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Vaginal Birth after Cesarean after Zavanelli Maneuver: A Woman’s Right to Choose

Open Journal of Obstetrics and Gynecology 2024年第7期14卷 1091-1095页

作者： Nicole Jenkins Gregory Vurture jonathan d. baum department of Obstetrics and Gynecology Jersey Shore University Medical Center Neptune NJ USA

Introduction: Vaginal birth after cesarean (VBAC) plays an essential role in lowering cesarean rates. despite endorsement, trial of labor after cesarean (TOLAC) attempt rates remain low, in part due to fear of lawsuits. Zavanelli maneuver is a last resort procedure in the management of shoulder dystocia. We discuss a case of a woman determined to have a vaginal birth after her prior birth was complicated by shoulder dystocia requiring a Zavanelli maneuver. Her physicians were reluctant to allow her a TOLAC given her prior obstetric history. Case: A 34-year-old para 1 with prior cesarean delivery due to shoulder dystocia that required Zavanelli maneuver presents determined to pursue VBAC in her current pregnancy. She considered her delivery route options and addressed her modifiable risk factors. She consulted with multiple perinatologists who agreed that a TOLAC was reasonable, however she had to travel more than 70 miles (from Pennsylvania to New Jersey) to find an obstetrical practice and hospital willing to consider VBAC. She transferred care and the remainder of her prenatal course was uncomplicated. She went into labor at 41 weeks and had a successful VBAC without complication. In a thank you letter to her obstetrician, she described her birth experience as euphoric. Conclusion: This case illustrates how a woman’s choice of delivery route may be impacted by fear of litigation. Local providers focused on her prior delivery instead of her overall improved risk profile. delivery route decisions should be based on a thorough evaluation of all risk factors and individualized to meet the reproductive goals of each woman. .

关键词： Vaginal Birth after Cesarean Zavanelli Autonomy Case Report

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Vaginal Birth after Cesarean after Zavanelli Maneuver: A Woman’s Right to Choose

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Open Journal of Obstetrics and Gynecology（妇产科期刊） 2024年第7期 1091页

作者： Nicole Jenkins Gregory Vurture jonathan d.baum

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Opioid Prescriptions in Women: Is the data Accurate?

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Open Journal of Obstetrics and Gynecology 2022年第9期12卷 934-940页

作者： Keren Khromchenko jonathan d. baum department of Obstetrics and Gynecology Jersey Shore University Medical Center Neptune NJ USA

Background: In 2012, U.S. health care providers wrote more than 259 million opioid prescriptions, which is twice as many as in 1998. Approximately 1 in 10 women report the use of opioids for pain management during pregnancy. The Centers for disease Control and Prevention (CdC) estimated that between 2008 and 2012, 39% of reproductive-aged women on Medicaid had filled a prescription for opioid medication each year, as did 28% of women with private insurance. The opioid epidemic extends to the state of New Jersey (NJ);however, limited data is available regarding opioid prescriptions among Medicaid and private insurance patients within the state. Objective: Evaluate opioid prescriptions filled in reproductive-aged women presenting in labor at a community teaching hospital in suburban New Jersey. Methods: We performed a retrospective cohort study using data obtained from patient records and the New Jersey Prescription Monitoring Program (NJPMP) database. We enrolled 200 patients that were admitted in labor between May 2015 and May 2016. data was collected from reproductive-aged women during the one year preceding labor admission. We compared our findings to national data reported by the CdC using Chi-square analysis. Maternal demographic data were extracted from patient records and included age, insurance status (private insurance, Medicaid, and no insurance), race, and ethnicity. The primary outcome was opioid prescriptions filled. Results: Of the 200 women admitted in labor, 129 had private insurance, 63 had Medicaid, and 8 had no insurance. We found that 5.4% (7/129) of patients with private insurance, 4.8% (3/63) of patients with Medicaid, and 12.5% (1/8) of patients with no insurance filled opioid prescriptions. Overall, 5.5% (11/200) of women filled opioid prescriptions during the study period. Opioid prescriptions confirmed via NJPMP were significantly lower than rates reported by the CdC in Medicaid (4.8% vs. 41.4%, p-value 0.001) and private insurance (5.4% vs.

关键词： Centers for disease Control and Prevention (CdC) Medicaid New Jersey New Jersey Prescription Monitoring Program (NJPMP) Opioid(s) Prescription Private Insurance Reproductive

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Life after Addiction—Post-Operative Pain Management in an Obstetrical Patient on Long-Term Buprenorphine Therapy

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Open Journal of Obstetrics and Gynecology 2017年第9期7卷 951-956页

作者： Kelly R Bowen jonathan d baum department of Obstetrics and Gynecology Jersey Shore University Medical Center Neptune USA

A G6P2032 female, prior cesarean x3 with history of opioid addiction maintained on buprenorphine presented for scheduled repeat cesarean section. Pre-operatively, her maintenance dose of medication was held secondary to concerns for partial agonist effect. Post-operative pain control was suboptimal with the patient ultimately proceeding to withdrawal. doses of hydromorphone were titrated to 10 mg every 3 hours to avoid further withdrawal. Review of expert opinion after discharge recommended against holding buprenorphine therapy in the post-operative period. Pain management options include maintenance therapy with additional doses of opioid and non-opioid pain relieving medications.

关键词： Buprenorphine Methadone Addiction Pregnancy Opiate Use in Pregnancy

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Cesarean Operative Reports: We Can do Better!

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Open Journal of Obstetrics and Gynecology 2021年第2期11卷 117-124页

作者： Sarah E. Goodheart jonathan d. baum department of Obstetrics and Gynecology Jersey Shore University Medical Center Neptune USA

Background: The operative report is an essential component of communication, patient care, and safety;it is a JCAHO requirement and legal document. Almost 80% of residency program directors surveyed agreed on the importance of the operative report, yet less than 20% of programs provide formal resident training. Documentation has important implications in obstetrics as route and timing of future deliveries are often influenced by operative findings. Purpose: Examine completeness of cesarean operative reports using a validated instrument adapted from general surgery. Assess the impact of an educational resident in-service on the required elements and documentation in resident generated cesarean operative reports. Methods: A quality improvement project identified significant deficiencies in resident generated cesarean operative reports. We conducted a retrospective chart review of cesarean operative reports from November 2019 to May 2020 at Jersey Shore University Medical Center. Our study was conducted in three phases. In phase 1, a cohort of cesarean operative reports was examined using a structured evaluation tool. In phase 2, an educational resident in-service on standardization of operative notes was provided. In phase 3, another cohort of cesarean operative reports was examined using the same evaluation tool after the resident in-service. Analysis for improvement was performed. Results: Fifty pre and post-in-service cesarean operative report evaluations weredana;"> compared (N = 100). Inclusion of date of surgery significantly improved from 78% to 100%, p-value d inclusion

关键词： Cesarean documentation Notes Operative Resident

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Gastric Perforation after Cesarean delivery: An Unintended Consequence of the Opioid Epidemic

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Open Journal of Obstetrics and Gynecology 2021年第5期11卷 563-568页

作者： Tesia A. McKenzie Eugene Zurkovsky jonathan d. baum department of Obstetrics and Gynecology Departments Affiliated with Jersey Shore University Medical Center Hackensack Meridian Health System Neptune USA department of General Surgery Departments Affiliated with Jersey Shore University Medical Center Hackensack Meridian Health System Neptune USA

30 year old female now para 1 presented to the Emergency department with nausea, vomiting, and abdominal pain 6 days after an uncomplicated primary cesarean delivery. She did not respond to conservative management and underwent exploratory laparotomy for worsening pain, pneumoperitoneum and intraabdominal fluid collections. Gastric perforations required repair via gastrojejunostomy. Postoperative course was unremarkable. The anti-opioid campaign has altered the approach to postoperative pain management in both positive and negative ways. It has sparked new interest in alternative approaches to postoperative pain management, which include an increased role for non-steroidal anti-inflammatory drugs (NSAIds). We present a case of a woman who had a significant complication due to the reliance of non-opioid pain medications after cesarean delivery.

关键词： Opioid Opioid Epidemic Gastric Perforation Gastrojejunostomy Cesarean delivery

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Pregnancy Craving and Pica: 60 Years Later

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Open Journal of Obstetrics and Gynecology 2020年第8期10卷 1079-1085页

作者： jonathan d. baum Erin E. Curcio Sarah E. Goodheart Jersey Shore University Medical Center Neptune NJ USA

Purpose: To study pregnancy craving and pica in a cohort of women and compare our findings to a historic study. Methods: Prospective survey of women in the third trimester of pregnancy. Data were collected using the same questionnaire from a study published in Obstetrics and Gynecology in 1957. All surveys were conducted by clinicians at 35 0/7-41 6/7 weeks gestational age. High risk pregnancies were excluded. Results: We included 547 women in the analysis. Of those, 60.8% reported food craving vs 65.7% in the 1957 cohort, p-value 0.09. The most common food craving was fruit, seen in 31.1% vs 13.6%, p-value p-value 0.00001. The cohorts differed in fruit craving, (31.1% vs 13.6%), meat, poultry, fish, dry beans, eggs, and nuts (21.0% vs 5.0%), milk, yogurt, and cheese, (17.0% vs 2.2%) and vegetable, (14.1% vs 6.9%), all with p-value

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Travel in Pregnancy: The Impact of Zika

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Open Journal of Obstetrics and Gynecology 2017年第10期7卷 1064-1071页

作者： Erin E. Curcio jonathan d. baum debra Gussman Mark Martens department of Obstetrics & Gynecology Jersey Shore University Medical Center Neptune NJ USA

OBJECTIVE: The purpose of our study was to examine current travel patterns and behaviors of pregnant women. METHOdS: We developed a questionnaire adapted from a publication by Kingman and Economides to examine the travel behavior of women during pregnancy in a suburban community. RESULTS: A convenience sample of 102 patients completed the travel questionnaire. Forty-six (45.1%) traveled during the current pregnancy. Thirty-one (30.4%) traveled more than once. A total of 257 trips were taken by the participants: 113 (43.9%) trips were taken in the first trimester, 87 (33.8%) in the second and 59 (22.9%) in the third trimester. Trip length ranged from 2-90 days with a mean of 11 days. Reasons for travel included: 193 (75.1%) for leisure, 37 (14.4%) work related, 10 (3.9%) trips for emergencies, and 3 (0.4%) trips for relocation.?Eighteen women (17.6%) traveled internationally. One (1.0%) woman was hospitalized while traveling. Manner of travel was as follows: car 167 (65.0%), plane 67 (26.1%), train 13 (5.1) %, bus 10 (3.9%) and none by boat. Nineteen (41.3%) women sought travel advice. Thirteen (68.4%) asked for advice from a doctor, 2 (10.5%) from a nurse, 2 (10.5%) from family and/or friends, 1 (5.3%) from the Internet and 1 (5.3%) from a travel book. Seventeen (37%), traveled without suitable insurance. dISCUSSION: Travel rates during pregnancy have remained surprisingly stable over the past 60 years. Almost 50% of our cohort traveled during pregnancy, and the majority did not seek advice prior to travel. In light of new infectious disease threats, obstetric practice and advice needs reassessment. The majority of travel during pregnancy remains optional. Improved patient education and consultations prior to travel could decrease health risks.

关键词： Travel Pregnancy Zika

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ChatGPT: An Evaluation of AI-Generated Responses to Commonly Asked Pregnancy Questions

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Open Journal of Obstetrics and Gynecology 2023年第9期13卷 1528-1546页

作者： Christopher Wan Angelo Cadiente Keren Khromchenko Natalie Friedricks Rima A. Rana jonathan d. baum department of Obstetrics and Gynecology Jersey Shore University Medical Center Neptune NJ USA

Background: A recent assessment of ChatGPT on a variety of obstetric and gynecologic topics was very encouraging. However, its ability to respond to commonly asked pregnancy questions is unknown. Reference verification needs to be examined as well. Purpose: To evaluate ChatGPT as a source of information for commonly asked pregnancy questions and to verify the references it provides. Methods: Qualitative analysis of ChatGPT was performed. We queried ChatGPT Version 3.5 on 12 commonly asked pregnancy questions and asked for its references. Query responses were graded as “acceptable” or “not acceptable” based on correctness and completeness in comparison to American College of Obstetricians and Gynecologists (ACOG) publications, PubMed-indexed evidence, and clinical experience. References were classified as “verified”, “broken”, “irrelevant”, “non-existent” or “no references”. Review and grading of responses and references were performed by the co-authors individually and then as a group to formulate a consensus. Results: In our assessment, a grade of acceptable was given to 50% of responses (6 out of 12 questions). A grade of not acceptable was assigned to the remaining 50% of responses (5 were incomplete and 1 was incorrect). In regard to references, 58% (7 out of 12) had deficiencies (5 had no references, 1 had a broken reference, and 1 non-existent reference was provided). Conclusion: Our evaluation of ChatGPT confirms prior concerns regarding both content and references. While AI has enormous potential, it must be carefully evaluated before being accepted as accurate and reliable for this purpose.

关键词： AI (Artificial Intelligence) ChatGPT Pregnancy

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On the calibration of a shear stress criterion for rock joints to represent the full stress-strain profile

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Journal of Rock Mechanics and Geotechnical Engineering 2024年第2期16卷 379-392页

作者： Akram deiminiat jonathan d.Aubertin Yannic Ethier department of Construction Engineering École de Technologie Supérieure(ÉTS)MontréalCanada

Conventional numerical solutions developed to describe the geomechanical behavior of rock interfaces subjected to differential load emphasize peak and residual shear *** detailed analysis of preand post-peak shear stress-displacement behavior is central to various time-dependent and dynamic rock mechanic problems such as rockbursts and structural instabilities in highly stressed *** complete stress-displacement surface(CSdS)model was developed to describe analytically the pre-and post-peak behavior of rock interfaces under differential *** formulations of the CSdS model required extensive curve-fitting iterations which limited its practical applicability and transparent integration into engineering *** present work proposes modifications to the CSdS model aimed at developing a comprehensive and modern calibration protocol to describe the complete shear stressdisplacement behavior of rock interfaces under differential *** proposed update to the CSdS model incorporates the concept of mobilized shear strength to enhance the post-peak ***’s concepts of joint roughness coefficient(JRC)and joint compressive strength(JCS)are incorporated to facilitate empirical estimations for peak shear stress and normal closure ***/uniaxial compression test and direct shear test results are used to validate the updated model and exemplify the proposed calibration *** results illustrate that the revised model successfully predicts the post-peak and complete axial stressestrain and shear stressedisplacement curves for rock joints.

关键词： Full shear profile Post-peak shear behavior Rock joint Joint roughness coefficient(JRC) Axial stress-strain curve

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