Robin B Kalish

Weill Cornell Medical College, New York City, New York, United States

Are you Robin B Kalish?

Claim your profile

Publications (96)242.23 Total impact

  • Stephen T Chasen, Robin B Kalish
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: A significant proportion of second-trimester abortions are done for fetal anomalies. Our objective was to evaluate the impact of ultrasound at <14 weeks on the gestational age at abortion for structural fetal abnormalities. STUDY DESIGN: Retrospective review identified all patients undergoing abortion following sonographic diagnosis of structural fetal anomalies at a single institution from 2004-2011. First-trimester ultrasound findings were reviewed, and abnormalities were categorized as "diagnostic" or "nondiagnostic." Chi-square analysis and Mann-Whitney U test were used for statistical comparison. RESULTS: One hundred thirty-two patients who underwent abortion due to structural fetal abnormalities were included, 109 of whom underwent ultrasound at 11-13 weeks. In those scanned at <14 weeks, there were diagnostic findings in 36 cases (33.0%) and abnormal nuchal translucency or other nondiagnostic finding leading to early second-trimester ultrasound in 16 cases (14.7%). In those scanned at <14 weeks, median gestational age at abortion was earlier compared to those who underwent initial anatomic evaluation in the second trimester, 19 weeks (13.5-21) versus 21 weeks (19-22), p=.001. CONCLUSION: Ultrasound at <14 weeks was associated with an earlier gestational age at abortion in pregnancies with structural fetal abnormalities.
    Contraception 10/2012; · 3.09 Impact Factor
  • Robin B. Kalish, Blair Chance, Stephen T. Chasen
    American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2011; 204(1).
  • Stephen T. Chasen, Robin B. Kalish
    American Journal of Obstetrics and Gynecology 12/2009; 201(6). · 3.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate the impact of restrictive versus routine use of "detailed" second-trimester sonography. Records of singleton pregnancies undergoing evaluation from 2004 to 2008 were reviewed. A detailed examination (Current Procedural Terminology [CPT] code 76811) was routinely performed on all patients. Major structural abnormalities were categorized on the basis of whether the structure would be included in a "basic" examination (CPT code 76805). Risk factors for anomalies were identified. The Fisher exact test and Student t test were used for statistical comparison. Major anomalies were identified in 218 patients, 75 of whom elected to undergo abortion. In 88 patients (40.4%), the abnormal structure would not be included in a basic examination. Risk factors were not more prevalent in those with anomalies requiring a detailed examination for diagnosis or in those patients who chose to undergo abortion. Restricting detailed evaluation to those with risk factors would have prevented detection of a substantial proportion of anomalies.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2009; 28(8):1015-8. · 1.40 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the relationship between levels of first-trimester serum analytes used in aneuploidy risk assessment and obstetric outcomes in twin pregnancy. Twin pregnancies undergoing first-trimester risk assessment from 2003 to 2005 were identified. Pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) were measured at 9-14 weeks. The association between extreme biochemical values (< 5th and > 95th percentile) and adverse outcomes was examined. Fisher's exact test and Mann-Whitney U were used for comparison. A total of 326 pregnancies were included. Median maternal age was 35 years. Median gestational age at delivery was 36 weeks. There were no significant associations between extreme free beta-hCG or high PAPP-A values and the rates of any adverse outcomes. Low PAPP-A (< 0.52 multiples of the median) was associated with higher rates of discordant growth (50% vs. 13%; p = 0.001) and hypertensive disorders of pregnancy (41.2% vs. 15.5%, p = 0.01). In twin pregnancies, low PAPP-A is associated with discordant growth and hypertensive disorders.
    The Journal of reproductive medicine 05/2009; 54(5):312-4. · 0.75 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2009; 201(6).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the study was to estimate practice patterns regarding bed rest in women with preterm premature rupture of membranes (PPROM) and arrested preterm labor. This was a mail-based survey of all Society for Maternal-Fetal Medicine members in the United States asking whether they would recommend bed rest in the setting of arrested preterm labor or PPROM at 26 weeks. Bed rest was defined as no more than 1-2 hours per day out of bed, with permitted activities including bathroom use, bathing, and brief ambulation inside the home/hospital. Seventy-one percent and 87% would recommend bed rest for women with cervical dilation and arrested preterm labor and women with PPROM, respectively, even though the majority believed bed rest was associated with minimal or no benefit. Female sex, nonacademic practice, and practice location in the South or West were independently associated with the recommendation for bed rest. Despite the belief that bed rest is associated with minimal or no benefit, most maternal-fetal medicine specialists recommend bed rest for arrested preterm labor and PPROM. Randomized, prospective trials are needed to evaluate the efficacy of bed rest in these settings.
    American journal of obstetrics and gynecology 12/2008; 200(2):165.e1-6. · 3.28 Impact Factor
  • American Journal of Obstetrics and Gynecology 12/2008; 199(6). · 3.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate maternal-fetal medicine specialists' practice patterns and perceived risks and benefits to tocolysis. We performed a mail-based survey of all Society for Maternal-Fetal Medicine (SMFM) members in the United States. Subjects were asked whether they would recommend tocolysis and what would be their first-line tocolytic in five scenarios: 1) acute preterm labor; 2) maintenance tocolysis after arrested preterm labor; 3) repeat acute preterm labor; 4) preterm premature rupture of membranes (PROM) without contractions; and 5) preterm PROM with contractions. A total of 827 (46%) SMFM members responded. Ninety-six percent, 56%, 56%, 32%, and 29% would recommend tocolysis for acute preterm labor, repeat acute preterm labor, preterm PROM with contractions, preterm PROM without contractions, and maintenance tocolysis, respectively. The most common first-line tocolytic was magnesium for acute preterm labor (45%) and repeat acute preterm labor (41%); nifedipine was the most common maintenance tocolysis (79%). Eighty percent believed tocolysis was associated with moderate or significant benefit in the setting of acute preterm labor; however, fewer than 50% responded similarly for the other four scenarios. In all five scenarios, more than 50% of respondents indicated there was minimal or no risk associated with tocolysis. Having a nonacademic practice was independently associated with the recommendation for tocolysis. Almost all maternal-fetal medicine specialists recommend tocolysis in the setting of acute preterm labor, and many recommend tocolysis for other indications. Magnesium and nifedipine are the most commonly prescribed first-line tocolytics. III.
    Obstetrics and Gynecology 08/2008; 112(1):42-7. · 4.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We have recently identified three salient questions within the patient choice cesarean delivery controversy. First, is performing cesarean delivery on maternal request consistent with good professional medial practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? Third, should patient choice cesarean delivery be routinely offered to all pregnant women? In a well informed patient, performing a cesarean delivery on maternal request is medically and ethically acceptable. Physicians, as patient advocates and promoters of overall health and welfare of their patients, however, should, in the absence of an accepted medical indication, recommend against medically unindicated cesarean delivery. While we believe that current evidence supports a physician's decision to accede to an informed patient's request for such a delivery, it does not follow that obstetricians should routinely offer elective cesareans to all patients. When a patient makes a request for an elective cesarean delivery, obstetricians, in their capacity as patient advocate, must help guide their patient through the labyrinth of detailed medical information toward a decision that respects both the patient's autonomy and the physician's obligation to optimize the health of both the mother and the newborn.
    Current Opinion in Obstetrics and Gynecology 05/2008; 20(2):116-9. · 2.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prematurity is the leading cause of infant morbidity and mortality. Altered intra-amniotic levels of anti-inflammatory cytokines, interleukin (IL) 1ra and IL-4, and beta2-adrenergic receptor (beta2AR) production have been associated with preterm labor and delivery. The aim of this study was to evaluate potential associations of polymorphisms in these genes with specific placental pathological findings. Maternal and fetal DNA were analyzed for a length polymorphism in the IL-1ra gene and for single nucleotide polymorphisms in the IL-4 and beta2AR genes. Placentas were evaluated for pathological abnormalities in the following major categories: meconium, malperfusion, acute deciduitis, chorioamnionitis, umbilical cord problems, villitis, and fetal vascular thrombosis. In fetal DNA, homozygosity for the IL-1ra 2 allele (P = 0.029) and carriage of the IL-4 T allele (P < 0.01) were associated with acute deciduitis. In addition, carriage of the beta2AR A allele (P = 0.036) was associated with umbilical cord problems. There were no associations between placental lesions and any maternal gene polymorphisms. Although susceptibility to premature delivery is multifactorial, the present study provides pathological evidence for a connection between specific alleles and placental abnormalities. Carriage of these alleles may render the fetus more susceptible to the adverse consequences of infection and inflammation.
    International Journal of Gynecological Pathology 02/2008; 27(1):79-85. · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is limited evidence supporting the effectiveness of history-indicated cerclage in preventing spontaneous pregnancy loss or preterm birth. This study was undertaken to estimate the practice patterns of maternal-fetal medicine specialists in regards to history-indicated cerclage. We performed a mail-based survey of all SMFM specialists in the US. Subjects were asked whether they would recommend a history-indicated cerclage at 12-14 weeks in a patient whose prior pregnancy was her first pregnancy and ended in a spontaneous, painless loss at 19 weeks with no identifiable cause. A total of 827 (46%) of SMFM members responded of which 75% would recommend a history-indicated cerclage for this patient. Twenty-one percent would not recommend one, but would place one if desired by the patient. Only 4% would not place a history-indicated cerclage in this scenario. A total of 71% believed a history-indicated cerclage was associated with moderate or significant benefit, and 89% believed it involved minimal or no risk. Female gender, non-academic practice, practicing in the southern region and greater interval since residency training were all independently associated with the recommendation for a history-indicated cerclage. Despite limited level-I evidence supporting its use, a history-indicated cerclage is recommended by most maternal-fetal medicine specialists.
    Journal of Perinatal Medicine 01/2008; 36(6):513-7. · 1.95 Impact Factor
  • Shira Fishman, Robin B. Kalish, Stephen T. Chasen
    American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2008; 199(6).
  • Robin B. Kalish, Rachel Moquete, Stephen T. Chasen
    American Journal of Obstetrics and Gynecology 01/2008; 199(6). · 3.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Our objective was to describe performance of first-trimester combined risk assessment in twin pregnancies. Twin pregnancies that underwent risk assessment in our ultrasound unit from 2003-2006 were included. Adjusted risks for trisomies 21 and 18 that were based on age, nuchal translucency (NT), and biochemistry were provided for each twin. Detection rates for Down syndrome and trisomy 18 were calculated for age/NT, and age/NT/biochemistry at a screen-positive rate of 5% of pregnancies. Five hundred thirty-five pregnancies were included. Median maternal age was 34 years, with 47% of women > or = 35 years old. There were 7 fetuses in 6 dichorionic pregnancies with Down syndrome and 3 fetuses in 3 pregnancies with trisomy 18. For a 5% false-positive rate, age/NT identified 83.3% of Down syndrome and 66.7% of Trisomy 18 pregnancies. Adding biochemistry resulted in 100% detection rates for both conditions. The addition of biochemistry may enhance first-trimester risk assessment in twin pregnancies. Further studies with larger numbers of affected pregnancies are needed.
    American journal of obstetrics and gynecology 11/2007; 197(4):374.e1-3. · 3.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prostaglandin levels vary during pregnancy, mostly under the control of the inducible enzyme cyclooxygenase-2 (COX-2). The expression of COX-2 has been associated with ischemic events in the heart and brain, but its direct effect on human placental perfusion has not been previously examined. The purpose of this study was to investigate whether a functional polymorphism in the COX-2 gene that controls enzyme expression levels is associated with placental histopathologic lesions. Maternal and neonatal DNA from twin gestations were analyzed by a polymerase chain reaction-based assay for a single G to C nucleotide polymorphism at position -765 in the COX-2 gene promoter. Placental histopathology was evaluated in 6 major categories: meconium, malperfusion, inflammation, umbilical cord problems, villitis, and thrombosis. There was no significant association between placental histopathologic findings and polymorphisms of the COX-2 gene in the mother. In the fetus, carriage of the COX-2 C allele, which is correlated with decreased COX-2 gene expression, was negatively associated with lesions of placental ischemia/malperfusion (P = 0.02). Placental ischemic lesions were positively associated with intrauterine growth restriction (IUGR; P < 0.001). No other group of histopathologic lesions was associated with fetal polymorphisms in the COX-2 gene or with IUGR. Thus, a fetal polymorphism in the COX-2 gene influences the occurrence of placental malperfusion and ischemia, which may be of sufficient severity to promote or allow the development of IUGR.
    International Journal of Gynecological Pathology 08/2007; 26(3):284-90. · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The current controversy concerning patient choice cesarean delivery potentially affects all women of child-bearing age and the physicians who care for them. The purpose of this paper is to address three salient issues within the patient choice cesarean delivery controversy. First, is performing patient choice cesarean delivery consistent with good professional medical practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? And, third, should patient choice cesarean delivery be routinely offered to all pregnant women?
    Journal of Perinatal Medicine 02/2007; 35(6):478-80. · 1.95 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2007; 197(6).
  • American Journal of Obstetrics and Gynecology 12/2006; 195(6). · 3.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the study was to determine whether spontaneous reduction in in vitro fertilization pregnancies results in outcomes comparable with in vitro fertilization singleton pregnancies or ongoing twin pregnancies. Women with in vitro fertilization pregnancies from 2003 to 2005 who had first-trimester ultrasound and delivered in our hospital were identified. Those with documented reduction from dichorionic twins to a single viable fetus at 14 weeks or less were categorized as spontaneous reduction pregnancies and were compared with dichorionic twin and singleton pregnancies without reduction. One hundred sixty-eight singleton, 55 spontaneous reduction, and 86 twin pregnancies were included. Gestational age at delivery was similar in the singleton and spontaneous reduction groups; twins delivered significantly earlier. Spontaneous reduction was associated with lower birth weight than other singleton pregnancies (median 3062 g versus 3425 g; P = .005). The rate of pre-eclampsia was higher in pregnancies with spontaneous reduction, compared with other singleton pregnancies 9.3% versus 2.4%; P = .04). Spontaneous reduction of a twin to a singleton pregnancy is associated with prolonged gestation and higher birth weight for the remaining fetus.
    American journal of obstetrics and gynecology 10/2006; 195(3):814-7. · 3.28 Impact Factor

Publication Stats

651 Citations
242.23 Total Impact Points

Institutions

  • 2002–2012
    • Weill Cornell Medical College
      • Department of Obstetrics and Gynecology
      New York City, New York, United States
  • 2003–2009
    • Cornell University
      • Department of Obstetrics and Gynecology
      Ithaca, NY, United States
  • 2007
    • New York Presbyterian Hospital
      New York City, New York, United States
  • 2004
    • Thomas Jefferson University
      • Department of Obstetrics & Gynecology
      Philadelphia, PA, United States