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147 results on '"Govindappagari, Shravya"'

1. Iron-deficiency anemia in pregnancy and the role of intravenous iron: Anemia in pregnancy should be treated due to its connection to adverse maternal and neonatal outcomes

Author

Govindappagari, Shravya, Newman, Rachel A., and Burwick, Richard M.

Subjects
Pregnancy, Glycosylated hemoglobin, Chronic diseases -- Complications and side effects, Infants (Newborn), Ferric carboxymaltose -- Complications and side effects, Iron deficiency anemia -- Complications and side effects, Health, World Health Organization
Abstract

Anemia, a condition in which the number of red blood cells is insufficient to meet the body's physiologic needs for oxygen transport, affects more than one-third of reproductive-age women worldwide. [...]

Published
2021

2. In Reply

Author

Govindappagari, Shravya, Burwick, Richard, and Gregory, Kimberly D.

Published
2020
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8. Pregnancy-Associated Atypical Hemolytic Uremic Syndrome

Author

Gupta, Megha, Govindappagari, Shravya, and Burwick, Richard M.

Subjects
Complement Inactivating Agents, Plasma Exchange, Pregnancy, Renal Dialysis, Postpartum Period, Pregnancy Complications, Hematologic, Humans, Contents, Female, Systematic Review, Antibodies, Monoclonal, Humanized, Atypical Hemolytic Uremic Syndrome
Abstract

Pregnancy-associated atypical hemolytic uremic syndrome usually presents in the postpartum period, often after a pregnancy complication, and eculizumab is effective for achieving disease remission., OBJECTIVE: To evaluate disease presentation, diagnosis, treatment, and clinical outcomes in pregnancy-associated atypical hemolytic uremic syndrome (aHUS). DATA SOURCES: We searched PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, Web of Science, EMBASE and Google Scholar, from inception until March 2018. METHODS OF STUDY SELECTION: We included English-language articles describing aHUS in pregnancy or postpartum. The diagnosis of aHUS was characterized by hemolysis, thrombocytopenia, and renal failure and was distinguished from typical diarrhea-associated hemolytic uremic syndrome. Patients were excluded if individual data could not be obtained, the diagnosis was unclear, or an alternative etiology was more likely, such as thrombotic thrombocytopenic purpura or Shiga toxin–producing Escherichia coli. Reports were appraised by two reviewers, with disagreements adjudicated by a third reviewer. TABULATION, INTEGRATION, AND RESULTS: The search identified 796 articles. After review of titles, abstracts, and full text, we identified 48 reports describing 60 unique cases of pregnancy-associated aHUS, with 66 pregnancies. Twelve cases involved pregnancy in women with known aHUS, and 54 cases involved first-episode pregnancy-associated aHUS. Women with known aHUS, particularly those with baseline creatinine at or above 1.5 mg/dL, had a high rate of adverse pregnancy outcomes. For first-episode pregnancy-associated aHUS, diagnosis most often occurred postpartum (94%), after a cesarean delivery (70%), in nulliparous women (58%). Preceding obstetric complications were common and included fetal death, preeclampsia, and hemorrhage. Diagnosis was usually made clinically, based on the triad of microangiopathic hemolysis, thrombocytopenia, and renal failure. Additional testing included renal biopsy, complement genetic testing, and ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) testing. Treatment modalities included corticosteroids, plasma exchange, dialysis, and eculizumab. More women with first-episode pregnancy-associated aHUS achieved disease remission when treated with eculizumab, compared with those not treated with eculizumab (88% vs 57%, P=.02). CONCLUSION: Pregnancy-associated aHUS usually presents in the postpartum period, often after a pregnancy complication, and eculizumab is effective for achieving disease remission. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019129266.

Published
2019

23. Postthrombotic Syndrome and Chronic Pulmonary Embolism after Obstetric Venous Thromboembolism.

Author

O'Shaugnessy, Fergal, Govindappagari, Shravya, Huang, Yongmei, Syeda, Sbaa K., D'Alton, Mary E., Wright, Jason D., and Friedman, Alexander M.

Subjects
*CHRONIC disease risk factors, *VEINS, *PULMONARY embolism, *NOSOLOGY, *ANTICOAGULANTS, *PATIENTS, *ACQUISITION of data, *RETROSPECTIVE studies, *RISK assessment, *OBSTETRICS, *VENOUS thrombosis, *THROMBOEMBOLISM, *PREGNANCY complications, *MEDICAL records, *DESCRIPTIVE statistics, *POSTTHROMBOTIC syndrome, *LONGITUDINAL method, *MEDICAL coding, *DISEASE risk factors, *PREGNANCY
Abstract

Objective While the majority of venous thromboembolism (VTE) during pregnancy events resolve with anticoagulation, long-term complications may occur including (1) postthrombotic syndrome and (2) chronic pulmonary embolism. The objective of this study was to determine risk of these two complications. Study Design A retrospective cohort study using the MarketScan databases was performed on deliveries from 2008 to 2014. We identified women aged 15 to 54 years diagnosed with acute VTE during pregnancy, the delivery hospitalization, or ≤60 days postpartum who received at least one prescription postpartum for anticoagulants. Risks of (1) chronic PE and (2) postthrombotic syndrome were evaluated for women at 6, 12, 24, and 60 months after delivery hospitalization through 2017 via the International Classification of Diseases, 9th/10th Revision, Clinical Modification codes. Results Of 4,267 of 4,128,900 pregnancies complicated by VTE, the majority had DVT alone (61.8%, n = 2,637), while 25.8% had PE alone (n = 1,103) and 12.4% (n = 527) had both DVT and PE. Of the entire cohort, 3,328 retained insurance coverage at 6 months, 2,823 at 12 months, 2,161 at 24 months, and 831 at 60 months. Restricted to DVT, risk of postthrombotic syndrome was 0.7% at 6 months (n = 17), 1.1% at 12 months (n = 22), 1.7% at 24 months (n = 26), and 2.7% at 60 months (n = 16). Among women with PE diagnoses, the risk of chronic PE was 2.4% at 6 months (n = 30), 3.3% at 12 months (n = 36), 4.2% at 24 months (n = 36), and 7.2% at 60 months (n = 24). Conclusion In comparison to the general population, the risk of postthrombotic syndrome was lower. In comparison, the risk of chronic PE was similar to the estimates in the general population at comparable time points after PE events. For women with obstetric PE, it may be appropriate to be vigilant for findings and symptoms associated with chronic PE. Key Points Risk of postthrombotic syndrome after obstetric deep vein thrombosis is low. Risk of chronic pulmonary embolism may approximate that in the general population. Overall risk of chronic complications after obstetric VTE was relatively low. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Severe Vitamin B12 Deficiency in Pregnancy Mimicking HELLP Syndrome

Author

Govindappagari, Shravya, Nguyen, Michelle, Gupta, Megha, Hanna, Ramy M., and Burwick, Richard M.

Subjects
Article Subject
Abstract

Severe vitamin B12 deficiency may present with hematologic abnormalities that mimic thrombotic microangiopathy disorders such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We report a patient diagnosed with severe vitamin B12 deficiency, following termination of pregnancy for suspected preeclampsia and HELLP syndrome at 21 weeks’ gestation. When hemolysis and thrombocytopenia persisted after delivery, testing was performed to rule out other etiologies of thrombotic microangiopathy, including atypical hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and vitamin B12 deficiency. This work-up revealed undetectable vitamin B12 levels and presence of intrinsic factor antibodies, consistent with pernicious anemia. Parenteral B12 supplementation was initiated, with subsequent improvement in hematologic parameters. Our case emphasizes the importance of screening for B12 deficiency in pregnancy, especially in at-risk women with unexplained anemia or thrombocytopenia. Moreover, providers should consider B12 deficiency and pernicious anemia in the differential diagnosis of pregnancy-associated thrombotic microangiopathy.

Published
2019
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34. Situs inversus totalis and prenatal diagnosis of a primary ciliary dyskinesia.

Author

Burwick, Richard M., Govindappagari, Shravya, Sanchez‐Lara, Pedro A., and Sanchez-Lara, Pedro A

Abstract

Situs inversus, a condition in which the major visceral organs are reversed from their normal positions in the body, can be detected by prenatal ultrasonography. Often benign, it may be associated with primary ciliary dyskinesia, an autosomal recessive disorder characterized by chronic respiratory disease. Yet, prenatal diagnosis of primary ciliary dyskinesia has not been reported. We describe a pregnancy in which situs inversus was diagnosed by fetal ultrasound at 20 weeks gestation. Prenatal testing for primary ciliary dyskinesia led to the discovery that both parents were asymptomatic carriers of a pathogenic mutation in the CCDC103 gene, with an affected neonate. [ABSTRACT FROM AUTHOR]

Published
2021
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47. Using publicly reported hospital data to predict obstetric quality.

Author

Govindappagari, Shravya, Friedman, Alexander M., Chen, Ling, Ananth, Cande V., D'Alton, Mary E., Hershman, Dawn L., and Wright, Jason D.

Subjects
*PREGNANCY complications, *HOSPITAL admission & discharge, *OBSTETRICS, *HIGH-risk pregnancy, *HOSPITAL administration
Abstract

Purpose: To determine the association between obstetric outcomes and publicly reported hospital data on patient satisfaction, surgical quality measures and medical outcomes. Materials and methods: Hospitals in the Nationwide Inpatient Sample in 2011 were linked to Hospital Compare, a source of hospital data on patient satisfaction, quality and mortality for medical conditions. The risk-adjusted hospital-level rates of obstetric morbidity, episiotomy and lacerations were compared across the hospitals and reported as the absolute reduction in risk (ARR). Results: We identified 528 708 women. There was no association between any of the metrics and risk-adjusted obstetric morbidity (range -0.15% to 0.03% difference). Hospitals with a high mortality rate for pneumonia had a 0.38% (95% CI: 0.13% to 0.64%) higher rate of risk-adjusted third- and fourth-degree lacerations, while hospitals with a higher death rate for myocardial infarction had a -0.74% (95% CI, -1.34% to -0.14%) lower risk-adjusted episiotomy rate. The differences in the remainder of the publicly reported metrics and the risk adjusted rates of third- and fourth-degree lacerations and episiotomy were small and not statistically significant (p>0.05). Conclusion: There is little association between currently available, publically reported hospital data and obstetric quality. Obstetric-specific hospital measures of quality and satisfaction are needed. [ABSTRACT FROM AUTHOR]

Published
2017
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