along the Kanawha River in West Virginia that have been designated as EPA FRS Sites and Superfund Sites.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ecoenv.2020.110819DOI Listing
October 2020

Inherited alterations of TGF beta signaling components in Appalachian cervical cancers.

Cancer Causes Control 2019 Oct 21;30(10):1087-1100. Epub 2019 Aug 21.

College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.

Purpose: This study examined targeted genomic variants of transforming growth factor beta (TGFB) signaling in Appalachian women. Appalachian women with cervical cancer were compared to healthy Appalachian counterparts to determine whether these polymorphic alleles were over-represented within this high-risk cancer population, and whether lifestyle or environmental factors modified the aggregate genetic risk in these Appalachian women.

Methods: Appalachian women's survey data and blood samples from the Community Awareness, Resources, and Education (CARE) CARE I and CARE II studies (n = 163 invasive cervical cancer cases, 842 controls) were used to assess gene-environment interactions and cancer risk. Polymorphic allele frequencies and socio-behavioral demographic measurements were compared using t tests and χ tests. Multivariable logistic regression was used to evaluate interaction effects between genomic variance and demographic, behavioral, and environmental characteristics.

Results: Several alleles demonstrated significant interaction with smoking (TP53 rs1042522, TGFB1 rs1800469), alcohol consumption (NQO1 rs1800566), and sexual intercourse before the age of 18 (TGFBR1 rs11466445, TGFBR1 rs7034462, TGFBR1 rs11568785). Interestingly, we noted a significant interaction between "Appalachian self-identity" variables and NQO1 rs1800566. Multivariable logistic regression of cancer status in an over-dominant TGFB1 rs1800469/TGFBR1 rs11568785 model demonstrated a 3.03-fold reduction in cervical cancer odds. Similar decreased odds (2.78-fold) were observed in an over-dominant TGFB1 rs1800469/TGFBR1 rs7034462 model in subjects who had no sexual intercourse before age 18.

Conclusions: This study reports novel associations between common low-penetrance alleles in the TGFB signaling cascade and modified risk of cervical cancer in Appalachian women. Furthermore, our unexpected findings associating Appalachian identity and NQO1 rs1800566 suggests that the complex environmental exposures that contribute to Appalachian self-identity in Appalachian cervical cancer patients represent an emerging avenue of scientific exploration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10552-019-01221-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768402PMC
October 2019

Congenital heart defects in West Virginia: Preliminary findings from an ecological study of effects of an industrial watershed on increased incidence.

Reprod Toxicol 2019 12 16;90:62-67. Epub 2019 Aug 16.

Department of Obstetrics and Gynecology, West Virginia University - Charleston Division, Charleston Area Medical Center, 800 Pennsylvania Ave, Charleston, WV 25302, United States.

Objective: Congenital anomalies are the leading cause of infant death, with congenital heart (CHD) defects the most common type. The study objective was to evaluate the incidence of fetal CHD in a tertiary care medical center's obstetric population in West Virginia and map areas of possible environmental exposure.

Methods: This was an observational study of patients with positive ultrasound screen for CHD from 1/1/2007-8/31/2016. An Optimized Hot Spot analysis and Ripley's K- Function was constructed to understand the effect of CHD in relation to proximity to chemical and coal extraction sites.

Results: Of the 16,871 obstetric pregnancies, 206 (1.2%) had fetal CHD with ventriculoseptal defects the most common (88; 42.7%). The majority of cases of CHD followed the industrial watershed of the Kanawha River in West Virginia. Direct point source exposure suggests a relationship in cases of CHD within Kanawha River and surrounding areas. The observed K was significantly above the expected K across all 10 distance bands. The fourth distance band exhibited the larger difference at (37914), between the expected verses the observed K function.

Conclusion: Through spatial analysis, there appears to be a direct point source exposure for observed cases of f CHD along the industrial watershed of Kanawha County, West Virginia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.reprotox.2019.08.011DOI Listing
December 2019

Healthy management of very early adolescent pregnancy.

Authors:
Byron C Calhoun

Issues Law Med 2016 ;31(2):191-203

West Virginia University-Charleston Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 800 Pennsylvania Avenue, Charleston, WV 25302; Phone: 304-388-1599; Fax: 304-388-2915;

Background: Very Early Pregnancy (< 15 years at delivery) is suggested as a risk factor for adverse pregnancy outcome including low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA) infants, stillbirth, and neonatal mortality.

Objective: To systematically review the risk of an infant being born LBW/ PTB/SGA/stillbirth or neonatal mortality among patients < 15 years of age. Search strategy: Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies.

Selection Criteria: Selection criteria: Studies reporting birth outcomes to mothers < 15 years of age with an appropriate control group of older gravidas. Data collection and analysis: A single reviewer collected data and assessed the quality of the studies for biases in sample selection, correct age cohorts, confounder adjustment, analytical, outcome assessments, and attrition. Main results: Forty-six studies were located with very early adolescent pregnancy. Of these, only 21 papers had the correct age group (< 15 years) with a comparison cohort. The studies found in the very early adolescent pregnancy: Increased risk of SGA; Increased risk of LBW < 2,500 gms; Increased risk of PTD < 37 weeks; Decreased risk of DM; Decreased risk of cesarean section; Decreased risk of use of pitocin/active phase length; Conflicting risks for Preeclampsia/VLBW/Episiotomy/instrumental delivery rates.

Selection Criteria: Very early adolescent pregnancies (< 15 years) do not have universally grim outcomes as normally quoted. Very early adolescent pregnancies have decreased risk of cesarean delivery, DM, and of active phase disorders. Further, many of the adverse outcomes may be ameliorated with earlier, adolescent-focused, and improved antenatal care.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2018

Pulmonary hypertension: Clinical parameters of a difficult case in pregnancy.

Authors:
Byron C Calhoun

Linacre Q 2017 Aug 22;84(3):243-247. Epub 2017 Aug 22.

Department of Obstetrics and Gynecology, West Virginia University-Charleston, Charleston, WV, USA.

Treatment of pulmonary hypertension in pregnancy with a prostacyclin analogue-iloprost and/or calcium channel antagonists appears to improve outcomes and survival. These medications could have been administered to the patient and the response monitored. If the patient did not respond to therapy, this patient may have had either a referral to or transfer to another high risk center with more experience in this type of pregnant patient. There is no literature to support termination of pregnancy improving maternal survival outcomes in these patients, even though termination is recommended by all obstetrical textbooks. Maternal survival, rather, appears to be related to response to therapy, type of therapy, and continuation of therapy.

Summary: A patient who is pregnant with pulmonary hypertension (increased right-sided heart pressures) may be managed with medications. There is no literature to support termination of pregnancy improving maternal survival outcomes in patients with pulmonary hypertension, even though termination is recommended by all obstetrical textbooks. Maternal survival, rather, appears to be related to response to therapy, type of therapy, and continuation of therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00243639.2016.1173812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592306PMC
August 2017

Outcomes in an obstetrical population with hereditary thrombophilia and high tobacco use.

J Matern Fetal Neonatal Med 2018 May 20;31(10):1267-1271. Epub 2017 Apr 20.

c Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine , Southside Hospital , Bay Shore , NY , USA.

Objective: The purpose of this study was to examine birth outcomes in women treated or untreated for thrombophilia during pregnancies affected or not by tobacco exposure.

Methods: This was a retrospective cohort study of consecutive women from a single maternal fetal medicine clinic who delivered between January 2009 and December 2013. We compared birth outcomes by four groups of thrombophilia and smoking combinations and then by treated or untreated groups.

Results: Of the 8889 pregnant women in this study, 113 had thrombophilia and 97 received treatment. Thromboprophylaxis included: low molecular weight heparin, aspirin, unfractionated heparin, folic acid, and combinations of these. Smokers with thrombophilia had significantly higher rates of preeclampsia, intrauterine growth restriction, preterm birth (<37 weeks gestation) and low birth weight (all p ≤ .001). Conversely, this group had significantly lower rates of hemolysis, elevated liver enzymes, low platelet count (HELLP syndrome) and placental abruption. Women with thrombophilia who received thromboprophylaxis had lower rates of adverse birth outcomes, reaching significance for preterm birth <32 weeks gestation (4.3% versus 21.1%, p = .026).

Conclusion: Pregnant women who smoke and have thrombophilia may be more likely to experience adverse birth outcomes and receive more benefit from thromboprophylaxis than their nonsmoking counterparts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2017.1313829DOI Listing
May 2018

Doppler screening and predictors of adverse outcomes in high risk pregnancies affected by tobacco.

Reprod Toxicol 2017 01 9;67:10-14. Epub 2016 Nov 9.

Departmen of Obstetrics and Gynecology, West Virginia University - Charleston Division, Charleston Area Medical Center, 800 Pennsylvania Ave, Charleston, WV 25302, United States. Electronic address:

Objective: The purpose of this study was to investigate associations between Doppler measurements and adverse outcomes in an obstetric population with high tobacco use.

Methods: This retrospective study included patients with Doppler data (umbilical systolic/diastolic velocity ratios (S/D), uterine S/D, uterine left/right ratio index (RI)). Receiver operator characteristic curve analysis determined cut-off elevated Doppler indices. Stepwise logistic regression was used to predict adverse outcomes.

Results: 338 of 745 patients (45.4%) had adverse outcomes. Doppler artery indices identified significant associations with IUGR, preeclampsia, low birth weight, pre-term birth and composite adverse outcome variable. An elevated Umbilical S/D was 2.1 (95% Confidence Interval (CI): 1.5-2.9; p<0.001) times was more likely to have an adverse outcome. For left uterine artery S/D and nulliparity, the odds ratios were 1.8 (95% CI: 1.3-2.5) and 1.4 (95% CI: 1.0-1.9), respectively.

Conclusion: Umbilical and uterine left S/D indices and nulliparity are significant independent predictors of adverse outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.reprotox.2016.11.006DOI Listing
January 2017

The Myth That Abortion is Safer Than Childbirth: Through the Looking Glass.

Authors:
Byron C Calhoun

Issues Law Med 2015 ;30(2):209-15

View Article and Find Full Text PDF

Download full-text PDF

Source
February 2016

Evaluation of a Training to Reduce Provider Bias Toward Pregnant Patients With Substance Abuse.

J Soc Work Pract Addict 2014 Jul;14(3):239-249

CAMC Women and Children's Hospital, Charleston, West Virginia, USA.

The objective of this article is not to present a scientific or systematic study, but to provide an initial framework for designing a training workshop to enhance health practitioners' (nurses, social workers, physicians, etc.) knowledge regarding substance abuse treatment and to decrease their bias toward substance-abusing women, particularly pregnant women in rural communities. We incorporated the 4 Transdisciplinary Foundations from the Substance Abuse and Mental Health Services Administration Competencies Model, with specific competencies targeted that related to provider bias. After the conference, 52 of the 70 participants completed a questionnaire to self-assess knowledge level and confidence in skill related to substance abuse management. Participant mean scores were statistically significantly higher following the conference than 1 week prior ( p < .001) in the area of "gender difference with substance abuse," moving from an average of 2.6 to 4.5 on a 5-point Likert scale. Our conference was successful in increasing attendees' knowledge about gender difference and substance abuse among pregnant patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/1533256X.2014.933730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508864PMC
July 2014

Transvaginal cervical length and tobacco use in Appalachian women: association with increased risk for spontaneous preterm birth.

W V Med J 2015 May-Jun;111(3):22-8

Currently ACOG recommends that a mid-term screening strategy may be considered to identify short cervix in low risk populations in an effort to prevent preterm birth. Vaginal progesterone is recommended for women with a cervical length ≤20 mm. Cerclage is recommended for women with prior spontaneous preterm birth who are already receiving progesterone supplementition and CL is <25 mm. This study examined risk factors for spontaneous preterm birth (SPB) <35 weeks among a general obstetrical population prior to these ACOG recommendations. However, cervical cerclage was a possible intervention. Study population included 1,074 patients from 1 Jan 2007-30 Jun 2008 receiving mid-trimester transvaginal ultrasounds during prenatal care at a tertiary medical center clinic. Receiver operator characteristic (ROC) curve cutoff optimal value was ≤34 mm, (n=224), corresponding to 8.9% SPB with shortened cervices compared to 1.4% in patients with normal cervices (>34 mm; n=850; p<0.001 (Area Under the Curve (AUC) 76.6, p<0.001). Cervical lengths <30 mm had 12 times the risk of SPB (p<0.001) while 30-34 mm had 5 times (p=0.005). Tobacco use (≥10 cigarettes per day), p=0.030, and low BMI, p=0.034, had additive effect. Shortened cervical length during routine screening independently predicted SPB while heavy smoking with shortened cervix during pregnancy doubled risk compared to shortened cervix alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560172PMC
June 2015

Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states.

BMJ Open 2015 Feb 23;5(2):e006013. Epub 2015 Feb 23.

Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, USA Center for Women's Health Research, University of North Carolina School of Medicine, Chapel Hill, USA.

Objective: To test whether there is an association between abortion legislation and maternal mortality outcomes after controlling for other factors thought to influence maternal health.

Design: Population-based natural experiment.

Setting And Data Sources: Official maternal mortality data from 32 federal states of Mexico between 2002 and 2011.

Main Outcomes: Maternal mortality ratio (MMR), MMR with any abortive outcome (MMRAO) and induced abortion mortality ratio (iAMR).

Independent Variables: Abortion legislation grouped as less (n=18) or more permissive (n=14); constitutional amendment protecting the unborn (n=17); skilled attendance at birth; all-abortion hospitalisation ratio; low birth weight rate; contraceptive use; total fertility rates (TFR); clean water; sanitation; female literacy rate and intimate-partner violence.

Main Results: Over the 10-year period, states with less permissive abortion legislation exhibited lower MMR (38.3 vs 49.6; p<0.001), MMRAO (2.7 vs 3.7; p<0.001) and iAMR (0.9 vs 1.7; p<0.001) than more permissive states. Multivariate regression models estimating effect sizes (β-coefficients) for mortality outcomes showed independent associations (p values between 0.001 and 0.055) with female literacy (β=-0.061 to -1.100), skilled attendance at birth (β=-0.032 to -0.427), low birth weight (β=0.149 to 2.166), all-abortion hospitalisation ratio (β=-0.566 to -0.962), clean water (β=-0.048 to -0.730), sanitation (β=-0.052 to -0.758) and intimate-partner violence (β=0.085 to 0.755). TFR showed an inverse association with MMR (β=-14.329) and MMRAO (β=-1.750) and a direct association with iAMR (β=1.383). Altogether, these factors accounted for (R(2)) 51-88% of the variance among states in overall mortality rates. No statistically independent effect was observed for abortion legislation, constitutional amendment or other covariates.

Conclusions: Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2014-006013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342595PMC
February 2015

The 80-hour work week for residents: views from obstetric and gynecology program directors.

W V Med J 2014 Sep-Oct;110(5):20-5

In 2003, the Accreditation Council for Graduate Medical Education mandated an 80-hour work week restriction for residency programs. We examined program directors' views on how this mandate affects the education of Obstetrics and Gynecology residents. A 25 question survey was administered via Survey Monkey to Obstetrics and Gynecology program directors in the United States over three months in 2011. Fifty program directors (response rate of 28%) completed it with more men (62%) than women (38%) respondents. Overall, only 28% (14/50) responded that the program had improved, with significantly fewer men (5/14; 16.1%) than women (47.4% 9/19; p < 0.0169) directors reporting this. There was little perceived improvement in any of the six core ACGME performance objectives and in the CREOG scores, with the improvement ranging from 8% to 12%. In fact, while we observed the percentage of women directors reporting improvement in patient care and interpersonal and communication skills significantly higher compared with their male counterparts, the majority of women still reported either no improvement or a decline in these areas. Though our sample size was small, we found some significant difference between the views of male and female program directors. Both groups nonetheless responded with the majority with a decline or no change rather than a perceived improvement in any of the educational endeavors studied.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504236PMC
February 2015

A second opinion: response to 100 professors.

Issues Law Med 2014 ;29(1):147-64

Induced abortion is a controversial topic among obstetricians. "100 Professors" extolled the benefits of elective abortion in a Clinical Opinion published in AJOG. However, scientific balance requires the consideration of a second opinion from practitioners who care for both patients, and who recognize the humanity of both. Alternative approaches to the management of a problem pregnancy, as well as short and long term risks to women as published in the peer reviewed medical literature are discussed. Maintaining a position of "pro-choice" requires that practitioners also be given a right to exercise Hippocratic principles in accordance with their conscience.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2014

The Maternal Mortality Myth in the Context of Legalized Abortion.

Authors:
Byron Calhoun

Linacre Q 2013 Aug 1;80(3):264-276. Epub 2013 Aug 1.

West Virginia University-Charleston, Charleston, WV, USA.

It was quoted recently in the literature that "The risk of death associated with childbirth is approximately 14 times higher than with abortion." This statement is unsupported by the literature and there is no credible scientific basis to support it. A reasonable woman would find any discussion about the risk of dying from a procedure as material, i.e., important and significant. In order for the physician-patient informed consent dialogue to address this critical issue, the physician must rely upon objective and accurate information concerning abortion. There are numerous and complicated methodological factors that make a valid scientific assessment of abortion mortality extremely difficult. Among the many factors responsible are incomplete reporting, definitional incompatibilities, voluntary data collection, research bias, reliance upon estimations, political correctness, inaccurate and/or incomplete death certificate completion, incomparability with maternal mortality statistics, and failing to include other causes of death such as suicides. Given the importance of this disclosure about abortion mortality, the lack of credible and reliable scientific evidence supporting this representation requires substantial discussion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1179/2050854913Y.0000000004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6027002PMC
August 2013

Fundamental discrepancies in abortion estimates and abortion-related mortality: A reevaluation of recent studies in Mexico with special reference to the International Classification of Diseases.

Int J Womens Health 2012 5;4:613-23. Epub 2012 Dec 5.

Institute of Molecular Epidemiology (MELISA), Center of Embryonic Medicine and Maternal Health, Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile ; Faculty of Medicine, University of Chile, Santiago, Chile.

In countries where induced abortion is legally restricted, as in most of Latin America, evaluation of statistics related to induced abortions and abortion-related mortality is challenging. The present article reexamines recent reports estimating the number of induced abortions and abortion-related mortality in Mexico, with special reference to the International Classification of Diseases (ICD). We found significant overestimations of abortion figures in the Federal District of Mexico (up to 10-fold), where elective abortion has been legal since 2007. Significant overestimation of maternal and abortion-related mortality during the last 20 years in the entire Mexican country (up to 35%) was also found. Such overestimations are most likely due to the use of incomplete in-hospital records as well as subjective opinion surveys regarding induced abortion figures, and due to the consideration of causes of death that are unrelated to induced abortion, including flawed denominators of live births. Contrary to previous publications, we found important progress in maternal health, reflected by the decrease in overall maternal mortality (30.6%) from 1990 to 2010. The use of specific ICD codes revealed that the mortality ratio associated with induced abortion decreased 22.9% between 2002 and 2008 (from 1.48 to 1.14 deaths per 100,000 live births). Currently, approximately 98% of maternal deaths in Mexico are related to causes other than induced abortion, such as hemorrhage, hypertension and eclampsia, indirect causes, and other pathological conditions. Therefore, only marginal or null effects would be expected from changes in the legal status of abortion on overall maternal mortality rates. Rather, maternal health in Mexico would greatly benefit from increasing access to emergency and specialized obstetric care. Finally, more reliable methodologies to assess abortion-related deaths are clearly required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/IJWH.S38063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526871PMC
December 2012

Reproductive history patterns and long-term mortality rates: a Danish, population-based record linkage study.

Eur J Public Health 2013 Aug 5;23(4):569-74. Epub 2012 Sep 5.

Human Development and Family Studies, Bowling Green State University, Bowling Green, OH 43403, USA.

Background: Inconsistent definitions and incomplete data have left society largely in the dark regarding mortality risks generally associated with pregnancy and with particular outcomes, immediately after resolution and over the long-term. Population-based record-linkage studies provide an accurate means for deriving maternal mortality rate data.

Method: In this Danish population-based study, records of women born between 1962 and 1993 (n = 1,001,266) were examined to identify associations between patterns of pregnancy resolution and mortality rates across 25 years.

Results: With statistical controls for number of pregnancies, birth year and age at last pregnancy, the combination of induced abortion(s) and natural loss(es) was associated with more than three times higher mortality rate than only birth(s). Moderate risks were identified with only induced abortion, only natural loss and having experienced all outcomes compared with only birth(s). Risk of death was more than six times greater among women who had never been pregnant compared with those who only had birth(s). Increased risks of death were 45%, 114% and 191% for 1, 2 and 3 abortions, respectively, compared with no abortions after controlling for other reproductive outcomes and last pregnancy age. Increased risks of death were equal to 44%, 86% and 150% for 1, 2 and 3 natural losses, respectively, compared with none after including statistical controls. Finally, decreased mortality risks were observed for women who had experienced two and three or more births compared with no births.

Conclusion: This study offers a broad perspective on reproductive history and mortality rates, with the results indicating a need for further research on possible underlying mechanisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurpub/cks107DOI Listing
August 2013

Preterm Birth Update.

Authors:
Byron C Calhoun

Linacre Q 2012 May 1;79(2):231-242. Epub 2012 May 1.

American College of Obstetricians and Gynecologists and the American College of Surgeons, and Department of Obstetrics and Gynecology at West Virginia University.

Preterm birth plagues modern society, with over three million deaths worldwide annually. When combined with low birth weight, preterm births are estimated to cost over one hundred million disability-adjusted life years. In the U.S., the low birth weight (newborn less than 2,500 gms) delivery rate in 2002 increased to 7.8 percent from 6.8 percent in 1985. This marks the highest rate in over thirty years. A large meta-analysis from 2009 analyzing abortion and preterm birth found an increased risk for preterm birth with an odds ratio of 1.35 (95 percent CI 1.20-1.52) for preterm demonstrating a 35 percent increase in the preterm birth rate in patients with only one abortion. The odds ratio for preterm birth for greater than two induced abortions was 1.72 (95 percent CI 1.45-2.04) demonstrating a 72 percent increase in the preterm birth rate and the important epidemiological principle of a dose-related effect: The more abortions one has prior to first pregnancy, the higher the risk for preterm birth. Finally, it is estimated that the concomitant expense due to prematurity from abortion may cost well over $1.2 billion per year in the U.S. in hospitalization (neonatal intensive care unit) costs alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1179/002436312803571366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6026974PMC
May 2012

Robotic-assisted hysterectomy in a patient with a ventriculoperitoneal shunt.

J Robot Surg 2011 Dec 27;5(4):291-3. Epub 2011 Mar 27.

Department of Obstetrics and Gynecology, West Virginia University - Charleston Division, Charleston, WV, USA.

There are several articles in the literature reporting laparoscopic surgery in patients with ventriculoperitoneal shunts (VPSs). Although the majority of these conclude that a pneumoperitoneum in these patients is safe, there are other reports indicating possible complications of the insufflation. This is the first known report of a robotic-assisted hysterectomy performed on a patient with a VPS and the management of the shunt during the procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11701-011-0264-9DOI Listing
December 2011

Process improvement of pap smear tracking in a women's medicine center clinic in residency training.

J Healthc Qual 2011 Nov;33(6):25-32

Department of Obstetrics andGynecology, West Virginia School of Medicine, 830 Pennsylvania Ave., Charleston, WV 25302, USA.

Application of Six-Sigma methodology and Change Acceleration Process (CAP)/Work Out (WO) tools to track pap smear results in an outpatient clinic in a hospital-based residency-training program. Observational study of impact of changes obtained through application of Six-Sigma principles in clinic process with particular attention to prevention of sentinel events. Using cohort analysis and applying Six-Sigma principles to an interactive electronic medical record Soarian workflow engine, we designed a system of timely accession and reporting of pap smear and pathology results. We compared manual processes from January 1, 2007 to February 28, 2008 to automated processes from March 1, 2008 to December 31, 2009. Using the Six-Sigma principles, CAP/WO tools, including "voice of the customer" and team focused approach, no outlier events went untracked. Applying the Soarian workflow engine to track prescribed 7 day turnaround time for completion, we identified 148 pap results in 3,936, 3 non-gynecological results in 15, and 41 surgical results in 246. We applied Six-Sigma principles to an outpatient clinic facilitating an interdisciplinary team approach to improve the clinic's reporting system. Through focused problem assessment, verification of process, and validation of outcomes, we improved patient care for pap smears and critical pathology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1945-1474.2011.00129.xDOI Listing
November 2011

Smoking in pregnancy in West Virginia: does cessation/reduction improve perinatal outcomes?

Matern Child Health J 2012 Jan;16(1):133-8

Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV 25302, USA.

To determine if pregnant women decreasing/quitting tobacco use will have improved fetal outcomes. Retrospective analysis of pregnant smokers from 6/1/2006-12/31/2007 who received prenatal care and delivered at a tertiary medical care center in West Virginia. Variables analyzed included birth certificate data linked to intervention program survey data. Patients were divided into four study groups: <8 cigarettes/day-no reduction, <8 cigarettes/day-reduction, ≥8 cigarettes/day-no reduction, and ≥8 cigarettes/day-reduction. Analysis performed using ANOVA one-way test for continuous variables and Chi-square for categorical variables. Inclusion criteria met by 250 patients. Twelve women (4.8%) quit smoking; 150 (60%) reduced; 27 (10.8%) increased; and 61 (24.4%) had no change. Comparing the four study groups for pre-term births (<37 weeks), 25% percent occurred in ≥8 no reduction group while 10% occurred in ≥8 with reduction group (P = 0.026). The high rate of preterm birth (25%) in the non-reducing group depended on 2 factors: (1) ≥8 cigarettes/day at beginning and (2) no reduction by the end of prenatal care. Finally, there was a statistically significant difference in birth weights between the two groups: ≥8 cigarettes/day with no reduction (2,872.6 g) versus <8 cigarettes/day with reduction (3,212.4 g) (P = 0.028). Smoking reduction/cessation lowered risk of pre-term delivery (<37 weeks) twofold. Encouraging patients who smoke ≥8 cigarettes/day during pregnancy to decrease/quit prior to delivery provides significant clinical benefit by decreasing the likelihood of preterm birth. These findings support tobacco cessation efforts as a means to improve birth outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10995-010-0730-4DOI Listing
January 2012

Prevalence of drug use in pregnant West Virginia patients.

W V Med J 2010 ;106(4 Spec No):48-52

Department of Obstetrics and Gynecology West Virginia University School of Medicine, USA.

Introduction: Substance abuse in pregnancy is of serious concern to society as well as health care providers caring for pregnant women and their infants. Various studies have suggested a prevalence of 10 -20%. This study used anonymous sampling of umbilical cord tissue to estimate the prevalence of substance abuse in West Virginia.

Methods: For the period of August 2009, as many umbilical cord samples as possible were collected at 8 regionally diverse hospitals in West Virginia. The cord tissue samples were then assayed for amphetamines, cocaine, opiates, marijuana, benzodiazapines, methadone, buprenorphine and alcohol.

Results: 146 of 759 collected (19.2%) were positive for drugs or alcohol. The regional diversity in drug and alcohol consumption was striking, as was the absence of cocaine, methamphetamine and buprenorphine. Voluntary reporting on birth certificates and other maternal questionnaires underestimated the prevalence by 2-3 fold.

Conclusion: One in five infants born in West Virginia has a significant drug exposure that is not captured by conventional reporting instruments. It is hard to estimate the societal and financial cost since so many infants are exposed.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2011

The ability of the quadruple test to predict adverse perinatal outcomes in a high-risk obstetric population.

J Med Screen 2009 ;16(2):55-9

Department of Obstetrics and Gynecology, West Virginia University-Charleston Division, Charleston Area Medical Center, Charleston, West Virginia, USA.

Objective: To determine the ability of the quadruple Down's syndrome screening test (quad screen) to predict other adverse perinatal outcomes (APO) in a high-risk obstetric population.

Setting: A tertiary medical centre in West Virginia.

Methods: We retrospectively reviewed 342 obstetric patients with quad screen data from a single clinic. The quad screen included maternal serum levels of alphafetoprotein (AFP), human chorionic gonadotrophin (hCG), uncongjugated oestriol (uE(3)), and inhibin A. The risk of APO was compared between patients with at least one abnormal marker versus no abnormal markers and >or=2 abnormal markers versus <2 abnormal markers. Abnormal markers were determined by cut-off values produced by Receiver Operator Characteristic (ROC) curves and the FASTER trial. Unadjusted and adjusted effects were estimated using logistic regression analysis.

Results: The risk of having an APO increased significantly for patients with abnormal markers by about three-fold using ROC and two-fold using FASTER trial thresholds.

Conclusions: The quad screen shows value in predicting risk of APO in high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1258/jms.2009.009017DOI Listing
September 2009

Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic.

Am J Manag Care 2007 Dec;13(12):686-90

Department of Obstetrics and Gynecology, West Virginia University-Charleston, Charleston, WV 25302, USA.

Objectives: To apply the Six Sigma tools of Change Acceleration Process and Work-Out and to improve patient access in an outpatient clinic in a hospital-based residency training program.

Study Design: Observational study.

Methods: Comparison of productivity in an obstetrics and gynecology clinic after implementation of the Six Sigma principles, with a comparable internal medicine clinic as a control group. Productivity from January 1 through December 31, 2005, was assessed in both clinics. After applying the Six Sigma tools to obstetrics and gynecology, outputs from both clinics from January 1 through December 31, 2006, were analyzed.

Results: Wait times for new obstetrical visits decreased from 38 to 8 days. The patient time spent in the clinic dropped from 3.2 to 1.5 hours. Initial gynecologic visits increased by 87% (from 453 to 850 per year), return gynecologic visits increased by 66% (from 1392 to 2311 per year), initial obstetrical visits increased by 55% (from 520 to 808 per year), repeat obstetrical visits increased by 45% (from 2239 to 3243 per year), and the mean patient satisfaction scores increased from 5.75 to 8.54 (on a 10-point scale). The gross clinic revenue increased by 73% in the first 6 months of 2006 over that of the previous year. By contrast, internal medicine patient wait times for new patients and for revisits, patient satisfaction scores, total number of clinic visits, and revenues remained unchanged.

Conclusion: Application of the Six Sigma principles resulted in a team approach to solving the clinic's productivity issues.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2007

Cost consequences of induced abortion as an attributable risk for preterm birth and impact on informed consent.

J Reprod Med 2007 Oct;52(10):929-37

Department of Obstetrics, West Virginia University, Charleston 25302, USA.

Objective: To investigate the human and monetary cost consequences of preterm delivery as related to induced abortion (IA), with its impact on informed consent and medical malpractice.

Study Design: A review of the literature in English was performed to assess the effect of IA on preterm delivery rates from 24 to 31 6/7 weeks to assess the risk for preterm birth attributable to IA. After calculating preterm birth risk, the increased initial neonatal hospital costs and cerebral palsy (CP) risks related to IA were calculated.

Results: IA increased the early preterm delivery rate by 31.5%, with a yearly increase in initial neonatal hospital costs related to IA of > $1.2 billion. The yearly human cost includes 22,917 excess early preterm births (EPB) (< 32 weeks) and 1096 excess CP cases in very-low-birth-weight newborns, <1500 g.

Conclusion: IA contributes to significantly increased neonatal health costs by causing 31.5% of EPB. Providers of obstetric care and abortion should be aware of the risk of preterm birth attributable to induced abortion, with its significant increase in initial neonatal hospital costs and CP cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2007

Fetal growth curves for an ethnically diverse military population: the American Institute of Ultrasound in Medicine-accredited platform experience.

Mil Med 2006 Jun;171(6):508-11

Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA.

Objective: To determine which fetal growth curve provided the best estimates of fetal weight for a cohort of ethnically diverse patients at sea level.

Methods: The study consisted of a population of 1,729 fetuses examined at sea level between January 1, 1997, and June 30, 2000, at 18 weeks, 28 weeks, and term. Gestational age (GA) based on menstrual dates was confirmed or adjusted by crown-rump length or early second-trimester biometry. Fetal weight was estimated by using biparietal diameter, head circumference, abdominal circumference, and femur length. Our fetal growth curves were analyzed with fourth-order polynomial regression analysis, applying four previously defined formulae for fetal growth.

Results: Fetal growth curves for estimated fetal weight demonstrated the expected parabolic shape, which varied according to the formulae used. Our curve best fit the following equation: estimated fetal weight = 4.522 - 0.22 x GA age + 0.25 x GA(2) - 0.001 x GA(3) + 5.248 x 10(-6) x GA(4) (R2 = 0.976). SD increased in concordance with GA.

Conclusion: Madigan Army Medical Center serves a racially mixed, culturally diverse, military community with unrestricted access to prenatal care. Determination of the optimal population-appropriate growth curve at the correct GA assists clinicians in identifying fetuses at risk for growth restriction or macrosomia and therefore at risk for increased perinatal morbidity and death.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7205/milmed.171.6.508DOI Listing
June 2006

The fetus as our patient: the confluence of faith and science in the care of the unborn.

Authors:
Byron C Calhoun

Linacre Q 2005 Aug;72(3):189-211

University of Illinois at Chicago, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/20508549.2005.11877751DOI Listing
August 2005

Maternal and fetal outcomes of spontaneous preterm premature rupture of membranes.

J Am Osteopath Assoc 2004 Dec;104(12):537-42

Saint Alexius Medical Center, Hoffman Estates, IL, USA.

The authors retrospectively evaluated maternal and fetal outcomes of 73 consecutive singleton pregnancies complicated by preterm premature rupture of amniotic membranes. When preterm labor occurred and fetuses were at a viable gestational age, pregnant patients were managed aggressively with tocolytic therapy, antenatal corticosteroid injections, and antenatal fetal testing. The mean gestational age at the onset of membrane rupture and delivery was 22.1 weeks and 23.8 weeks, respectively. The latency from membrane rupture to delivery ranged from 0 to 83 days with a mean of 8.6 days. Among the 73 pregnant patients, there were 22 (30.1%) stillbirths and 13 (17.8%) neonatal deaths, resulting in a perinatal death rate of 47.9%. The perinatal survival rate based on gestational age at the onset of fetal membrane rupture was 12.1% at less than 23 weeks of gestation, 60% at 23 weeks, and 100% at 24 to 26 weeks. Maternal morbidity was minimal with puerperal endomyometritis in 5 (6.8%) cases, one of which became septic; however, there was no long-term sequela. Eight (15.7%) liveborn infants had pulmonary hypoplasia, 5 (62.5%) of which resulted in neonatal death. In 33 (45.2%) patients, amniotic membranes ruptured before 23 weeks of gestation. At previable gestational age, the risk of neonatal pulmonary hypoplasia appears to be primarily dependent on gestational age at the onset of premature rupture of membrane rather than gestational age at delivery. Pregnancy outcomes remain dismal when the fetal membrane ruptures before 23 weeks of gestation.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2004

Pelvic organ support in pregnancy and postpartum.

Int Urogynecol J Pelvic Floor Dysfunct 2005 Jan-Feb;16(1):69-72; discussion 72. Epub 2004 Jul 31.

Department of Obstetrics and Gynecology, Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, VA 23078, USA.

The purpose of this study was to evaluate pelvic organ support during pregnancy and following delivery. This was a prospective observational study. Pelvic organ prolapse quantification (POPQ) examinations were performed during each trimester of pregnancy and in the postpartum. Statistical comparisons of POPQ stage and of the nine measurements comprising the POPQ between the different time intervals were made using Wilcoxon's signed rank and the paired t-test. Comparison of POPQ stage by mode of delivery was made using Fisher's exact test. One hundred thirty-five nulliparous women underwent 281 pelvic organ support evaluations. During both the third trimester and postpartum, POPQ stage was significantly higher compared to the first trimester (p<0.001). In the postpartum, POPQ stage was significantly higher in women delivered vaginally compared to women delivered by cesarean (p=0.02). In nulliparous pregnant women, POPQ stage appears to increase during pregnancy and does not change significantly following delivery. In the postpartum, POPQ stage may be higher in women delivered vaginally compared to women delivered by cesarean.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00192-004-1210-4DOI Listing
May 2005

Challenges to the FDA approval of mifepristone.

Ann Pharmacother 2004 Jan;38(1):163-8

Antepartum Diagnostic Center, Rockford, IL, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1345/aph.1D448DOI Listing
January 2004