Kenneth J Moise

University of Texas Health Science Center at Houston, Houston, Texas, United States

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Publications (138)517.25 Total impact

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    ABSTRACT: The objective of this study was to elucidate the possible toxic effects on the fetal tissues after exposure to two clinically relevant concentrations of granisetron. Primary cells were isolated from human fetal organs of 16-19 weeks gestational age and treated with 3ng/mL or 30ng/mL of granisetron. Cell cycle progression was evaluated by flow cytometry. ELISA was used to detect alterations in major apoptotic proteins. Up to 10% apoptosis in cardiac tissue was observed following treatment with 30ng/mL granisetron. Neither concentration of granisetron caused alteration in cell cycle progression or alterations in apoptotic proteins in any of the other tissues. At 30ng/mL granisetron concentration had the potential to induce up to 10% apoptosis in cardiac tissue; clinical significance needs further evaluation. At granisetron 3ng/mL there was no detectable toxicity or on any fetal tissue in this study. Further research is needed to confirm these preliminary findings and determine if clinically significant. Copyright © 2015 Elsevier Inc. All rights reserved.
    Reproductive Toxicology 03/2015; 53. DOI:10.1016/j.reprotox.2015.02.011 · 2.77 Impact Factor
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    ABSTRACT: Objective To compare the outcomes of dichorionic triamniotic (DCTA) triplet gestations with the outcomes of a paired cohort of monochorionic diamniotic (MCDA) twin gestations undergoing laser therapy for treatment of twin-to-twin transfusion syndrome (TTTS).Methods All DCTA triplets treated at 4 referral centers were included. A matched cohort group of MCDA twin gestations affected by TTTS was used for comparison.Results16 sets of DCTA triplets treated with laser photocoagulation of placental anastomosis were compared to 32 matched sets of MCDA twins. All of the “singleton” fetuses in the triplet gestations survived to birth and to the end of the neonatal period. There were no differences in the single or double survival or the rate of non-survivors to birth and at 28 days of life. A mean 3-week difference was found in the procedure-to-delivery interval in DCTA triplets vs. MCDA twins [60 ± 35.8 days vs. 83.6 ± 33.2 days; p = 0.029]. A mean difference of 3 weeks was also found in the gestational age at delivery in DCTA triplets vs. MCDA twins [28.5 ± 3.5 weeks vs. 31.9 ± 5weeks; p = 0.024]. A similar post-laser fetal growth pattern in donors and recipients of both groups was noted.ConclusionsDCTA triplet gestations with TTTS have a similar rate of post-laser survival but deliver earlier than can be expected for twins treated with laser. These findings have potential implications for prematurity risks and long-term outcomes.
    Ultrasound in Obstetrics and Gynecology 11/2014; 44(5). DOI:10.1002/uog.13369 · 3.14 Impact Factor
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    ABSTRACT: Objective To determine the risk faxtors for spontaneous preterm delivery (sPTD) or preterm premature rupture of membranes <34 weeks gestation after fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS) and to identify the optimal threshold for pre-operative cervical length (CL).Study DesignSecondary analysis of prospectively collected data from 449 patients from 3 fetal centers was analyzed. CL measurements were obtained from pre-operative transvaginal ultrasound, between the gestational ages of 16–26 weeks. The risk factors associated with sPTD <34 weeks was determined using multivariate logistic regression. We excluded patients due to dual fetal demise and maternal or fetal indications for delivery without preterm premature rupture of membranes(n = 63). The optimal threshold for cervical length to predict sPTD <34 weeks was determined using receiver operator characteristics (ROC) curve and Youden index. Additionally, CL threshold for sPTD between 24 to 34 weeks, at every 2 weeks was determined.ResultssPTD <34 weeks occurred in 206 (53.4%) in the included patients. Only the pre-operative CL was significantly associated with sPTD. The pre-operative CL was normally distributed with a mean of 37.6 ± 10.3 mm (range 5–66 mm). Maternal age and parity were positively associated and gestational age at procedure and anterior placenta were negatively associated with cervical length on a multivariate linear regression. The area under the ROC curve for predicting sPTD with CL measurement was 0.61 (p = 0.02) and the optimal threshold was 28 mm with Youden index of 0.20 (sensitivity, and specificity of 92% and 27%, respectively). CL <25-28 mm increased risk for sPTD various all gestational age thresholds.ConclusionsPTD <34 weeks is associated with pre-operative CL < 28 mm. Preventive strategies should focus on this high-risk group.
    Ultrasound in Obstetrics and Gynecology 10/2014; 45(2). DOI:10.1002/uog.14696 · 3.14 Impact Factor
  • Kenneth J Moise
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    ABSTRACT: Until recently, all twin pregnancies were treated in a similar fashion. Ultrasounds were undertaken every 3 to 4 weeks to assess serial fetal growth. Monochorionic (MC) twins comprise only 20% of all twin pregnancies yet unique complications such as twin-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence, twin anemia-polycythemia sequence, and selective intrauterine growth restriction can occur. In addition, the in utero death of one twin of a MC pair poses significant risks for death or severe neurologic morbidity in the cotwin. With the exception of discordant growth, these complications are not seen in dichorionic twinning due to the lack of placental anastomoses. In the last two decades, new technologies such as laser photocoagulation for the treatment of severe TTTS and radiofrequency ablation and bipolar cautery for selective reduction have markedly improved outcomes for many of the complications of MC twins. Thus, stratification of "low-risk" twinning (dichorionic twins) versus "high-risk" twinning (MC twins) is paramount to improved outcomes. This can be easily and accurately accomplished with first trimester ultrasound by evaluating the interface of the intertwin membrane with the placenta. This should now be the standard of care for all multiple gestations.
    American Journal of Perinatology 07/2014; 31. DOI:10.1055/s-0034-1382256 · 1.60 Impact Factor
  • Kenneth J Moise
    American Journal of Perinatology 07/2014; 31. DOI:10.1055/s-0034-1382775 · 1.60 Impact Factor
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    ABSTRACT: The objective of this study was to estimate maternal-fetal transplacental passage of granisetron in an ex vivo placental perfusion model. Term human placentas (N=8) were collected immediately after delivery. A single cotyledon from each placenta was perfused granisetron concentration to mimic systemic maternal peak plasma concentrations following either IV (50ng/mL) or transdermal administration (5ng/mL). To assess drug transfer and accumulation, samples were collected from maternal and fetal compartments. In the 50ng/mL open model, the mean transport fraction was 0.21 ± 0.08 with clearance index of 0.53±0.66. Fetal peak concentrations achieved was 5.6±6.6ng/mL with mean accumulation of 5.35±6.4ng/mL. No drug was detected in the fetal compartment with the 5ng/mL models. Transplacental passage of granisetron was inconsistent at the 50ng/mL concentration that achieved with IV dosing. However, there consistently was no detectable passage in all the placentas evaluated of the granisetron at 5ng/mL concentration that would be achieved after transdermal patch administration.
    Reproductive Toxicology 07/2014; 49. DOI:10.1016/j.reprotox.2014.06.003 · 2.77 Impact Factor
  • Article: Editorial.
    Kenneth J Moise, Susan R Hintz
    American Journal of Perinatology 06/2014; DOI:10.1055/s-0034-1382253 · 1.60 Impact Factor
  • Kenneth J Moise
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    ABSTRACT: The Fetal Treatment Center founded by Michael Harrison is credited as the birthplace of fetal surgery. His trainees in pediatric surgery subsequently founded fetal centers throughout the United States. In Europe, the advent of minimally invasive fetal surgical techniques led to the establishment of treatment centers led predominantly by perinatologists. More recently, perinatologists in North America have begun to play a greater role in the field of fetal intervention.Intrauterine transfusion for the treatment of hemolytic disease of the fetus/newborn was the first successful fetal intervention. Although not subjected to the rigors of clinical trials, this treatment has withstood the test of time. Interventions for other fetal disease states such as twin-twin transfusion and repair of fetal myelomeningocele were investigated in animal models followed by randomized clinical trials before widespread adoption. Tracheal occlusion for diaphragmatic hernia is still currently being investigated as the next promising step in fetal intervention.
    American Journal of Perinatology 02/2014; 31(7). DOI:10.1055/s-0033-1364191 · 1.60 Impact Factor
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    ABSTRACT: Despite improved perinatal survival following fetoscopic laser ablation (FLA) for twin twin transfusion syndrome (TTTS), prematurity remains an important contributor to perinatal mortality and morbidity. The objective of the study was to identify risk factors for complicated preterm delivery after FLA. Retrospective cohort study of prospectively collected data on maternal/fetal demographics and pre-operative, operative and post-operative variables of 459 patients treated in 3 U.S. fetal centers . Multivariate linear regression was performed to identify significant risk factors associated with preterm delivery, which was cross-validated using K-fold method. Multivariate logistic regression was performed to identify risk factors for early vs. late preterm delivery based on median gestational age at delivery of 32 weeks. There were significant differences in case selection and outcomes between the centers. After controlling for the center of surgery, a multivariate analysis indicated a lower maternal age at procedure, history of previous prematurity, shortened cervical length , use of amnioinfusion, 12 Fr cannula diameter, lack of a collagen plug placement and iatrogenic preterm premature rupture of membranes (iPPROM) were significantly associated with a lower gestational age at delivery. Specific fetal/maternal and operative variables are associated with preterm delivery after FLA for the treatment of TTTS. Further studies to modify some of these variables may decrease the perinatal morbidity after laser therapy.
    Ultrasound in Obstetrics and Gynecology 01/2014; 43(1). DOI:10.1002/uog.13206 · 3.14 Impact Factor
  • Kenneth J Moise
    Obstetrics and Gynecology 12/2013; 122(6):1306. DOI:10.1097/AOG.0000000000000036 · 4.37 Impact Factor
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    ABSTRACT: Introduction Fetal exsanguination is a rare complication of cordocentesis. Successful correction of fetal thrombocytopenia is essential for the reduction of risks. Case Report A 25-year-old, gravida 3, P2-0-0-0-2, was referred at 27 weeks of gestation for evaluation of newly diagnosed nonimmune hydrops secondary to parvovirus infection. Despite the use of ancillary platelet transfusions to correct the severe fetal thrombocytopenia, prolonged bleeding from the cord puncture site still occurred, necessitating five intrauterine transfusions to ultimately correct the fetal anemia. Conclusions The use of a smaller-diameter procedure needle, correction of the fetal thrombocytopenia early in the procedure, and external cord compression with the ultrasound transducer were ultimately successful measures in allowing for minimal loss of transfused red cells from the intravascular compartment.
    10/2013; 3(2):75-8. DOI:10.1055/s-0033-1341576
  • Kenneth J Moise
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    ABSTRACT: Amniotic fluid is typically measured by ultrasound using the amniotic fluid index (AFI) or the maximum vertical pocket (MVP). Although both parameters correlate poorly with the actual amniotic fluid volume measured with dye-dilution methods, cross-sectional studies have been used to establish gestational norms. The current acceptable definition of polyhydramnios in the late second and the third trimester in both singleton and multiple gestations is a MVP > 8cm, while the definition of oligohydramnios is a MVP < 2cm. The pocket to be measured should exclude the umbilical cord or fetal parts. Randomized clinical trials have indicated that defining oligohydramnios as a MVP < 2cm will result in fewer obstetrical interventions and similar perinatal outcomes when compared to an AFI < 5cm.
    Seminars in perinatology 10/2013; 37(5):370-4. DOI:10.1053/j.semperi.2013.06.016 · 2.42 Impact Factor
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    ABSTRACT: Objective Despite fetoscopic laser ablation (FLA) having emerged as an effective treatment for twin-twin transfusion syndrome (TTTS), major postintervention challenges, such as iatrogenic preterm premature rupture of membranes (iPPROM), remain. A chorioamniotic plug (CAP) made of absorbable gelatin sponge has been used to seal the trocar entry site in the chorioamniotic layers to promote healing and prevent iPPROM, yet the results have been equivocal. Our objective was to test the hypothesis that, following FLA for TTTS, iPPROM may be prevented by placement of an absorbable gelatin CAP. MethodsA retrospective cohort study was performed on prospectively collected data from 134 consecutive patients who underwent FLA for TTTS. The decision for CAP placement was at the discretion of the physician. Preoperative, operative and postoperative variables were collected and analyzed. The primary outcome was the incidence of iPPROM, and the secondary outcomes were procedure-to-delivery interval and gestational age at delivery. Comparative statistical analysis was performed as appropriate. ResultsA CAP was placed in 72 (54%) of 134 patients. Factors significantly associated with CAP placement were higher gravidity (P = 0.03), anterior placentation (P = 0.04), general endotracheal intubation (P = 0.02) and a cannula diameter of 12-Fr (P = 0.003). There were no differences between CAP and no-CAP groups in the rate of iPPROM (39% vs 34%, respectively; P = 0.42) or in the procedure-to-delivery interval (65.3 34.7 days vs 58.2 +/- 30.8 days, respectively; P = 0.21). The gestational age at delivery was later in the CAP group compared with the no-CAP group (30.7 +/- 4.5 weeks vs 28.9 +/- 3.9 weeks, respectively; P = 0.02). Conclusions CAP did not reduce the overall risk for iPPROM and did not increase the procedure-to-delivery interval. Further research is needed to identify other methods to prevent iPPROM and prolong pregnancy after laser therapy. Copyright (c) 2013 ISUOG. Published by John Wiley & Sons Ltd.
    Ultrasound in Obstetrics and Gynecology 09/2013; 42(4). DOI:10.1002/uog.12487 · 3.14 Impact Factor
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    ABSTRACT: OBJECTIVE: To understand the biological pathways involved in twin-twin transfusion syndrome (TTTS) by performing global gene expression analysis of amniotic fluid (AF) cell-free RNA. METHODS: Prospective whole transcriptome microarray study analyzing cell-free RNA in AF from TTTS recipient twins and singleton controls. Significantly differentially-regulated genes in TTTS cases (N = 8) vs. matched controls (N = 8) were identified and pathways analyses performed. Significant gene expression differences between Stage II TTTS recipients (N = 5) and Stage III TTTS recipients with abnormal Doppler measurements (N = 5) were also analysed. RESULTS: Analysis of paired data from TTTS cases and controls revealed differential expression of 801 genes, which were significantly enriched for neurological disease and cardiovascular system pathways. We also identified cardiovascular genes and pathways associated with the presence of critically abnormal Doppler measurements in Stage III TTTS recipients. CONCLUSIONS: This study provides the first transcriptome-wide data on the impact of TTTS on fetal development. Our results show that gene expression involving neurological and cardiovascular pathways are altered in recipient fetuses prior to surgical treatment. This has relevance for the origins of long-term complications seen in survivors and for the development of future fetal biomarkers. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 09/2013; 33(9). DOI:10.1002/pd.4150 · 2.51 Impact Factor
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    ABSTRACT: Twin reversed arterial perfusion sequence (TRAP) is a rare complication of multiple gestations. Only a few cases of TRAP in monochorionic triplets have been reported. A case of TRAP sequence in a monochorionic, triamniotic triplet gestation treated with radiofrequency ablation (RFA) of the acardiac fetus is reported. The response to the RFA procedure and the subsequent examination of the placenta support the hypothesis of an "indirect" pump triplet. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
    Ultrasound in Obstetrics and Gynecology 07/2013; 42(1). DOI:10.1002/uog.12354 · 3.14 Impact Factor
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    ABSTRACT: INTRODUCTION: Single fetal demise in monochorionic twin gestations represents a significant risk for co-twin demise and neurodevelopmental morbidity. Indirect observations have led to a theory of acute exsanguination of the normal twin into the dying twin as the proposed mechanism. CASE: A 22-year-old G3P2 (2002) female with Quintero Stage IV twin-twin transfusion was referred for evaluation. During the course of the examination, bradycardia with impending fetal demise was noted in the recipient twin. Sudden and rapid development of tachycardia and elevation of the peak systolic velocity of the middle cerebral artery in the donor twin were witnessed. The demise of the donor twin was detected 24 hours later. Placental examination revealed one AV and two VA anastomoses. CONCLUSIONS: These observations support the "vascular sink" hypothesis for co-twin demise and neurodevelopmental abnormalities following single fetal demise in monochorionic twins. Rapid fetal exsanguination can occur even in the presence of a minimal number of placental vascular anastomoses.
    Ultrasound in Obstetrics and Gynecology 07/2013; 42(1). DOI:10.1002/uog.12480 · 3.14 Impact Factor
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    ABSTRACT: Amniotic fluid-derived stem cells (AFSC) have been reported to differentiate into cardiomyocyte-like cells and form gap junctions when directly mixed and cultured with neonatal rat ventricular myocytes (NRVM). This study investigated whether or not culture of AFSC on the opposite side of a Transwell membrane from NRVM, allowing for contact and communication without confounding factors such as cell fusion, could direct cardiac differentiation and enhance gap junction formation. Results were compared to shared media (Transwell), conditioned media and monoculture media controls. After a 2-week culture period, AFSC did not express cardiac myosin heavy chain or troponin T in any co-culture group. Protein expression of cardiac calsequestrin 2 was up-regulated in direct transmembrane co-cultures and media control cultures compared to the other experimental groups, but all groups were up-regulated compared with undifferentiated AFSC cultures. Gap junction communication, assessed with a scrape-loading dye transfer assay, was significantly increased in direct transmembrane co-cultures compared to all other conditions. Gap junction communication corresponded with increased connexin 43 gene expression and decreased phosphorylation of connexin 43. Our results suggest that direct transmembrane co-culture does not induce cardiomyocyte differentiation of AFSC, though calsequestrin expression is increased. However, direct transmembrane co-culture does enhance connexin-43-mediated gap junction communication between AFSC.
    Journal of Cellular and Molecular Medicine 05/2013; 17(6). DOI:10.1111/jcmm.12056 · 3.70 Impact Factor
  • American journal of obstetrics and gynecology 03/2013; DOI:10.1016/j.ajog.2013.03.020 · 3.97 Impact Factor
  • Kenneth J Moise, Pedro S Argoti
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    ABSTRACT: : To evaluate the application of new technologies to the management of the red cell alloimmunized pregnancy. : We searched three computerized databases for studies that described treatment or prevention of alloimmunization in pregnancy (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials [1990 to July 2012]). The text words and MeSH included Rhesus alloimmunization, Rhesus isoimmunization, Rhesus prophylaxis, Rhesus disease, red cell alloimmunization, red cell isoimmunization, and intrauterine transfusion. : Of the 2,264 studies initially identified, 246 were chosen after limiting the review to those articles published in English and crossreferencing to eliminate duplication. : Both authors independently reviewed the articles to eliminate publications involving less than six patients. Special emphasis was given to publications that have appeared since 2008. : Quantitative polymerase chain reaction can be used instead of serology to more accurately determine the paternal RHD zygosity. In the case of unknown or a heterozygous paternal RHD genotype, new DNA techniques now make it possible to diagnose the fetal blood type through cell-free fetal DNA in maternal plasma. Serial Doppler assessment of the peak systolic velocity in the middle cerebral artery is now the standard to detect fetal anemia and determine the need for the first intrauterine transfusion. Assessment of the peak systolic velocity in the middle cerebral artery can be used to time the second transfusion, but its use to decide when to perform subsequent procedures awaits further study. New data suggest normal neurologic outcome in 94% of cases after intrauterine transfusion, although severe hydrops fetalis may be associated with a higher risk of impairment. Recombinant Rh immune globulin is on the horizon. Cell-free fetal DNA for fetal RHD genotyping may be used in the future to decide which patients should receive antenatal Rh immune globulin.
    Obstetrics and Gynecology 11/2012; 120(5):1132-9. DOI:10.1097/AOG.0b013e31826d7dc1 · 4.37 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the phenomenon of vascular ischemic limb necrosis in twin-twin transfusion syndrome (TTTS). This was a multicenter retrospective review of ischemic limb necrosis in patients with TTTS. Twenty cases of fetal ischemic limb necrosis in association with TTTS were identified from 10 fetal medicine centers. The recipient was affected in 19 cases, and the lower limb was affected in 17 cases. The extent of the damage correlated with TTTS severity. Eighty percent of limb defects (16/20) clearly were unrelated to laser treatment (3 cases untreated, 7 cases after amnioreduction, 6 cases present at time of laser). The recipient was relatively polycythemic in 5 of 7 cases in which neonatal or fetal hemoglobin/hematocrit levels were available. Ischemic limb necrosis is a rare complication of TTTS. The lesion is unrelated to therapy and may be the result of polycythemia, hypertension, and vasoconstriction.
    American journal of obstetrics and gynecology 08/2012; 207(2):131.e1-10. DOI:10.1016/j.ajog.2012.06.005 · 3.97 Impact Factor

Publication Stats

2k Citations
517.25 Total Impact Points

Institutions

  • 2012–2015
    • University of Texas Health Science Center at Houston
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Houston, Texas, United States
    • Rice University
      • Department of Bioengineering
      Houston, TX, United States
  • 2013–2014
    • Memorial Hermann Hospital
      Houston, Texas, United States
  • 2012–2013
    • University of Texas Medical School
      • Department of Obstetrics, Gynecology & Reproductive Sciences
      Houston, Texas, United States
  • 1987–2013
    • Baylor College of Medicine
      • • Department of Pediatrics
      • • Department of Obstetrics and Gynecology
      Houston, Texas, United States
  • 2000–2012
    • University of North Carolina at Chapel Hill
      • Department of Obstetrics and Gynecology
      North Carolina, United States
  • 2010
    • Texas Children's Hospital
      Houston, Texas, United States
  • 2009
    • Society for Maternal-Fetal Medicine
      Houston, Texas, United States
  • 2006
    • University of North Carolina at Charlotte
      Charlotte, North Carolina, United States
  • 2005
    • University of Texas Medical Branch at Galveston
      Galveston, Texas, United States
  • 1998–1999
    • Houston Zoo
      Houston, Texas, United States