Publications by authors named "Justin S Brandt"

31 Publications

Singleton pregnancies conceived with infertility treatments and the risk of neonatal and infant mortality.

Fertil Steril 2021 Oct 5. Epub 2021 Oct 5.

Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey; Cardiovascular Institute of New Jersey and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. Electronic address:

Objectives: To examine the risks of neonatal and infant mortality in relation to infertility treatment and to quantify the extent to which preterm delivery mediates this relationship.

Design: Cross-sectional study.

Setting: United States, 2015-2018.

Patient(s): A total of 14,961,207 pregnancies resulting in a singleton live birth.

Intervention(s): Any infertility treatment, including assisted reproductive technology and fertility-enhancing drugs.

Main Outcome Measure(s): Neonatal (<28 days) mortality. The effect measure, risk ratio (RR), and 95% confidence interval (CI) were derived from log-linear Poisson models. A causal mediation analysis of the relationship between infertility treatment and mortality associated with preterm delivery (<37 weeks) was performed. The effects of exposure misclassification and unmeasured confounding biases were assessed.

Result(s): Any infertility treatment was documented in 1.3% (n = 198,986) of pregnancies. Infertility treatment was associated with a 51% increased risk of neonatal mortality (RR 1.51, 95% CI 1.39-1.64), with a slightly higher risk for early neonatal mortality (RR 1.57, 95% CI 1.43-1.73) than late neonatal mortality (RR 1.33, 95% CI 1.11-1.58). These risks were similar for pregnancies conceived through assisted reproductive technology and fertility-enhancing drugs. The mediation analysis showed that 72% (95% CI 59-85) of the total effect of infertility treatment on neonatal mortality was mediated through preterm delivery. In a sensitivity analysis, following corrections for exposure misclassification and unmeasured confounding biases, these risks were higher for early, but not for late, neonatal mortality.

Conclusion(s): Pregnancies conceived with infertility treatment are associated with increased neonatal mortality, and this association is largely mediated through preterm delivery. However, given the substantial underreporting of infertility treatment, these associations must be cautiously interpreted.
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http://dx.doi.org/10.1016/j.fertnstert.2021.08.007DOI Listing
October 2021

Intermittent opioid use and ischemic placental disease: Study quantifies risks, raises questions.

Am J Epidemiol 2021 Sep 15. Epub 2021 Sep 15.

Discomfort and, to a lesser extent, pain are common complaints during pregnancy, and some patients may turn to opioids for pain relief. Esposito and colleagues (Am J Epidemiol. 2021, in press) report associations between intermittent exposure to opioids during pregnancy and the risk of ischemic placental disease (IPD) - a syndrome that includes preeclampsia, placental abruption, small for gestational age (SGA) births, and preterm delivery. They found that early opioid exposure in pregnancy was associated with a modestly increased risk for abruption, SGA births, and preterm delivery, and both early and late exposure was associated with the greatest risk for these outcomes. Surprisingly, preeclampsia was not associated with opioid use. Through quantitative bias analysis, the authors cleverly tackle a number of biases to assess their roles in explaining the associations, including unmeasured confounding, outcome misclassification, and residual confounding; none exerted strong influences on the associations. Although the findings appear fairly robust on the surface, the lack of association between intermittent opioid use and preeclampsia, and important differences in characteristics of patients in the opioid exposed group compared to the unexposed group, suggest that further study is needed to clarify the relationship between intermittent opioid use, lifestyle factors, and IPD risk.
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http://dx.doi.org/10.1093/aje/kwab225DOI Listing
September 2021

Historical and Recent Changes in Maternal Mortality Due to Hypertensive Disorders in the United States, 1979 to 2018.

Hypertension 2021 Nov 13;78(5):1414-1422. Epub 2021 Sep 13.

School of Population and Public Health (K.S.J.), University of British Columbia, Vancouver, Canada.

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17661DOI Listing
November 2021

Obstetrical outcomes and follow-up for patients with asymptomatic COVID-19 at delivery: a multicenter prospective cohort study.

Am J Obstet Gynecol MFM 2021 Aug 8;3(6):100454. Epub 2021 Aug 8.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (Drs Hill, Patrick, and Brandt, Ms Schwebel, and Dr Rosen).

Background: Universal testing for COVID-19 on admission to the labor and delivery unit identifies asymptomatic patients. Whether or not these patients are at increased risk for adverse outcomes and go on to develop clinically significant disease is uncertain.

Objective: This study aimed to assess the prevalence of asymptomatic COVID-19 presentation among pregnant patients admitted for delivery and to determine whether these patients become symptomatic or require hospital readmission after discharge.

Study Design: We performed a multicenter, prospective cohort study of pregnant patients who delivered between 20 and 41 weeks' gestation and who were found to have COVID-19 based on universal screening on admission for delivery at 1 of 4 medical centers in New Jersey (exposed group). The unexposed group, comprising patients who tested negative for COVID-19, were identified at the primary study site. The primary outcomes were the rates of asymptomatic COVID-19 presentation, the development of symptoms among the asymptomatic positive patients, and hospital readmission rates in the 2 weeks following discharge. We compared the frequency of the distribution of risk factors and outcomes in relation to the COVID-19 status among patients with COVID-19 across all centers and among those without COVID-19 at the primary site. Associations between categorical risk factors and COVID-19 status were expressed as relative risks with 95% confidence intervals.

Results: Between April 10, 2020, and June 15, 2020, there were 218 patients with COVID-19 at the 4 sites and 413 patients without COVID-19 at the primary site. The majority (188 [83.2%]) of patients with COVID-19 were asymptomatic. Compared with the negative controls, these asymptomatic patients were not at increased risk for obstetrical complications that may increase the risk associated with COVID-19, including gestational diabetes (8.2% vs 11.4%; risk ratio, 0.72; 95% confidence interval, 0.24-2.01) and gestational hypertension (6.1% vs 7.0%; risk ratio, 0.88; 95% confidence interval, 0.29-2.67). Postpartum follow-ups via telephone surveys revealed that these patients remained asymptomatic and had low rates of family contacts acquiring the disease, but their adherence to social distancing guidelines waned during the 2-week postpartum period. Review of inpatient and emergency department records revealed low rates of hospital readmission.

Conclusion: Most of the pregnant patients who screened positive for COVID-19 are asymptomatic and do not go on to develop clinically significant infection after delivery. Routine surveillance of these patients after hospital discharge appears to be sufficient.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349406PMC
August 2021

Overuse of antenatal care amongst low-risk patients in France: Study underscores the need for an evidence-based standard for adequate antenatal care.

Paediatr Perinat Epidemiol 2021 Aug 6. Epub 2021 Aug 6.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA.

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http://dx.doi.org/10.1111/ppe.12804DOI Listing
August 2021

Dissemination of research during the first year of the coronavirus disease 2019 pandemic.

J Investig Med 2021 10 28;69(7):1388-1390. Epub 2021 May 28.

Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.

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http://dx.doi.org/10.1136/jim-2021-001923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172267PMC
October 2021

SARS-CoV-2 infection in pregnancy: Lessons learned from the first pandemic wave.

Paediatr Perinat Epidemiol 2021 01;35(1):34-36

School of Epidemiology and Public Health, University of Ottawa, Ontario.

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http://dx.doi.org/10.1111/ppe.12745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013326PMC
January 2021

A bibliometric analysis of obstetrics and gynecology articles with highest relative citation ratios, 1980 to 2019.

Am J Obstet Gynecol MFM 2021 01 11;3(1):100293. Epub 2020 Dec 11.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address:

Background: The Relative Citation Ratio is a novel bibliometric tool that quantifies the impact of research articles. The objectives of this study were to identify the 100 obstetrics and gynecology articles with the highest relative citation ratios, evaluate how characteristics of these articles changed over time, and compare characteristics of these articles with top-cited obstetrics and gynecology articles.

Objective: We undertook a cross-sectional bibliometric study to examine the 100 obstetrics and gynecology articles with the highest relative citation ratios and the top 100 cited articles in the National Institutes of Health Open Citations Collection from 1980 to 2019.

Study Design: We identified every obstetrics and gynecology article published from 1980 to 2019 that was indexed in the National Institutes of Health Open Citations Collection. The top 100 articles with the highest relative citation ratios and the top 100 cited articles were selected for further review. Each article was evaluated using metrics of influence, translation, and other characteristics. We compared the top 100 articles with the highest relative citation ratios published from 1980 to 1999 versus 2000 to 2019 and characteristics of the top 100 articles with the highest relative citation ratios versus the top 100 top-cited articles (after excluding those on both lists). Means, standard deviations, and mean differences with corresponding 95% confidence intervals were calculated. Associations were expressed as relative risks (95% confidence interval).

Results: A total of 323,673 obstetrics and gynecology articles were published between 1980 and 2019. Among the top 100 articles with the highest relative citation ratios, most were observational studies (36%), reviews (26%), and consensus statements (21%). There were only 5 randomized clinical trials. Compared with the articles with the highest relative citation ratios published from 1980 to 1999, articles published from 2000 to 2019 were more likely about benign gynecology (relative risks, 1.3; 95% confidence interval, 0.6-2.8) and less likely about gynecology-oncology (relative risks, 0.6; 95% confidence interval, 0.2-1.9) and urogynecology (relative risks, 0.6; 95% confidence interval, 0.1-3.3). The articles after 2000 were more likely about systematic reviews (relative risks, 7.7; 95% confidence interval, 1.0-58.3) and consensus statements (relative risks, 5.1; 95% confidence intervals, 1.6-16.3) and were published as open access articles (relative risks, 1.3; 95% confidence interval, 0.9-2.0). There were 60 articles in common between the top 100 articles with the highest relative citation ratios and the top 100 cited articles. Compared with articles that were top cited (after excluding articles on both lists), articles with the highest relative citation ratios received fewer mean citations (266.9 [135.3] vs 514.3 [54.6]; mean differences, 247.4; 95% confidence interval, 201.5-293.3) but had higher numbers of citations per year (37.5 [4.1] vs 31.6 [8.1]; mean difference, -5.9; 95% confidence interval, -14.6 to -2.7). Compared with the articles with the highest relative citation ratios, top-cited articles were more likely to address gynecology topics (relative risk, 1.6; 95% confidence interval, 1.1-2.5), less likely to be randomized clinical trials (relative risk, 0.7; 95% confidence interval, 0.1-3.8), and less likely to be published as open access articles (relative risk, 0.52; 95% confidence interval, 0.31-0.86).

Conclusion: The Relative Citation Ratio is a novel bibliometric tool that does not rely on absolute citation rates and provides unique insight into the dissemination of knowledge in obstetrics and gynecology. Nearly half of the influential obstetrics and gynecology articles identified with this metric would not have been recognized as citation classics by conventional bibliometric analysis.
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http://dx.doi.org/10.1016/j.ajogmf.2020.100293DOI Listing
January 2021

Fetal growth and gestational age prediction by machine learning.

Lancet Digit Health 2020 07 23;2(7):e336-e337. Epub 2020 Jun 23.

Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

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http://dx.doi.org/10.1016/S2589-7500(20)30143-6DOI Listing
July 2020

Attitudes about marijuana use, potential risks, and legalization: a single-center survey of pregnant women.

J Matern Fetal Neonatal Med 2020 Dec 8:1-9. Epub 2020 Dec 8.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Objective: There is an association between recreational marijuana use in pregnancy and legalization. As more states legalize marijuana, its use in pregnancy may increase. The objective of this study was to evaluate pregnant women's knowledge and opinions about marijuana use, potential risks, and legalization.

Methods: A cross-sectional survey of pregnant women at a regional perinatal center in New Jersey was performed from January-December 2019. Pregnant subjects were invited to complete a voluntary, anonymous 23-question survey about marijuana use in pregnancy, potential risks, and legalization. Subjects were excluded if they could not read in English or Spanish. Survey questions were based on a 5-point Likert scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Likelihood of agreeing or disagreeing with potential risks, with neutral responses as the reference, were estimated based on the relative risk (RR) (95% confidence interval [CI]). Associations were examined with prior tobacco/marijuana use and education level.

Results: During the study period, approximately 1133 consecutive patients were approached and 843 completed the study (74.4% response rate). The majority of participants were English-speaking, college educated, and employed. 204 (25.2%) reported prior marijuana use and 36 (4.5%) reported marijuana use during pregnancy. Overall, pregnant women had poor knowledge about potential risks of marijuana use in pregnancy. Although 234 (29.0%) patients were opposed to legalization, more than 90% of pregnant subjects indicated that they would be more likely to use marijuana in pregnancy if it were legalized. Associations of marijuana risks by prior tobacco use showed that nonsmokers had more awareness about risks. Nonsmokers had higher likelihood of agreeing that marijuana use may be harmful to a pregnancy (RR 1.41, 95% CI 1.12-1.76), may hurt the growth of a baby (RR 1.36, 95% CI 1.07-1.74), may cause preterm birth (RR 1.18, 95% CI 1.00-1.40), and may hurt a child's ability to learn (RR 1.20, 95% CI 0.95-1.51). Similar trends were observed for subjects who reported no prior marijuana use and for subjects with more than high school education.

Conclusions: The majority of surveyed pregnant women demonstrated poor knowledge about the possible risks of marijuana in pregnancy and indicated that they would be more likely to use marijuana in pregnancy if it were legalized. As the use of marijuana increases, providers should focus on educating their patients about potential risks associated with marijuana use in pregnancy while additional research is needed to clarify associated risks.
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http://dx.doi.org/10.1080/14767058.2020.1858279DOI Listing
December 2020

Epidemiology of coronavirus disease 2019 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes.

Am J Obstet Gynecol 2021 04 25;224(4):389.e1-389.e9. Epub 2020 Sep 25.

Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ.

Background: Coronavirus disease 2019 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there are few controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors.

Objective: This study aimed to quantify the associations of coronavirus disease 2019 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors.

Study Design: We performed a matched case-control study of pregnant patients with confirmed coronavirus disease 2019 cases who delivered between 16 and 41 weeks' gestation from March 11 to June 11, 2020. Uninfected pregnant women (controls) were matched to coronavirus disease 2019 cases on a 2:1 ratio based on delivery date. Maternal demographic characteristics, coronavirus disease 2019 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (1) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death, and (2) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, 5-minute Apgar score of <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. To quantify the associations between exposure to mild and severe or critical coronavirus disease 2019 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio and 95% confidence interval based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders.

Results: A total of 61 confirmed coronavirus disease 2019 cases were enrolled during the study period (mild disease, n=54 [88.5%]; severe disease, n=6 [9.8%]; critical disease, n=1 [1.6%]). The odds of adverse composite maternal outcome were 3.4 times higher among cases than controls (18.0% vs 8.2%; adjusted odds ratio, 3.4; 95% confidence interval, 1.2-13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group than to the control group (18.0% vs 13.9%; adjusted odds ratio, 1.7; 95% confidence interval, 0.8-4.8). Stratified analyses by disease severity indicated that the morbidity associated with coronavirus disease 2019 in pregnancy was largely driven by the severe or critical disease phenotype. Major risk factors for associated morbidity were black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019.

Conclusion: Coronavirus disease 2019 during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe or critical coronavirus disease 2019. Black and Hispanic race, obesity, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019 are risk factors for associated morbidity.
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http://dx.doi.org/10.1016/j.ajog.2020.09.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518835PMC
April 2021

Lymphoma Occurring During Pregnancy: Current Diagnostic and Therapeutic Approaches.

Curr Oncol Rep 2020 08 17;22(11):113. Epub 2020 Aug 17.

Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.

Purpose Of Review: Pregnancy-associated lymphoma (PAL) is an uncommon entity that lacks detailed prospective data. It poses significant management challenges that incorporate maternal and fetal risks associated with treatment or delayed intervention. Herein, we review the current literature for the diagnosis, management, and supportive care strategies for PAL.

Recent Findings: Establishment of a multidisciplinary team, including hematology-oncology, maternal-fetal medicine, and neonatology, is critical in the management of PAL. For staging, ultrasound and MRI are preferred modalities with use of computerized tomography in select situations. Data for the safety and effectiveness of therapy for PAL is largely based on retrospective studies. The timing of lymphoma-directed antenatal systemic therapy depends on the trimester, gestational age, lymphoma subtype and aggressiveness, and patient wishes. Therapy in the first trimester is usually not advocated, while treatment in the second and third trimesters appears to result in similar outcomes for PAL compared with non-pregnant patients with lymphoma. An overarching goal in most PAL cases should be to plan for delivery at term (i.e., gestational age > 37 weeks). For supportive care, most antiemetics, including agents such as neurokinin-1 receptor antagonists, have been used safely during pregnancy. For prevention or treatment of infections, particular antibiotics (i.e., macrolides, cephalosporins, penicillins, metronidazole), antivirals (i.e., acyclovir, valacyclovir, famciclovir), and antifungals (amphotericin B) have demonstrated safety and with use of growth factors reserved for treatment of neutropenia (vs. primary prophylaxis). Therapy for PAL should be individualized with goals of care that balance maternal and fetal well-being, which should include a multidisciplinary care team and overall intent for term delivery in most cases.
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http://dx.doi.org/10.1007/s11912-020-00972-1DOI Listing
August 2020

Characterization of Perineum Elasticity and Pubic Bone-Perineal Critical Distance with a Novel Tactile Probe: Results of an Intraobserver Reproducibility Study.

Open J Obstet Gynecol 2020 Apr;10(4):493-503

Advanced Tactile Imaging, Inc., Trenton, NJ, USA.

Background: Tactile imaging provides biomechanical mapping of soft tissues. Objective biomechanical and anatomical assessment of critical structures within the vagina and pelvis may allow development and validation of a clinical tool that could assist with clinical decisions regarding obstetrical procedures and mode of delivery. Objective: To assess intraobserver reproducibility of measurements of perineal elasticity and pubic bone-perineal critical distance with a novel tactile probe in pregnant women.

Methods: An Antepartum Tactile Imager (ATI) was designed with a vaginal probe resembling a fetal skull. The probe comprises 128 tactile sensors on a double curved surface and measures 46 mm in width and 72 mm in length. The probe has a motion tracking sensor that allows acquisition of 3D tactile images. There were two arms of the study. In the first arm, biomechanical mapping of the perineum and pelvic bone location was performed in 10 non-pregnant women for purposes of demonstrating safety and feasibility. In the second arm, biomechanical mapping was performed in 10 pregnant women to explore intraobserver reproducibility. Each subject had two standardized examinations over 3 - 5 minutes by the same observer. Examination comfort and pain levels were assessed by post-procedure survey. Reproducibility was analyzed by intraclass correlation coefficients (ICC) with 95% confidence intervals and Bland-Altman plots. Bias and the 95% limits of agreement were also calculated.

Results: The safety and feasibility arm of the study demonstrated high degree of safety and tolerability and reliable acquisition of tactile signals. In the reproducibility arm, 10 pregnant women were recruited at mean gestational age of 34.2 ± 6.5 weeks. The mean perineum elasticity (Young's modulus, E) was 9.8 ± 5.9 kPa, and the mean pubic bone-perineal critical distance (D) at 20 kPa load was 34.6 ± 6.2 mm. The ICC was 0.97 [95% confidence interval (CI) 0.91, 0.99] and 0.82 [CI 0.44, 0.95] for E and D respectively, consistent with excellent intrarater agreement. The bias and the 95% limits of agreement of E were -6.3% and -29.4% to +16.7%, respectively. The bias and the 95% limits of agreement of D were -2.6% and -25.3% to +20.2%, respectively.

Conclusions: The tactile imaging data obtained in the study reproducibly characterized perineal elasticity and pubic bone-perineal critical distance. Further evaluation of this tool in clinical settings is warranted.
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http://dx.doi.org/10.4236/ojog.2020.1040044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213583PMC
April 2020

Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study.

Am J Obstet Gynecol MFM 2020 08 8;2(3):100134. Epub 2020 May 8.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

Background: The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited.

Objective: This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2.

Study Design: This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation ≤93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24-48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported.

Results: Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m. Gestational age was at a mean of 29±6 weeks at symptom onset and a mean of 30±6 weeks at hospital admission, with a median disease day 7 since first symptoms. Most women (81%) were treated with hydroxychloroquine; 7% of women with severe disease and 65% of women with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation during their admission. The median duration of hospital stay was 6 days (6 days [severe group] and 10.5 days [critical group]; =.01). Intubation was usually performed around day 9 on patients who required it, and peak respiratory support for women with severe disease was performed on day 8. In women with critical disease, prone positioning was required in 20% of cases, the rate of acute respiratory distress syndrome was 70%, and reintubation was necessary in 20%. There was 1 case of maternal cardiac arrest, but there were no cases of cardiomyopathy or maternal death. Thirty-two of 64 (50%) women with coronavirus disease 2019 in this cohort delivered during their hospitalization (34% [severe group] and 85% [critical group]). Furthermore, 15 of 17 (88%) pregnant women with critical coronavirus disease 2019 delivered preterm during their disease course, with 16 of 17 (94%) pregnant women giving birth through cesarean delivery; overall, 15 of 20 (75%) women with critical disease delivered preterm. There were no stillbirths or neonatal deaths or cases of vertical transmission.

Conclusion: In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.
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http://dx.doi.org/10.1016/j.ajogmf.2020.100134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205698PMC
August 2020

Disentangling the mediating effects of gestational age on neonatal outcomes: Still many unresolved questions.

Paediatr Perinat Epidemiol 2020 05 27;34(3):341-343. Epub 2020 Feb 27.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

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http://dx.doi.org/10.1111/ppe.12656DOI Listing
May 2020

A Bibliometric Analysis of Citation Classics in the Journal of Ultrasound in Medicine.

J Ultrasound Med 2020 Jul 16;39(7):1289-1297. Epub 2020 Jan 16.

Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

Objectives: A bibliometric analysis of articles in the Journal of Ultrasound in Medicine (JUM) identified the journals' most impactful articles.

Methods: A bibliometric analysis of citation classics that were published in the JUM from its inception in 1982 to 2019 was performed. All citation classics, defined as articles cited 100 or more times, were evaluated for the number of citations, citations per year, publication year, subspecialty, design, and country of origin. Characteristics were compared before and after 1998 by the Mann-Whitney test for unpaired data and 2-sample z tests of sample proportions. The Kruskal-Wallis test for nonparametric continuous data was used to compare the median number of citations per year by decade of publication.

Results: A total of 7868 articles were published in the JUM between 1982 and 2019; 54 (0.7%) were citation classics. The median citation classics year of publication was 1998 (interquartile range [IQR], 1991-2003). Most citation classics originated from the United States (36 of 54 [66.7%]), were observational (47 of 54 [87%]), and were related to obstetric and gynecologic topics (16 of 54 [29.6%]). Citation classics after 1998 received significantly more citations per year (9.3 versus 4.7; P < .001), with no other differences noted. The median number of citations per year increased for each decade, with medians of 4 citations (IQR, 3.6-4.7) in 1982 to 1991 and 11.2 citations (IQR, 9-13.9) in 2002 to 2012 (P < .001).

Conclusions: This list provides insight into the most influential articles that were published in the JUM. Most citation classics were observational, were from the United States, and covered obstetric and gynecologic topics. Citation classics received more citations per year after 1998.
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http://dx.doi.org/10.1002/jum.15220DOI Listing
July 2020

A Bibliometric Analysis of Top-Cited Journal Articles in Obstetrics and Gynecology.

JAMA Netw Open 2019 12 2;2(12):e1918007. Epub 2019 Dec 2.

Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

Importance: Citation analysis is a bibliometric method that uses citation rates to evaluate research performance. This type of analysis can identify the articles that have shaped the modern history of obstetrics and gynecology (OBGYN).

Objectives: To identify and characterize top-cited OBGYN articles in the Institute for Scientific Information Web of Science's Science Citation Index Expanded and to compare top-cited OBGYN articles published in specialty OBGYN journals with those published in nonspecialty journals.

Design, Setting, And Participants: Cross-sectional bibliometric analysis of top-cited articles that were indexed in the Science Citation Index Expanded from 1980 to 2018. The Science Citation Index Expanded was queried using search terms from the American Board of Obstetrics and Gynecology's 2018 certifying examination topics list. The top 100 articles from all journals and the top 100 articles from OBGYN journals were evaluated for specific characteristics. Data were analyzed in March 2019.

Main Outcomes And Measures: The articles were characterized by citation number, publication year, topic, study design, and authorship. After excluding articles that featured on both lists, top-cited articles were compared.

Results: The query identified 3 767 874 articles, of which 278 846 (7.4%) were published in OBGYN journals. The top-cited article was published by Rossouw and colleagues in JAMA (2002). Top-cited articles published in nonspecialty journals were more frequently cited than those in OBGYN journals (median [interquartile range], 1738 [1490-2077] citations vs 666 [580-843] citations, respectively; P < .001) and were more likely to be randomized trials (25.0% vs 2.2%, respectively; difference, 22.8%; 95% CI, 13.5%-32.2%; P < .001). Whereas articles from nonspecialty journals focused on broad topics like osteoporosis, articles from OBGYN journal focused on topics like preeclampsia and endometriosis.

Conclusions And Relevance: This study found substantial differences between top-cited OBGYN articles published in nonspecialty vs OBGYN journals. These differences may reflect the different goals of the journals, which work together to ensure optimal dissemination of impactful articles.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.18007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991228PMC
December 2019

Transgender men, pregnancy, and the "new" advanced paternal age: A review of the literature.

Maturitas 2019 Oct 8;128:17-21. Epub 2019 Jul 8.

Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.

Transgender men are assigned female at birth, but self-identify as male. Although some transgender men undergo gender-affirming hormonal treatment and/or surgery that preclude pregnancy, many (if not most) retain their female reproductive organs and, as a result, their capacity to become pregnant. Although the visibility of the transgender community has increased, the exposure of healthcare providers to transgender individuals, especially transgender men during pregnancy, as well as research that addresses evidence-based practice remain limited. In this review, we discuss obstetrical issues for transgender men who are ≥35 years old, termed the "new" advanced paternal age. We review preconception care and focus on fertility issues, the impact of stopping gender-affirming hormonal treatment, and age-appropriate health maintenance. We review antepartum and postpartum care, including labor and delivery, monitoring for perinatal depression, contraception, and chest feeding. Finally, we conclude with suggestions for areas for further research and study.
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http://dx.doi.org/10.1016/j.maturitas.2019.07.004DOI Listing
October 2019

Transvaginal ultrasound is superior to transabdominal ultrasound in the identification of a short cervix.

Am J Obstet Gynecol 2019 10 7;221(4):365-367. Epub 2019 Jun 7.

Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

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http://dx.doi.org/10.1016/j.ajog.2019.05.051DOI Listing
October 2019

Standard vs population reference curves in obstetrics: which one should we use?

Am J Obstet Gynecol 2019 04;220(4):293-296

Department of Obstetrics and Gynecology, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, NY.

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http://dx.doi.org/10.1016/j.ajog.2019.02.060DOI Listing
April 2019

Advanced paternal age, infertility, and reproductive risks: A review of the literature.

Prenat Diagn 2019 01 10;39(2):81-87. Epub 2019 Jan 10.

Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

Advanced paternal age (APA) is associated with infertility and other reproductive risks. Studies looking at APA and outcomes have used different paternal age cut-offs, which has complicated systematic evaluations of reproductive risk associated with paternal aging. This review of the literature suggests that the impact of paternal aging on adverse reproductive outcomes is small, but significant. Studies suggest the incidence of paternal age effect disorders attributed to de novo autosomal dominant mutations is less than 0.5%. Other risks associated with APA include infertility, miscarriage, birth defects, poor neurodevelopmental outcomes, and childhood cancer. Although the increasing prevalence of APA has mirrored the rise in maternal age, this topic has not received similar attention. In this review, we summarize the available literature on the reproductive risks associated with APA to provide a framework for comprehensive genetic counseling and evidence-based management of APA pregnancies.
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http://dx.doi.org/10.1002/pd.5402DOI Listing
January 2019

Top-cited articles in the Journal: a bibliometric analysis.

Am J Obstet Gynecol 2019 01 16;220(1):12-25. Epub 2018 Nov 16.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address:

Background: The Journal has had a profound influence in nearly 150 years of publishing. A bibliometric analysis, which uses citation analyses to evaluate the impact of articles, can be used to identify the most impactful papers in the Journal's history.

Objective: The objective was to identify and characterize the top-cited articles published in the Journal since 1920.

Study Design: We used the Web of Science and Scopus databases to identify the most frequently cited articles of the Journal from 1920 through 2018. The top 100 articles from each database were included in our analysis. Articles were evaluated for several characteristics including year of publication, article type, topic, open access, and country of origin. Using the Scopus data, we performed an unadjusted categorical analysis to characterize the articles and a 2 time point analysis to compare articles before and after 1995, the median year of publication from each database list.

Results: The top 100 articles from each database were included in the analysis. This included 120 total articles: 80 articles listed in both and 20 unique in each database. More than half (52%) were observational studies, 9% were RCTs, and 75% were from US authors. When the post-1995 studies were compared with the articles published before 1995, articles were more frequently cited (median 27 vs 13 citations per year, P < .001), more likely to be randomized (14.0% vs 4.8%, P = .009), and more likely to originate from international authors (33.3% vs 17.5%, P = .045).

Conclusion: Slightly more than half of the top-cited papers in the Journal since 1920 were observational studies and three quarters of all papers were from US authors. Compared with top-cited papers before 1995, the Journal's top-cited papers after 1995 were more likely to be randomized and to originate from international authors.
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http://dx.doi.org/10.1016/j.ajog.2018.11.1091DOI Listing
January 2019

Second-Trimester Sonographic Thymus Measurements Are Not Associated With Preterm Birth and Other Adverse Obstetric Outcomes.

J Ultrasound Med 2016 May 12;35(5):989-97. Epub 2016 Apr 12.

Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA.

Objectives: Previous studies have demonstrated an association between adverse obstetric outcomes, such as preterm birth, and in utero inflammation. The fetal thymus, which can be visualized in the anterior mediastinum on obstetric sonography, may involute in response to such inflammation and thus may identify pregnancies at increased risk for these outcomes. We therefore sought to determine whether second-trimester fetal thymus measurements are associated with preterm birth.

Methods: Transabdominal fetal thymus measurements were prospectively obtained in singleton pregnancies at gestational ages of 18 weeks to 23 weeks 6 days during a 5-month period. The transverse and anterorposterior thymus diameters and the thymic-thoracic ratio were measured. Delivery outcomes were collected from our clinical database. The primary outcome was preterm birth, which we defined as delivery between 24 weeks and 36 weeks 6 days. Small for gestational age (SGA) and pregnancy-related hypertension, which are adverse obstetric outcomes that may also be associated with in utero inflammation, were included as secondary outcomes.

Results: We included 520 patients with thymus measurements and obstetric outcome data. The prevalence of preterm birth was 12.3% (n = 64). None of the thymus measurements were associated with preterm birth. Similarly, there was no association between thymus measurements and SGA or pregnancy-related hypertension.

Conclusions: Sonographic assessment of the second-trimester fetal thymus did not identify patients at increased risk for preterm birth, SGA, and pregnancy-related hypertension. Routine thymus measurements during the second-trimester anatomic scan are not clinically useful for prediction of preterm birth and other adverse outcomes.
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http://dx.doi.org/10.7863/ultra.15.06095DOI Listing
May 2016

Utility of a Single 3-Vessel View in the Evaluation of the Ventricular Outflow Tracts.

J Ultrasound Med 2015 Aug;34(8):1415-21

Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania USA (J.S.B., E.W., N.S.); and Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania USA (J.R., D.S., M.L.M.).

Objectives: Prenatal diagnosis of congenital heart disease can improve neonatal outcomes. The purpose of this study was to evaluate the utility of an isolated 3-vessel view image in evaluating the ventricular outflow tracts.

Methods: Three-vessel view images were prospectively collected from consecutive patients referred to a regional fetal heart center for fetal echocardiography between gestational ages of 18 weeks and 23 weeks 6 days. Cardiac malformations were categorized as anomalies of the outflow tracts, the 4-chamber view, or combined lesions. A single representative still-frame 3-vessel view image was reviewed by 2 independent and blinded observers who were asked to label each image as "normal" or "abnormal." Test characteristics of the isolated 3-vessel view were calculated.

Results: During the study period, 122 consecutive patients (139 fetuses) underwent fetal echocardiography. Eight fetuses with fetal chest anomalies and 12 fetuses with oblique images were excluded. Thirty-four of 119 fetuses (28.6%) had abnormal echocardiograms, including 11 outflow tract anomalies and 16 combined anomalies. Using the 3-vessel view alone, both reviewers achieved 91% sensitivity for the detection of isolated outflow tract anomalies and mean sensitivity of 88% for combined anomalies. All cases of tetralogy of Fallot and transposition of the great arteries were identified in the 3-vessel view.

Conclusions: A single 3-vessel view image can serve as a representative view of the outflow tracts and can show ventricular outflow tract anomalies with high sensitivity. Given that the conventional outflow tract views can be difficult to obtain, the 3-vessel view may serve as an effective first-line view when evaluating the ventricular outflow tracts for congenital heart disease.
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http://dx.doi.org/10.7863/ultra.34.8.1415DOI Listing
August 2015

Does a maternal-fetal medicine-centered labor and delivery coverage model put the 'M' back in MFM?

Am J Obstet Gynecol 2014 Apr 20;210(4):333.e1-333.e7. Epub 2014 Feb 20.

Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Objective: Maternal morbidity is increasing in the United States. Our objectives were to examine whether a labor and delivery (L&D) provider model with regular maternal-fetal medicine (MFM) coverage decreases the rates of maternal morbidity during delivery hospitalizations and has an impact on obstetrician-gynecologist residents' perceptions of safety and education.

Study Design: We performed a retrospective cohort study to compare the rates of maternal morbidity before and after the implementation of an MFM-centered coverage model on L&D. Outcomes were identified using International Classification of Diseases, ninth revision, codes. The primary outcome was a composite of severe maternal morbidity. Additionally, obstetrician-gynecologist residents completed an anonymous survey asking them to compare coverage models, and their Council on Resident Education in Obstetrics and Gynecology examination scores were compared.

Results: Data from 4715 deliveries were included. There were no differences in composite morbidity or individual adverse outcomes. Most residents (81.3%) preferred the new provider model, with median 5-point Likert scores indicating perceived increases in safety and education. Mean Council on Resident Education in Obstetrics and Gynecology scores improved in the 18 residents exposed to both models.

Conclusion: Although the MFM-centered provider model appears to have had a positive impact on residents' perceptions of safety and education, it was not associated with significant changes in severe maternal morbidity.
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http://dx.doi.org/10.1016/j.ajog.2014.01.008DOI Listing
April 2014

Academic differences among male and female candidates applying for obstetrics and gynecology residency: the experience of one program.

J Surg Educ 2013 Jul-Aug;70(4):439-42. Epub 2013 Apr 29.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.

Objective: The purpose of this study was to identify academic differences between male and female candidates applying to our obstetrics and gynecology (OBGYN) residency.

Methods: We reviewed the Electronic Residency Application Service applications of candidates applying to our residency program from 2005 to 2009. Academic qualifications of male and female candidates were compared using the Fisher exact and Student t tests.

Results: Of 2263 applicants, 1710 (75.6%) were women. Compared with male candidates, female candidates in the United States were more likely to have earned honors in OBGYN (51.3% vs 41.2%, p = 0.02) and internal medicine clerkships (27.6% vs 19.1%, p = 0.03). There was a nonsignificant trend toward more female membership in the Alpha Omega Alpha. There were no differences in United States Medical Licensing Exam scores based on gender.

Conclusions: Although no difference in United States Medical Licensing Exam scores were observed, female applicants performed better in select clerkships during medical school than their male counterparts. This difference in clerkship grades may contribute to the low proportion of male residents in OBGYN, although the overall low proportion of male applicants is likely an important factor as well.
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http://dx.doi.org/10.1016/j.jsurg.2013.03.012DOI Listing
February 2014

Hysteroscopic Removal of Cervical Ectopic Pregnancy Following Failed Intramuscular/Intra-Sac Methotrexate: A Case Report.

J Gynecol Surg 2012 Oct;28(5):369-371

Department of Obstetrics and Gynecology, New York Methodist Hospital , Brooklyn, NY.

Cervical pregnancy is a diagnosis associated with significant morbidity, specifically life-threatening hemorrhage that potentially requires hysterectomy to prevent maternal death. Conservative and fertility-sparing management strategies are poorly described in the literature, and there is no clear standard of care. The patient was a 34-year-old gravida 1, para 0 who had conceived spontaneously after laparoscopic treatment of endometriosis, and was found to have cervical pregnancy. She received both intramuscular and intra-sac methotrexate, with no resolution of the ectopic pregnancy. The pregnancy was removed hysteroscopically. Subsequently, the patient was able to achieve a normal clinical pregnancy with ovulation induction/intrauterine insemination. This pregnancy was carried to term. Although cervical pregnancy is particularly hazardous and potentially fatal, conservative/fertility-sparing management of these pregnancies can be successful. (J GYNECOL SURG 28:369).
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http://dx.doi.org/10.1089/gyn.2012.0006DOI Listing
October 2012

Ovarian pregnancy and a copper intrauterine device.

Rev Obstet Gynecol 2010 ;3(3):81

New York Presbyterian Hospital, New York Weill Cornell Medical Center New York, NY.

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July 2011

Embryonal rhabdomyosarcoma of the cervix and appendiceal carcinoid tumor.

Obstet Gynecol 2011 Feb;117(2 Pt 2):482-484

From Weill Cornell Medical College; New York Presbyterian Hospital-Weill Cornell Medical Center; the Department of Pathology, New York Presbyterian Hospital-Weill Cornell Medical Center; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York.

Background: Rhabdomyosarcomas, particularly those of gynecologic origin, are very rare in adults. As a result, there is little literature on the optimal staging procedure and treatment modalities for this population.

Case: A 43-year-old woman presented with a long-standing history of menorrhagia and was subsequently diagnosed with embryonal rhabdomyosarcoma of the cervix. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymph node dissection, omentectomy, and appendectomy, which also revealed a synchronous tubular carcinoid tumor of appendiceal origin. Plans for treatment involve adjuvant chemotherapy with vincristine, dactinomycin, and cyclophosphamide.

Conclusion: This case adds to the small body of literature surrounding cervical embryonal rhabdomyosarcoma in women over the age of 40 years and proposes that appendectomy be considered during surgical management.
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http://dx.doi.org/10.1097/AOG.0b013e3182051dd0DOI Listing
February 2011

Citation classics in obstetrics and gynecology: the 100 most frequently cited journal articles in the last 50 years.

Am J Obstet Gynecol 2010 Oct;203(4):355.e1-7

Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10021, USA.

Objective: Our objective was to characterize the most frequently cited articles published in obstetrics and gynecology journals during the last 50 years.

Study Design: We utilized the 2008 edition of Journal Citation Reports and Social Sciences Citation Index database to determine the most frequently cited articles published after 1956. Articles were evaluated for several characteristics, and an unadjusted categorical analysis was performed to compare pre- and post-1980 articles.

Results: The 100 most frequently cited articles were published in 11 journals between 1957 and 2004. Most articles were published by US-based authors. Forty-four articles were related to obstetrics and 56 were related to gynecology. The most common study design was observational. There were only 7 randomized controlled trials, and randomized controlled trials were not more common after 1980 (6.3% vs 8.1%; P = .71).

Conclusion: Most "citation classics" in obstetrics and gynecology are observational studies published in high-impact journals by US-based authors after 1980.
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http://dx.doi.org/10.1016/j.ajog.2010.07.025DOI Listing
October 2010
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