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Binsted ACS, Nehme L, Abuhamad AZ, Kawakita T. Outcomes of Ultrasound or Physical Examination-Indicated Cerclage according to the Degree of Cervical Dilation. Am J Perinatol 2024; 41:684-689. [PMID: 37923387 DOI: 10.1055/a-2203-3696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Pregnancy outcomes of individuals receiving cervical cerclage when the cervix is dilated are not well known. We sought to examine preterm birth rates after ultrasound or physical examination-indicated cerclage placement according to the degree of cervical dilation. STUDY DESIGN This was a retrospective cohort study of individuals with singleton pregnancies undergoing ultrasound or physical examination-indicated cerclage before 240/7 weeks of gestation from 2004 to 2018. Individuals were categorized based on the degree of cervical dilation at the time of cerclage. Our primary outcome was preterm delivery at less than 37 weeks of gestation. Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95th confidence intervals (95% CI), controlling for predefined covariates. RESULTS Of 147 individuals undergoing ultrasound or physical examination-indicated cerclage, 90/147 (61%) had a closed or 0.5 cm dilated cervix at the time of cerclage placement, 45/147 (31%) had a cervical dilation of 1 to 2.5 cm, and 12/147 (8%) had a cervical dilation of 3 to 4 cm at the time of placement. Individuals with a cervical dilation of 1 to 2.5 cm compared with those who had a closed cervix did not have increased odds of preterm delivery (58 vs. 42%; aOR: 1.95; 95% CI: 0.93-4.07). However, individuals with a cervical dilation of 3 to 4 cm compared with individuals who had a closed cervix had significantly increased odds of preterm delivery (75 vs. 42%; aOR: 4.33; 95% CI: 1.05-17.77). CONCLUSION The rate of preterm birth increases with increasing cervical dilation at the time of cerclage placement. However, individuals who have a cerclage placed when the cervix is 1 to 2.5 cm can achieve an outcome that is not significantly different from those who had a cerclage placed when the cervix is closed. KEY POINTS · Time from cerclage placement to delivery decreases as cervical dilation increases.. · Individuals 1 to 2.5 cm dilated at the time of cerclage can achieve a favorable outcome.. · A cervical dilation of ≥3 cm at cerclage placement was associated with extreme prematurity..
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Affiliation(s)
| | - Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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Hessami K, Horgan R, Munoz JL, Norooznezhad AH, Nassr AA, Fox KA, Di Mascio D, Caldwell M, Catania V, D'Antonio F, Abuhamad AZ. Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2024. [PMID: 38324675 DOI: 10.1002/uog.27606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND This study aimed to assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second and third trimester ultrasound in pregnancies at risk for PAS. METHODS PubMed, Embase, and Web of Science, databases were searched to identify relevant studies published from inception until March 10th, 2023. Inclusion criteria were all studies, including cohort, case-control, or cross-sectional studies, that evaluated the diagnostic accuracy of first trimester ultrasound performed prior to 14 weeks (first trimester) or after 14 weeks of gestation (second/third trimester) for diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was to assess the diagnostic accuracy of ultrasound in detecting PAS in the first trimester, and to compare it with the accuracy of ultrasound in the second and third trimesters. The secondary outcome was to evaluate the diagnostic accuracy of each ultrasonographic marker individually across the trimesters of pregnancy. Reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios. RESULTS A total of 37 studies including 5,764 pregnancies at risk of PAS, with 1,348 cases of confirmed PAS, were included in our analysis. The meta-analysis yielded a sensitivity of 86% (95% CI: 78%, 92%) and specificity of 63% (95% CI: 55%, 70%) during the 1st trimester, while the sensitivity was 88% (95% CI: 84%, 91%) and specificity was 92% (95% CI: 85%, 96%) during the 2nd/3rd trimester. Regarding ultrasonographic markers examined in the 1st trimester, lower uterine hypervascularity exhibited the highest sensitivity of 97% (95% CI: 19%, 100%), and uterovesical interface irregularity demonstrated the highest specificity of 99% (95% CI: 96%, 100%). However, in the 2nd/3rd trimester, loss of clear zone had the highest sensitivity of 80% (95% CI: 72%, 86%), while uterovesical interface irregularity exhibited the highest specificity of 99% (95% CI: 97%, 100%). CONCLUSION First trimester ultrasound has similar accuracy to second and third trimester ultrasound for the diagnosis of PAS. Routine first trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- K Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - R Horgan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J L Munoz
- Division of Fetal Therapy and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - A H Norooznezhad
- Medical Biology Research Centre, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - A A Nassr
- Division of Fetal Therapy and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - K A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - M Caldwell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - V Catania
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - F D'Antonio
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - A Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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Khandelwal M, Shipp TD, Zelop CM, Abuhamad AZ, Afshar Y, Einerson BD, Fox KA, Huisman TAGM, Lyell DJ, Perni U, Platt LD, Shainker SA. Imaging the Uterus in Placenta Accreta Spectrum Disorder. Am J Perinatol 2023; 40:1013-1025. [PMID: 37336220 DOI: 10.1055/s-0043-1761914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Antenatal diagnosis of placenta accreta spectrum (PAS) improves maternal and neonatal outcomes by allowing for multidisciplinary planning and preparedness. Ultrasound is the primary imaging tool. Simplification and standardization of placental evaluation and reporting terminology allows improved communication and understanding between teams. Prior to 10 weeks of gestation, gestational sac position and least myometrial thickness surrounding the gestational sac help PAS diagnosis very early in pregnancy. Late first-, second-, and third-trimester evaluation includes comprehensive evaluation of the placenta, transabdominal and transvaginal with partially full maternal urinary bladder, and by color Doppler. Subsequently, the sonologist should indicate whether the evaluation was optimal or suboptimal; the level of suspicion as low, moderate, or high; and the extent as focal, global, or extending beyond the uterus. Other complementary imaging modalities such as 3D-power Doppler ultrasound, magnetic resonance imaging (MRI), and vascular topography mapping strive to improve antenatal placental evaluation but remain investigational at present. KEY POINTS: · Antenatal imaging, primarily using ultrasound with partially full maternal urinary bladder, is an essential means of evaluation of those at risk for PAS.. · Simplification and standardization of placental evaluation and reporting will allow improved communication between the multidisciplinary teams.. · Gestational sac location prior to 10 weeks of gestation and four markers after that (placental lacunae and echostructure, myometrial thinning, hypoechoic zone with or without bulging between placenta and myometrium, and increased flow on color Doppler)..
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Affiliation(s)
- Meena Khandelwal
- Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Thomas D Shipp
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carolyn M Zelop
- Department of Obstetrics and Gynecology, Valley Medical Group, Paramus, New Jersey and Clinical Professor of Obstetrics and Gynecology, Ne NYU Grossman School of Medicine, New York
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Brett D Einerson
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Thierry A G M Huisman
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houstan, Texas
| | - Deirdre J Lyell
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
| | - Uma Perni
- Subspecialty Care for Women's Health, Cleveland Clinic, Beachwood, Ohio
| | - Lawrence D Platt
- Center for Fetal Medicine & Women's Ultrasound and the David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Seagraves E, Baraki D, Donaldson T, Barake C, Brush J, Abuhamad AZ, Kawakita T. Concentric cardiac remodeling and hypertrophy in pregnant individuals with chronic hypertension. Am J Perinatol 2023. [PMID: 37216976 DOI: 10.1055/a-2096-5114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate rates of superimposed preeclampsia in pregnant individuals with echocardiography-diagnosed cardiac geometric changes in the setting of chronic hypertension. STUDY DESIGN This was a retrospective study of pregnant individuals with chronic hypertension who delivered singleton pregnancies at 20 weeks' gestation or greater at a tertiary care center. Analyses were limited to individuals who had an echocardiogram during any trimester. Cardiac changes were categorized as normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy according to the American Society of Echocardiography guidelines. Our primary outcome was early-onset superimposed preeclampsia defined as delivery at less than 34 weeks' gestation. Other secondary outcomes were also examined. Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated, controlling for pre-specified covariates. RESULTS Of the 168 individuals who delivered from 2010 to 2020, 57 (33.9%) had normal morphology, 54 (32.1%) had concentric remodeling, 9 (5.4%) had eccentric hypertrophy, and 48 (28.6%) had concentric hypertrophy. Non-Hispanic black individuals presented over 76% of the cohort. Rates of the primary outcome in individuals with normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were 15.8%, 37.0%, 22.2%, and 41.7%, respectively (P =0.01). Compared to individuals with normal morphology, individuals with concentric remodeling were more likely to have the primary outcome (aOR 3.28; 95%CI 1.28-8.39), fetal growth restriction (crude OR 2.98; 95%CI 1.05-8.43), and iatrogenic preterm delivery <34 weeks' gestation (aOR 2.72; 95%CI 1.15-6.40). Compared to individuals with normal morphology, individuals with concentric hypertrophy were more likely to have the primary outcome (aOR 4.16; 95%CI 1.57-10.97), superimposed preeclampsia with severe features at any gestational age (aOR 4.75; 95%CI 1.94-11.62), iatrogenic preterm delivery < 34 weeks' gestation (aOR 3.60; 95%CI 1.47-8.81), and neonatal intensive care unit admission (aOR 4.82; 95%CI 1.90-12.21). CONCLUSION Concentric remodeling and concentric hypertrophy were associated with increased odds of early-onset superimposed preeclampsia.
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Affiliation(s)
| | | | | | - Carole Barake
- The University of Texas Medical Branch at Galveston, Galveston, United States
| | - John Brush
- Sentara Norfolk General Hospital, Norfolk, United States
| | | | - Tetsuya Kawakita
- Tetsuya Kawakita, Eastern Virginia Medical School, Norfolk, United States
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Onishi K, Seagraves E, Baraki D, Donaldson T, Barake C, Abuhamad AZ, Huang J, Kawakita T. Risk factors for early- and late-onset superimposed preeclampsia. Am J Perinatol 2023. [PMID: 37211009 DOI: 10.1055/a-2096-5052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Objective Risk factors of early- and late-onset preeclampsia among pregnant individuals with chronic hypertension are not well described in the literature. We hypothesized that early- and late-onset superimposed preeclampsia (SIPE) have different risk factors. Therefore, we aimed to examine the risk factors of early- and late-onset SIPE among individuals with chronic hypertension. Study Design This was a retrospective case-control study of pregnant individuals with chronic hypertension who delivered at 22 weeks' gestation or greater at an academic institution. Early-onset SIPE was defined as SIPE diagnosed before 34 weeks' gestation. To identify risk factors, we first compared individuals' characteristics between individuals who developed early- and late-onset SIPE and those who did not. We then compared characteristics between individuals who developed early-onset SIPE and late-onset SIPE. Characteristics with p-values of less than 0.05 by bivariable variables were analyzed by simple and multivariable logistic regression models to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Missing values were imputed with multiple imputation. Results Of 839 individuals, 156 (18.6%) had early-onset, 154 (18.4%) had late-onset SIPE, and 529 (63.1%) did not have SIPE. The multivariate logistic regression model showed serum creatinine ≥ 0.7 mg/dL compared to less than 0.7 mg/dL (aOR: 2.89 [95% CI: 1.63-5.13]), increase of creatinine (1.33 [1.16-1.53]), nulliparity compared to multiparity (1.77 [1.21-2.60]), and pregestational diabetes (1.70 [1.11-2.62]) were risk factors for early-onset SIPE. The multivariate logistic regression model showed nulliparity compared to multiparity (1.53 [1.05-2.22]) and pregestational diabetes (1.74 [1.14-2.64]) was a risk factor for late-onset SIPE. Serum creatinine ≥ 0.7 mg/dL (2.90 [1.36-6.15]) and increase of creatinine (1.33 [1.10-1.60]) were significantly associated with early-onset SIPE compared to late-onset SIPE. Conclusion Kidney dysfunction seemed to be associated with the pathophysiology of early-onset SIPE. Nulliparity and PDM were common risk factors for both early- and late-onset SIPE.
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Affiliation(s)
- Kazuma Onishi
- Department of Obstetrics and Gynecology, Eastern Virginia Medical College, Norfolk, United States
| | | | - Dana Baraki
- Cleveland Clinic Foundation, Cleveland, United States
| | | | - Carole Barake
- The University of Texas Medical Branch at Galveston, Galveston, United States
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, United States
| | - Jim Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, United States
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Barake C, Seagraves E, Huang J, Baraki D, Donaldson T, Abuhamad AZ, Kawakita T. Effect of calcium channel blocker on labor curve in pregnant individuals with chronic hypertension. Am J Perinatol 2023. [PMID: 37207673 DOI: 10.1055/a-2096-2338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To compare the labor progress between individuals who received calcium channel blocker (CCB) and those who did not receive CCB during labor. METHODS This was a secondary analysis of a retrospective cohort study of individuals with chronic hypertension who underwent vaginal delivery at a tertiary care center from January 2010 to December 2020. We excluded individuals with prior uterine surgeries, and a 5-minute Apgar score of less than 5. We used a repeated-measures regression with a 3rd order polynomial function to compare the average labor curves according to antihypertensive medication. Estimates of the median (5th-95th percentile) traverse times between two dilations were computed using interval-censored regression. RESULTS Of 285 individuals with chronic hypertension, 88 (30.9%) received CCB. Individuals who received CCB during labor compared to those who did not were more likely to deliver at earlier gestational age and to have pregestational diabetes and superimposed preeclampsia (P < 0.01). The progress of labor in the latent phase was not found to be significantly different between both groups (median 11.51 hours vs. 8.74 hours; P = 0.08). However, after stratification by parity, nulliparous individuals who received CCB during labor were more likely to have a longer latent phase of labor (median 14.4 hours vs. 8.5 hours; P = 0.03) Conclusion: A calcium channel blocker may slow the latent phase of labor in individuals with chronic hypertension. Aiming to minimize intrapartum iatrogenic interventions, allowing adequate time for pregnant individuals during the latent phase of labor is especially important if individuals are on a calcium channel blocker.
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Affiliation(s)
- Carole Barake
- The University of Texas Medical Branch at Galveston, Galveston, United States
| | | | - Jim Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Dana Baraki
- Eastern Virginia Medical School, Norfolk, United States
| | | | | | - Tetsuya Kawakita
- Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, United States
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Onishi K, Seagraves E, Baraki D, Donaldson T, Barake C, Abuhamad AZ, Huang J, Kawakita T. Comparison of adverse maternal outcomes between early- and late-onset superimposed preeclampsia. Am J Perinatol 2023. [PMID: 37207676 DOI: 10.1055/a-2096-3403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Superimposed preeclampsia (SIPE), defined as preeclampsia in individuals with chronic hypertension, is one of the most common complications, accounting for 13-40 % of pregnancies with chronic hypertension. However, there are limited data regarding maternal outcomes of early- and late-onset SIPE in individuals with chronic hypertension. We hypothesized that early-onset SIPE was associated with increased odds of adverse maternal outcomes compared to late-onset SIPE. Therefore, we aimed to compare adverse maternal outcomes between individuals with early-onset SIPE and those with late-onset SIPE. Study Design This was a retrospective cohort study of pregnant individuals with SIPE who delivered at 22 weeks' gestation or greater at an academic institution. Early-onset SIPE was defined as the onset of SIPE before 34 weeks' gestation. Late-onset SIPE was defined as the onset of SIPE at or after 34 weeks' gestation. Our primary outcome was a composite of eclampsia, HELLP syndrome, maternal death, placental abruption, pulmonary edema, SIPE with severe features, and thromboembolic disease. Maternal outcomes were compared between early-onset SIPE and late-onset SIPE. We used simple and multivariate logistic regression models to calculate crude and adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Results Of 311 individuals, 157 (50.5 %) had early-onset, 154 (49.5 %) had late-onset SIPE. There were significant differences in the proportions of obstetric complications, including the primary outcome, HELLP syndrome, SIPE with severe features, fetal growth restriction (FGR), and cesarean delivery between early- and late-onset SIPE. Compared to individuals with late-onset SIPE, those with early-onset SIPE had increased odds of the primary outcome (aOR 3.28; 95%CI 1.42-7.59), SIPE with severe features (aOR 2.72; 95%CI 1.25-5.90), FGR (aOR 6.07; 95%CI 3.25-11.36), and cesarean delivery (aOR 3.42; 95%CI 2.03-5.75). Conclusion In individuals with chronic hypertension, individuals with early-onset SIPE had higher odds of adverse maternal outcomes compared to those with late-onset SIPE.
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Affiliation(s)
- Kazuma Onishi
- Obstetrics and Gynecology, Eastern Virginia Medical College, Norfolk, United States
| | | | - Dana Baraki
- Eastern Virginia Medical School, Norfolk, United States
| | | | - Carole Barake
- Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, United States
| | | | - Jim Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Tetsuya Kawakita
- Tetsuya Kawakita, Eastern Virginia Medical School, Norfolk, United States
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Stone J, Abu-Rustum RS, Bromley B, Fuchs KM, Anton T, Cooper T, Minton KK, Dashe J, Lee W, Platt LD, Porche LM, Norton ME, Benacerraf BR, Abuhamad AZ. Curriculum and competency assessment program for training maternal-fetal medicine fellows in the performance of the detailed obstetric ultrasound examination: A consensus report. Am J Obstet Gynecol 2023; 228:B2-B9. [PMID: 36087741 DOI: 10.1016/j.ajog.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Joanne Stone
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, NY
| | - Reem S Abu-Rustum
- Department of Obstetrics and Gynecology, University of Florida College of Medicine
| | - Bryann Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, MA
| | - Karin M Fuchs
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, NY
| | - Tracy Anton
- Department of Obstetrics and Gynecology, University of California at San Diego, CA
| | | | | | - Jodi Dashe
- Department of Obstetrics and Gynecology UT Southwestern
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine TX
| | - Lawrence D Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Lea M Porche
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Virginia
| | - Mary E Norton
- Department of Obstetrics and Gynecology, University of California at San Francisco, CA
| | - Beryl R Benacerraf
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, MA
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, VA
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Stone J, Abu-Rustum RS, Bromley B, Fuchs KM, Anton T, Cooper T, Minton KK, Dashe J, Lee W, Platt LD, Porche LM, Norton ME, Benacerraf BR, Abuhamad AZ. Curriculum and Competency Assessment Program for Training Maternal-Fetal Medicine Fellows in the Performance of the Detailed Obstetric Ultrasound Examination. J Ultrasound Med 2022; 41:2925-2932. [PMID: 36073175 DOI: 10.1002/jum.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Joanne Stone
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reem S Abu-Rustum
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Bryann Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karin M Fuchs
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York, USA
| | - Tracy Anton
- Department of Obstetrics and Gynecology, University of California at San Diego, San Diego, California, USA
| | - Therese Cooper
- American Institute of Ultrasound in Medicine, Laurel, Maryland, USA
| | | | - Jodi Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Lawrence D Platt
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lea M Porche
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Beryl R Benacerraf
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Horgan R, Hossain S, Fulginiti A, Patras A, Massaro R, Abuhamad AZ, Kawakita T, Graebe R. Trial of labor after two cesarean sections: A retrospective case-control study. J Obstet Gynaecol Res 2022; 48:2528-2533. [PMID: 35793784 PMCID: PMC9796916 DOI: 10.1111/jog.15351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 01/07/2023]
Abstract
AIM The objective of this study was to compare neonatal and maternal outcomes among women with two previous cesarean deliveries who undergo trial of labor after two cesarean section (TOLA2C) versus elective repeat cesarean delivery (ERCD). Our primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes included APGAR score <7 at 5 min, TOLA2C success rate, uterine rupture, postpartum hemorrhage, maternal blood transfusion, maternal bowel and bladder injury, immediate postpartum infection, and maternal mortality. METHODS This retrospective cohort study was undertaken at a community medical center from January 1, 2008 to December 31, 2018. Inclusion criteria were women with a vertex singleton gestation at term and a history of two prior cesarean sections. Exclusion criteria included a previous successful TOLA2C, prior classical uterine incision or abdominal myomectomy, placenta previa or invasive placentation, multiple gestation, nonvertex presentation, history of uterine rupture or known fetal anomaly. Maternal and neonatal outcomes were assessed using Fisher exact test and Wilcoxon rank sum test. RESULTS A total of 793 patients fulfilled study criteria. There were no differences in neonatal intensive care unit admissions or 5-min APGAR scores <7 between the two groups. Sixty-eight percent of women who underwent TOLAC (N = 82) had a successful vaginal delivery. The uterine rupture rate was 1.16% (N = 1) in the TOLA2C group with no case of uterine rupture in the ERCD group. No difference in maternal morbidity was noted between the two groups. No maternal or neonatal mortalities occurred in either group. CONCLUSIONS There was no difference in maternal or neonatal morbidity among patients in our study population with two previous cesarean sections who opted for TOLA2C versus ERCD.
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Affiliation(s)
- Rebecca Horgan
- Department of Obstetrics & GynecologyMonmouth Medical CenterLong BranchNew JerseyUSA,Department of Maternal Fetal MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Saif Hossain
- Department of Obstetrics & GynecologyMonmouth Medical CenterLong BranchNew JerseyUSA
| | - Adriana Fulginiti
- Department of Obstetrics & GynecologyMonmouth Medical CenterLong BranchNew JerseyUSA
| | - Ariana Patras
- Department of Obstetrics & GynecologyMonmouth Medical CenterLong BranchNew JerseyUSA
| | - Robert Massaro
- Department of Obstetrics & GynecologyMonmouth Medical CenterLong BranchNew JerseyUSA
| | - Alfred Z. Abuhamad
- Department of Maternal Fetal MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Tetsuya Kawakita
- Department of Maternal Fetal MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Robert Graebe
- Department of Obstetrics & GynecologyMonmouth Medical CenterLong BranchNew JerseyUSA
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Martins JG, Kawakita T, Gurganus M, Baraki D, Jain P, Papageorghiou AT, Abuhamad AZ. Influence of maternal body mass index on interobserver variability of fetal ultrasound biometry and amniotic-fluid assessment in late pregnancy. Ultrasound Obstet Gynecol 2021; 58:892-899. [PMID: 33836119 DOI: 10.1002/uog.23646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine the interobserver reproducibility of fetal ultrasound biometric and amniotic-fluid measurements in the third trimester of pregnancy, according to maternal body mass index (BMI) category. METHODS This was a prospective cohort study of women with a singleton gestation beyond 34 weeks, recruited into four groups according to BMI category: normal (18.0-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2) , obese (30.0-39.9 kg/m2 ) and morbidly obese (≥ 40 kg/m2 ). Multiple pregnancies, women with diabetes and pregnancies with a fetal growth, structural or genetic abnormality were excluded. In each woman, fetal biometric (biparietal diameter (BPD), head circumference, abdominal circumference (AC), femur length (FL) and estimated fetal weight) and amniotic-fluid (amniotic-fluid index (AFI) and maximum vertical pocket (MVP)) measurements were obtained by two experienced sonographers or physicians, blinded to gestational age and each other's measurements. Differences in measurements between observers were expressed as gestational age-specific Z-scores. The interobserver intraclass correlation coefficient (ICC) and Cronbach's reliability coefficient (CRC) were calculated. Bland-Altman analysis was used to assess the degree of reproducibility. RESULTS In total, 110 women were enrolled prospectively (including 1320 measurements obtained by 17 sonographers or physicians). Twenty (18.2%) women had normal BMI, 30 (27.3%) women were overweight, 30 (27.3%) women were obese and 30 (27.3%) women were morbidly obese. Except for AFI (ICC, 0.65; CRC, 0.78) and MVP (ICC, 0.49; CRC, 0.66), all parameters had a very high level of interobserver reproducibility (ICC, 0.72-0.87; CRC, 0.84-0.93). When assessing reproducibility according to BMI category, BPD measurements had a very high level of reproducibility (ICC ≥ 0.85; CRC > 0.90) in all groups. The reproducibility of AC and FL measurements increased with increasing BMI, while the reproducibility of MVP measurements decreased. Among the biometric parameters, the difference between the BMI categories in measurement-difference Z-score was significant only for FL. Interobserver differences for biometric measurements fell within the 95% limits of agreement. CONCLUSION Obesity does not seem to impact negatively on the reproducibility of ultrasound measurements of fetal biometric parameters when undertaken by experienced sonographers or physicians who commonly assess overweight, obese and morbidly obese women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J G Martins
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - T Kawakita
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - M Gurganus
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - D Baraki
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - P Jain
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - A T Papageorghiou
- St George's, University of London, London, UK
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - A Z Abuhamad
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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12
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Shainker SA, Silver RM, Modest AM, Hacker MR, Hecht JL, Salahuddin S, Dillon ST, Ciampa EJ, D'Alton ME, Otu HH, Abuhamad AZ, Einerson BD, Branch DW, Wylie BJ, Libermann TA, Karumanchi SA. Placenta accreta spectrum: biomarker discovery using plasma proteomics. Am J Obstet Gynecol 2020; 223:433.e1-433.e14. [PMID: 32199927 DOI: 10.1016/j.ajog.2020.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Many cases of placenta accreta spectrum are not diagnosed antenatally, despite identified risk factors and improved imaging methods. Identification of plasma protein biomarkers could further improve the antenatal diagnosis of placenta accreta spectrum . OBJECTIVE The purpose of this study was to determine if women with placenta accreta spectrum have a distinct plasma protein profile compared with control subjects. STUDY DESIGN We obtained plasma samples before delivery from 16 participants with placenta accreta spectrum and 10 control subjects with similar gestational ages (35.1 vs 35.5 weeks gestation, respectively). We analyzed plasma samples with an aptamer-based proteomics platform for alterations in 1305 unique proteins. Heat maps of the most differentially expressed proteins (T test, P<.01) were generated with matrix visualization and analysis software. Principal component analysis was performed with the use of all 1305 proteins and the top 21 dysregulated proteins. We then confirmed dysregulated proteins using enzyme-linked immunosorbent assay and report significant differences between placenta accreta spectrum and control cases (Wilcoxon-rank sum test, P<.05). RESULTS Many of the top 50 proteins that significantly dysregulated in participants with placenta accreta spectrum were inflammatory cytokines, factors that regulate vascular remodeling, and extracellular matrix proteins that regulate invasion. Placenta accreta spectrum, with the use of the top 21 proteins, distinctly separated the placenta accreta spectrum cases from control cases (P<.01). Using enzyme-linked immunosorbent assay, we confirmed 4 proteins that were dysregulated in placenta accreta spectrum compared with control cases: median antithrombin III concentrations (240.4 vs 150.3 mg/mL; P=.002), median plasminogen activator inhibitor 1 concentrations (4.1 vs 7.1 ng/mL; P<.001), soluble Tie2 (13.5 vs 10.4 ng/mL; P=.02), soluble vascular endothelial growth factor receptor 2 (9.0 vs 5.9 ng/mL; P=.003). CONCLUSION Participants with placenta accreta spectrum had a unique and distinct plasma protein signature.
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Lane AS, Mlynarczyk MA, de Veciana M, Green LM, Baraki DI, Abuhamad AZ. Real-Time Continuous Glucose Monitoring in Gestational Diabetes: A Randomized Controlled Trial. Am J Perinatol 2019; 36:891-897. [PMID: 30818406 DOI: 10.1055/s-0039-1678733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate whether real-time continuous glucose monitoring improves glycemic control over intermittent self-monitoring of blood glucose in gestational diabetes. STUDY DESIGN We performed a single-institution randomized controlled trial. Patients with gestational diabetes were randomized to use either real-time or blinded continuous glucose monitoring. The primary outcome was mean sensor glucose level during the fourth week of continuous glucose monitoring use. Secondary outcomes included glycemic control and a composite of obstetric and neonatal outcomes. RESULTS Of the 40 enrolled patients, 12 (60%) patients in the blinded continuous glucose monitoring group and 11 (55%) in the real-time continuous glucose monitoring group completed 4 weeks of monitoring and were included in the final analysis. There was no significant difference in mean sensor glucose level between the blinded continuous glucose monitoring group (98.9 ± 8.9 mg/dL) and the real-time continuous glucose monitoring group (107.5 ± 11.4 mg/dL). There were also no significant differences in the time spent in glycemic target, maternal, or neonatal outcomes. CONCLUSION Our study shows that the use of continuous glucose monitoring with real-time feedback did not significantly decrease mean glucose values compared with intermittent self-monitoring of blood glucose after 4 weeks of continuous glucose monitoring use.
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Affiliation(s)
- Andrew S Lane
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Malgorzata A Mlynarczyk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Margarita de Veciana
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Lauren M Green
- Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia
| | | | - Alfred Z Abuhamad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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14
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Affiliation(s)
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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15
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Benacerraf BR, Minton KK, Benson CB, Bromley BS, Coley BD, Doubilet PM, Lee W, Maslak SH, Pellerito JS, Perez JJ, Savitsky E, Scarborough NA, Wax J, Abuhamad AZ. Proceedings: Beyond Ultrasound First Forum on Improving the Quality of Ultrasound Imaging in Obstetrics and Gynecology. J Ultrasound Med 2018; 37:7-18. [PMID: 29297609 DOI: 10.1002/jum.14504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.
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Affiliation(s)
| | | | - Carol B Benson
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Bryann S Bromley
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | - Brian D Coley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Wesley Lee
- Texas Children's Hospital Pavilion for Women, Houston, TX
| | | | | | - James J Perez
- OhioHealth Obstetrics and Gynecology Physicians, Columbus, OH
| | - Eric Savitsky
- University of California, Los Angeles, Los Angeles, CA
| | | | - Joseph Wax
- Maine Medical Partners-Women's Health Maternal Fetal Medicine, Portland, ME
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Ashdown AJ, Scerbo MW, Belfore LA, Davis SS, Abuhamad AZ. Categorizing Fetal Heart Rate Variability with and without Visual Aids. AJP Rep 2016; 6:e359-e366. [PMID: 27722031 PMCID: PMC5053820 DOI: 10.1055/s-0036-1593605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study examined the ability of clinicians to correctly categorize images of fetal heart rate (FHR) variability with and without the use of exemplars. Study Design A sample of 33 labor and delivery clinicians inspected static FHR images and categorized them into one of four categories defined by the National Institute of Child Health and Human Development (NICHD) based on the amount of variability within absent, minimal, moderate, or marked ranges. Participants took part in three conditions: two in which they used exemplars representing FHR variability near the center or near the boundaries of each range, and a third control condition with no exemplars. The data gathered from clinicians were compared with those from a previous study using novices. Results Clinicians correctly categorized more images when the FHR variability fell near the center rather than the boundaries of each range, F (1,32) = 71.69, p < 0.001, partial η2 = 0.69. They also correctly categorized more images when exemplars were available, F (2,64) = 5.44, p = 0.007, partial η2 = 0.15. Compared with the novices, the clinicians were more accurate and quicker in their category judgments, but this difference was limited to the condition without exemplars. Conclusion The results suggest that categorizing FHR variability is more difficult when the examples fall near the boundaries of each NICHD-defined range. Thus, clinicians could benefit from training with visual aids to improve judgments about FHR variability and potentially enhance safety in labor and delivery.
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Affiliation(s)
- Amanda J Ashdown
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - Mark W Scerbo
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - Lee A Belfore
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, Virginia
| | - Stephen S Davis
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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17
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Hammad IA, Chauhan SP, Mlynarczyk M, Rabie N, Goodie C, Chang E, Magann EF, Abuhamad AZ. Uncomplicated Pregnancies and Ultrasounds for Fetal Growth Restriction: A Pilot Randomized Clinical Trial. AJP Rep 2016; 6:e83-90. [PMID: 26929878 PMCID: PMC4737635 DOI: 10.1055/s-0035-1567857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/01/2015] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this multicenter pilot study was to determine the feasibility of randomizing uncomplicated pregnancies (UPs) to have third trimester ultrasonographic exams (USE) versus routine prenatal care (RPNC) to improve the detection of small for gestational age (SGA; birth weight < 10% for GA). Material and Methods At three referral centers, 50 UPs were randomized after gestational diabetes was ruled out. Women needed to screen, consenting, and loss to follow-up was ascertained, as was the detection rate of SGA in the two groups. Results During the study period at the three centers, there were 7,680 births, of which 64% were uncomplicated. Of the 234 women approached for randomization, 36% declined. We recruited 149 women and had follow-up delivery data on 97%. The antenatal detection rate of SGA in the intervention group was 67% (95% confidence intervals 31-91%) and 9% (0.5-43%) in control. Conclusion The pilot study provides feasibility data for a multicenter randomized clinical trial to determine if third trimester USE, compared with RPNC, improves the detection of SGA and composite neonatal morbidity.
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Affiliation(s)
- Ibrahim A. Hammad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Suneet P. Chauhan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health Science Center, Houston, Texas
| | - Malgorzata Mlynarczyk
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Nader Rabie
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas
| | - Chris Goodie
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Eugene Chang
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Everett F. Magann
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas
| | - Alfred Z. Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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18
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Kennedy RA, Scerbo MW, Anderson-Montoya BL, Belfore LA, Abuhamad AZ, Davis SS. The Influence of a Crosshair Visual Aid on Observer Detection of Simulated Fetal Heart Rate Signals. AJP Rep 2016; 6:e115-20. [PMID: 26989564 PMCID: PMC4794439 DOI: 10.1055/s-0036-1571331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To determine whether a visual aid overlaid on fetal heart rate (FHR) tracings increases detection of critical signals relative to images with no visual aid. Study Design In an experimental study, 21 undergraduate students viewed 240 images of simulated FHR tracings twice, once with the visual aids and once without aids. Performance was examined for images containing three different types of FHR signals (early deceleration, late deceleration, and acceleration) and four different FHR signal-to-noise ratios corresponding to FHR variability types (absent, minimal, moderate, and marked) identified by the National Institute of Child Health and Human Development (2008). Performance was analyzed using repeated-measures analyses of variance. Results The presence of the visual aid significantly improved correct detections of signals overall and decreased false alarms for the marked variability condition. Conclusion The results of the study provide evidence that the presence of a visual aid was useful in helping novices identify FHR signals in simulated maternal-fetal heart rate images. Further, the visual aid was most useful for conditions in which the signal is most difficult to detect (when FHR variability is highest).
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Affiliation(s)
- Rebecca A Kennedy
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | - Mark W Scerbo
- Department of Psychology, Old Dominion University, Norfolk, Virginia
| | | | - Lee A Belfore
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, Virginia
| | | | - Stephen S Davis
- Eastern Virginia Medical School, Hofheimer Hall, Norfolk, Virginia
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19
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Donofrio MT, Rychik J, Donofrio MT, Moon-Grady AJ, Rychik J, Puchalski MD, Tworetzky W, Cuneo BF, Abuhamad AZ, Ayers NA, Copel JA, Gardiner HM, Golding F, Freud LR, Jaeggi ET, Lee W, Miller S, Morris SA, Peyvandi S, Schidlow DN, Silverman NH. Multidisciplinary Collaboration in Fetal Cardiovascular Research: The Time Has Come. J Am Soc Echocardiogr 2016; 29:140-2. [DOI: 10.1016/j.echo.2015.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 11/15/2022]
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20
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Larion S, Warsof SL, DiNonno W, Peleg D, Abuhamad AZ. 320: Prenatal findings predictive of termination of pregnancy: a retrospective cohort analysis. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE The purpose of this review was to determine the likelihood of malignancy or complications with ultrasonographic diagnosis of adnexal masses in pregnancy and to evaluate the obstetrical outcomes. Materials and METHODS A review of literature was performed using keywords "adnexal mass and pregnancy" or "ovarian mass and pregnancy." RESULTS Out of the 340 abstracts reviewed, 313 were excluded. The incidence of adnexal mass in pregnancy varied from 0.1 to 2.4%, with an average of 0.02%. Regarding the likelihood of malignancy, in seven publications, there were 557 women with 563 adnexal masses. Of these 563 masses, 48% were classified as simple and 52% as complex. Among the simple masses, 1% were malignant. Among the complex masses, 9% were malignant. When comparing laparoscopy and laparotomy, the rate of preterm contractions was found to be higher in patients undergoing laparotomy and this was statistically significant. Other measures, such as spontaneous abortion, vaginal bleeding, < 37 week delivery, and intrauterine fetal demise, were not found to have a significant difference. CONCLUSION Adnexal masses in pregnancy occur infrequently and depending on whether the surgery was performed emergently or electively, via laparoscopy or laparotomy, the outcomes will vary.
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Affiliation(s)
- Kathryn E Webb
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Khaled Sakhel
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Suneet P Chauhan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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22
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Larion S, Warsof SL, Romary L, Mlynarczyk M, Peleg D, Abuhamad AZ. Use of the Combined First-Trimester Screen in High- and Low-Risk Patient Populations After Introduction of Noninvasive Prenatal Testing. Journal of Ultrasound in Medicine 2015; 34:1423-1428. [DOI: 10.7863/ultra.34.8.1423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Warsof SL, Larion S, Abuhamad AZ. Overview of the impact of noninvasive prenatal testing on diagnostic procedures. Prenat Diagn 2015; 35:972-9. [PMID: 25868782 DOI: 10.1002/pd.4601] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022]
Abstract
Noninvasive prenatal testing (NIPT) has had a profound influence in the field of prenatal diagnosis since the 1997 discovery of cell-free fetal DNA in maternal blood. Research has progressed rapidly, with clinical data supporting laboratory studies showing that NIPT is highly sensitive and specific for fetal aneuploidy, resulting in marked uptake in the high-risk patient population. The superior accuracy of NIPT compared with conventional screening methods has led to significant decreases in the number of invasive diagnostic procedures, in addition to a concomitant decrease in the number of procedure-related fetal losses. Yet, NIPT has been described as a 'disruptive innovation' due to the considerable changes the technology has commanded on current prenatal screening and diagnostic practices. This review summarizes both institutional and global experience with NIPT uptake, its effect on reducing diagnostic invasive procedures, and the unique challenges that reduced procedural volume may have on physician and trainee proficiency, cytogenetic laboratories, and neonatal outcome.
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Affiliation(s)
- Steven L Warsof
- Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Sebastian Larion
- Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Alfred Z Abuhamad
- Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK, Belfort MA, Wright JD. Center of excellence for placenta accreta. Am J Obstet Gynecol 2015; 212:561-8. [PMID: 25460838 DOI: 10.1016/j.ajog.2014.11.018] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/03/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Abstract
Placenta accreta spectrum is one of the most morbid conditions obstetricians will encounter. The incidence has dramatically increased in the last 20 years. The major contributing factor to this is believed to be the increase in the rate of cesarean delivery. Despite the increased incidence of placenta accreta, most obstetricians have personally managed only a small number of women with placenta accreta. The condition poses dramatic risk for massive hemorrhage and associated complication such as consumption coagulopathy, multisystem organ failure, and death. In addition, there is an increased risk for surgical complications such as injury to bladder, ureters, and bowel and the need for reoperation. Most women require blood transfusion, often in large quantities, and many require admission to an intensive care unit. As a result of indicated, often emergent preterm delivery, many babies require admission to a neonatal care intensive care unit. Outcomes are improved when delivery is accomplished in centers with multidisciplinary expertise and experience in the care of placenta accreta. Such expertise may include maternal-fetal medicine, gynecologic surgery, gynecologic oncology, vascular, trauma and urologic surgery, transfusion medicine, intensivists, neonatologists, interventional radiologists, anesthesiologists, specialized nursing staff, and ancillary personnel. This article highlights the desired features for a center of excellence in placenta accreta, and which patients should be referred for evaluation and/or delivery in such centers.
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Benacerraf BR, Abuhamad AZ, Bromley B, Goldstein SR, Groszmann Y, Shipp TD, Timor-Tritsch IE. Consider ultrasound first for imaging the female pelvis. Am J Obstet Gynecol 2015; 212:450-5. [PMID: 25841638 DOI: 10.1016/j.ajog.2015.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/18/2015] [Indexed: 01/27/2023]
Abstract
Ultrasound technology has evolved dramatically in recent years and now includes applications such as 3-dimensional volume imaging, real-time evaluation of pelvic organs (simultaneous with the physical examination), and Doppler blood flow mapping without the need for contrast, which makes ultrasound imaging unique for imaging the female pelvis. Among the many cross-sectional imaging techniques, we should use the most informative, less invasive, and less expensive modality to avoid radiation when possible. Hence, ultrasound imaging should be the first imaging modality used in women with pelvic symptoms.
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Larion S, Warsof SL, Romary L, Mlynarczyk M, Peleg D, Abuhamad AZ. Uptake of noninvasive prenatal testing at a large academic referral center. Am J Obstet Gynecol 2014; 211:651.e1-7. [PMID: 24954652 DOI: 10.1016/j.ajog.2014.06.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/21/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Noninvasive prenatal testing (NIPT) is a recently developed risk-assessment technique with high sensitivity and specificity for fetal aneuploidy. The effect NIPT has had on traditional screening and diagnostic testing has not been clearly demonstrated. In this study, NIPT uptake and subsequent changes in the utilization of first-trimester screen (FTS), chorionic villus sampling (CVS), and amniocentesis in a single referral center is reported. STUDY DESIGN Monthly numbers of NIPT (in high-risk patients), FTS, CVS, and amniocentesis were compared between a 35-month baseline period (April 2009 through February 2012) before introduction of NIPT, and the initial 16 months following NIPT introduction divided in 4-month quarters beginning in March 2012 through June 2013. RESULTS A total of 1265 NIPT, 6637 FTS, 251 CVS, and 1134 amniocentesis were recorded over the 51-month study period in singleton pregnancies of women who desired prenatal screening and diagnostic testing. NIPT became the predominant FTS method by the second quarter following its introduction, increasing by 55.0% over the course of the study period. Total first-trimester risk assessments (NIPT+FTS) were not statistically different following NIPT (P = .312), but average monthly FTS procedures significantly decreased following NIPT introduction, decreasing by 48.7% over the course of the study period. Average monthly CVS and amniocentesis procedures significantly decreased following NIPT introduction, representing a 77.2% and 52.5% decrease in testing, respectively. Screening and testing per 100 morphological ultrasounds followed a similar trend. CONCLUSION NIPT was quickly adopted by our high-risk patient population, and significantly decreased alternate prenatal screening and diagnostic testing in a short period of time.
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Abstract
OBJECTIVE The purpose of this review is to ascertain the indications, techniques, and the associated morbidity with the use of Bakri balloon. MATERIAL AND METHODS A literature search using the PubMed database was conducted from 2001 to 2013. We calculated 95% confidence intervals (CIs) for complications. RESULTS We identified 12 publications that met the inclusion criteria. Four reports provided the frequency of Bakri use during the study period, with the overall rate being 0.20% (138/69, 174; 95% CI, 0.17-0.25%). Two-thirds of use followed cesarean delivery (67%; 182/273). Uterine atony was specified as the underlying etiology of postpartum hemorrhage in 75% (9/12) of publication. The rate of balloon displacement was 10% (95% CI, 6-16%) and need for transfusion, 43% (95% CI, 32-55%). Hysterectomy was undertaken in 6% (95% CI, 4-10%). CONCLUSIONS There is a paucity of publications on Bakri balloon. Before its utilization is recommended in guidelines, a randomized clinical trial comparing uterotonics alone versus with balloon is warranted.
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Affiliation(s)
- Cara E Wright
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Suneet P Chauhan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: Executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014; 210:387-97. [PMID: 24793721 DOI: 10.1016/j.ajog.2014.02.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/28/2022]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and magnetic resonance imaging in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost-effectiveness and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX.
| | - Alfred Z Abuhamad
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - Deborah Levine
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - George R Saade
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med 2014; 33:745-757. [PMID: 24764329 DOI: 10.7863/ultra.33.5.745] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 4B03F, Bethesda, MD 20892-7510 USA.
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Chauhan SP, Beydoun H, Chang E, Sandlin AT, Dahlke JD, Igwe E, Magann EF, Anderson KR, Abuhamad AZ, Ananth CV. Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. Am J Perinatol 2014; 31:187-94. [PMID: 23592315 DOI: 10.1055/s-0033-1343771] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We examined the rate of detecting small for gestational age (SGA; birth weight < 10%) as intrauterine growth restriction (IUGR) prenatally at four centers and determined risks of composite neonatal morbidity (CNM) and mortality among detected versus undetected (no antenatal diagnosis of IUGR). A multicenter cohort study of 11,487 nonanomalous, singleton live births with sonographic exam before 22 weeks was performed. Of 11,487 births, 8% (n = 929) were SGA that met the inclusion criteria, with 25% of them being prenatally detected. The CNM among SGA births that were prenatally detected as IUGR was higher (23.3%) than undetected SGA (9.7%), but this difference was no longer significant following adjustments for confounding factors. Among preterm births (< 37 weeks), undetected SGA had significantly higher CNM (risk ratio [RR] 10.0, 95% confidence interval [CI] 6.3, 16.1) for deliveries at 24 to 33 weeks and RR 3.0, 95% CI 1.7, 5.4 for 34 to 36 weeks). In summary, only a quarter of SGA births were detected prenatally as IUGR and among preterm SGA, the CNM is significantly higher when SGA births are undetected as IUGR.
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Affiliation(s)
- Suneet P Chauhan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Hind Beydoun
- Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, Virginia
| | - Eugene Chang
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Adam T Sandlin
- Department of Obstetrics and Gynecology, University of Arkansas, Little Rock, Arkansas
| | - Josh D Dahlke
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Elena Igwe
- Department of Obstetrics and Gynecology, Temple University, Philadelphia, Pennsylvania
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas, Little Rock, Arkansas
| | - Kristi R Anderson
- Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York
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Chauhan SP, Beydoun H, Hammad IA, Babbar S, Hill JB, Mlynarczyk M, D'Alton ME, Abuhamad AZ, Vintzileos AM, Ananth CV. Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity. BJOG 2014; 121:1395-402. [DOI: 10.1111/1471-0528.12669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- SP Chauhan
- Department of Obstetrics and Gynecology; Eastern Virginia Medical School; Norfolk VA USA
| | - H Beydoun
- Graduate Program in Public Health; Eastern Virginia Medical School; Norfolk VA USA
| | - IA Hammad
- Department of Obstetrics and Gynecology; Eastern Virginia Medical School; Norfolk VA USA
| | - S Babbar
- Department of Obstetrics and Gynecology; Eastern Virginia Medical School; Norfolk VA USA
| | - JB Hill
- Department of Obstetrics and Gynecology; Eastern Virginia Medical School; Norfolk VA USA
| | - M Mlynarczyk
- Department of Obstetrics and Gynecology; Eastern Virginia Medical School; Norfolk VA USA
| | - ME D'Alton
- Department of Obstetrics and Gynecology; College of Physicians and Surgeons; Columbia University; New York NY USA
| | - AZ Abuhamad
- Department of Obstetrics and Gynecology; Eastern Virginia Medical School; Norfolk VA USA
| | - AM Vintzileos
- Department of Obstetrics and Gynecology; Winthrop University Hospital; Mineola NY USA
| | - CV Ananth
- Department of Obstetrics and Gynecology; College of Physicians and Surgeons; Columbia University; New York NY USA
- Department of Epidemiology; Joseph L. Mailman School of Public Health; Columbia University; New York NY USA
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Sakhel K, Sinkovskaya E, Horton S, Beydoun H, Chauhan SP, Abuhamad AZ. Orientation of the uterine fundus in reference to the longitudinal axis of the body: a 3-dimensional sonographic study. J Ultrasound Med 2014; 33:323-328. [PMID: 24449736 DOI: 10.7863/ultra.33.2.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this pilot study was to measure the angle of rotation of the uterus at the fundus from horizontal using 3-dimensional sonography in women presenting for annual gynecologic examinations. METHODS A total of 51 patients participated in the study. All patients underwent transvaginal sonography, and 3-dimensional volumes were acquired. The cervicouterine angle and the angle of rotation at the fundus were measured. RESULTS The uteri were noted to be anteverted in 64.7%, retroverted in 25.5%, and euverted in 9.8%. They were noted to be pointing toward the right side of the pelvis in 49.0%, to the left side in 39.2%, and at the midline in 11.8%. The median cervicouterine angle was 122° (interquartile range [IQR], 105°-137°). The median angle of rotation at the fundus away from horizontal in either a clockwise or counterclockwise direction on the transverse B-plane was 10.4° (IQR, 7.1°-19.0°), with a maximal angle of 43°, and on the coronal C-plane, it was 10.0° (IQR, 3.0°-20.0°), with a maximal angle of 43°. Noneuverted uteri were more likely to be rotated at the fundus. CONCLUSIONS Our study reveals that, contrary to traditional thinking, the uterus can be rotated at the fundus in relation to the body (z-axis) along the longitudinal axis of the cervical canal.
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Affiliation(s)
- Khaled Sakhel
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 310, Norfolk, VA 23507 USA.
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Ball JD, Abuhamad AZ, Mason JL, Burket J, Katz E, Deutsch SI. Clinical outcomes of mild isolated cerebral ventriculomegaly in the presence of other neurodevelopmental risk factors. J Ultrasound Med 2013; 32:1933-1938. [PMID: 24154896 DOI: 10.7863/ultra.32.11.1933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate neuropsychological test data in school-aged children whose fetal sonograms revealed mild isolated cerebral ventriculomegaly without asymmetry of the lateral ventricles. METHODS Nine of 52 children 6 years and older with sonographic evidence of mild isolated cerebral ventriculomegaly without asymmetry of the lateral ventricles were able to be recruited for follow-up school-aged neuropsychological testing. The children received a half-day battery of neuropsychological tests, including the Wechsler Abbreviated Scales of Intelligence; Beery-Buktenica Developmental Test of Visual Motor Integration, Fifth Edition; Wide Range Achievement Test, Fourth Edition; and Integrated Visual and Auditory Continuous Performance Test. Parents completed the Conners 3 Parent Short Form and the Personality Inventory for Children, Second Edition. RESULTS In this small group, other risk factors for neurodevelopmental disorders were often present, including preterm birth, perinatal hypoxia, and a family history of psychiatric disease or substance abuse. Within this sample, the proportion of children with a pattern of test results showing poorer nonverbal intelligence than verbal intelligence scores and poorer math than reading performance, as well as meeting criteria for a diagnosis of attention deficit/hyperactivity disorder, was higher than the basal rates of these problems among children in general. CONCLUSIONS Particularly given the complexity of various factors affecting neurodevelopment, follow-up neuropsychological evaluation is warranted in children with sonographic evidence of mild isolated cerebral ventriculomegaly without asymmetry of the lateral ventricle (eg, in the context of poor school performance).
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Affiliation(s)
- John D Ball
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 710, Norfolk, VA 23507-1912 USA.
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Hammad IA, Chauhan SP, Magann EF, Abuhamad AZ. Peripartum complications with cesarean delivery: a review of Maternal-Fetal Medicine Units Network publications. J Matern Fetal Neonatal Med 2013; 27:463-74. [DOI: 10.3109/14767058.2013.818970] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Eliza M Berkley
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507 USA.
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Chen HY, Chauhan SP, Grobman WA, Ananth CV, Vintzileos AM, Abuhamad AZ. Association of labor induction or stimulation with infant mortality in women with failed versus successful trial of labor after prior cesarean. J Matern Fetal Neonatal Med 2013; 26:1162-5. [DOI: 10.3109/14767058.2013.777700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chauhan SP, Rouse DJ, Ananth CV, Magann EF, Chang E, Dahlke JD, Abuhamad AZ. Screening for intrauterine growth restriction in uncomplicated pregnancies: time for action. Am J Perinatol 2013; 30:33-9. [PMID: 22814800 DOI: 10.1055/s-0032-1321497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A randomized clinical trial (RCT) noted that sonographic examination in the third trimester, in conjunction with delivery at term for abnormalities of fetal growth, significantly decreased the likelihood of small-for-gestational-age (SGA) neonates in uncomplicated pregnancies. We identified 15 characteristics of screening tests and attempted to determine if there is evidence to routinely obtain sonographic estimates of fetal weight in the third trimester and decrease rates of SGA. Of the 15 suggested characteristics, currently 10 (67%) are fulfilled, two are uncertain (sonographic examination is cost-effective or reliable), and one (the test must do its job) is possibly valid. Due to the lack of RCTs demonstrating reduction in morbidity, there is potential for lead-time and length bias. To observe a 36% decrease (from 4.1 to 2.6%) decrease in composite perinatal morbidity, 6000 women need to be randomized to at least two sonographic examinations in the third trimester versus routine prenatal care. Such an RCT is warranted and justified.
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Affiliation(s)
- Suneet P Chauhan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical University, Norfolk, Virginia, USA.
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Affiliation(s)
- Silvina M Bocca
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 601 Colley Ave, Norfolk, VA 23507, USA.
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Johnson JM, Chauhan SP, Lopes V, Sibai B, Abuhamad AZ. Society of Maternal-Fetal Medicine annual meeting and a continuing medical education course: results of pre- and postcourse survey. Am J Perinatol 2012; 29:833-41. [PMID: 22773288 DOI: 10.1055/s-0032-1321496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the influence of a continuing medical education (CME) course on knowledge acquired and potential to change clinical management or opinion. STUDY DESIGN During the annual Society of Maternal-Fetal Medicine meeting, a survey consisting of 11 knowledge-based, 10 management plan, and 8 opinion questions was administered at the start and completion of the CME course. Chi-square and Fisher exact test were used, and p < 0.05 was considered significant. RESULTS The survey was administered electronically to 394 attendees. Questions assessing knowledge showed significant improvement with 91% (10/11) of queries. Purported management changed significantly with 60% (6/10) scenarios and opinions in 62% (5/8) of clinical situations. CONCLUSION A survey done at the completion of a course indicates that CME improves knowledge and can change management and opinions. The prolonged benefits of CME need to be investigated.
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Affiliation(s)
- Julie M Johnson
- Department of Obstetrics and Gynecology at Women and Infants Hospital/Brown University, Providence, Rhode Island, USA.
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Abstract
Evidence-based guidelines regarding intrapartum fetal surveillance from three countries (United States, Canada, and Australia/New Zealand) were reviewed. The similarities in the three national guidelines (purported etiology, management of periodic changes, and intermittent auscultation for low-risk women) are understandable. Differences in recommendations (role of fetal admission test, amnioinfusion for variable decelerations, scalp pH, umbilical arterial acid-base status, and education in interpretation of fetal heart tracing) are not explained. The likelihood of recommendations being categorized as level A differed for the countries: United States, 41% (7/17); Canada, 18% (3/17); and Australia and New Zealand, 17% (2/12). Only one publication was cited by all three guidelines. To avoid confusion and possibly enhance their quality, national guidelines should acknowledge the presence of others on the same topic, and if there are differences then provide explanations for dissimilarities.
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Affiliation(s)
- James B Hill
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
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Paulson JF, Chauhan SP, Hill JB, Abuhamad AZ. Severe small size for gestational age and cognitive function: catch-up phenomenon possible. Am J Obstet Gynecol 2012; 207:119.e1-5. [PMID: 22728029 DOI: 10.1016/j.ajog.2012.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/11/2012] [Accepted: 05/30/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to compare cognitive functioning in children born with birthweight <3% vs ≥3% for gestational age (GA) between 9 months and kindergarten. STUDY DESIGN Nonanomalous singletons from the Early Childhood Longitudinal Study-Birth Cohort were included. Associations between weight for GA and cognitive functioning were examined using a series of confounder-adjusted general linear models. RESULTS Of 3633 cohorts, 585 (16%) were <3% for GA. At 9 months, cognitive performance of newborns <3% was about 12 percentile points lower than their normal counterparts (P < .001). By 2 years, however, no significant cognitive differences between these groups were observed (P = .668). Academic performance at preschool age (around 3.5 years) was not different for reading (P = .245) or math (P = .880), nor different at kindergarten age. CONCLUSION Newborns <3% for GA exhibit catch-up cognitive functioning by 2 years, with relatively no decrements in academic functioning observed by kindergarten.
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Chauhan SP, Chen HY, Ananth CV, Vintzileos AM, Abuhamad AZ. Reply. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Bocca SM, Oehninger S, Stadtmauer L, Agard J, Duran EH, Sarhan A, Horton S, Abuhamad AZ. A study of the cost, accuracy, and benefits of 3-dimensional sonography compared with hysterosalpingography in women with uterine abnormalities. J Ultrasound Med 2012; 31:81-85. [PMID: 22215773 DOI: 10.7863/jum.2012.31.1.81] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES We conducted a prospective blinded study to evaluate the costs, accuracy, risks, and benefits of 3-dimensional (3D) transvaginal sonography compared to hysterosalpingography. METHODS A total of 101 women aged 26 to 44 years with evidence of uterine anomalies were enrolled. All participants had routine hysterosalpingography as part of their infertility evaluation as well as 3D transvaginal sonography as part of the study. Surgical findings were used as the standard for final diagnosis. RESULTS A total of 6 normal uteri and 119 uterine anomalies were classified: 30 congenital uterine anomalies (3 arcuate, 1 unicornuate, 4 bicornuate, 2 didelphys, and 20 septate uteri) and 89 acquired anomalies (38 polyps, 30 fibroids, 17 synechiae, and 4 adenomyosis). Congenital anomalies were correctly identified in 30 of 30 cases by 3D sonography but from 10 to 30 of 30 cases by hysterosalpingography. The detection rates for acquired uterine anomalies were lower for both techniques: 44 to 89 of 89 cases for 3D sonography and 22 to 74 of 89 cases for hysterosalpingography. Only 7 of the 20 septi would have been surgically corrected if patients only had hysterosalpingography. On the contrary, 30 of 30 patients with congenital uterine anomalies, 2 of 4 patients with adenomyosis, and all 6 patients with normal uteri were spared from surgery with diagnoses by 3D sonography. No adverse effects were reported after sonography, and only 6 minor ones were reported after hysterosalpingography. CONCLUSIONS Three-dimensional transvaginal sonography provides visualization and evaluation of the uterine cavity with similar or better accuracy than standard hysterosalpingography in the office setting, with lower cost and morbidity.
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Affiliation(s)
- Silvina M Bocca
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507-1627, USA.
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Rizzo G, Abuhamad AZ, Benacerraf BR, Chaoui R, Corral E, Addario VD, Espinoza J, Lee W, Mercé Alberto LT, Pooh R, Sepulveda W, Sinkovskaya E, Viñals F, Volpe P, Pietrolucci ME, Arduini D. Collaborative study on 3-dimensional sonography for the prenatal diagnosis of central nervous system defects. J Ultrasound Med 2011; 30:1003-8. [PMID: 21705734 DOI: 10.7863/jum.2011.30.7.1003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Prenatal diagnosis of central nervous system (CNS) anomalies by 2-dimensional sonography is challenging because of difficulties in obtaining complete visualization of the fetal brain during routine examinations, which is necessary for identification of its axial, coronal, and sagittal planes. Three-dimensional (3D) sonography has been introduced as a tool for studying the fetal CNS because of its ability to facilitate examinations of the fetal brain. The objective of this study was to determine inter-center agreement in diagnosing CNS defects by review of 3D volume data sets. METHODS This study included 11 centers with expertise in 3D fetal neurosonography. A total of 217 fetuses with and without confirmed CNS defects were scanned after 18 weeks' gestation, and their volume data sets were uploaded onto a centralized file transfer protocol server and later analyzed by all of the centers. Intercenter agreement was determined using a κ statistic for multiple raters. RESULTS All volumes were made anonymous and sent to the centers for blinded analysis with the exception of the data sets they had themselves previously uploaded. For identification of fetuses with CNS defects, the sensitivity, specificity, positive and negative predictive values, and false-positive and -negative rates were 93.3%, 96.5%, 96.5%, 93.3%, 3.5%, and 6.7%, respectively. No differences were found in the efficacy of the diagnostic indices according to either the route of acquisition (transabdominal or trans-vaginal) or the gestational age at diagnosis (18-24 or >24 weeks). Intercenter agreement was excellent (κ = 0.92; 95% confidence interval, 0.88-0.97). CONCLUSIONS Among centers with technical expertise, remote review of 3D sonographic volumes of the fetal CNS resulted in an accurate and reliable method for diagnosis of fetal brain malformations.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli S. Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy.
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Abstract
Interest in centralized monitoring in labor and delivery units is growing because it affords the opportunity to monitor multiple patients simultaneously. However, a long history of research on sustained attention reveals these types of monitoring tasks can be problematic. The goal of the present experiment was to examine the ability of individuals to detect critical signals in fetal heart rate (FHR) tracings in one or more displays over an extended period of time. Seventy-two participants monitored one, two, or four computer-simulated FHR tracings on a computer display for the appearance of late decelerations over a 48-minute vigil. Measures of subjective stress and workload were also obtained before and after the vigil. The results showed that detection accuracy decreased over time and also declined as the number of displays increased. The subjective reports indicated that participants found the task to be stressful and mentally demanding, effortful, and frustrating. The results suggest that centralized monitoring that allows many patients to be monitored simultaneously may impose a detrimental attentional burden on the observer. Furthermore, this seemingly benign task may impose an additional source of stress and mental workload above what is commonly found in labor and delivery units.
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Chen HY, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. Am J Obstet Gynecol 2011; 204:491.e1-10. [PMID: 21752753 DOI: 10.1016/j.ajog.2011.04.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/22/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. STUDY DESIGN We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. RESULTS In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores <4 at 5 minutes (relative risk, 0.54); in high-risk pregnancies, with decreased risk of neonatal seizures (relative risk, 0.65). CONCLUSION In the United States, the use of electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality.
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Abuhamad AZ. Thanks to Beryl Benacerraf from the AIUM. J Ultrasound Med 2010; 29:1681. [PMID: 21098835 DOI: 10.7863/jum.2010.29.12.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Affiliation(s)
- Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk, VA 23507-1912 USA.
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Deutch TD, Abuhamad AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of müllerian duct anomalies: a review of the literature. J Ultrasound Med 2008; 27:413-423. [PMID: 18314520 DOI: 10.7863/jum.2008.27.3.413] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this article is to review the published literature and determine the roles that magnetic resonance imaging (MRI) and endovaginal 3-dimensional ultrasonography (3DUS) play in the diagnosis of müllerian duct anomalies (MDAs). METHODS A PubMed search was performed to identify all of the articles pertaining to the use of MRI or 3DUS for the evaluation or diagnosis of MDAs. Clinical studies, review articles, case reports, and descriptive studies were reviewed. RESULTS Magnetic resonance imaging and 3DUS are highly sensitive and specific in identifying women with MDAs. Magnetic resonance imaging is 100% to 28.6% sensitive and 100% to 66% specific in correctly categorizing MDAs. Three-dimensional ultrasonography is 100% to 98% sensitive and 100% specific in correctly categorizing MDAs. CONCLUSIONS In experienced hands, both MRI and 3DUS are adequate modalities for identifying women with MDAs. There is a lack of studies comparing MRI with 3DUS for the diagnosis and categorization of MDAs. However, it seems likely that 3DUS is more sensitive and specific than MRI in categorizing specific types of MDAs. The high sensitivity and specificity of 3DUS make it an ideal tool for identifying women with MDAs that are amenable to hysteroscopic resection. Therefore, we believe that as practitioners become more experienced, 3DUS will emerge as the reference standard for the diagnosis of MDAs.
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Affiliation(s)
- Todd D Deutch
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Bocca SM, Oehninger S, Abuhamad AZ. Detection of transient postoperative changes in the endometrial cavity by 3-dimensional ultrasonography after hysteroscopic correction of various uterine anomalies. J Ultrasound Med 2008; 27:461-465. [PMID: 18314524 DOI: 10.7863/jum.2008.27.3.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this series was to prospectively evaluate early postoperative intrauterine changes by 3-dimensional ultrasonography (3DUS) in patients undergoing hysteroscopic correction of various uterine anomalies. METHODS Thirty consecutive patients with a diagnosis of an anomaly of the uterine cavity who underwent hysteroscopic correction were studied. Patients had transvaginal 3DUS to display the midcoronal view of the uterus immediately before and 1 and 2 months after hysteroscopy. The presence of postoperative changes and the pregnancy outcomes (either spontaneous or after assisted reproduction) in the subsequent 6 months after hysteroscopy were recorded. RESULTS Postoperative changes 1 month after hysteroscopy were detected by 3DUS in 20% (6/30) of these patients. The changes detected consisted of intrauterine cystic loculations in 3 patients and endometrial irregularities/possible mucus accumulations in the other 3. These loculations and irregularities were sometimes larger and more complex in nature than the original lesions and always coincided with the resection site. These changes resolved spontaneously after the second postoperative month and did not interfere with embryo implantation or cause pregnancy loss in patients attempting to conceive during the study period. CONCLUSIONS Patients who underwent hysteroscopic correction of various anomalies of the uterine cavity had immediate postoperative findings when imaged by 3DUS that were transient and of no clinical relevance. These transient and self-resolving ultrasonographic changes did not affect the patients' reproductive capacity.
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Affiliation(s)
- Silvina M Bocca
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 601 Colley Ave, Norfolk, VA 23507, USA.
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