Publications (153) View all
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Article: Letter to the editor.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2013; 32(4):725. · 1.25 Impact Factor -
Article: Fetal sex and intrauterine growth patterns.
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ABSTRACT: Objectives- To analyze the effect of fetal sex on intrauterine growth patterns during the second and third trimesters. Methods- We conducted a cross-sectional study of women with uncomplicated singleton pregnancies who underwent sonographic fetal weight estimation during the second and third trimesters in a single tertiary center. The effect of fetal sex on intrauterine growth patterns was analyzed for each of the routine fetal biometric indices (biparietal diameter, head circumference, occipitofrontal diameter, abdominal circumference, and femur length) and their ratios. Sex-specific regression models were generated for these indices and their ratios as a function of gestational age. Sex-specific growth curves were generated from these models for each of the biometric indices and their ratios for gestational weeks 15 to 42. Results- Overall, 12,132 sonographic fetal weight estimations were included in the study. Fetal sex had an independent effect on the relationship between each of the biometric indices and their ratios and gestational age. These effects were most pronounced for biparietal diameter (male/female ratio, 1.021) and the head circumference/femur length and biparietal diameter/femur length ratios (male/female ratios, 1.014 and 1.016, respectively). For the head measurements, these sex-related differences were observed as soon as the early second trimester, whereas for abdominal circumference, the differences were most notable during the late second and late third trimesters. Conclusions- Female fetuses grow considerably slower than male fetuses, and these differences are observed from early gestation. However, the female fetus is not merely a smaller version of the male fetus, but, rather, there is a sex-specific growth pattern for each of the individual fetal biometric indices. These findings provide support for the use of sex-specific sonographic models for fetal weight estimation as well as the use of sex-specific reference growth charts.Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2013; 32(1):35-43. · 1.25 Impact Factor -
Article: Psychological response to multifetal reduction and pregnancy termination due to fetal abnormality.
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ABSTRACT: Objective: To investigate the emotional response in cases of multifetal reduction and pregnancy termination and to compare the psychological response between these two groups. Methods: A prospective study in a tertiary-care, university-affiliated medical center. The study group included 65 women who had been advised to terminate pregnancy because of a finding of a severe fetal abnormality on ultrasound screening (pregnancy termination group) and 41 women advised to undergo reduction because of the presence of multiple fetuses (multifetal reduction group). All women underwent psychological testing using validated questionnaires addressing perinatal grief and anxiety levels. Results: Women in both the multifetal reduction and the pregnancy termination groups reported significant degree of grief and anxiety before and after the procedure, although the levels of anxiety on the day of procedure and anxiety and grief at follow up were higher in the pregnancy termination group (t = 2.438, p = 0.016; t = 2.441, p = 0.017; and t = 3.111, p = 0.03, respectively). In both groups there was a gradual decrease in the state anxiety with time (48.01 ± 8.26 to 37.59 ± 9.23; t = -9.931; p < 0.001). Several factors affected the emotional response in the cases, including marital status, level of education, employment status, and gestational age. There was no association between a history of prior perinatal loss and emotional response. Conclusion: There is need for a continuing psychosocial support of women undergoing multifetal reduction and pregnancy termination for fetal abnormalities.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2012; · 1.36 Impact Factor -
Article: Labor induction with prostaglandin E2: characteristics of response and prediction of failure.
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ABSTRACT: Objective: To characterize the response to labor induction with prostaglandin E2 (PGE2) and to identify risk factors for induction failure. Methods: A prospective controlled study of women admitted for labor induction with PGE2. Maternal characteristics, Bishop score and sonographic cervical length were documented at admission. The change in cervical characteristics and the emergence of uterine contractions following each application of PGE2 were analyzed. Results: Of the 88 women who were included in the study, 19 (21.6%) failed to response to PGE2. The following factors were independently associated with induction failure: nulliparity (odds ratio [OR] = 5.9, 95% confidence interval (CI): 1.2-30.2), pre-pregnancy body mass index >25 kg/m2 (OR = 5.4, 95% CI: 1.1-26.5), Bishop score <4 (OR = 2.3, 95% CI: 1.05-14.4), cervical length <25 mm (OR = 0.2, 95% CI: 0.1-0.8) and the development of uterine contractions in response to the first application of PGE2 (OR = 0.4, 95% CI: 0.1-0.93). Overall, most women required only one (60.9%) or two (85.5%) applications of PGE2 to achieve successful induction. The number of applications of PGE2 required to achieve successful induction was related to parity and cervical status at presentation. Conclusions: Overall, most women who eventually respond to PGE2 do so following the first two applications of PGE2, and the contribution of subsequent applications is relatively small and related to cervical status at admission.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 08/2012; · 1.36 Impact Factor -
Article: Early first-trimester crown-rump length measurements in male and female singleton fetuses in IVF pregnancies.
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ABSTRACT: Objectives: The generally higher birth-weight of male newborns compared to female newborns is attributed mainly to intrauterine exposure to testosterone. We aimed to determine if crown-rump length (CRL) differs between male and female fetuses early in the first trimester. Methods: A retrospective cohort study of 333 women with nondiabetic singleton IVF pregnancies attending a single university-affiliated tertiary medical center in 2000-2007 who underwent CRL measurement before 50 days of pregnancy (date of measurement minus oocyte retrieval date plus 14 days). Data on pregnancy outcome, including fetal sex, were collected by routine follow-up telephone interview and combined with the delivery data. Results: There were 169 female and 164 male fetuses according to the reported fetal sex at delivery. Most of the CRL measurements (68.7%) were performed at an actual gestational age of 43-45 days. On linear regression analysis, male fetal sex was a significant (p = 0.011) predictor of larger CRL: CRL (mm) = -23.851 + GA (days) × 0.621 + 0.334 × Sex (F = 1, M = 2), R(2) = 0.512, p <0.001. A general linear model, adjusted for gestational age (40-50 days), revealed that mean CRL was significantly higher in male than in female fetuses (4.58 ± 0.09 mm, [95% CI: 4.3-4.7] vs 4.24 ± 0.09 mm [4.0-4.4]; p < 0.001). Conclusions: Male fetuses are larger than female fetuses in the early first trimester. Given that gonadal differentiation has not yet occurred, still unidentified nonhormonal factors are apparently responsible for this difference.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 07/2012; · 1.36 Impact Factor
