Browsing by Author "Grotegut, Chad"
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Item Open Access Multidisciplinary approach to manage antenatally suspected placenta percreta: updated algorithm and patient outcomes.(Gynecol Oncol Res Pract, 2017) Lee, Paula S; Kempner, Samantha; Miller, Michael; Dominguez, Jennifer; Grotegut, Chad; Ehrisman, Jessie; Previs, Rebecca; Havrilesky, Laura J; Broadwater, Gloria; Ellestad, Sarah C; Secord, Angeles AlvarezBACKGROUND: Due to the significant morbidity and mortality associated with placenta percreta, alternative management options are needed. Beginning in 2005, our institution implemented a multidisciplinary strategy to patients with suspected placenta percreta. The purpose of this study is to present our current strategy, maternal morbidity and outcomes of patients treated by our approach. METHODS: From 2005 to 2014, a retrospective cohort study of patients with suspected placenta percreta at an academic tertiary care institution was performed. Treatment modalities included immediate hysterectomy at the time of cesarean section (CHYS), planned delayed hysterectomy (interval hysterectomy 6 weeks after delivery) (DH), and fertility sparing (uterine conservation) (FS). Prognostic factors of maternal morbidity were identified from medical records. Complications directly related to interventional procedures and DH was recorded. Descriptive statistics were utilized. RESULTS: Of the 21 patients with suspected placenta percreta, 7 underwent CHYS, 13 underwent DH, and 1 had FS with uterine preservation. Of the 20 cases that underwent hysterectomy, final pathology showed 11 increta, 7 percreta, and 2 inconclusive. 19/20 cases underwent interventional radiology (IR) procedures. Selective embolization was utilized in 14 cases (2/7 CHYS; 12/13 DH). The median time from cesarean section (CS) to DH was 41 [26-68] days. There were no cases of emergent hysterectomy, delayed hemorrhage, or sepsis in the DH group. Both estimated blood loss and number of packed red blood cell transfusions were significantly higher in the CHYS group. 3/21 cases required massive transfusion (2 CHYS, 1 FS) with median total blood product transfusion of 13 units [12-15]. The four IR-related complications occurred in the DH group. Incidence of postoperative complications was similar between both groups. Median hospital length of stay (LOS) after CHYS was 4 days [3-8] compared to DH cohort: 7 days [3-33] after CS and 4 days [1 -10] after DH. The DH cohort had a higher rate of hospital readmission of 54% (7/13) compared to 14% (1/7) CHYS, most commonly due to pain. There were no maternal deaths. CONCLUSION: This multidisciplinary strategy may appear feasible; however, further investigation is warranted to evaluate the effectiveness of alternative approaches to cesarean hysterectomy in cases of morbidly adherent placenta.Item Open Access Risk of obstetric anal sphincter injuries at the time of admission for delivery: A clinical prediction model.(BJOG : an international journal of obstetrics and gynaecology, 2022-11) Luchristt, Douglas; Meekins, Ana Rebecca; Zhao, Congwen; Grotegut, Chad; Siddiqui, Nazema Y; Alhanti, Brooke; Jelovsek, John EricObjective
To develop and validate a model to predict obstetric anal sphincter injuries (OASIS) using only information available at the time of admission for labour.Design
A clinical predictive model using a retrospective cohort.Setting
A US health system containing one community and one tertiary hospital.Sample
A total of 22 873 pregnancy episodes with in-hospital delivery at or beyond 21 weeks of gestation.Methods
Thirty antepartum risk factors were identified as candidate variables, and a prediction model was built using logistic regression predicting OASIS versus no OASIS. Models were fit using the overall study population and separately using hospital-specific cohorts. Bootstrapping was used for internal validation and external cross-validation was performed between the two hospital cohorts.Main outcome measures
Model performance was estimated using the bias-corrected concordance index (c-index), calibration plots and decision curves.Results
Fifteen risk factors were retained in the final model. Decreasing parity, previous caesarean birth and cardiovascular disease increased risk of OASIS, whereas tobacco use and black race decreased risk. The final model from the total study population had good discrimination (c-index 0.77, 95% confidence interval [CI] 0.75-0.78) and was able to accurately predict risks between 0 and 35%, where average risk for OASIS was 3%. The site-specific model fit using patients only from the tertiary hospital had c-stat 0.74 (95% CI 0.72-0.77) on community hospital patients, and the community hospital model was 0.77 (95%CI 0.76-0.80) on the tertiary hospital patients.Conclusions
OASIS can be accurately predicted based on variables known at the time of admission for labour. These predictions could be useful for selectively implementing OASIS prevention strategies.