10 results on '"Navathe, R."'
Search Results
2. Induction of labour for suspected macrosomia at term in non‐diabetic women: a systematic review and meta‐analysis of randomized controlled trials
- Author
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Magro‐Malosso, ER, primary, Saccone, G, additional, Chen, M, additional, Navathe, R, additional, Di Tommaso, M, additional, and Berghella, V, additional
- Published
- 2016
- Full Text
- View/download PDF
Catalog
3. Decrease in the incidence of threatened preterm labor after implementation of transvaginal ultrasound cervical length universal screening
- Author
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Amanda Roman, Vincenzo Berghella, Michela Villani, Yury Cruz, Jacquelyn Knapp, Gabriele Saccone, Reshama Navathe, Rupsa C. Boelig, Navathe, R., Saccone, G., Villani, M., Knapp, J., Cruz, Y., Boelig, R., Roman, A., and Berghella, V. more...
- Subjects
Pessary ,Adult ,medicine.medical_specialty ,progesterone ,Asymptomatic ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Obstetric Labor, Premature ,Pregnancy ,medicine ,Humans ,Preterm delivery ,030212 general & internal medicine ,Retrospective Studies ,Philadelphia ,030219 obstetrics & reproductive medicine ,Singleton ,Obstetrics ,business.industry ,Incidence (epidemiology) ,Incidence ,pessary ,cerclage ,preterm birth ,Obstetrics and Gynecology ,Retrospective cohort study ,Triage ,Transvaginal ultrasound ,Cervical Length Measurement ,Pregnancy Trimester, Second ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,medicine.symptom ,business - Abstract
BACKGROUND: It is unknown if universal second-trimester transvaginal ultrasound (TVU) cervical length (CL) screening in asymptomatic women with singleton gestations and no prior spontaneous preterm birth (SPTB) affects the incidence of symptoms of preterm labor (PTL) later in pregnancy. OBJECTIVE: To evaluate the incidence of threatened PTL before and after the implementation of universal second trimester TVU CL screening. STUDY DESIGN: This was a retrospective cohort study of all consecutive singleton gestations without prior SPTB presenting to obstetric triage for threatened PTL between 23 0/7 and 33 6/7 week in 2011 (1 January-31 December), and in 2014 (1 January-31 December) at Thomas Jefferson University Hospital (TJU) (Philadelphia, PA). These 2 years were chosen as a new protocol for universal TVU CL screening was started on 1 January 2012. This protocol involved one measurement of TVU CL in all singleton gestations without a prior SPTB at 18 0/7 - 23 6/7 week, the time of the "anatomy" scan. Women with prior SPTB were excluded from this study. The primary outcome included the incidence of threatened PTL, defined as the number of women with singleton gestations without prior SPTB who presented with threatened PTL to our labor and delivery (L&D) triage unit annually, divided by the total number of annual deliveries of women with singleton gestation without prior SPTB. Secondary outcomes were the incidence of PTL, defined as the number of women with singleton gestations without prior SPTB admitted for PTL annually divided by the total number of annual deliveries of women with singleton gestation and without prior SPTB; and length of stay in the hospital. We aimed to compare primary and secondary outcome in the "2011" versus the "2014" group. RESULTS: In 2011, there were a total of 1745 deliveries at TJU, of which 1550 (88.8%) were singletons without prior SPTB. In 2014, there were a total of 1924 deliveries at TJU, 1751 (91.0%) were singletons without prior SPTB who were offered universal TVU CL screening. One hundred and seventy-two women with singletons without prior SPTB presented in L&D triage unit in 2011; and 118 women with singletons without prior SPTB presented in L&D triage unit in 2014. There were significant decreases in the incidence of threatened PTL from 11.1% (172/1550) in 2011 to 6.7% (118/1751) in 2014 (p more...
- Published
- 2019
4. Induction of labour for suspected macrosomia at term in non-diabetic women: a systematic review and meta-analysis of randomized controlled trials
- Author
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Elena Rita Magro-Malosso, Vincenzo Berghella, M Chen, Gabriele Saccone, Reshama Navathe, M. Di Tommaso, Magro-Malosso, E. R., Saccone, G., Chen, M., Navathe, R., Di Tommaso, M., and Berghella, V.
- Subjects
medicine.medical_specialty ,Term Birth ,Birth weight ,Fetal Macrosomia ,law.invention ,03 medical and health sciences ,Shoulder dystocia ,0302 clinical medicine ,Obstetrics and gynaecology ,Randomized controlled trial ,Pregnancy ,law ,medicine ,Humans ,Labor, Induced ,030212 general & internal medicine ,macrosomia ,Watchful Waiting ,induction ,non-diabetic ,Randomized Controlled Trials as Topic ,expectant management ,Caesarean ,030219 obstetrics & reproductive medicine ,Cesarean Section ,Obstetrics ,business.industry ,Incidence ,Incidence (epidemiology) ,Obstetrics and Gynecology ,medicine.disease ,Confidence interval ,Obstetric Labor Complications ,Relative risk ,Female ,Apgar score ,shoulder dystocia ,business - Abstract
Background Several randomized controlled trials (RCTs) compared induction of labour with expectant management in non-diabetic women with suspected fetal macrosomia. Objective To evaluate the effects of labour induction for suspected fetal macrosomia. Search strategy Literature search in electronic databases. Selection criteria We included all RCTs of suspected fetal macrosomia comparing labour induction with expectant management in term pregnancy. Data collection and analysis The primary outcome was the incidence of caesarean delivery. Main results Four RCTs, including 1190 non-diabetic women with suspected fetal macrosomia at term, were analysed. Pooled data did not show a significant difference in incidence of caesarean delivery [relative risk (RR) 0.91, 95% confidence interval (CI) 0.76–1.09], operative and spontaneous vaginal delivery, shoulder dystocia, intracranial haemorrhage, brachial plexus palsy, Apgar score more...
- Published
- 2017
5. Azithromycin vs erythromycin for the management of preterm premature rupture of membranes.
- Author
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Navathe R, Schoen CN, Heidari P, Bachilova S, Ward A, Tepper J, Visintainer P, Hoffman MK, Smith S, Berghella V, and Roman A
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- Adult, Amoxicillin administration & dosage, Ampicillin administration & dosage, Chorioamnionitis epidemiology, Cohort Studies, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Infant, Newborn, Intensive Care Units, Neonatal, Length of Stay statistics & numerical data, Pregnancy, Respiratory Distress Syndrome, Newborn epidemiology, Retrospective Studies, Anti-Bacterial Agents administration & dosage, Azithromycin administration & dosage, Erythromycin administration & dosage, Fetal Membranes, Premature Rupture drug therapy
- Abstract
Background: Preterm premature rupture of membranes complicates 2-3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile, and decreased cost of azithromycin as compared with erythromycin., Objective: The objective of the study was to evaluate whether there are differences in the latency from preterm premature rupture of membranes to delivery in patients treated with different dosing regimens of azithromycin vs erythromycin., Study Design: This is a multicenter, retrospective cohort of women with singleton pregnancies with confirmed rupture of membranes between 23
0 and 336 weeks from January 2010 to June 2015. Patients were excluded if there was a contraindication to expectant management of preterm premature rupture of membranes. Patients received 1 of 4 antibiotic regimens: (1) azithromycin 1000 mg per os once (azithromycin 1 day group); (2) azithromycin 500 mg per os once, followed by azithromycin 250 mg per os daily for 4 days (azithromycin 5 day group); (3) azithromycin 500 mg intravenously for 2 days, followed by azithromycin 500 mg per os daily for 5 days (azithromycin 7 day group); or (4) erythromycin intravenously for 2 days followed by erythromycin per os for 5 days (erythromycin group). The choice of macrolide was based on institutional policy and/or availability of antibiotics at the time of admission. In addition, all patients received ampicillin intravenously for 2 days followed by amoxicillin per os for 5 days. Primary outcome was latency from diagnosis of rupture of membranes to delivery. Secondary outcomes included clinical and histopathological chorioamnionitis and neonatal outcomes., Results: Four hundred fifty-three patients who met inclusion criteria were identified. Seventy-eight patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. Women who received the 5 day regimen were younger and less likely to be non-African American, have hypertension, have sexually transmitted infection, or experienced substance abuse. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% confidence interval, 3.3-6.4), azithromycin 5 days (5.0, 95% confidence interval, 3.9-6.1), or azithromycin 7 days (4.9 days, 95% confidence interval, 2.8-7.0) when compared with erythromycin (5.1 days, 95% confidence interval, 3.9-6.4) after adjusting for demographic variables (P = .99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome was increased in the azithromycin 5 day group vs azithromycin 1 day vs erythromycin (44% vs. 29% and 29%, P = .005, respectively)., Conclusion: There was no difference in latency to delivery, incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. Azithromycin could be considered as an alternative to erythromycin in the expectant management of preterm premature rupture of membranes if erythromycin is unavailable or contraindicated. There appears to be no additional benefit to an extended course of azithromycin beyond the single-day dosing, but final recommendations on dosing strategies should rely on clinical trials., (Copyright © 2019 Elsevier Inc. All rights reserved.) more...- Published
- 2019
- Full Text
- View/download PDF
6. Decrease in the incidence of threatened preterm labor after implementation of transvaginal ultrasound cervical length universal screening.
- Author
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Navathe R, Saccone G, Villani M, Knapp J, Cruz Y, Boelig R, Roman A, and Berghella V
- Subjects
- Adult, Female, Humans, Incidence, Philadelphia epidemiology, Pregnancy, Pregnancy Trimester, Second, Retrospective Studies, Young Adult, Cervical Length Measurement, Obstetric Labor, Premature epidemiology
- Abstract
Background: It is unknown if universal second-trimester transvaginal ultrasound (TVU) cervical length (CL) screening in asymptomatic women with singleton gestations and no prior spontaneous preterm birth (SPTB) affects the incidence of symptoms of preterm labor (PTL) later in pregnancy., Objective: To evaluate the incidence of threatened PTL before and after the implementation of universal second trimester TVU CL screening., Study Design: This was a retrospective cohort study of all consecutive singleton gestations without prior SPTB presenting to obstetric triage for threatened PTL between 23 0/7 and 33 6/7 week in 2011 (1 January-31 December), and in 2014 (1 January-31 December) at Thomas Jefferson University Hospital (TJU) (Philadelphia, PA). These 2 years were chosen as a new protocol for universal TVU CL screening was started on 1 January 2012. This protocol involved one measurement of TVU CL in all singleton gestations without a prior SPTB at 18 0/7 - 23 6/7 week, the time of the "anatomy" scan. Women with prior SPTB were excluded from this study. The primary outcome included the incidence of threatened PTL, defined as the number of women with singleton gestations without prior SPTB who presented with threatened PTL to our labor and delivery (L&D) triage unit annually, divided by the total number of annual deliveries of women with singleton gestation without prior SPTB. Secondary outcomes were the incidence of PTL, defined as the number of women with singleton gestations without prior SPTB admitted for PTL annually divided by the total number of annual deliveries of women with singleton gestation and without prior SPTB; and length of stay in the hospital. We aimed to compare primary and secondary outcome in the "2011" versus the "2014" group., Results: In 2011, there were a total of 1745 deliveries at TJU, of which 1550 (88.8%) were singletons without prior SPTB. In 2014, there were a total of 1924 deliveries at TJU, 1751 (91.0%) were singletons without prior SPTB who were offered universal TVU CL screening. One hundred and seventy-two women with singletons without prior SPTB presented in L&D triage unit in 2011; and 118 women with singletons without prior SPTB presented in L&D triage unit in 2014. There were significant decreases in the incidence of threatened PTL from 11.1% (172/1550) in 2011 to 6.7% (118/1751) in 2014 (p < .001), as well as in the rate of admission for PTL from 2.3% (35/1550) to 1.4% (24/1751), respectively (p = .04). Length of stay was not significantly different between the two groups., Conclusion: The introduction of a universal TVU CL screening program in women with singleton gestations without a history of SPTB is associated with a reduction in the frequency of threatened PTL and admission for PTL. Key Message The introduction of a second trimester universal transvaginal ultrasound (TVU) cervical length (CL) screening program in women without a history of spontaneous preterm birth (SPTB) is associated with a reduction in the incidence of threatened preterm labor (PTL) and admission for PTL. more...
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- 2019
- Full Text
- View/download PDF
7. A retrospective cohort study of fetal assessment following preterm premature rupture of membranes.
- Author
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Tepper J, Corelli K, Navathe R, Smith S, and Baxter JK
- Subjects
- Adult, Cesarean Section statistics & numerical data, Female, Gestational Age, Humans, Infant, Newborn, Perinatal Mortality, Pregnancy, Pregnancy Outcome epidemiology, Retrospective Studies, Watchful Waiting, Young Adult, Cardiotocography methods, Fetal Membranes, Premature Rupture therapy
- Abstract
Objective: To evaluate maternal and neonatal outcomes following management of preterm premature rupture of membranes (PPROM) by two fetal assessment strategies., Methods: In a retrospective cohort study performed at two hospitals in Philadelphia, Pennsylvania between July 2010 and June 2015, data were reviewed from 180 singleton pregnancies with PPROM at 23
0 -336 weeks of gestation that underwent expectant management. Outcomes were compared between continuous electronic fetal heart monitoring (EFM) with daily biophysical profile (BPP) ("continuous monitoring") and non-stress test (NST) three times per day ("periodic monitoring") using Mann-Whitney U and Fisher exact tests., Results: Overall, 119 (66.1%) pregnancies were assessed by continuous monitoring and 61 (33.9%) by periodic monitoring. There was no difference in frequency of intrauterine death between the continuous monitoring (1, 0.8%) and periodic monitoring (3, 4.9%) groups (OR, 0.16; 95% CI, 0.02-1.61). The continuous monitoring group was more likely to have an interventional (OR, 2.17; 95% CI, 1.06-4.44) or cesarean (OR 3.30, 95% CI 1.70-6.38) delivery., Conclusion: Continuous EFM with daily BPP was associated with higher rates of intervention and cesarean delivery compared with periodic NST, but there was no difference in intrauterine or perinatal mortality., (© 2019 International Federation of Gynecology and Obstetrics.) more...- Published
- 2019
- Full Text
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8. Progesterone as a tocolytic agent for preterm labor: a systematic review.
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Navathe R and Berghella V
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- Administration, Oral, Adrenal Cortex Hormones therapeutic use, Female, Humans, Lung drug effects, Magnesium Sulfate therapeutic use, Pregnancy, Time Factors, Uterus drug effects, Obstetric Labor, Premature drug therapy, Progesterone administration & dosage, Progesterone therapeutic use, Tocolytic Agents therapeutic use
- Abstract
Purpose of Review: Tocolytic agents have been used for over 60 years in the fight against preterm labor, which ultimately can lead to preterm birth. Currently, clinicians can choose from a variety of drug classes to achieve the primary goal of delaying delivery by 48 h, thereby allowing time for administration of corticosteroids for fetal lung maturity, and if appropriate, starting magnesium sulfate for fetal neuroprotection. However, there are currently no known therapies to maintain the tocolytic effect beyond those initial 48 h., Recent Findings: Progesterone, which has been used in the prevention of preterm birth for over 10 years, has long been known to have the effect of uterine quiescence. It was first studied as a tocolytic agent in the 1960s. In the last several years, more studies have been done that suggest a potential use for maintenance tocolysis after the successful arrest of preterm labor. Although the studies are conflicting, the meta-analyses on progesterone show some promise in different outcomes of delayed delivery, reduced incidence of preterm birth, and reduced neonatal morbidity., Summary: Progesterone is currently the most promising agent for maintenance tocolysis. Although further trials are certainly needed, this is an exciting advancement in the realm of tocolysis. more...
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- 2016
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9. Tocolysis for Acute Preterm Labor: Where Have We Been, Where Are We Now, and Where are We Going?
- Author
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Navathe R and Berghella V
- Subjects
- Adrenergic beta-Agonists therapeutic use, Calcium Channel Blockers therapeutic use, Cyclooxygenase Inhibitors therapeutic use, Female, Humans, Infant, Newborn, Magnesium Sulfate therapeutic use, Nitric Oxide Donors therapeutic use, Pregnancy, Receptors, Oxytocin antagonists & inhibitors, Tocolytic Agents therapeutic use, Obstetric Labor, Premature drug therapy, Premature Birth prevention & control, Tocolysis methods, Tocolysis trends
- Abstract
Tocolytics have been used for over 60 years for women with preterm labor, which ultimately can lead to preterm birth (PTB). Diagnosing preterm labor is challenging, but use of objective tests such as transvaginal ultrasound of cervical length assists in the identification of women at the highest risk for PTB. Once preterm labor has been diagnosed, clinicians can choose from a variety of drug classes (cyclooxygenase inhibitors, calcium channel blockers, and betamimetics) to achieve the primary goal of delaying delivery by 48 hours, thereby allowing time for administration of corticosteroids for fetal lung maturity, and if appropriate, starting magnesium sulfate for fetal neuroprotection. Cyclooxygenase inhibitors are the only class of tocolytics proven to decrease PTB < 37 weeks. Knowledge of the safety and effectiveness of these medications is paramount. Several additional agents (e.g., oxytocin receptor antagonists) have significant promise, but further studies are required before these medications can be approved for tocolysis in the United States. As we look into the future of tocolysis, we anticipate that deeper understanding of the complex physiology of preterm labor will allow us to uniquely target different etiologies that lead to the final path resulting in spontaneous preterm delivery., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.) more...
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- 2016
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10. Failed induction of labor.
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Schoen C and Navathe R
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- Adult, Female, Humans, Labor, Induced methods, Observational Studies as Topic, Parity, Pregnancy, Pregnancy Outcome, Randomized Controlled Trials as Topic, Risk Factors, Treatment Failure, Cervix Uteri physiopathology, Cesarean Section statistics & numerical data, Labor, Induced adverse effects
- Abstract
Induction of labor will affect almost a quarter of all pregnancies, but historically there has been no generally accepted definition of failed induction of labor. Only recently have studies analyzed the lengths of latent labor that are associated with successful labor induction ending in a vaginal delivery, and recommendations for uniformity in the diagnosis of failed induction have largely resulted from this data. This review assesses the most recent and inclusive definition for failed induction, risk factors associated with failure, complications, and special populations that may be at risk for a failed induction., (Copyright © 2015 Elsevier Inc. All rights reserved.) more...
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- 2015
- Full Text
- View/download PDF
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