Publications by authors named "Triebwasser J"

Article Synopsis
  • * Researchers analyzed data from over 15 million vaginal births between 2016 and 2021, finding an overall OASI incidence of 1.1%, with vaginal parity and operative birth being the strongest predictive factors.
  • * The final model explained 11.8% of the variability in OASI occurrences, indicating that while some clinical factors are useful for prediction, many OASI cases still lack clear explanatory factors, urging further research on underlying mechanisms.
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Article Synopsis
  • The study examines how the time of day affects the likelihood of operative vaginal births (OVBs) compared to spontaneous vaginal births (SVBs) using U.S. birth data from 2016 to 2021.
  • After analyzing over 15 million births, it was found that OVBs were more common during the late afternoon (4:30-7:30 p.m.) and less common in the early morning (3:00-6:00 a.m.).
  • The results suggest that different times of day influence the use of birth intervention methods, indicating a need for further research into the reasons behind these temporal trends.
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SARS-CoV-2 infection can cause severe disease among pregnant persons. Pregnant persons were not included in initial studies of therapeutics for COVID-19, but cumulative experience demonstrates that most are safe for pregnant persons and the fetus, and effective for prevention or treatment of severe COVID-19.

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Objective:  This study aimed to assess the impact of implementation of an induction of labor (IOL) guideline on IOL length and utilization of evidence-based practices.

Study Design:  We conducted a quality improvement project to increase utilization of three evidence-based IOL practices: combined agent ripening, vaginal misoprostol, and early amniotomy. Singletons with intact membranes and cervical dilation ≤2 cm admitted for IOL were included.

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Objective: To determine delivery risk phenotype-specific incidence of early-onset sepsis (EOS) among preterm infants.

Study Design: Retrospective cohort study of infants born <35 weeks' gestation at four perinatal centers during 2017-2021. Infants were classified into one of six delivery risk phenotypes incorporating delivery mode, presence of labor, and duration of rupture of membranes (ROM).

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Objective: Sickle cell disease is associated with adverse perinatal outcomes. Aspects of sickle cell disease in pregnancy, such as health care utilization and neonatal abstinence syndrome, are understudied. We aimed to describe contemporary sickle cell disease outcomes in a U.

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Objective: Scalable interventions are needed to improve preventive care for those with increased cardiovascular disease (CVD) risk identified during pregnancy. We hypothesized that an automated reminder message for clinicians (nudge) would increase counseling at the postpartum visit on patient transitions of care.

Methods: We conducted a single-center, randomized controlled trial including birthing people with a hypertensive disorder of pregnancy evaluating a nudge compared with usual care.

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Article Synopsis
  • Pregnant individuals face a higher risk of severe COVID-19, making vaccination during pregnancy important for protecting both mother and baby.
  • This study, conducted at Pennsylvania Hospital, analyzed the impact of different COVID-19 vaccines on the transfer of antibodies from mothers to newborns, examining maternal and cord blood samples.
  • Results indicated that vaccinated individuals had significantly higher levels of antibodies compared to those who were infected, with the Moderna vaccine producing better antibody levels than the Pfizer/BioNTech vaccine.
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Objective: To quantify the extent to which neighborhood characteristics contribute to racial and ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity in pregnancy.

Methods: This cohort study included pregnant patients who presented for childbirth at two hospitals in Philadelphia, Pennsylvania from April 13 to December 31, 2020. Seropositivity for SARS-CoV-2 was determined by measuring immunoglobulin G and immunoglobulin M antibodies by enzyme-linked immunosorbent assay in discarded maternal serum samples obtained for clinical purposes.

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Basic knowledge about contraceptive types, efficacy, and indications is absolutely necessary for cardiologists caring for reproductive-age women for whom pregnancy could cause significant morbidity or mortality and for those on teratogenic medications. This summary provides a comprehensive overview of contraception options.

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Objective: Opioid prescription after cesarean delivery is excessive and can lead to chronic opioid use disorder. We assessed the impact of an enhanced recovery after surgery (ERAS) pathway on inpatient opioid consumption after cesarean delivery.

Study Design: An ERAS pathway was implemented as a quality improvement initiative in December 2019.

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Importance: Maternally derived antibodies are a key element of neonatal immunity. Understanding the dynamics of maternal antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and subsequent transplacental antibody transfer can inform neonatal management as well as maternal vaccination strategies.

Objective: To assess the association between maternal and neonatal SARS-CoV-2-specific antibody concentrations.

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Background: Hypertensive disorders of pregnancy are associated with increased cardiovascular disease risk across the lifespan. The American College of Obstetricians and Gynecologists and the American Heart Association emphasize the postpartum period as an important opportunity to identify and intervene women at high risk of future cardiovascular disease.

Objective: This study aimed to determine the proportion of women with documented counseling on risks and transitions of care after hypertensive disorders of pregnancy at the postpartum visit.

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Objectives: A clinical trial showed postpartum text-based blood pressure (BP) monitoring is effective in meeting clinical guidelines and reduces racial disparities in postpartum hypertension care. Our objective was to compare clinical outcomes to those from a clinical trial after implementation of the program in a second hospital within our hospital system.

Study Design: Comparison of women randomized to text-based BP monitoring in a clinical trial compared to an implementation cohort clinically enrolled in text-based BP monitoring.

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Article Synopsis
  • - Preeclampsia and gestational hypertension are pregnancy-related hypertension issues that elevate the risk of chronic hypertension and heart disease later in life, making postpartum follow-up crucial for early screening and treatment of these risks.
  • - A study analyzed insurance claims from over 566,000 women to assess postpartum visit patterns within the first 6 months after delivery, revealing only 13% of normotensive women and even fewer with hypertension received primary care follow-ups.
  • - The findings indicate that only 58% of women with hypertensive disorders had continuity follow-up care, highlighting a significant gap in cardiovascular risk management for these women, particularly among those over 30, Black, Hispanic, or with multiple births.
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Neuroimaging may predict response to cognitive remediation therapy and social skills training (CRT + SST) in schizophrenia. Identifying biological predictors of response is crucial for treatment decision making given not all patients respond to such interventions. Nineteen veterans with schizophrenia enrolled in an 8-week trial of CRT + SST.

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Objectives: To test the hypothesis that ibuprofen is equivalent to acetaminophen in its effect on postpartum blood pressure in women with gestational hypertension or preeclampsia without severe features.

Study Design: Single-center randomized, crossover, equivalence trial among women with hypertensive disorders of pregnancy without severe features after vaginal delivery. Participants were assigned in a double-blind fashion to ibuprofen 600 mg or acetaminophen 650 mg every 6 h for 24 h followed by crossover to the other drug.

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Article Synopsis
  • The study aimed to explore the link between cardiac remodeling in early pregnancy and negative perinatal outcomes in women with a BMI of 40 kg/m or more.
  • It involved analyzing women who had echocardiograms before 24 weeks of pregnancy and categorized their heart geometry into normal or abnormal types.
  • The findings indicated a higher association of abnormal heart geometry with hypertensive disorders during pregnancy, although it did not significantly correlate with other adverse perinatal outcomes like preterm birth or low birth weight.
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Objective: To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC).

Study Design: This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included.

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Objective: Impaired cognition is a hallmark of schizophrenia spectrum disorders, including schizotypal personality disorder, and it is the best predictor of functional outcome. Cognitive remediation therapy has demonstrated efficacy for improving cognition, augmenting other rehabilitation efforts in schizophrenia, and effecting gains in real-world functioning. Pharmacological augmentation of cognitive remediation has been attempted, but the effects of augmentation on combined therapies, such as cognitive remediation and social skills training, have not been studied.

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Objective: To assess whether prolonged induction of labor was associated with increased maternal or neonatal morbidity.

Study Design: We performed a retrospective cohort study of women undergoing induction of labor at a single institution. We included women with singletons ≥ 36 weeks with initial cervical dilation ≤4 cm.

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The pubovisceral muscles (PVM) help form the distal maternal birth canal. It is not known why 13% of vaginal deliveries end in PVM tears, so insights are needed to better prevent them because their sequelae can lead to pelvic organ prolapse later in life. In this paper we provide the first quantification of the variation in in vivo viscoelastic properties of the intact distal birth canal in healthy nulliparous women using Fung's Quasilinear Viscoelastic Theory and a secondary analysis of data from a clinical trial of constant force birth canal dilation to 8 cm diameter in the first stage of labor in 26 nullipara.

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Article Synopsis
  • - The study examined the growth patterns of fetuses diagnosed with hypoplastic left heart syndrome (HLHS) compared to expected growth for their gestational age through a retrospective analysis of ultrasound data.
  • - Out of 169 fetuses studied, a significant drop in growth metrics was observed, with mean z-scores for estimated fetal weight and head circumference showing declines from initial to last ultrasounds.
  • - Impaired somatic growth was common, with 32% of the fetuses showing a significant decrease in z-scores over time, indicating the importance of regular ultrasound evaluations to monitor fetal growth in HLHS cases.
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