- Greensboro, North Carolina, United States
Paul Whitecar
Wake Forest University School of Medicine, Ob Gyn, Faculty Member
Objective. This study reports results of the first 22 months of partnership between Womack Army Medical Center (WAMC) and the Carolinas Cord Blood Bank (CCBB) at Duke Medical Center, Durham, North Carolina in cord blood donations for... more
Objective. This study reports results of the first 22 months of partnership between Womack Army Medical Center (WAMC) and the Carolinas Cord Blood Bank (CCBB) at Duke Medical Center, Durham, North Carolina in cord blood donations for public banking. Methods. In 2009, WAMC formalized an agreement with the CCBB to become the first military hospital to serve as a cord blood collection site for public cord blood banking in the United States. Interested pregnant mothers were identified, screened, educated and consented for cord blood donation. Collected cord blood was transported to the CCBB laboratory, processed, tested, cryopreserved and listed on the National Marrow Donor Program’s Be the Match donor registry. Results. From 3 July 2009 to 31 December 2012, 2204 maternal donors were consented and 1502 cord blood units were collected. Of these, 463 were processed, cryopreserved and banked. The median volume of units collected was 67.0 ml. The median cell count of units banked was 1.4x10...
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Research Interests:
Synthetic cannabinoid (spice) and synthetic cocaine (bath salts) are relatively new designer drugs of abuse. To date, there have been few reports in the medical literature documenting their use during pregnancy. A 22 year-old gravid woman... more
Synthetic cannabinoid (spice) and synthetic cocaine (bath salts) are relatively new designer drugs of abuse. To date, there have been few reports in the medical literature documenting their use during pregnancy. A 22 year-old gravid woman at 32 weeks gestation presented with suicidal ideation and agitation that required restraints and admission to the psychiatric ward. The woman had a long history of illicit drug use as well as both spice and bath salt use during early pregnancy. She was briefly admitted to the psychiatric ward and subsequently had an uneventful delivery and postpartum course. Acute spice and bath salt intoxication is frequently encountered in Emergency Departments and providers need to be aware of the serious health threats of these designer drugs to mothers and their fetuses. Central Cabán et al. (2013) Email: cristobal.s.berrycaban.civ@mail.mil J Subst Abuse Alcohol 1(1): 1002 (2013) 2/4 bath salts range from 5-10mg for the more lipophilic MDPV and 100mg-250mg fo...
OBJECTIVE: To determine if deployment of a spouse to a combat zone during pregnancy increases the risk for preterm delivery, obstetrical complications, or postpartum depression. STUDY DESIGN: An anonymous survey was administered to... more
OBJECTIVE: To determine if deployment of a spouse to a combat zone during pregnancy increases the risk for preterm delivery, obstetrical complications, or postpartum depression. STUDY DESIGN: An anonymous survey was administered to patients presenting for routine appointments at the OB/GYN clinics at Womack Army Medical Center, located in Fort Bragg, North Carolina. The survey asked patients to answer questions regarding their first pregnancy. Pregnancy outcomes from women whose spouses were deployed during their first pregnancy (deployed group) were compared to women whose spouses were not deployed during their first pregnancy (non-deployed group). RESULTS: A total of 308 surveys were completed and used for analysis. More than a two-fold increased risk for preterm delivery was detected in the spouse deployed group compared to the non-deployed group (8.9% versus 21.4%). The risk of postpartum depression was more than doubled between the two groups (9.0% vs. 16.4%). No other statisti...
OBJECTIVE Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN... more
OBJECTIVE Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN clerkship improves performance of vaginal deliveries, we assessed the effectiveness of simulation in third-year medical students. METHODS During the OB/GYN clerkship, third-year students were assigned to receive vaginal delivery simulation (n=54) or cervical exam simulation (n=56), with each group serving as a simulation naïve control for the other skill. As a final assessment of their skill, students performed a simulated vaginal delivery scored by a blinded observer using a procedural checklist (score 0-30). A satisfactory score was considered 26 or greater. The individual scores and percentage of satisfactory scores were compared between both groups using a Mann-Whitney U test and chi-square test, respectively. RESULTS Vaginal delivery students h...
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Differential Expression of TcR-CD3 Zeta as Evidence for Altered Immunoregulation in Preeclamptic vs. Normotensive Women Garrett K. Lam, MD, Paul W. Whitecar, MD, Susan Orton, PhD, Kim A. Boggess, MD, Douglas D. Taylor, PhD Objective: To... more
Differential Expression of TcR-CD3 Zeta as Evidence for Altered Immunoregulation in Preeclamptic vs. Normotensive Women Garrett K. Lam, MD, Paul W. Whitecar, MD, Susan Orton, PhD, Kim A. Boggess, MD, Douglas D. Taylor, PhD Objective: To exhibit and quantify the difference in modulation of CD3-zeta protein (an integral component of the T-cell receptor) in preeclamptic and normotensive women. Study Design: Serum was collected from 10 preeclamptic and 10 normotensive women >37 weeks gestation upon admission. Jurkat E-61 cells were incubated with the sera (20% volume to volume) and analyzed via western immunoblot using mouse monoclonal CD3-zeta antibody. Enhanced chemiluminescence and densitometry were used to qualitatively measure zeta expression of the cells. A de novo flow cytometry assay was developed to quantify the difference in CD3 zeta expression of these cells. Comparsions were done by t-test (p <0.05 was significant). Results: Preeclamptic patient sera produced a 2.4-fol...
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Research Interests:
Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN clerkship... more
Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN clerkship improves performance of vaginal deliveries, we assessed the effectiveness of simulation in third-year medical students. During the OB/GYN clerkship, third-year students were assigned to receive vaginal delivery simulation (n=54) or cervical exam simulation (n=56), with each group serving as a simulation naïve control for the other skill. As a final assessment of their skill, students performed a simulated vaginal delivery scored by a blinded observer using a procedural checklist (score 0-30). A satisfactory score was considered 26 or greater. The individual scores and percentage of satisfactory scores were compared between both groups using a Mann-Whitney U test and chi-square test, respectively. Vaginal delivery students had a significantly higher ...
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Research Interests:
The purpose of this study was to evaluate maternal alloimmunization to paternal leukocytes as a treatment for hemolytic disease of the fetus/newborn in a rabbit model. Twelve does and paired red blood cell-incompatible bucks underwent the... more
The purpose of this study was to evaluate maternal alloimmunization to paternal leukocytes as a treatment for hemolytic disease of the fetus/newborn in a rabbit model. Twelve does and paired red blood cell-incompatible bucks underwent the experimental protocol. Fetal hematologic parameters that were obtained by ultrasound-guided intracardiac sampling were compared from unaffected, compatible litters; from affected, incompatible litters (after alloimmunization to red blood cell antigens); and from affected, incompatible litters after alloimmunization to paternal leukocytes. Generalized estimation equations were used for statistical analysis. A probability value of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05 was considered significant. Six of 12 does had at least one affected litter after alloimmunization to paternal leukocytes. After an adjustment for the mating cycle, the fetuses of does that underwent white blood cell immunization exhibited higher hemoglobin and hematocrit levels (beta = 4.6, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001, and beta = 11.6, P =.006, respectively) compared with the fetuses of does that were immunized only to red blood cells. Maternal alloimmunization to paternal leukocytes decreases the severity of hemolytic disease and may play a role in the treatment of severe hemolytic disease of the newborn in humans.
Research Interests: Statistical Analysis, Treatment, Ultrasound, Fathers, Serology, and 15 moreFemale, Animals, Male, Immunization, Animal Model, Study design, Red blood cell, Rabbits, Erythrocytes, Leukocytes, White Blood Cell, Hematocrit, Hemoglobins, Generalized estimating equation, and Paediatrics and reproductive medicine
To estimate whether simulation training improves medical students' cervical examination accuracy. The training paradigm for the labor cervical examination exposes patients to additional examinations, lacks a gold standard, and does... more
To estimate whether simulation training improves medical students' cervical examination accuracy. The training paradigm for the labor cervical examination exposes patients to additional examinations, lacks a gold standard, and does not objectively assess trainee competence. To address these issues and optimize training, we assessed the effectiveness of cervical examination simulation in third-year medical students. During the obstetrics and gynecology clerkship, a cohort study was performed in which third-year students were assigned to receive cervical examination simulation (n=50) or vaginal delivery simulation (n=48), with each group serving as a simulation-naive control for the other skill. As a final assessment, students performed 10 cervical examinations using task trainers. Exact accuracy and accuracy within 1 cm were compared between groups. Cumulative summation analyses were performed on the cervical examination group to assess competence and the average number of repeti...
Research Interests: Program Evaluation, Obstetrics, Educational Measurement, Quality Improvement, Pregnancy, and 11 moreHumans, Female, Undergraduate medical education, Male, Obstetrics Gynecology, Adult, Clinical Competence, Simulation Training, Clinical clerkship, Gynecological Examination, and Paediatrics and reproductive medicine
Although the diagnostic workup and management regimens for many of the common fetal thoracic lesions have been well described, the understanding of pulmonary agenesis is more limited. A better understanding of the published reports of... more
Although the diagnostic workup and management regimens for many of the common fetal thoracic lesions have been well described, the understanding of pulmonary agenesis is more limited. A better understanding of the published reports of this condition is essential to provide proper care for these complicated pregnancies. The aims of this study were to provide a better understanding of the difficulties in the diagnosis and management of fetal thoracic lesions and to consolidate what is known about unilateral pulmonary agenesis. We performed a review of the English medical literature covering the last 20 years (1993-2013) in PubMed, MEDLINE, and MD Consult using search terms pulmonary agenesis, pulmonary aplasia, unilateral pulmonary agenesis, unilateral pulmonary aplasia, lung agenesis, lung aplasia, unilateral lung agenesis, and unilateral lung aplasia. Prenatal diagnosis of pulmonary agenesis and other fetal thoracic lesions can be particularly challenging given that many anomalies h...
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Reproductive outcomes in women after pregnancy complicated by an open maternal-fetal surgery (OMFS) are limited. A review of the medical literature reveals only isolated cases of successful multiple pregnancies, and there are no prior... more
Reproductive outcomes in women after pregnancy complicated by an open maternal-fetal surgery (OMFS) are limited. A review of the medical literature reveals only isolated cases of successful multiple pregnancies, and there are no prior documented cases of successful triplet gestations following OMFS. We report the delivery of a triplet gestation at 34-week gestation in a patient with a history of previous OMFS.
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Uterine rupture of an unscarred uterus is a rare complication in a quadruplet pregnancy. A 30-year-old woman, gravida 4 para 0030, with a quadruplet pregnancy and no previous uterine surgeries presented with moderate vaginal bleeding at... more
Uterine rupture of an unscarred uterus is a rare complication in a quadruplet pregnancy. A 30-year-old woman, gravida 4 para 0030, with a quadruplet pregnancy and no previous uterine surgeries presented with moderate vaginal bleeding at 32 4/7 weeks of gestation. Fetal testing was reassuring, and the cervix showed no signs of preterm labor. A decision was made to proceed with cesarean delivery because of the amount of vaginal bleeding, with surgical findings of uterine rupture superior to the lower uterine segment. High-order gestations may be an independent risk factor for uterine rupture.
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... of Author Reference ofpatients IVIG transfusion fetal deaths neonatal deaths Besalduch et al., 1991 1 1 Yes Yes 0 0 Odendaal et al., 1991 2 9 No No 1 0 Al-Omari, 1989 3 50 No No 10 3 Berlin et al., 1985 4 1 Yes Yes 0 0 Eklund, 1985 5... more
... of Author Reference ofpatients IVIG transfusion fetal deaths neonatal deaths Besalduch et al., 1991 1 1 Yes Yes 0 0 Odendaal et al., 1991 2 9 No No 1 0 Al-Omari, 1989 3 50 No No 10 3 Berlin et al., 1985 4 1 Yes Yes 0 0 Eklund, 1985 5 1 No Yes 0 0 Van&amp;#x27;t Veer-Korthofet al ...
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Methotrexate and misoprostol are frequently used in combination for medical termination of pregnancy. Despite their frequent use, published information about low-dose exposures to these known teratogens is sparse and neonatal follow-up... more
Methotrexate and misoprostol are frequently used in combination for medical termination of pregnancy. Despite their frequent use, published information about low-dose exposures to these known teratogens is sparse and neonatal follow-up data are limited. We present neonatal outcomes in three infants from two different women who had failed medical terminations with methotrexate and misoprostol. A young gravida 1, para 0, presented with intrauterine pregnancy complicated by first-trimester exposure to oral methotrexate and vaginal misoprostol. Ultrasonography determined that the fetus had intrauterine growth restriction and ventriculomegaly. The infant had growth and developmental delays. A young gravida 4, para 3-0-0-3, also presented after first trimester exposure to methotrexate and misoprostol, and was found to have a twin gestation. The infants were noted to have multiple congenital anomalies, growth restriction, and developmental delay. Even single doses of methotrexate and misoprostol used in medical termination of pregnancy can be associated with multiple congenital anomalies.
Research Interests: Risk assessment, Pregnancy, Humans, Female, Obstetrics Gynecology, and 12 moreDevelopmental disabilities, Follow-up studies, Newborn Infant, MISOPROSTOL, Adult, Methotrexate, Risk Assessment, Fetus, Gestational Age, Congenital abnormalities, Pregnancy Outcome, and Paediatrics and reproductive medicine
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The purpose of this study was to evaluate maternal alloimmunization to paternal leukocytes as a treatment for hemolytic disease of the fetus/newborn in a rabbit model. Twelve does and paired red blood cell-incompatible bucks underwent the... more
The purpose of this study was to evaluate maternal alloimmunization to paternal leukocytes as a treatment for hemolytic disease of the fetus/newborn in a rabbit model. Twelve does and paired red blood cell-incompatible bucks underwent the experimental protocol. Fetal hematologic parameters that were obtained by ultrasound-guided intracardiac sampling were compared from unaffected, compatible litters; from affected, incompatible litters (after alloimmunization to red blood cell antigens); and from affected, incompatible litters after alloimmunization to paternal leukocytes. Generalized estimation equations were used for statistical analysis. A probability value of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05 was considered significant. Six of 12 does had at least one affected litter after alloimmunization to paternal leukocytes. After an adjustment for the mating cycle, the fetuses of does that underwent white blood cell immunization exhibited higher hemoglobin and hematocrit levels (beta = 4.6, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001, and beta = 11.6, P =.006, respectively) compared with the fetuses of does that were immunized only to red blood cells. Maternal alloimmunization to paternal leukocytes decreases the severity of hemolytic disease and may play a role in the treatment of severe hemolytic disease of the newborn in humans.
Research Interests: Statistical Analysis, Treatment, Ultrasound, Fathers, Serology, and 15 moreFemale, Animals, Male, Immunization, Animal Model, Study design, Red blood cell, Rabbits, Erythrocytes, Leukocytes, White Blood Cell, Hematocrit, Hemoglobins, Generalized estimating equation, and Paediatrics and reproductive medicine
Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among... more
Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (e.g., had strong intentions to return). We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum RESULTS: Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences (Control: 36% (95% CI: 29-43) vs. 35% (95% CI: 28-43), p=0.81). Among women at low risk of retur...
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Research Interests:
Published reports, case studies, and articles from the English language regarding ultrasonographic detection of fetal anemia in red blood cell alloimmunization were obtained from a MEDLINE search from 1966 to November 1999 using the... more
Published reports, case studies, and articles from the English language regarding ultrasonographic detection of fetal anemia in red blood cell alloimmunization were obtained from a MEDLINE search from 1966 to November 1999 using the keywords Rh disease, hemolytic disease of the newborn, ultrasound, and Doppler flow studies and combinations thereof. All articles were cross-referenced. Ultrasound techniques including early findings associated with immune hydrops fetalis, multiple morphologic ultrasound markers, and Doppler flow studies that have been used to detect fetal anemia are reviewed and critically evaluated. Noninvasive sonographic techniques may reduce the number of invasive procedures that traditionally are used to follow fetuses at risk for anemia and decrease the associated risks from these procedures.
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Research Interests: Obstetrics, Pregnancy, Humans, Smoking Cessation, Toxicity, and 20 moreSmoking, Female, Cognitive Therapy, Young Adult, American, Risk factors, Self Concept, Gynecology, Adult, Adverse Event, Odds ratio, Retrospective Studies, Risk Factors, Nicotine Replacement Therapy, Gestation, Preterm Birth, Logistic Models, Pregnancy Outcome, Premature Birth, and Socioeconomic Factors
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Objective: To investigate TCR-CD3ζ expression by cultured T lymphocytes exposed to midtrimester sera from pregnant women in whom preeclampsia developed at term compared with normotensive pregnant control subjects. Study Design: Sera... more
Objective: To investigate TCR-CD3ζ expression by cultured T lymphocytes exposed to midtrimester sera from pregnant women in whom preeclampsia developed at term compared with normotensive pregnant control subjects. Study Design: Sera obtained at 24 to 28 weeks&#x27; gestation from 16 nulliparous women in whom preeclampsia developed at term and from 32 gestational age-matched control subjects without preeclampsia were evaluated for TCR-CD3ζ chain expression with use of Jurkat cells. Subsets of serum samples from 6 women with preeclampsia and 6 control subjects were then evaluated for their ability to induce apoptosis and to suppress interleukin-2 production. Groups were compared by use of the Kruskal-Wallis test, and P &lt; .05 was considered significant. Results: TCR-CD3ζ chain expression in cultured T lymphocytes was suppressed in approximately 60% of untreated control subjects after incubation with sera from normotensive pregnant women compared with 30% after incubation with sera from women with preeclampsia (P &lt; .001). T-cell apoptosis was significantly higher after incubation with sera from normotensive control subjects, as was the expression of the proapoptotic regulator Bax, compared with sera from women with preeclampsia. Interleukin-2 levels were higher in T cells incubated with sera from women in whom preeclampsia later developed compared with sera from normotensive pregnant women (27.7 ng/mL versus 72.5 ng/mL; P &lt; .001). Conclusions: Nulliparous women in whom preeclampsia developed did not suppress TCR-CD3ζ levels to the extent of normotensive control subjects, which may be linked to decreased lymphocyte apoptosis. This occurs remotely from the manifestation of clinical disease and suggests a deficiency in a serum factor in preeclampsia that may induce T cell ζ chain suppression in normal pregnancy. (Am J Obstet Gynecol 2001;185: 812-18.)
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Research Interests:
Splenic rupture in the newborn is a rare complication in erythroblastosis fetalis. There are no reports of splenic rupture in the fetus affected by hemolytic disease of the newborn. A 41-year-old gravida 3, para 2-0-0-2 with severe rhesus... more
Splenic rupture in the newborn is a rare complication in erythroblastosis fetalis. There are no reports of splenic rupture in the fetus affected by hemolytic disease of the newborn. A 41-year-old gravida 3, para 2-0-0-2 with severe rhesus alloimmunization was managed with serial intrauterine transfusions resulting in fetal death after the fourth procedure. Autopsy findings revealed intra-abdominal clotted blood and splenic capsular defects consistent with splenic rupture. Fetal splenic rupture might occur in hemolytic disease of the newborn associated with splenomegaly. Acute hemodynamic changes with increased intra-abdominal pressure from intrauterine transfusion might precipitate splenic rupture. (Obstet Gynecol 2001;97:824-5.
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Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. Maternal and fetal records of 130 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy... more
Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. Maternal and fetal records of 130 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of cesarean section were reviewed. The chi(2) and Fisher&#39;s exact tests were used for statistical analysis. A P value of &lt;/=.05 was considered significant. The incidence of adnexal masses in pregnant women who required surgical management was 1 in 1312 live births. A malignant tumor or a tumor of low malignant potential was found in 6.1% of cases. In 10 patients the only finding at the time of laparotomy was leiomyomas. Ultrasonography was not helpful in distinguishing tumors of low malignant potential from benign neoplasms or in identifying the source of the pelvic mass in patients found to have only leiomyomas. There were 2 intrauterine fetal deaths and 1 neonatal death in this cohort of patients. Patients who underwent laparotomy after 23 weeks&#39; gestation had a significantly higher adverse pregnancy outcome compared with those who underwent laparotomy earlier in pregnancy (P =.005). The incidence of an adnexal mass during pregnancy in our population was consistent with what has been reported in the literature. However, the percentage of malignant tumors or tumors of low malignant potential was 2-fold greater than previously reported. Preoperative ultrasonography was not helpful in differentiating tumors of low malignant potential from benign neoplasms.