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Gonzalez JM, Harris I, Jimenez Ramirez N, Myers D, Killion M, Thiet MP, Bianco K. Maternal cardiac disease and perinatal outcomes in a single tertiary care center. J Matern Fetal Neonatal Med 2023; 36:2223336. [PMID: 37369374 DOI: 10.1080/14767058.2023.2223336] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE Maternal mortality in the U.S. has increased, with a substantial contribution from maternal cardiac disease. As a result of improved childhood survival, more women with congenital heart disease are reaching reproductive age leading to a growing high-risk obstetric population. We sought to determine the obstetrical and neonatal outcomes of women with maternal cardiac disease, including acquired cardiovascular disease and congenital heart disease. METHODS We studied a retrospective cohort study of women that delivered from 2008 to 2013 (N = 9026). Singleton pregnancies without preexisting conditions were established as the unexposed group for this study. Maternal and neonatal outcomes were compared between the unexposed group (N = 7277) and women exposed to maternal (acquired or congenital) cardiac disease (N = 139) as well as only congenital heart disease (N = 85). Statistical comparisons used univariate/multivariable logistic and linear regression analysis controlling for confounders with p < .05 and 95% confidence intervals indicating statistical significance. RESULTS Pregnancies complicated by maternal cardiac disease were associated with increased odds of preterm birth (<34 weeks, <37 weeks), intrauterine growth restriction (IUGR), need for assisted vaginal delivery, maternal ICU admission, and prolonged maternal hospitalization (>7 d). Neonatal outcomes including small for gestational age and Apgar score <7 at 5 min were increased in the pregnancies complicated by maternal cardiac disease. When pregnancies complicated by congenital heart disease were analyzed as a sub-group of the cohort, the results were similar. There were increased odds of preterm birth (<37 weeks), early-term delivery, need for assisted vaginal delivery, and prolonged hospitalization. Neonatal outcomes were only significant for small for gestational age. CONCLUSION We observed that in a select cohort of pregnancies complicated by maternal cardiac diseases (acquired or congenital), there were significant increases of adverse perinatal outcomes. Therefore, a multidisciplinary approach including maternal-fetal medicine specialists, cardiologists, obstetric anesthesia, and dedicated ancillary support is imperative for optimal care of this high-risk obstetrics population.
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Affiliation(s)
- Juan M Gonzalez
- Division of Maternal-Fetal Medicine and Perinatal Genetics, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA
| | - Ian Harris
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Dana Myers
- Division of Maternal-Fetal Medicine, Sutter West Bay Medical Group, San Francisco, CA, USA
| | - Molly Killion
- Division of Maternal-Fetal Medicine and Perinatal Genetics, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA
| | - Mari-Paule Thiet
- Division of Maternal-Fetal Medicine and Perinatal Genetics, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA
| | - Katherine Bianco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
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Panelli DM, Leonard SA, Joudi N, Judy AE, Bianco K, Gilbert WM, Main EK, El-Sayed YY, Lyell DJ. Clinical and Physician Factors Associated With Failed Operative Vaginal Delivery. Obstet Gynecol 2023; 141:1181-1189. [PMID: 37141591 PMCID: PMC10440297 DOI: 10.1097/aog.0000000000005181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/02/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To examine clinical and physician factors associated with failed operative vaginal delivery among individuals with nulliparous, term, singleton, vertex (NTSV) births. METHODS This was a retrospective cohort study of individuals with NTSV live births with an attempted operative vaginal delivery by a physician between 2016 and 2020 in California. The primary outcome was cesarean birth after failed operative vaginal delivery, identified using linked diagnosis codes, birth certificates, and physician licensing board data stratified by device type (vacuum or forceps). Clinical and physician-level exposures were selected a priori, defined using validated indices, and compared between successful and failed operative vaginal delivery attempts. Physician experience with operative vaginal delivery was estimated by calculating the number of operative vaginal delivery attempts made per physician during the study period. Multivariable mixed effects Poisson regression models with robust standard errors were used to estimate risk ratios of failed operative vaginal delivery for each exposure, adjusted for potential confounders. RESULTS Of 47,973 eligible operative vaginal delivery attempts, 93.2% used vacuum and 6.8% used forceps. Of all operative vaginal delivery attempts, 1,820 (3.8%) failed; the success rate was 97.3% for vacuum attempts and 82.4% for forceps attempts. Failed operative vaginal deliveries were more likely with older patient age, higher body mass index, obstructed labor, and neonatal birth weight more than 4,000 g. Between 2016 and 2020, physicians who attempted more operative vaginal deliveries were less likely to fail. When vacuum attempts were successful, physicians who conducted them had a median of 45 vacuum attempts during the study period, compared with 27 attempts when vacuum attempts were unsuccessful (adjusted risk ratio [aRR] 0.95, 95% CI 0.93-0.96). When forceps attempts were successful, physicians who conducted them had a median of 19 forceps attempts, compared with 11 attempts when forceps attempts were unsuccessful (aRR 0.76, 95% CI 0.64-0.91). CONCLUSION In this large, contemporary cohort with NTSV births, several clinical factors were associated with operative vaginal delivery failure. Physician experience was associated with operative vaginal delivery success, more notably for forceps attempts. These results may provide guidance for physician training in maintenance of operative vaginal delivery skills.
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Affiliation(s)
- Danielle M Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, the Department of Obstetrics and Gynecology, Sutter Medical Center, Sacramento, and the California Maternal Quality Care Collaborative, Palo Alto, California
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Minor KC, Mayo JA, Bianco K, Judy A, Abir G, Lee HC, Leonard SA, Sie L, Ayotte S, Daniels KI. A novel virtual simulation training improves providers’ knowledge and confidence to manage obstetric emergencies. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.308] [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: 01/09/2023]
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Darmawan KF, Panelli DM, Mayo JA, Leonard SA, Girsen A, Carmichael SL, Bianco K. Severe maternal morbidity among people with cardiac disease: getting to the heart of the problem. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.314] [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: 01/09/2023]
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Panelli DM, Mayo JA, Wong RJ, Becker M, Maric I, Wu E, Gotlib IH, Aghaeepour N, Druzin ML, Stevenson DK, Shaw GM, Bianco K. Shorter maternal leukocyte telomere length following cesarean birth: Implications for future research. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.790] [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: 01/09/2023]
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Panelli DM, Diwan M, Cruz GI, Leonard SA, Chueh J, Gotlib IH, Bianco K. An exploratory analysis of leukocyte telomere length among pregnant and non-pregnant people. Brain Behav Immun Health 2022; 25:100506. [PMID: 36110146 PMCID: PMC9467886 DOI: 10.1016/j.bbih.2022.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022] Open
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Parameshwar PS, Bianco K, Sherwin EB, Meza PK, Tolani A, Bates P, Sie L, López Enríquez AS, Sanchez DE, Herrarte ER, Daniels K. Mixed methods evaluation of simulation-based training for postpartum hemorrhage management in Guatemala. BMC Pregnancy Childbirth 2022; 22:513. [PMID: 35751071 PMCID: PMC9229498 DOI: 10.1186/s12884-022-04845-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background To assess if simulation-based training (SBT) of B-Lynch suture and uterine balloon tamponade (UBT) for the management of postpartum hemorrhage (PPH) impacted provider attitudes, practice patterns, and patient management in Guatemala, using a mixed-methods approach. Methods We conducted an in-country SBT course on the management of PPH in a governmental teaching hospital in Guatemala City, Guatemala. Participants were OB/GYN providers (n = 39) who had or had not received SBT before. Surveys and qualitative interviews evaluated provider knowledge and experiences with B-Lynch and UBT to treat PPH. Results Multiple-choice surveys indicated that providers who received SBT were more comfortable performing and teaching B-Lynch compared to those who did not (p = 0.003 and 0.005). Qualitative interviews revealed increased provider comfort with B-Lynch compared to UBT and identified multiple barriers to uterine balloon tamponade implementation. Conclusions Simulation-based training had a stronger impact on provider comfort with B-Lynch compared to uterine balloon tamponade. Qualitative interviews provided insight into the challenges that hinder uptake of uterine balloon tamponade, namely resource limitations and decision-making hierarchies. Capturing data through a mixed-methods approach allowed for more comprehensive program evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04845-2.
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Affiliation(s)
| | - Katherine Bianco
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, USA
| | - Elizabeth B Sherwin
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, USA
| | - Pamela K Meza
- Stanford University Medical Center, Stanford, CA, HH333, USA
| | - Alisha Tolani
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, USA
| | - Paige Bates
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, USA
| | - Lillian Sie
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, USA
| | - Andrea Sofía López Enríquez
- Hospital de Gineco Obstetricia, Instituto Guatemalteco de Seguridad Social - Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - Diana E Sanchez
- Stanford University Medical Center, Stanford, CA, HH333, USA
| | - Edgar R Herrarte
- Hospital de Gineco Obstetricia, Instituto Guatemalteco de Seguridad Social - Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - Kay Daniels
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, USA.
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Panelli DM, Leonard SA, Wong RJ, Becker M, Mayo JA, Wu E, Girsen AI, Gotlib IH, Aghaeepour N, Druzin ML, Shaw GM, Stevenson DK, Bianco K. Leukocyte telomere dynamics across gestation in uncomplicated pregnancies and associations with stress. BMC Pregnancy Childbirth 2022; 22:381. [PMID: 35501726 PMCID: PMC9063069 DOI: 10.1186/s12884-022-04693-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Short leukocyte telomere length is a biomarker associated with stress and morbidity in non-pregnant adults. Little is known, however, about maternal telomere dynamics in pregnancy. To address this, we examined changes in maternal leukocyte telomere length (LTL) during uncomplicated pregnancies and explored correlations with perceived stress. METHODS In this pilot study, maternal LTL was measured in blood collected from nulliparas who delivered live, term, singleton infants between 2012 and 2018 at a single institution. Participants were excluded if they had diabetes or hypertensive disease. Samples were collected over the course of pregnancy and divided into three time periods: < 200/7 weeks (Timepoint 1); 201/7 to 366/7 weeks (Timepoint 2); and 370/7 to 9-weeks postpartum (Timepoint 3). All participants also completed a survey assessing a multivariate profile of perceived stress at the time of enrollment in the first trimester. LTL was measured using quantitative polymerase chain reaction (PCR). Wilcoxon signed-rank tests were used to compare LTL differences within participants across all timepoint intervals. To determine whether mode of delivery affected LTL, we compared postpartum Timepoint 3 LTLs between participants who had vaginal versus cesarean birth. Secondarily, we evaluated the association of the assessed multivariate stress profile and LTL using machine learning analysis. RESULTS A total of 115 samples from 46 patients were analyzed. LTL (mean ± SD), expressed as telomere to single copy gene (T/S) ratios, were: 1.15 ± 0.26, 1.13 ± 0.23, and 1.07 ± 0.21 for Timepoints 1, 2, and 3, respectively. There were no significant differences in LTL between Timepoints 1 and 2 (LTL T/S change - 0.03 ± 0.26, p = 0.39); 2 and 3 (- 0.07 ± 0.29, p = 0.38) or Timepoints 1 and 3 (- 0.07 ± 0.21, p = 0.06). Participants who underwent cesareans had significantly shorter postpartum LTLs than those who delivered vaginally (T/S ratio: 0.94 ± 0.12 cesarean versus 1.12 ± 0.21 vaginal, p = 0.01). In secondary analysis, poor sleep quality was the main stress construct associated with shorter Timepoint 1 LTLs (p = 0.02) and shorter mean LTLs (p = 0.03). CONCLUSIONS In this cohort of healthy pregnancies, maternal LTLs did not significantly change across gestation and postpartum LTLs were shorter after cesarean than after vaginal birth. Significant associations between sleep quality and short LTLs warrant further investigation.
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Affiliation(s)
- Danielle M Panelli
- Department of Obstetrics and Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Martin Becker
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Jonathan A Mayo
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Erica Wu
- Department of Obstetrics and Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Anna I Girsen
- Department of Obstetrics and Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Katherine Bianco
- Department of Obstetrics and Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA
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Miller H, Seckel E, White CL, Sanchez D, Rubesova E, Mueller C, Bianco K. Gender-based salary differences in academic medicine: a retrospective review of data from six public medical centers in the Western USA. BMJ Open 2022; 12:e059216. [PMID: 35393330 PMCID: PMC8991058 DOI: 10.1136/bmjopen-2021-059216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We assessed the effect of gender, rank and research productivity on compensation for faculty at academic medical centres. DESIGN A web-based retrospective review of salary for professors in 2016. SETTING Faculty from six state-run, publicly funded academic medical centres in the Western USA. PARTICIPANTS 799 faculty members, 225 assistant (51% women), 200 associate (40% women) and 374 full professors (32% women) from general surgery (26% women), obstetrics and gynaecology (70% women) and radiology (34% women). METHODS Archived online faculty profiles were reviewed for gender, rank and compensation (total, baseline and supplemental). Total compensation was defined as baseline compensation plus supplemental income. Baseline compensation was defined as base salary minus reductions due to participation in the voluntary Employee Reduction in Time and phased retirement programmes. Supplemental income was defined as additional salary for clinical care and research (eg, grants). Elsevier's Scopus was used to collect data on h-index, a measure of research productivity. Linear regression models were estimated to determine the relationship between these factors and salary. RESULTS Total compensation was significantly higher for men across all professorial ranks in both general surgery [Formula: see text] and obstetrics and gynaecology [Formula: see text]. Women faculty members within these departments earned almost US$75 000 less than their men colleagues. The disparity in salary originates from gaps in supplemental income, as baseline compensation was not significantly different between men and women. No significant gender difference in total compensation for radiology was found [Formula: see text]. Higher h-index was associated with higher baseline compensation across all departments as well as with supplemental income for general surgery. Higher h-index was related to lower supplemental income for radiology and was not related to supplemental income for obstetrics and gynaecology. CONCLUSIONS Further investigations should focus on discrepancies in supplemental income, which may preferentially benefit men.
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Affiliation(s)
- Hayley Miller
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Elizabeth Seckel
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Chrislyn L White
- Obstetrics & Gynecology, Kaiser Permanente San Leandro Medical Center, San Leandro, California, USA
| | - Diana Sanchez
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Erika Rubesova
- Department of Radiology, Stanford University, Palo Alto, California, USA
| | - Claudia Mueller
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
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Miller HE, Sie L, Minor KC, Bianco K, Druzin ML, Lee HC, Leonard SA. Preterm twin gestation: The association between severity of small for gestational age and neonatal outcomes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.655] [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: 11/01/2022]
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Miller SE, Contrepois K, Michael B, Cruz G, Simms I, Datoc I, Sylvester K, Silver RM, Einerson BD, Bianco K, Lyell DJ. Metabolic profiling of placental tissue and maternal plasma to identify biomarkers of placenta accreta spectrum. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.071] [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: 11/15/2022]
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Panelli DM, Wang X, Wong RJ, Cruz G, Hong X, Aghaeepour N, Druzin ML, Shaw GM, Zuckerman BS, Stevenson DK, Bianco K. Cellular aging and pregnancy complications: Examining maternal leukocyte telomere length in two diverse cohorts. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1066] [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: 11/28/2022]
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Panelli DM, Sherwin EB, Lee CJ, Leonard SA, Miller SE, Miller HE, Tolani AT, Hoover V, Ansari JR, Khandelwal A, Bianco K. Clinical factors associated with a positive postpartum depression screen in people with cardiac disease during pregnancy. Curr Res Psychiatry 2022; 2:25-29. [PMID: 36570491 PMCID: PMC9788649 DOI: 10.46439/psychiatry.2.027] [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] [Indexed: 12/24/2022]
Abstract
Background While people with cardiac disease are known to be at increased lifetime risk of depression, little is known about postpartum depression rates in this population. Describing rates of positive postpartum depression screens and identifying risk factors that are unique to cardiac patients may help inform risk reduction strategies. Methods This retrospective cohort study included pregnant patients with congenital and/or acquired cardiac disease who delivered at a single institution between 2014 and 2020. The primary outcome was a positive postpartum depression screen, defined as Edinburgh Postpartum Depression Score (EPDS) ≥10. Potential exposures were selected a priori and compared between patients with and without a positive postpartum depression screen using Wilcoxon rank-sum and Fisher's exact tests. Secondary outcomes were responses to a longitudinal follow-up survey sent to English-speaking patients evaluating cardiac status, mental health, and infant development. Results Of 126 eligible cardiac patients, 23 (18.3%) had a positive postpartum depression screen. Patients with a positive postpartum depression screen were more likely to have had antepartum anticoagulation with heparin or enoxaparin (56.5% versus 26.2%, p=0.007), blood transfusion during delivery (8.7% versus 0%, p=0.032), and maternal-infant separation postpartum (52.2% versus 28.2%, p=0.047) compared to patients with a negative screen. Among 29 patients with a positive screen who responded to the follow up survey, 50% reported being formally diagnosed with anxiety or depression and 33.3% reported child development problems. Conclusions Our results highlight the importance of screening for postpartum depression in patients with cardiac disease, especially those requiring antepartum anticoagulation or maternal-infant separation postpartum.
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Affiliation(s)
- Danielle M. Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA,Author for correspondence:
| | - Elizabeth B. Sherwin
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine J. Lee
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie A. Leonard
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah E. Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Hayley E. Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alisha T. Tolani
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie Hoover
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jessica R. Ansari
- Division of Obstetric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Abha Khandelwal
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Bianco
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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Lutz AB, Young-Lin N, Leon-Martinez D, Bianco IC, Seckel E, Mrazek-Pugh B, Bianco K. Measurement of Marginal Placental Cord Insertion by Prenatal Ultrasound Was Found Not to Be Predictive of Adverse Perinatal Outcomes. J Ultrasound Med 2021; 40:2079-2086. [PMID: 33277931 DOI: 10.1002/jum.15586] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/25/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The clinical importance of marginal cord insertion (MCI) is currently controversial. In this study, we examined the association between MCI and adverse perinatal outcomes. We also evaluated the ultrasound-measured distance from the site of placental cord insertion (PCI) to the placental margin (PCI distance) and perinatal outcomes. METHODS This was a retrospective cohort study of MCI and control pregnancies presenting to a single institution between September 2014 and August 2016. Marginal cord insertion was diagnosed on routine anatomy ultrasound scans at 20 weeks' gestation. The primary outcome was fetal intolerance to labor. Secondary outcomes of interest included mode of delivery, gestational age at delivery, Apgar scores at 1 and 5 minutes, birth weight, delivery complications, and neonatal intensive care unit admission. The PCI distance was determined by an ultrasound review. Statistical significance was evaluated by a χ2 analysis, descriptive statistics, Wilcoxon tests, and regression models with log-transformed outcomes, the PCI distance, or both as needed. RESULTS Of 675 abnormal cord insertion cases, we identified 183 that met inclusion criteria. We found no statistically significant association between MCI and fetal intolerance to labor (odds ratio, 1.24 [95% confidence interval, 0.55-2.80]; P = .71) or secondary outcomes. Furthermore, we found no significant correlation between perinatal outcomes and the PCI distance. CONCLUSIONS Our study suggests that MCI pregnancies, regardless of the specific PCI distance, might not be at increased risk of adverse perinatal outcomes. This finding questions the need for heightened antepartum surveillance of this patient population.
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Affiliation(s)
- Amanda Brosius Lutz
- Department of Obstetrics and Gynecology, University Hospital, University of Bern, Bern, Switzerland
| | - Nichole Young-Lin
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | - Daisy Leon-Martinez
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Isabel C Bianco
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | - Elizabeth Seckel
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | - Barbora Mrazek-Pugh
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, USA
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Bianco K, Sherwin EB, Konigshofer Y, Girsen AI, Sylvester KG, Garlick RK. Novel Approaches to Develop Critical Reference Materials for Noninvasive Prenatal Testing: A Pilot Study. J Appl Lab Med 2021; 6:1492-1504. [PMID: 34080621 DOI: 10.1093/jalm/jfab037] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Highly characterized reference materials are required to expand noninvasive prenatal testing (NIPT) for low incidence aneuploidies and microdeletions. The goal of this study was to develop reference materials for the development of next generation circulating cell-free DNA (ccfDNA) assays. METHODS This was a prospective study of pregnancies complicated by positive prenatal genetic screening. ccfDNA was isolated from maternal plasma and amplified. Lymphoblastoid cell lines were prepared from maternal peripheral blood mononuclear cells and fetal cord blood cells. Cells were Epstein-Barr virus immortalized and expanded. Amplified DNA and to a limited extent formulated lymphoblastoid-derived ccfDNA was tested in SNP-based and chromosome counting (CC) based massively parallel sequencing assays. RESULTS Enrolled cases included fetuses with: T21 (2), T18 (1), T18-XXX (1), XYY (1), microdeletions (1), and euploid (2). Three lymphoblastoid cells lines were prepared. Genomic DNA was extracted from cell lines and fragmented to simulate ccfDNA. ccfDNA isolation yielded about 2000 usable genome equivalents of DNA for each case for amplification. Although the sonicated genomic DNA derived from lymphoblastoid cell lines did not yield results compatible with NIPT assays, when blinded, NIPT platforms correctly identified the amplified ccfDNA isolated from blood in the majority of cases. CONCLUSIONS This study showed that maternal blood samples from pregnancies complicated by common chromosomal abnormalities can be used to generate materials for the development and evaluation of NIPT assays.
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Affiliation(s)
- Katherine Bianco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth B Sherwin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Anna I Girsen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl G Sylvester
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Miller HE, Henkel A, Leonard SA, Miller SE, Tran L, Bianco K, Shaw KA. The impact of the COVID-19 pandemic on postpartum contraception planning. Am J Obstet Gynecol MFM 2021; 3:100412. [PMID: 34058421 PMCID: PMC8161810 DOI: 10.1016/j.ajogmf.2021.100412] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The COVID-19 pandemic necessitated rapid adjustment of obstetrical delivery models including fewer antenatal appointments and increased use of telehealth. We hypothesized that an increase in telemedicine and a decrease in antepartum visits owing to the COVID-19 pandemic led to a decreased proportion of people with a postpartum contraception plan at the time of the birth-hospitalization admission and a reduced uptake of top-tier forms of contraception at birth-hospitalization admission and discharge, and the routine postpartum visit, which has otherwise been increasing in recent years.1,2 STUDY DESIGN A retrospective cohort study comparing a randomly selected sample of people giving birth at a large, tertiary referral center during a regional “shelter in place” order, March 16, 2020, to July 31, 2020, with a previously abstracted random sample of people delivering between November 1, 2017, and April 30, 2018, was conducted. This study was reviewed and approved by the Stanford University Institutional Review Board before its initiation. The study was powered to detect a 10% difference in the proportion of those arriving at birth-hospitalization with a contraceptive plan (power 80%, alpha 0.05). The final sample size included 586 people (318 in the pre-COVID cohort and 268 in the COVID cohort). Multivariable modified Poisson regression model was used to estimate the relative risk of arriving at birth-hospitalization with a contraceptive plan in pre-COVID vs COVID cohorts, adjusting for age, parity, insurance status, and delivery mode. Secondary outcomes included tier of contraception plan at admission, discharge, and 6 weeks postpartum (classified by World Health Organization Tiered-Effectiveness3), attendance at postpartum visit, and whether the postpartum visit was conducted via telehealth. Tiered effectiveness was used for this study's purposes because it was hypothesized that telehealth would mostly affect the provision of top-tier forms of contraception that require in-person initiation. Fisher exact test was used to compare the secondary outcomes. RESULTS For the 2 cohorts, the median age was 32 years (range, 17–48 years) and median parity was 1 (range, 0–6). The majority (78%) had private insurance and most commonly identified as non-Hispanic White (38%) and Asian (36%). Baseline demographics did not differ between the cohorts. At birth-hospitalization admission, a smaller proportion of people had a postpartum contraceptive plan in the COVID cohort than in the pre-COVID cohort (73.9% vs 99.4%, adjusted risk ratio, 0.87; 95% confidence interval, 0.84–0.91, P<.001). A smaller proportion of people had a plan for top-tier contraception among the COVID cohort compared with the pre-COVID cohort at both admission and discharge (46.0% vs 71.0%, P<.01 and 31.0% vs 37.9%, P=.05) (Figure). More than 80% of the people attended a routine postpartum visit in both cohorts (P=.30) with 17.7% being telehealth visits in the COVID cohort compared with telehealth not being offered pre-COVID. Among those who attended their postpartum visit, the proportion discharged with a plan for interval top-tier contraception that was fulfilled was high in both groups (76.3% pre-COVID vs 71.2% post-COVID, P=.56). CONCLUSION The study found a significant decrease in people arriving at birth-hospitalization with a contraception plan in the months following a COVID-19 “shelter in place” order when compared with the pre-COVID cohort. It is suspected that changes in the obstetrical service models indirectly deprioritized the most effective forms of postpartum contraception because sterilization requires a signed consent before birth-hospitalization and postplacental intrauterine devices require consent before delivery.4,5 Current state legislation requiring in-person signature to consent for federally funded sterilization remains a barrier. We found that fewer individuals left with top-tier contraception than with plan on admission, especially within the COVID cohort. In addition to clinical contraindications that arise during labor, which preclude placement of an intrauterine device in the postpartum setting, many patients requested an expedited discharge during the peak of the COVID-19 pandemic. As the prenatal care model continues, this transition to adopt virtual visits, reduce visit schedules, and expedite postpartum discharge, actualizing patients’ contraceptive plans is increasingly more dependent on early inpatient provision. Maternity care providers should consider initiating postpartum contraception counseling and completing mandatory consents earlier in the antenatal period. This study is inherently limited by its retrospective nature of review and additional qualitative studies may better characterize this trend in contraceptive uptake. In the meantime, obstetrical care providers should carefully evaluate institutional barriers to postpartum contraception during this movement to telehealth.
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Affiliation(s)
- Hayley E Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Dr. HH333, Stanford, CA 94305.
| | - Andrea Henkel
- Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Stephanie A Leonard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Sarah E Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Linh Tran
- Department of Obstetrics and Gynecology Stanford University School of Medicine San Mateo County Medical Center Stanford, CA
| | | | - Kate A Shaw
- Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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Minor K, Bianco K, Sie L, Druzin ML, Lee HC, Leonard SA. 834 Outcomes in pregnancies complicated by IUGR before 32 weeks: does the degree of SGA matter? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.857] [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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Meza PK, Bianco K, Herrarte E, Daniels K. Changing the landscape of obstetric resident education in low- and middle-income countries using simulation-based training. Int J Gynaecol Obstet 2021; 154:72-78. [PMID: 33314149 DOI: 10.1002/ijgo.13526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/28/2020] [Accepted: 12/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate simulation-based training (SBT) in low- and-middle-income countries (LMIC) and the long-term retention of knowledge and self-efficacy. METHODS We conducted an SBT course on the management of postpartum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) in three government teaching hospitals in Guatemala. We evaluated changes in knowledge and self-efficacy using a multiple-choice questionnaire for 46 obstetrics/gynecology residents. A paired Student's t test was used to analyze changes at 1 week and 6 months after the SBT. RESULTS There was an increase in scores in clinical knowledge of MCA (p < 0. 001, 95% confidence interval [CI] 0.81-1.49) and SD (p < 0.001, 95% CI 0.41-1.02) 1 week after SBT, and a statistically insignificant increase in PPH scores (p = 0.617, 95% CI -0.96 to 0.60). This increase in scores was maintained after 6 months for MCA (p < 0.001, 95% CI 0.69-1.53), SD (p = 0.02 95% CI 0.07-0.85), and PPH (p = 0.04, 95% CI 0.01-1.26). For MCA and SD, the levels of self-efficacy were increased 1 week following training (p < 0.001, 95% CI 0.83-2.30 and p = 0.008, 95% CI 0.60-3.92, respectively), and at 6 months (p < 0.001, 95% CI 0.79-2.42 and p = 0.006, 95% CI 0.66-3.81, respectively). There was a slight increase in PPH self-efficacy scores 1 week after SBT (p = 0.73, 95% CI -6.05 to 4.41), maintained after 6 months (p = 0.38, 95% CI -6.85 to 2.85). CONCLUSION SBT was found to be an effective and feasible method to increase short- and long-term clinical knowledge and self-efficacy of obstetric emergencies in LMIC.
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Affiliation(s)
- Pamela K Meza
- Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Bianco
- Division of Maternal-Fetal Medicine, Stanford University School of Medicine Department of Obstetrics & Gynecology, Stanford, CA, USA
| | - Edgar Herrarte
- Hospital de Gineco Obstetricia, Instituto Guatemalteco de Seguridad Social - Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - Kay Daniels
- Division of Maternal-Fetal Medicine, Stanford University School of Medicine Department of Obstetrics & Gynecology, Stanford, CA, USA
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Igbinosa I, Miller S, Bianco K, Nelson J, Kappagoda S, Blackburn BG, Grant P, Subramanian A, Lyell DJ, El-Sayed YY, Aziz N. Use of remdesivir for pregnant patients with severe novel coronavirus disease 2019. Am J Obstet Gynecol 2020; 223:768-770. [PMID: 32771381 PMCID: PMC7410790 DOI: 10.1016/j.ajog.2020.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Irogue Igbinosa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA.
| | - Sarah Miller
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Katherine Bianco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Joanna Nelson
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Shanthi Kappagoda
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Brian G Blackburn
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Philip Grant
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Aruna Subramanian
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Deirdre J Lyell
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Yasser Y El-Sayed
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Natali Aziz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
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Bryant E, Tsai S, Levin E, Fleischman D, Ansari J, Fischbein M, Bianco K, Khandelwal A. Bicuspid Aortic Valve and Ascending Aortic Aneurysm in a Twin Pregnancy. JACC Case Rep 2020; 2:96-100. [PMID: 34316973 PMCID: PMC8301692 DOI: 10.1016/j.jaccas.2019.12.012] [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] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022]
Abstract
Bicuspid aortic valve with ascending aortic aneurysm is a common condition encountered in pregnancy. There are limited data on how to manage these patients. To our knowledge, we report the only case of a bicuspid aortic valve and aortic aneurysm with twin gestations. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Eryn Bryant
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
| | - Sandra Tsai
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
- Department of Primary Care and Population Health, Stanford School of Medicine, Stanford, California
| | - Eleanor Levin
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
| | - Dominic Fleischman
- Department of Radiology, Stanford School of Medicine, Stanford, California
| | - Jessica Ansari
- Division of Obstetric Anesthesia, Stanford School of Medicine, Stanford, California
| | - Michael Fischbein
- Division of Cardiothoracic Surgery, Stanford School of Medicine, Stanford, California
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Stanford School of Medicine, Stanford, California
| | - Abha Khandelwal
- Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
- Address for correspondence: Dr. Abha Khandelwal, Division of Cardiovascular Medicine, Stanford School of Medicine, 300 Pasteur Drive, H2156 MC 5319, Stanford, California 94305.
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Miller HE, Seckel E, Sanchez D, White C, Mueller C, Bianco K. 553: Impact of gender, rank and research productivity on salary in obstetrics and gynecology. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.569] [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: 11/29/2022]
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Leon-Martinez D, Robinson JF, Zdravkovic T, Genbacev O, Gormley M, Mcmaster M, Fisher SJ, Bianco K. Trisomy 21 is Associated with Caspase-2 Upregulation in Cytotrophoblasts at the Maternal-Fetal Interface. Reprod Sci 2020; 27:100-109. [PMID: 32046398 DOI: 10.1007/s43032-019-00002-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 02/28/2019] [Indexed: 11/26/2022]
Abstract
Impaired placentation is implicated in poor perinatal outcomes associated with Trisomy 21. Earlier studies revealed abnormal cytotrophoblast differentiation along the invasive pathway as a contributing mechanism. To further elucidate the causes, we evaluated Caspase-2 expression at the protein level (immunolocalization and immunoblot) in samples from Trisomy 21 (n = 9) and euploid (n = 4) age-matched placentas. Apoptosis was investigated via the TUNEL assay. An immunolocalization approach was used to characterize Caspase-3, Fas (CD95), and Fas ligand in the same samples. Caspase-2 was significantly overexpressed in Trisomy 21 placentas, with the highest expression in villous cores and invasive cytotrophoblasts. Immunolocalization showed that Caspase-3 had a similar expression pattern as Caspase-2. Using the TUNEL approach, we observed high variability in the number of apoptotic cells in biopsies from different regions of the same placenta and among different placentas. However, Trisomy 21 placentas had more apoptotic cells, specifically in cell columns and basal plates. Furthermore, Caspase-2 co-immunolocalized with Fas (CD95) and FasL in TUNEL-positive extravillous cytotrophoblasts, but not in villous cores. These results help explain the higher levels of apoptosis among placental cells of Trisomy 21 pregnancies in molecular terms. Specifically, the co-expression of Caspase-2 and Caspase-3 with other regulators of the apoptotic process in TUNEL-positive cells suggests these molecules may cooperate in launching the observed apoptosis. Among trophoblasts, only the invasive subpopulation showed this pattern, which could help explain the higher rates of adverse outcomes in these pregnancies. In future experiments, this relationship will be further examined at a functional level in cultured human trophoblasts.
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Affiliation(s)
- Daisy Leon-Martinez
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT, USA
| | - Joshua F Robinson
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Tamara Zdravkovic
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Olga Genbacev
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Matthew Gormley
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Michael Mcmaster
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Susan J Fisher
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Katherine Bianco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, 300 Pasteur Dr. HH333 MC 5317, Stanford, CA, 94305, USA.
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Tolani AT, Do SC, Blumenfeld YJ, Sie L, Girsen AI, Lee CJ, Sherwin EB, Tsur A, El-Sayed YY, Khandelwal A, Bianco K. 819: Care of the pregnant cardiac patient – the importance of a multidisciplinary approach. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.842] [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: 10/27/2022]
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Konigshofer Y, Butler MG, Dickens J, Bianco K, Sylvester KG, Anekella B, Garlick RK. Abstract 5569: Donor-derived circulating cell-free DNA (ccfDNA) reference materials for concordance studies. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5569] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The limited quantities of ccfDNA in plasma can make it difficult to assess the sensitivities and specificities of circulating tumor DNA (ctDNA) assays because there is often insufficient material to confirm the presence or absence of particular mutations by orthogonal assays. Additionally, there have been reports of discordance between different ctDNA assays with patient samples at lower variant allele frequencies (VAF), but the limited amount of material is a bottleneck to investigating the causes of discordance. To overcome this, we developed a method to amplify nanograms of ccfDNA from donors to microgram quantities. As an initial proof of concept, we amplified ccfDNA from pregnant female donors that were known to be carrying either a normal fetus or one with chromosomal abnormalities. These samples were analyzed externally at commercial Non-Invasive Prenatal Testing (NIPT) laboratories and were found to be compatible with both chromosome counting and SNP-based testing, and fetal fraction could also be assessed. In order to evaluate the suitability of amplified ccfDNA for ctDNA assays, we split ccfDNA samples so that part was analyzed as-is by a given ctDNA assay and part was analyzed after amplification. The same amplified material was also analyzed with four different ctDNA assays on different NGS platforms in order to assess concordance between assays in shared regions. Good concordance was seen between variants and their VAFs identified in native and amplified ccfDNA, although increasing amounts of discordant background errors were observed at lower VAF. With the Archer Reveal ctDNA 28 assay, obtaining more unique fragments was associated with obtaining more low VAF background errors that could be offset by obtaining more replicate reads of a given unique fragment. Discordant variants were often C>T (or the corresponding G>A) that can be generated by cytosine deamination, which can occur by heating the sample during PCR for library construction. In conclusion, we have developed a method for amplifying limited amounts of ccfDNA that generates sufficient donor ccfDNA-like material for analysis by multiple assays. This should enable the development, improvement and validation of assays that analyze ccfDNA - and especially ctDNA - because sufficient material can be generated in order to assess sensitivity and specificity using orthogonal assays. Additionally, this should also allow for concordance studies that attempt to analyze the same material at multiple sites and with multiple assays.
Citation Format: Yves Konigshofer, Matthew G. Butler, Jessica Dickens, Katherine Bianco, Karl G. Sylvester, Bharathi Anekella, Russell K. Garlick. Donor-derived circulating cell-free DNA (ccfDNA) reference materials for concordance studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5569.
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Bentley J, Lee H, Lyell D, El-Sayed Y, Ness A, Bianco K, Spiegel A, Blumenfeld Y. 575: Hospital variations in the use of forceps assisted delivery - results from a state-wide analysis. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.102] [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: 11/29/2022]
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Bentley JP, Lee H, Lyell D, El-Sayed Y, Ness A, Bianco K, Yeaton-Massey A, Blumenfeld Y. 574: Neonatal outcomes after operative vaginal delivery - are forceps or vacuum safer? Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.101] [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: 10/18/2022]
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Leon-Martinez D, Ling XB, Hao S, Sylvester K, Bianco K. 254: Gene expression network analysis in aneuploid human trophoblast progenitor cells (TBPC) reveals modular structures. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.182] [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: 11/27/2022]
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Arunamata A, Axelrod DM, Bianco K, Balasubramanian S, Quirin A, Tacy TA. Chronic antepartum maternal hyperoxygenation in a case of severe fetal Ebstein's anomaly with circular shunt physiology. Ann Pediatr Cardiol 2017; 10:284-287. [PMID: 28928616 PMCID: PMC5594941 DOI: 10.4103/apc.apc_20_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/07/2022] Open
Abstract
Perinatal mortality remains high among fetuses diagnosed with Ebstein's anomaly of the tricuspid valve. The subgroup of patients with pulmonary valve regurgitation is at particularly high risk. In the setting of pulmonary valve regurgitation, early constriction of the ductus arteriosus may be a novel perinatal management strategy to reduce systemic steal resulting from circular shunt physiology. We report the use of chronic antepartum maternal oxygen therapy for constriction of the fetal ductus arteriosus and modulation of fetal pulmonary vascular resistance in a late presentation of Ebstein's anomaly with severe tricuspid valve regurgitation, reversal of flow in the ductus arteriosus, and continuous pulmonary valve regurgitation.
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Affiliation(s)
- Alisa Arunamata
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - David M Axelrod
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Sowmya Balasubramanian
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Amy Quirin
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Theresa A Tacy
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
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Henry D, Gonzalez JM, Harris IS, Sparks T, Killion M, Thiet MP, Bianco K. Maternal arrhythmia and perinatal outcomes. J Perinatol 2016; 36:823-7. [PMID: 27309629 PMCID: PMC5045765 DOI: 10.1038/jp.2016.90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether arrhythmia in the setting of maternal cardiac disease (MCD) affects perinatal outcomes. STUDY DESIGN This is a retrospective cohort study of pregnant women with MCD who delivered during 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared with those without. RESULTS Among 143 women, 36 (25%) had an arrhythmia. Those with an arrhythmia were more likely to have a spontaneous vaginal delivery (64 vs 43%, P<0.05) and required fewer operative vaginal births (8 vs 27%, P=0.02). Pregnancies were more likely to be complicated by intrauterine growth restriction (IUGR) (17 vs 5%, P<0.05), although there were no differences in the rate of small for gestational age. The risk of IUGR remained increased after controlling for confounding (adjusted odds ratio 6.98, 95% confidence interval 1.59 to 30.79, P=0.01). Two cases of placental abruption were identified among mothers with arrhythmia while none were identified in the controls (P<0.05). CONCLUSION Patients with arrhythmias were more likely to have a spontaneous vaginal delivery. Our data suggest that these pregnancies were an increased risk for IUGR.
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Affiliation(s)
- Dana Henry
- Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, California
| | - Juan M Gonzalez
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Ian, S. Harris
- Department of Internal Medicine, University of California, San Francisco. San Francisco, California
| | - Teresa Sparks
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Molly Killion
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Mari-Paule Thiet
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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Bianco K, Gormley M, Farrell J, Zhou Y, Oliverio O, Tilden H, McMaster M, Fisher SJ. Cover Image, Volume 36, Issue 9. Prenat Diagn 2016. [DOI: 10.1002/pd.4742] [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: 11/10/2022]
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Bianco K, Gormley M, Farrell J, Zhou Y, Oliverio O, Tilden H, McMaster M, Fisher SJ. Placental transcriptomes in the common aneuploidies reveal critical regions on the trisomic chromosomes and genome-wide effects. Prenat Diagn 2016; 36:812-22. [PMID: 27328057 DOI: 10.1002/pd.4862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/12/2016] [Accepted: 06/17/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Chromosomal aberrations are frequently associated with birth defects and pregnancy losses. Trisomy 13, Trisomy 18 and Trisomy 21 are the most common, clinically relevant fetal aneusomies. This study used a transcriptomics approach to identify the molecular signatures at the maternal-fetal interface in each aneuploidy. METHODS We profiled placental gene expression (13-22 weeks) in T13 (n = 4), T18 (n = 4) and T21 (n = 8), and in euploid pregnancies (n = 4). RESULTS We found differentially expressed transcripts (≥2-fold) in T21 (n = 160), T18 (n = 80) and T13 (n = 125). The majority were upregulated and most of the misexpressed genes were not located on the relevant trisomic chromosome, suggesting genome-wide dysregulation. A smaller number of the differentially expressed transcripts were encoded on the trisomic chromosome, suggesting gene dosage. In T21, <10% of the genes were transcribed from the Down syndrome critical region (21q21-22), which contributes to the clinical phenotype. In T13, 15% of the upregulated genes were on the affected chromosome (13q11-14), and in T18, the percentage increased to 24% (18q11-22 region). CONCLUSION The trisomic placental (and possibly fetal) phenotypes are driven by the combined effects of genome-wide phenomena and increased gene dosage from the trisomic chromosome. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Katherine Bianco
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Gormley
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, USA
| | - Jason Farrell
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, USA
| | - Yan Zhou
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, USA
| | - Oliver Oliverio
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, USA
| | - Hannah Tilden
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.,The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, USA
| | - Michael McMaster
- Department of Cell and Tissue Biology, University of California, San Francisco, CA, USA
| | - Susan J Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA. .,Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA. .,The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, CA, USA.
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Bianco K, Leon-Martinez D, Farrell J, Gormley M, McMaster M, Fisher SJ. 620: Human trophoblast progenitor cell (TBPC) lines derived from aneuploid placentas: studying fundamental aspects of trophoblast biology. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Miranda C, de Filippis I, Pinto L, Coelho-Souza T, Bianco K, Cacci L, Picão R, Clementino M. Genotypic characteristics of multidrug-resistant Pseudomonas aeruginosa
from hospital wastewater treatment plant in Rio de Janeiro, Brazil. J Appl Microbiol 2015; 118:1276-86. [DOI: 10.1111/jam.12792] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/16/2015] [Accepted: 02/24/2015] [Indexed: 11/27/2022]
Affiliation(s)
- C.C. Miranda
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - I. de Filippis
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - L.H. Pinto
- Departamento de Bioquímica; Instituto de Biologia Roberto Alcântara Gomes; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
| | - T. Coelho-Souza
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - K. Bianco
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - L.C. Cacci
- Instituto de Microbiologia Paulo de Góes; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - R.C. Picão
- Instituto de Microbiologia Paulo de Góes; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - M.M. Clementino
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
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Bianco K, Harris I, Henry D, Killion M, Bosco V, Thiet MP, Gonzalez J. 102: Pregnancy complications are increased among women with cardiomyopathy compared to those with other cardiac diseases. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.148] [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: 10/24/2022]
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Farrell J, Tilden H, Zhou Y, Fisher S, Bianco K. 47: Differential expression of Rac1 in common aneuploidies: a model for altered placentation. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.080] [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: 11/27/2022]
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Zhou Y, Gormley MJ, Hunkapiller NM, Kapidzic M, Stolyarov Y, Feng V, Nishida M, Drake PM, Bianco K, Wang F, McMaster MT, Fisher SJ. Reversal of gene dysregulation in cultured cytotrophoblasts reveals possible causes of preeclampsia. J Clin Invest 2013. [DOI: 10.1172/jci72817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zhou Y, Gormley MJ, Hunkapiller NM, Kapidzic M, Stolyarov Y, Feng V, Nishida M, Drake PM, Bianco K, Wang F, McMaster MT, Fisher SJ. Reversal of gene dysregulation in cultured cytotrophoblasts reveals possible causes of preeclampsia. J Clin Invest 2013; 123:2862-72. [PMID: 23934129 PMCID: PMC3999620 DOI: 10.1172/jci66966] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 04/04/2013] [Indexed: 11/17/2022] Open
Abstract
During human pregnancy, a subset of placental cytotrophoblasts (CTBs) differentiates into cells that aggressively invade the uterus and its vasculature, anchoring the progeny and rerouting maternal blood to the placenta. In preeclampsia (PE), CTB invasion is limited, reducing placental perfusion and/or creating intermittent flow. This syndrome, affecting 4%-8% of pregnancies, entails maternal vascular alterations (e.g., high blood pressure, proteinuria, and edema) and, in some patients, fetal growth restriction. The only cure is removal of the faulty placenta, i.e., delivery. Previously, we showed that defective CTB differentiation contributes to the placental component of PE, but the causes were unknown. Here, we cultured CTBs isolated from PE and control placentas for 48 hours, enabling differentiation and invasion. In various severe forms of PE, transcriptomics revealed common aberrations in CTB gene expression immediately after isolation, including upregulation of SEMA3B, which resolved in culture. The addition of SEMA3B to normal CTBs inhibited invasion and recreated aspects of the PE phenotype. Additionally, SEMA3B downregulated VEGF signaling through the PI3K/AKT and GSK3 pathways, effects that were observed in PE CTBs. We propose that, in severe PE, the in vivo environment dysregulates CTB gene expression; the autocrine actions of the upregulated molecules (including SEMA3B) impair CTB differentiation, invasion and signaling; and patient-specific factors determine the signs.
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Affiliation(s)
- Yan Zhou
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Matthew J. Gormley
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Nathan M. Hunkapiller
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Mirhan Kapidzic
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Yana Stolyarov
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Victoria Feng
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Masakazu Nishida
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Penelope M. Drake
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Katherine Bianco
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Fei Wang
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Michael T. McMaster
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
| | - Susan J. Fisher
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell
Research, Center for Reproductive Sciences, Department
of Obstetrics, Gynecology and Reproductive Sciences, Division of
Maternal Fetal Medicine, and Department of Anatomy, UCSF, San Francisco,
California, USA
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Cheng YW, Shaffer BL, Bianco K, Caughey AB. Timing of operative vaginal delivery and associated perinatal outcomes in nulliparous women. J Matern Fetal Neonatal Med 2011; 24:692-7. [DOI: 10.3109/14767058.2010.521872] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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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Bianco K, Haston K, Blumenfeld Y, Chueh J, Zlatnik M, Norton M, Reijo-Pera R. 722: Genomic imprinting in offspring conceived with assisted reproductive technology. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.744] [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: 11/27/2022]
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Bianco K, Gormley M, Goldfien G, Johnson B, McMaster M, Thiet MP, Fisher S. 721: Global gene expression profiling of the maternal-fetal interface in common aneuploidies: identification of gene dosage-dependant phenotypes. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.743] [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: 11/24/2022]
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Gilmore J, Genbacev O, Donne M, Bianco K, Fisher S. 122: Human trophoblast progenitor cell lines: a new tool for studying placental development and more. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.138] [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: 10/18/2022]
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Glenn OA, Bianco K, Barkovich AJ, Callen PW, Parer JT. Fetal cerebellar hemorrhage in parvovirus-associated non-immune hydrops fetalis. J Matern Fetal Neonatal Med 2009; 20:769-72. [PMID: 17763280 DOI: 10.1080/14767050701580960] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report two cases of fetal cerebellar hemorrhage in the setting of parvovirus-associated hydrops fetalis and fetal blood transfusion. In both cases, the cerebellar hemorrhage was diagnosed by fetal magnetic resonance imaging after intrauterine blood transfusion. To our knowledge, this is the first report of fetal cerebellar hemorrhage in the setting of parvovirus-associated hydrops fetalis, and may be the result of cerebrovascular changes both during and after the transfusion.
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Affiliation(s)
- Orit A Glenn
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143-0628, USA.
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Bianco K, Mahutte NG, Arici A, Sakkas D, Taylor HS. Effect of estradiol on oocyte development. Int J Gynaecol Obstet 2008; 104:230-2. [PMID: 19056082 DOI: 10.1016/j.ijgo.2008.10.015] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 10/17/2008] [Accepted: 10/21/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether elevated serum estradiol (E(2)) concentrations in oocyte donors affect assisted reproduction outcome. METHOD In a retrospective cohort study of 58 consecutive oocyte donation cycles, donors were stratified into 2 groups according to E(2) concentration, group 1 (n=32; E(2)<or=2000 pg/mL [range 456-2000 pg/mL]) and group 2 (n=27; E(2)>2000 pg/mL [range, 2062-6957 pg/mL]). Data were analyzed using the t test and chi(2) test. RESULTS Donors in group 1 produced significantly less oocytes than donors in group 2 (19.3+/-1.7 vs 12.0+/-1.4; P<0.001), and recipients of oocytes from group 1 had significantly fewer numbers of embryos available for transfer (10.4+/-1.1 vs 6.4+/-0.8; P=0.003). However, the mean number (3.3) of embryos transferred and the pregnancy rate were the same in both groups. CONCLUSION Elevated estradiol concentration in oocyte donors did not affect pregnancy outcome, suggesting that estradiol levels in donors do not affect oocyte development.
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Affiliation(s)
- Katherine Bianco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California 94143, USA.
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Bianco K, Cheng Y, Fisher S, McMaster M, De La Garza J, Caughey A. 613: Chromosomal abnormalities and the risk for preeclampsia/eclampsia. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.643] [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: 10/21/2022]
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Cheng Y, Bianco K, Kurbisch-Block I, Nakagawa S, Esakoff T, Caughey A. 364: Diabetes in pregnancy: Do different hispanic ethnicities have different outcomes? Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.10.381] [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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Zhou Y, Bianco K, Huang L, Nien JK, McMaster M, Romero R, Fisher SJ. Comparative analysis of maternal-fetal interface in preeclampsia and preterm labor. Cell Tissue Res 2007; 329:559-69. [PMID: 17549520 DOI: 10.1007/s00441-007-0428-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
The maternal-fetal interface, a chimeric structure, is formed when fetal cytotrophoblasts (CTBs) from the placenta invade the uterine wall and its resident vasculature. In preeclampsia (PE), interstitial and endovascular invasion are often shallow, and fewer spiral arterioles are breached in toto. Our previous work has shown that faulty CTB differentiation to an invasive phenotype is a contributing factor. Here, we have tested the hypothesis that the constellation of morphological and molecular defects that are associated with PE are unique to this condition. Specifically, we have compared the histology of the maternal-fetal interface and CTB expression of stage-specific antigens in PE and in preterm labor (PTL) with or without inflammation. In the absence of inflammation, biopsies obtained after PTL were near normal at histological and molecular levels. In accord with previously published data, PE had severe negative effects on the endpoints analyzed. Biopsies obtained after PTL with inflammation had an intermediate phenotype. Our results suggest that the maternal-fetal interface from cases of PTL without inflammation can be used for comparative purposes, e.g., as age-matched controls, in studies of the effects of PE on cells in this region.
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Affiliation(s)
- Yan Zhou
- Department of Cell and Tissue Biology, University of California San Francisco, San Francisco, CA, USA
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Bianco K, Norton ME, Angeles VT, Pera RR. Genomic imprinting disorders and birth defects in pregnancies conceived with assisted reproductive technology (ART). Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.040] [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: 10/23/2022]
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Myers D, Cheng Y, Shaffer B, Kaimal A, Bianco K, Caughey A. Active phase arrest: Who will deliver vaginally? Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.296] [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: 10/23/2022]
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Bianco K, Small M, Julien S, Kershaw T, Michon M, Copel J. Second-trimester ductus venosus measurement and adverse perinatal outcome in fetuses with congenital heart disease. J Ultrasound Med 2006; 25:979-82; quiz 983. [PMID: 16870891 DOI: 10.7863/jum.2006.25.8.979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether Doppler velocimetry of the ductus venosus (DV) predicts adverse perinatal outcome in congenital heart disease (CHD). METHODS We conducted a retrospective cohort study of all pregnant women undergoing fetal echocardiography for CHD in a single perinatal center during a 2-year period. We compared outcomes for fetuses having a diagnosis of CHD in the second trimester and abnormal DV Doppler velocimetric findings with those having CHD and normal DV Doppler findings. Karyotype, gestational age at delivery, fetal loss rate, and rate of termination were assessed. The referral value for an abnormal DV pulsatility index was above the 95th percentile for gestational age. Statistical analysis included the t test, Fisher exact test, and chi(2) test. RESULTS The incidence of CHD in our population was 7%. There were 98 patients with CHD; of those, 31 had DV measurement. A total of 9 patients had an abnormal DV. Three of this group (33%) had intrauterine fetal death or perinatal death. In patients with CHD and normal DV measurements, 83% had living children versus 33% in the group with an abnormal DV (P < .05). There was no statistically significant difference in the rate of aneuploidy between the normal DV (15%) and abnormal DV (20%) groups (P = .65). The mean gestational age at delivery was similar between the normal (37.63 weeks) and abnormal (38.33 weeks) DV groups (P = .71). There was no difference in the rate of pregnancy termination. CONCLUSIONS Abnormal second-trimester DV measurements are predictive of adverse perinatal outcome in patients with CHD, independent of karyotype or gestational age at delivery. This information may have a role in the counseling of parents with CHD.
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Affiliation(s)
- Katherine Bianco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94143, USA.
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Abstract
OBJECTIVE The purpose of this study was to examine the association between history of spontaneous abortion and aneuploidy in a subsequent pregnancy. METHODS This was a retrospective cohort study of women who underwent fetal karyotype analysis with amniocentesis or chorionic villus sampling at a single prenatal diagnosis center. Information on spontaneous abortions, parity, maternal age, ethnicity, type of prenatal diagnosis, and karyotype was assessed. Univariable and multivariable analyses were conducted. RESULTS A total of 46,939 women were included in our analysis. Women with no prior spontaneous abortions had a 1.39% risk for any aneuploidy. In women with one prior spontaneous abortion, this risk increased to 1.67%; for women with 2 previous spontaneous abortions, the risk increased to 1.84%; and for those women who had had 3 or more prior spontaneous abortions, the risk increased further to 2.18% (P < .007). When controlling for maternal age, parity, ethnicity, and mode of prenatal diagnosis and compared with women with no prior spontaneous abortions, women with one prior spontaneous abortion (adjusted odds ratio [AOR] 1.21, 95% confidence interval [CI] 1.01-1.47) or 3 or more prior spontaneous abortions (AOR 1.51, 95% CI 1.02-2.25) had a statistically significant increase in aneuploidy in a subsequent pregnancy. Women with 2 prior spontaneous abortions had an AOR of 1.26 for aneuploidy, but the 95% CI contained unity. CONCLUSION An increased risk of karyotypic abnormality identified at the time of prenatal diagnosis is demonstrated in patients with an increasing number of spontaneous abortions. This study provides information regarding this risk among women presenting for prenatal diagnosis. According to our data, for a woman with an a priori risk of 1 in 300 for Down syndrome, 3 prior spontaneous abortions would increase that risk by 47% to 1 in 204. These results should be confirmed in low-risk populations.
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Affiliation(s)
- Katherine Bianco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94143, USA.
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