Joseph G Ouzounian

BACKGROUND: Although an infrequent occurrence, the placenta can adhere abnormally to the gravid uterus leading to significantly high maternal morbidity and mortality during cesarean delivery. Contemporary national statistics related to a morbidly adherent placenta, referred to as placenta accreta spectrum, are needed.

OBJECTIVE: This study aimed to examine national trends, characteristics, and perioperative outcomes of women who underwent cesarean delivery for placenta accreta spectrum ...

OBJECTIVE: Our purpose was to evaluate the predictive value of the baseline systemic vascular resistance index for the development of maternal hypotension during regional anesthesia for cesarean delivery.

STUDY DESIGN: Patients receiving a standardized spinal or epidural anesthetic for nonemergency cesarean delivery were studied prospectively. Hemodynamic data were obtained noninvasively with an NCCOM-3 cardiac output monitor (Bomed Medical Manufacturing, Irvine, Calif.), which uses ...

OBJECTIVE: Much of our understanding and knowledge of shoulder dystocia has been blurred by inconsistent and scientific studies that are of limited scientific quality. In an evidence-based format, we sought to answer the following questions: (1) Is shoulder dystocia predictable? (2) Can shoulder dystocia be prevented? (3) When shoulder dystocia does occur, what maneuvers should be performed? and (4) What are the sequelae of shoulder dystocia?

STUDY DESIGN: Electronic databases, including ...

Objective:To determine whether women with gestational diabetes mellitus (GDM) whose weight gain exceeded the 2009 Institute of Medicine (IOM) recommendations were more likely to have macrosomia.Study Design:Retrospective cohort study of the association of weight gain in women with Class A1 GDM, with term (⩾37 weeks) singleton liveborns and macrosomia (birthweight ⩾4000 g). Multivariate logistic regression models were used to adjust for covariates and test for interactions.Result:Of 1502 ...

OBJECTIVE: We sought to determine the fetal injury rate associated with shoulder dystocia and to determine whether there is a higher rate of brachial plexus injury or bone fracture when fetal manipulation techniques are required for delivery.

STUDY DESIGN: A retrospective review of 285 cases of shoulder dystocia that occurred between January 1991 and December 1995 was performed. The type, sequence, and combination of obstetric maneuvers used to relieve the shoulder dystocia were noted. ...

OBJECTIVE: Our purpose was to determine the rate of success of the McRoberts' maneuver as the initial treatment for shoulder dystocia and to compare the rate of maternal and neonatal morbidity with those cases of shoulder dystocia requiring additional obstetric maneuvers. A secondary goal was to assess those factors associated with successful McRoberts' maneuvers.

STUDY DESIGN: A retrospective review of shoulder dystocia cases occurring between 1991 and 1994 was performed. The identified ...

OBJECTIVE: We tested the hypothesis that women with gestational diabetes mellitus (GDM) and their fetuses would demonstrate alterations in markers of endothelial nitric oxide synthase (eNOS) uncoupling, oxidative stress, and endothelial dysfunction and these changes would correlate with the levels of hyperglycemia through a pilot observational case-control study of women with GDM and their fetuses.

METHODS: Levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular ...

OBJECTIVE: Acute fatty liver of pregnancy has been associated with a syndrome of marked depression of antithrombin III and disseminated intravascular coagulation. We sought to identify the clinical importance of this accelerated coagulation.

STUDY DESIGN: The medical records of patients with acute fatty liver of pregnancy identified during the period of 1982 to 1994 were retrospectively reviewed.

RESULTS: Twenty-eight patients with acute fatty liver of pregnancy were identified for an ...

OBJECTIVE: Our purpose was to compare the accuracy of ultrasonographic fetal weight estimation in pregnant diabetic women with that of matched nondiabetic controls.

STUDY DESIGN: We performed a case-control study of pregnant patients who underwent ultrasonographic fetal weight estimation within 3 days of delivery. The study group consisted of pregnant diabetic women and nondiabetic controls matched for maternal body mass index and neonatal birth weight. Fetal weight estimates were ...

OBJECTIVE: Accurate diagnosis of acute appendicitis in pregnancy by clinical evaluation is difficult. A safe, reliable test was sought to decrease a delay in diagnosis and to avoid unnecessary invasive procedures. A helical or spiral computed tomographic technique has proven to be a very accurate test in the nonobstetric population for the identification of acute appendicitis. We report its use in pregnant patients with suspected acute appendicitis.

STUDY DESIGN: All pregnant patients ...

Thoracic electrical bioimpedance is a noninvasive, continuous method of obtaining cardiac output that requires no operator skill. However, the most recent thoracic electrical bioimpedance technology has not been validated in pregnancy. We therefore compared two methods of measuring cardiac output in pregnancy, thoracic electrical bioimpedance and thermodilution. We studied 11 patients who required pulmonary artery catheterization for peripartum management and measured cardiac output ...

We assessed the rate of uterine rupture in patients undergoing labor induction for attempted vaginal birth after cesarean (VBAC). A retrospective study was performed of data from a computerized database. Deliveries from January 1, 1998, to June 30, 2001, in the Southern California Kaiser Permanente system were reviewed and various perinatal characteristics analyzed. A total of 16,218 patients had a prior low transverse cesarean section. Of these, 6832 (42.1%) had a trial of labor. ...

OBJECTIVE: Our goal was to compare the pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy managed expectantly with antepartum testing with those of other patients who were followed up with a similar testing scheme.

STUDY DESIGN: Cases of intrahepatic cholestasis of pregnancy monitored with antepartum testing at our institution over a 7-year period were reviewed. Their pregnancy outcomes were compared with those of control patients followed up with the same testing ...

OBJECTIVE: To identify perioperative risk factors for preterm delivery (PTD) in laser-treated patients with twin-twin transfusion syndrome (TTTS).

STUDY DESIGN: Twin-twin transfusion syndrome patients who underwent laser surgery were followed prospectively. Univariate and multivariate analyses were performed to identify gestational and surgical characteristics associated with preterm delivery.

RESULTS: Of 318 eligible patients, the mean (SD) gestational age of delivery was 32.8 (4.2) ...

OBJECTIVE: Our purpose was to evaluate the clinical significance of intestinal dilatation detected by prenatal ultrasonographic examination in fetuses with gastroschisis.

STUDY DESIGN: A retrospective chart review was performed of all patients cared for at Los Angeles County/University of Southern California Women's and Children's Hospital with the prenatal diagnosis of gastroschisis over a 7-year period (1988 through 1995). Patients were divided into two groups on the basis of the ...