Jaimie Maines - Academia.edu (original) (raw)
Papers by Jaimie Maines
Ultrasound in Obstetrics & Gynecology, 2021
Cervical ectopic pregnancies are a rare but potentially life threatening complication of pregnanc... more Cervical ectopic pregnancies are a rare but potentially life threatening complication of pregnancy. Several different treatment modalities for cervical ectopic pregnancies have been documented in the literature. In this case a 38-year-old gravid 1 para 0 presented with a cervical ectopic pregnancy diagnosed at an outside hospital. Medical management was undertaken with potassium chloride and methotrexate. The patient developed symptomatic vaginal bleeding requiring surgical management via dilation and curettage. Medical management can be attempted for cervi-cal ectopic pregnancies, provided that a physician with the ability to perform surgical intervention is readily available. Additionally, in the case of viable cervical pregnancies, attempted medical management can result in decreased blood loss should surgical intervention be required.
American Journal of Obstetrics and Gynecology
American Journal of Obstetrics and Gynecology, 2021
American Journal of Obstetrics and Gynecology, 2021
Essential updated guidance on FGR workup and timing of delivery; term and preterm PROM management... more Essential updated guidance on FGR workup and timing of delivery; term and preterm PROM management strategies based on gestational age; and approaches to VTE prophylaxis, including for patients with COVID-19 infection
Obstetrics & Gynecology, May 1, 2020
Obstetrics & Gynecology, May 1, 2020
Maternal-Fetal Evidence Based Guidelines
The Journal of Maternal-Fetal & Neonatal Medicine
Journal of Psychosomatic Obstetrics & Gynecology
American Journal of Obstetrics and Gynecology
Among these women, demographic and baseline clinical risk factors were compared in individuals wi... more Among these women, demographic and baseline clinical risk factors were compared in individuals with and without IE and unconditional logistic regression was used to estimate the effect of risk factors on associated maternal mortality. RESULTS: There were 475 cases of IE among 13,219,726 deliveries from 1999-2014 in the United States (3.6 per 100,000 deliveries). As compared to women with no IE, women with IE in pregnancy tended to be older (35+), Caucasian, and reported income within the lowest quartile. Women with IE were more commonly found to have a history of prior valvular disease, congestive heart failure (CHF), rheumatic heart disease and drug abuse as compared to women with no IE. Staphylococcus species was the most commonly implicated organism, accounting for 68.6% of total cases. In women with IE in pregnancy, 11.5% underwent valve replacement surgery. Mortality with IE was 5.3% compared to .003% in all other pregnant women (p< .0001). In adjusted analyses, acute renal failure (OR 3.3, 95% CI 1.2-9.5 p¼.02), acute myocardial infarction (MI) (OR 15.4, 95% CI 2.1-111.9 p¼.007) and sepsis (OR 4.7, 95% CI 1.9-11.6 p< .001) were all associated with a significantly increased risk of death. CONCLUSION: IE in pregnancy is rare but it is associated with an increased risk of maternal morbidity and mortality. Pregnancies with suspected IE should be transferred to centers capable of providing cardiac surgery and intensive care.
American Journal of Obstetrics and Gynecology
progression. We tested the hypothesis that women with cHTN are more likely to have a longer first... more progression. We tested the hypothesis that women with cHTN are more likely to have a longer first stage of labor. STUDY DESIGN: This was a retrospective cohort study of all women with singleton term pregnancies that reached 10 cm cervical dilation at a tertiary care center from 2004 to 2014. Labor curves were compared between patients with and without cHTN and was then stratified by labor type (induction vs spontaneous) and by need for anti-hypertensive agent during pregnancy. T-tests & Mann Whitney U tests were used for continuous variables and chi-square/Fisher's exact tests for categorical variables. Interval-censored regression was used to estimate median times for cervical change. RESULTS: Of the 21,841 patients with term pregnancies that reached 10 cm cervical dilation, 746 (3.4%) had cHTN. Compared to those without cHTN, patients with cHTN were more likely to be 35 or older, obese, African-American, diabetic, have a prior cesarean, undergo induction, and receive oxytocin augmentation. Patients with cHTN were less likely to nulliparous. cHTN patients were more likely to have a longer first stage of labor with a longer time to dilate from 4 to 10 cm (adjusted median 5.86 vs 4.67 hours, p< .01), even after adjusting for confounders. After stratifying by antihypertensive use, there was no difference in labor progression between patients with and without antihypertensive use. CONCLUSION: Women with cHTN had longer first stages of labor than women without cHTN, even after adjusting for relevant confounders and accounting for induction of labor. As the number of pregnant women with cHTN increases, understanding the natural history of labor in this population is essential to the modern practice of obstetrics.
American Journal of Obstetrics and Gynecology
comorbidities. Spearman rank correlation was used to evaluate correlations between continuous var... more comorbidities. Spearman rank correlation was used to evaluate correlations between continuous variables. RESULTS: 105 ultrasounds from 49 women were included. Mean maternal age was 34.5 years (19-51) with a mean gestational age of 35.1 weeks (12-41). 17% of the women had underlying hypertensive disease and 16.6% had a fetus with growth restriction. Maternal age correlated with time-averaged maximum velocity (r¼-0.6, p<0.05), as well as the mean aortic valve (AV) peak gradient (r¼-0.7, p<0.05). When comparing the group with hypertensive disease to all others, the systemic vascular resistance index (SVRI) is significantly higher (1324 vs 1149 dyn d s/cm 5 ,p¼0.03). However, stroke volume index (SVI) and cardiac index (CI) were not different. When comparing group with growth restriction to the rest there was no significant difference in CI, SVI nor SVRI versus controls. CONCLUSION: Maternal hemodynamic profiles are obtained through the descending aorta. The SVRI is significantly elevated with hypertensive disease. However, there was no evidence of decreased systemic perfusion. Components of the descending aorta cardiac profile may allow identification of the pregnancy at risk for adverse outcome prior to manifesting traditional markers of severe disease.
Case Reports in Obstetrics and Gynecology
Umbilical cord ulceration has been associated with congenital upper intestinal (duodenal or jejun... more Umbilical cord ulceration has been associated with congenital upper intestinal (duodenal or jejunal) atresia and can lead to fatal fetal intrauterine hemorrhage. We report a case of spontaneous hemorrhage from the umbilical cord, incidentally noted at the time of ultrasound in a 33-week fetus with suspected duodenal atresia, in which immediate delivery resulted in a good outcome. Despite many reports in the literature of congenital upper intestinal atresia and its association with umbilical cord ulceration, the propensity for this lesion for fetal hemorrhage, and the resulting perinatal morbidity and mortality, there appears to be a gap in the dissemination of this knowledge. In fetuses with suspected congenital upper intestinal atresia, recognition of the entity of umbilical cord ulceration may be improved by ultrasound with special attention to the amount of Wharton’s jelly within the cord. Routine antepartum fetal surveillance may reduce perinatal morbidity and mortality from thi...
Proceedings in Obstetrics and Gynecology
Malignant transformation of a mature cystic teratoma is extremely rare, occurring in 0.17-2% of c... more Malignant transformation of a mature cystic teratoma is extremely rare, occurring in 0.17-2% of cases.
Ultrasound in Obstetrics & Gynecology, 2021
Cervical ectopic pregnancies are a rare but potentially life threatening complication of pregnanc... more Cervical ectopic pregnancies are a rare but potentially life threatening complication of pregnancy. Several different treatment modalities for cervical ectopic pregnancies have been documented in the literature. In this case a 38-year-old gravid 1 para 0 presented with a cervical ectopic pregnancy diagnosed at an outside hospital. Medical management was undertaken with potassium chloride and methotrexate. The patient developed symptomatic vaginal bleeding requiring surgical management via dilation and curettage. Medical management can be attempted for cervi-cal ectopic pregnancies, provided that a physician with the ability to perform surgical intervention is readily available. Additionally, in the case of viable cervical pregnancies, attempted medical management can result in decreased blood loss should surgical intervention be required.
American Journal of Obstetrics and Gynecology
American Journal of Obstetrics and Gynecology, 2021
American Journal of Obstetrics and Gynecology, 2021
Essential updated guidance on FGR workup and timing of delivery; term and preterm PROM management... more Essential updated guidance on FGR workup and timing of delivery; term and preterm PROM management strategies based on gestational age; and approaches to VTE prophylaxis, including for patients with COVID-19 infection
Obstetrics & Gynecology, May 1, 2020
Obstetrics & Gynecology, May 1, 2020
Maternal-Fetal Evidence Based Guidelines
The Journal of Maternal-Fetal & Neonatal Medicine
Journal of Psychosomatic Obstetrics & Gynecology
American Journal of Obstetrics and Gynecology
Among these women, demographic and baseline clinical risk factors were compared in individuals wi... more Among these women, demographic and baseline clinical risk factors were compared in individuals with and without IE and unconditional logistic regression was used to estimate the effect of risk factors on associated maternal mortality. RESULTS: There were 475 cases of IE among 13,219,726 deliveries from 1999-2014 in the United States (3.6 per 100,000 deliveries). As compared to women with no IE, women with IE in pregnancy tended to be older (35+), Caucasian, and reported income within the lowest quartile. Women with IE were more commonly found to have a history of prior valvular disease, congestive heart failure (CHF), rheumatic heart disease and drug abuse as compared to women with no IE. Staphylococcus species was the most commonly implicated organism, accounting for 68.6% of total cases. In women with IE in pregnancy, 11.5% underwent valve replacement surgery. Mortality with IE was 5.3% compared to .003% in all other pregnant women (p< .0001). In adjusted analyses, acute renal failure (OR 3.3, 95% CI 1.2-9.5 p¼.02), acute myocardial infarction (MI) (OR 15.4, 95% CI 2.1-111.9 p¼.007) and sepsis (OR 4.7, 95% CI 1.9-11.6 p< .001) were all associated with a significantly increased risk of death. CONCLUSION: IE in pregnancy is rare but it is associated with an increased risk of maternal morbidity and mortality. Pregnancies with suspected IE should be transferred to centers capable of providing cardiac surgery and intensive care.
American Journal of Obstetrics and Gynecology
progression. We tested the hypothesis that women with cHTN are more likely to have a longer first... more progression. We tested the hypothesis that women with cHTN are more likely to have a longer first stage of labor. STUDY DESIGN: This was a retrospective cohort study of all women with singleton term pregnancies that reached 10 cm cervical dilation at a tertiary care center from 2004 to 2014. Labor curves were compared between patients with and without cHTN and was then stratified by labor type (induction vs spontaneous) and by need for anti-hypertensive agent during pregnancy. T-tests & Mann Whitney U tests were used for continuous variables and chi-square/Fisher's exact tests for categorical variables. Interval-censored regression was used to estimate median times for cervical change. RESULTS: Of the 21,841 patients with term pregnancies that reached 10 cm cervical dilation, 746 (3.4%) had cHTN. Compared to those without cHTN, patients with cHTN were more likely to be 35 or older, obese, African-American, diabetic, have a prior cesarean, undergo induction, and receive oxytocin augmentation. Patients with cHTN were less likely to nulliparous. cHTN patients were more likely to have a longer first stage of labor with a longer time to dilate from 4 to 10 cm (adjusted median 5.86 vs 4.67 hours, p< .01), even after adjusting for confounders. After stratifying by antihypertensive use, there was no difference in labor progression between patients with and without antihypertensive use. CONCLUSION: Women with cHTN had longer first stages of labor than women without cHTN, even after adjusting for relevant confounders and accounting for induction of labor. As the number of pregnant women with cHTN increases, understanding the natural history of labor in this population is essential to the modern practice of obstetrics.
American Journal of Obstetrics and Gynecology
comorbidities. Spearman rank correlation was used to evaluate correlations between continuous var... more comorbidities. Spearman rank correlation was used to evaluate correlations between continuous variables. RESULTS: 105 ultrasounds from 49 women were included. Mean maternal age was 34.5 years (19-51) with a mean gestational age of 35.1 weeks (12-41). 17% of the women had underlying hypertensive disease and 16.6% had a fetus with growth restriction. Maternal age correlated with time-averaged maximum velocity (r¼-0.6, p<0.05), as well as the mean aortic valve (AV) peak gradient (r¼-0.7, p<0.05). When comparing the group with hypertensive disease to all others, the systemic vascular resistance index (SVRI) is significantly higher (1324 vs 1149 dyn d s/cm 5 ,p¼0.03). However, stroke volume index (SVI) and cardiac index (CI) were not different. When comparing group with growth restriction to the rest there was no significant difference in CI, SVI nor SVRI versus controls. CONCLUSION: Maternal hemodynamic profiles are obtained through the descending aorta. The SVRI is significantly elevated with hypertensive disease. However, there was no evidence of decreased systemic perfusion. Components of the descending aorta cardiac profile may allow identification of the pregnancy at risk for adverse outcome prior to manifesting traditional markers of severe disease.
Case Reports in Obstetrics and Gynecology
Umbilical cord ulceration has been associated with congenital upper intestinal (duodenal or jejun... more Umbilical cord ulceration has been associated with congenital upper intestinal (duodenal or jejunal) atresia and can lead to fatal fetal intrauterine hemorrhage. We report a case of spontaneous hemorrhage from the umbilical cord, incidentally noted at the time of ultrasound in a 33-week fetus with suspected duodenal atresia, in which immediate delivery resulted in a good outcome. Despite many reports in the literature of congenital upper intestinal atresia and its association with umbilical cord ulceration, the propensity for this lesion for fetal hemorrhage, and the resulting perinatal morbidity and mortality, there appears to be a gap in the dissemination of this knowledge. In fetuses with suspected congenital upper intestinal atresia, recognition of the entity of umbilical cord ulceration may be improved by ultrasound with special attention to the amount of Wharton’s jelly within the cord. Routine antepartum fetal surveillance may reduce perinatal morbidity and mortality from thi...
Proceedings in Obstetrics and Gynecology
Malignant transformation of a mature cystic teratoma is extremely rare, occurring in 0.17-2% of c... more Malignant transformation of a mature cystic teratoma is extremely rare, occurring in 0.17-2% of cases.