Publications by authors named "Sarah K Dotters-Katz"

Article Synopsis
  • - Fetal macrosomia (FM) poses significant health risks for both mothers and newborns, particularly in cases without maternal diabetes, yet existing research largely focuses on diabetic populations.
  • - Key risk factors for nondiabetic FM include previous macrosomic births, excessive weight gain during pregnancy, and obesity; complications from FM can lead to higher cesarean rates and neonatal challenges such as shoulder dystocia.
  • - Exercise during pregnancy may help reduce FM risk, and current guidelines recommend against inducing labor before 39 weeks or opting for elective cesarean delivery unless fetal weight is notably high, underscoring the need for further research in this area.
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Importance: Though the incidence of familial Mediterranean fever (FMF) in pregnancy is rare, understanding the etiology and symptomatology of FMF is essential for obstetric treatment of patients with FMF.

Objective: Familial Mediterranean fever is a hereditary periodic fever syndrome that has unique obstetric considerations. Familial Mediterranean fever is typically characterized by recurrent episodes of high-grade fevers, pleuritis/pericarditis, and arthritis lasting 1-3 days with complete recovery seen in between episodes.

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  • Pregnant individuals often use cannabis to alleviate symptoms, but national medical groups strongly advise against it due to safety concerns for fetal neurodevelopment.
  • The study reviewed existing literature and identified potential negative impacts of prenatal cannabis exposure, such as increased neonatal startle responses, memory and reasoning challenges in early childhood, and issues like inattention and hyperactivity.
  • Current data on the effects of prenatal cannabis use are limited by various confounding factors, but the potential risks highlighted suggest that complete avoidance of cannabis during pregnancy is advisable until more comprehensive research is conducted.
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Article Synopsis
  • The study investigates pregnancy and delivery outcomes for women with hereditary hemorrhagic telangiectasia (HHT), focusing on severe maternal morbidity (SMM) and other related complications.
  • A significant rise in HHT diagnoses during pregnancy was observed from 2010 to 2021, with women diagnosed showing higher rates of complications compared to those without HHT.
  • Key findings include increased risks for SMM, preterm birth, cesarean delivery, respiratory bleeding, and cerebrovascular complications in pregnant women with HHT.
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Background: Pre-eclampsia is a leading cause of maternal morbidity and mortality in the United States. Emerging data suggests that postpartum pre-eclampsia may be associated with a higher incidence of maternal morbidity compared to hypertensive disorders of pregnancy (HDP) diagnosed antenatally. Understanding postpartum maternal risk across facilities with a spectrum of obstetric services is critical with the rising rates of pre-eclampsia in all healthcare settings.

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Importance: With advances in prenatal cell-free DNA (cfDNA) technology, the information available with cfDNA continues to expand beyond the common fetal aneuploidies such as trisomies 21, 18, and 13. Due to the admixture of maternal and fetal/placental DNA, prenatal cfDNA remains a screening test with the possibility of false-positive and false-negative results.

Objective: This review aims to summarize unusual incidental maternal and fetal genomic abnormalities detectable by cfDNA and to provide anticipatory guidance regarding management.

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Importance: The latent phase of labor poses a challenge for pregnant patients due to the limited options available for pain relief and management. Therapeutic rest, an intervention involving medication administration during this phase, has shown promise in addressing prelabor discomfort and anxiety.

Objective: To emphasize the significance of therapeutic rest during early labor, describe methods of administering this intervention, review data on efficacy and maternal/fetal outcomes, and determine appropriate criteria and timing of utilization.

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Objective:  This study aimed to assess the rates of vaginal delivery (VD) and the predictors of VD in a cohort of patients with early (<34 weeks) preeclampsia with severe features (Early Severe PreEClampsia [ESPEC]).

Study Design:  We conducted a retrospective cohort study of patients with ESPEC admitted to a single center from 2013 to 2019. Exclusion criteria included patients with contraindications to labor, multifetal gestation, or presenting in spontaneous labor.

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Influenza(flu) in pregnancy is associated with higher rates of hospitalization, ICU admission, and death and with increased odds of congenital anomalies and stillbirth, but not preterm birth. Clinical manifestations of flu in pregnancy are the same as nonpregnant patients. Pregnant individuals with flu-like symptoms or flu exposure should be treated with antivirals.

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Importance: Diabetes mellitus is one of the most common complications in pregnancy with adverse maternal and neonatal risks proportional to the degree of suboptimal glycemic control, which is not well defined. Literature guiding providers in identifying and managing patients at highest risk of complications from diabetes is lacking.

Objective: This article reviews the definition, epidemiology, and pathophysiology of suboptimal control of diabetes in pregnancy, including "diabetic fetopathy"; explores proposed methods of risk stratification for patients with diabetes; outlines existing antepartum management and delivery timing guidelines; and guides direction for future research.

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Background: Letters of recommendation for Maternal-Fetal Medicine(MFM) fellowship are a critical part of the applicant selection process. However, data regarding best practices for how to write LOR for MFM is limited. Similarly, within letters of recommendation, differences in the "code" or meaning of summative words/phrases used at the end of letters of recommendation are seen between surgery, pediatrics, and medicine.

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Importance: Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for proper treatment of fetuses with nonimmune hydrops fetalis. In addition, continued investigation into delivery management, breastfeeding recommendations, and congenital abnormalities associated with pregnancies complicated by parvovirus B19 infection is needed.

Objective: This review describes the risks associated with parvovirus B19 infection during pregnancy and the management strategies for fetuses with vertically transmitted infections.

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Objective:  The objective of this study was to compare the cost and effectiveness of three strategies for screening and/or treating bacterial vaginosis (BV) during pregnancy prior to delivery: (1) the current standard of care was neither test nor treat for BV (Treat None); (2) test all patients for BV at 36 weeks' gestation; treat if positive (Test Treat); and (3) treat all patients undergoing cesarean delivery with intravenous metronidazole at time of surgery (Treat All Cesarean). Effectiveness was defined as avoidance of postpartum surgical site infection (SSI).

Study Design:  A decision analytic cost-effectiveness model was designed from a third-party payer perspective using clinical and cost estimates obtained from the literature, American College of Surgeons National Surgical Quality Improvement Program participant use file (2005-2019), 2019 National Vital Statistics, Medicare costs, and wholesale drug costs.

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Objective: Patients with severe preeclampsia (sPREX) face barriers to successful breastfeeding (BF), including an increased risk of maternal and newborn complications, prematurity, and low birth weight. Patients with early-onset sPREX (before 34 weeks' gestation) may be at even greater risk, yet there are little data available on factors associated with BF challenges in this population. We describe rates of BF initiation at hospital discharge and BF continuation at postpartum (PP) visit and identify factors associated with BF noninitiation and BF cessation among patients admitted with early-onset sPREX.

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Article Synopsis
  • * This review summarizes existing research on LPD, highlights the lack of validated diagnostic criteria, and discusses the controversial role of progesterone supplementation in treating RPL.
  • * There's a need for better assessment tools for LPD and further research to understand its impact on fertility and find effective treatments.
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 Group B (GBS) colonization of the lower urinary tract in pregnancy is associated with severe infections such as chorioamnionitis, endometritis, and pyelonephritis. The objective of this study was to compare rates of progression to pyelonephritis between GBS and lower urinary tract infections (LUTIs), as well as compare infectious and obstetric morbidity secondary to these pathogens.  Retrospective cohort of pregnant women with LUTIs (asymptomatic bacteria or acute cystitis [AC]) from a single health system between July 2013 and May 2019.

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Rocky Mountain spotted fever (RMSF) is a common tick-borne disease and can have variable presentation with potentially fatal outcomes when untreated. We describe an atypical presentation of RMSF in the third trimester. A 37-year-old multiparous woman at 31 weeks' gestation presented normotensive with headaches and fever but no rash or significant tick exposure.

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Background: An increased allostatic load (cumulative physiologic wear and tear of the body) can lead to adverse health outcomes. Symptom experiences are known to influence allostatic load. Yet, the relationships between postpartum symptom typologies and maternal allostatic load remain unknown.

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Importance: Obstetrics and gynecology (OB/GYN) accounts for at least half of all open abdominal surgeries performed. Rates of surgical wound complications after open procedures in OB/GYN range from 5% to 35%. Therefore, optimizing management of surgical wound complications has the potential to significantly reduce cost and morbidity.

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Article Synopsis
  • Smoking and nicotine use during pregnancy increases the risk of negative effects on the fetus, such as low birth weight and preterm birth.
  • Education and research efforts have led to a decrease in smoking rates among pregnant individuals, dropping from 13.2% in 2006 to 7.2% in 2016.
  • Effective smoking cessation strategies should include personalized care that combines behavioral counseling, medication when appropriate, and continuous support for pregnant individuals.
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