Sarah Keating

University of Toronto, Toronto, Ontario, Canada

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Publications (65)169.74 Total impact

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    ABSTRACT: Background: Late-onset intrauterine growth restriction (IUGR) results from failure of the placenta to supply adequate nutrients and oxygen to the rapidly growing late gestation fetus. Limitations in current monitoring methods present the need for additional techniques for more accurate diagnosis of IUGR in utero. New magnetic resonance imaging (MRI) technology now provides a non-invasive technique for fetal hemodynamic assessment, which could provide additional information over conventional Doppler methods. Objectives: To use new MRI techniques to measure hemodynamic parameters and brain growth in late-onset intrauterine growth restriction (IUGR) fetuses. Study design: A prospective observational case control study to compare the flow and T2 of blood in the major fetal vessels and brain imaging findings using MRI. Indexed fetal oxygen delivery and consumption were calculated. Middle cerebral artery and umbilical artery pulsatility indexes and cerebro-placental ratio were acquired using ultrasound. A score of ≥2 out of 4 following parameters defined IUGR: 1) birth weight ≤3(rd) centile or ≥20% drop in centile in estimated fetal weight; 2) lowest cerebro-placental ratio after 30 weeks <5(th) centile; 3) ponderal index <2.2; 4) placental histology meets pre-defined criteria for placental under-perfusion. Measurements were compared between the two groups (t-test) and correlations between parameters were analyzed (Pearson's correlation). MRI measurements were compared with Doppler parameters for identifying IUGR defined by postnatal criteria (birthweight, placental histology, ponderal index) using receiver operating characteristic curves. Results: We studied 14 IUGR and 26 non-IUGR fetuses at 35 weeks gestation. IUGR fetuses had lower umbilical vein (P=0.004) and pulmonary blood flow (P=0.01) and higher superior vena caval flow (P<0.0001) by MRI. IUGR fetuses had asymmetric growth but smaller brains than normals (P<0.0001). Newborns with IUGR also had smaller brains with otherwise essentially normal findings on MRI. Vessel T2s, oxygen delivery, oxygen consumption, middle cerebral artery pulsatility index and cerebro-placental ratio were all significantly lower in IUGR fetuses, while there was no significant difference in umbilical artery pulsatility index. IUGR score correlated positively with superior vena caval flow, and inversely with oxygen delivery, oxygen consumption, umbilical vein T2 and cerebro-placental ratio. ROC curves revealed equivalent performance of MRI and Doppler techniques in identifying IUGR that was defined based on postnatal parameters with superior vena caval flow AUC = 0.94 (95%CI 0.87-1.00) versus cerebro-placental ratio AUC = 0.80 (95%CI 0.64-0.97). Conclusions: MRI revealed the expected circulatory redistribution in response to hypoxia in IUGR fetuses. The reduced oxygen delivery in IUGR fetuses indicated impaired placental oxygen transport, while reduced oxygen consumption presumably reflected metabolic adaptation to diminished substrate delivery, resulting in slower fetal growth. Despite brain-sparing, placental insufficiency limits fetal brain growth. Superior vena caval flow and umbilical vein T2 by MRI may be useful new markers of late-onset IUGR.
    American journal of obstetrics and gynecology 10/2015; DOI:10.1016/j.ajog.2015.10.004 · 4.70 Impact Factor
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    ABSTRACT: The association between low birth weight and premature cardiovascular disease has led to the "prenatal origin of adult disease-hypothesis". We postulated that fetal growth restriction is associated with cardiovascular changes detectable at birth and in early infancy. Fifty-two appropriately grown fetuses (AGA) and 60 growth-restricted fetuses (FGR) with (n = 20) or without (n = 40) absent or reversed end-diastolic umbilical artery blood flow were prospectively examined by echocardiography before birth, at 1 week and 6 months of life. The impact of growth restriction on postnatal blood pressure, heart rate, cardiovascular dimensions, and function, as well as on vascular morphology of umbilical cord vessels was studied. FGR fetuses displayed significant blood flow redistribution and were delivered earlier with lower birth weights than AGA fetuses. After adjustment for gender, gestational age, and weight at birth, there were no intergroup differences in blood pressure, heart rate, left ventricular morphology, mass, and performance, and in cord vessel morphology. During the first 6 months of life brachioradial pulse wave velocity increased more in FGR fetuses, while other parameters describing vascular stiffness remained comparable between the groups. Fetal growth restriction had no detectable adverse impact on cardiovascular dimensions and function at birth. Cardiovascular findings also remained comparable during the first 6 months of life between the groups except a higher increase in brachioradial pulse wave velocity in the FGR group. Our observations suggest that abnormalities that link reduced intrauterine growth with premature cardiovascular diseases may commence later in childhood, indicating a potential window for screening and prevention.
    Heart and Vessels 09/2015; DOI:10.1007/s00380-015-0742-5 · 2.07 Impact Factor
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    ABSTRACT: Decidual natural killer (dNK) cells express an array of activation receptors to regulate placental immunity and development during early pregnancy. We investigated the functional character of human dNK cells during the first and second trimester of gestation and the interaction between dNK and trophoblast cells. Although the frequency of CD56(+)CD16(-) dNK among the total CD45(+) leukocytes did not change over this period, the expression of the activating receptors, NKp80 and NKG2D, was greatly upregulated. We observed a significantly higher number of extravillous trophoblast cells in proximity to the dNK cells in the first trimester in comparison with the second trimester decidua. NKG2D expression by first trimester dNK cells was decreased when co-cultured with the HTR-8 trophoblast cell line. In the second trimester, functional markers of dNK activation, i.e., angiogenic factor production (e.g., vascular endothelial growth factor, interleukin-8, interferon-gamma), remained stable despite an increase in NKp80 or NKG2D surface expression. Furthermore, the degranulation capacity of dNK cells, as assessed by CD107a, was decreased in the second trimester. We suggest that in the first trimester, trophoblast-dNK interactions generate a population of dNK cells with a suppressed activating phenotype. In the second trimester, the loss of trophoblast-dNK interactions led to the inhibition of dNK cell function, although their activating receptor expression was increased. We speculate that during pregnancy, two mechanisms operate to modulate the dNK cell activation:suppression of activating receptor levels in the first trimester by trophoblasts and disengagement of receptor-ligand coupling in the second trimester.Cellular & Molecular Immunology advance online publication, 17 August 2015; doi:10.1038/cmi.2015.66.
    Cellular & molecular immunology 08/2015; DOI:10.1038/cmi.2015.66 · 4.11 Impact Factor
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    ABSTRACT: The distal villous hypoplasia pattern (DVH) is a placental correlate of fetal growth restriction. DVH is recognized as sparse and widely spaced small distal villi around thin intermediate villi. Because the pattern seems to involve less complexity we postulated that it may be associated with lower fractal dimension (FD) - a mathematical measure of complexity. Our objectives were: 1)To evaluate inter-observer agreement among expert pathologists. 2) To determine whether pathologist classification correlates with FD. A study set of 30 images at 4X magnification was created by a single pathologist from a digital slide archive. The images included: 10 graded as no DVH (0), 10 graded as mild to moderate DVH (1) and 10 graded as severe DVH (2). The images were scrambled and shown to a panel of 4 international experts who similarly graded the images. Weighted kappas were calculated. For each of the images, fractal dimension was calculated by the Box Counting method. The correlation coefficient between average pathologist DVH score versus FD was calculated. The mean weighted kappa score among 5 pathologist observers was 0.59. The range was 0.424 - 0.7. The correlation coefficient between FD and the averaged pathologist score was r = -0.915 (p < 0.001). Expert pathologists achieve fair to substantial agreement in grading DVH. Thus there is already some consensus on the definition of DVH, but it can be improved with precise criteria. DVH correlates extremely well with FD. This provides a future objective measure for outcome studies.
    Pediatric and Developmental Pathology 08/2015; DOI:10.2350/15-03-1619-OA.1 · 0.87 Impact Factor
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    ABSTRACT: Fetal infection with human parvovirus B19 (hParvo-B19) has been mainly associated with fetal anemia, while data regarding other fetal hematological effects are limited. Our aim was to assess the rate and consequences of severe fetal thrombocytopenia following fetal hParvo-B19 infection. We conducted a retrospective study of pregnancies complicated by fetal hParvo-B19 infection which underwent fetal blood sampling (FBS). The characteristics and outcome of fetuses with severe thrombocytopenia (< 50 x10(9)/L) were compared with those of fetuses with a platelet concentration ≥ 50 x10(9)/L. (controls). Fetuses in whom 3 FBS's were performed (N=4) were analyzed to assess the natural history of platelet levels following fetal hParvo-B19 infection. A total of 37 pregnancies affected by fetal hParvo-B19 infection were identified. Of the 29 cases which underwent FBS and had information regarding fetal platelets, 11 (38%) were complicated by severe fetal thrombocytopenia. Severely thrombocytopenic fetuses were characterized by a lower hemoglobin concentration (2.6±0.9 vs. 5.5±3.6 g/dL, p=0.01), lower reticulocyte count (9.1±2.8% vs. 17.3±10.6%, p=0.02), and lower gestational age (GA) at the time of diagnosis (21.4±3.1 vs. 23.6±2.2 wks, p=0.03). Both the fetal death rate within 48 hrs of FBS (27.3% vs. 0%, p=0.02), and the risk of prematurity (100.0% vs. 13.3%, p<0.001) were higher in fetuses with severe thrombocytopenia. Fetal thrombocytopenia was more common during the 2(nd) trimester, but in some cases persisted into the 3(rd). Intrauterine transfusion (IUT) of RBCs resulted in a further mean decrease of 40.1±31.0% in fetal platelet concentration. Severe fetal thrombocytopenia is relatively common following fetal hParvo-B19 infection, can be further worsened by IUT and may be associated with an increased risk of procedure related fetal loss following either FBS or IUT. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 01/2015; 212(6). DOI:10.1016/j.ajog.2015.01.048 · 4.70 Impact Factor
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    ABSTRACT: Trisomy 9 is a rare chromosomal abnormality usually associated with first-trimester miscarriage; few fetuses survive until the second trimester. We report two new cases of complete trisomy 9 that both present unusual phenotypic associations, and we analyze the genetic pathway involved in this chromosomal abnormality. The first fetus investigated showed Dandy-Walker malformation, cleft lip, and cleft palate) at the second trimester scan. Cardiovascular abnormalities were characterized by a right-sided, U-shaped aortic arch associated with a ventricular septal defect (VSD). Symmetrical intrauterine growth restriction and multicystic dysplastic kidney disease were associated findings. The second fetus showed a dysmorphic face, bilateral cleft lip, hypoplastic corpus callosum, and a Dandy-Walker malformation. Postmortem examination revealed cardiovascular abnormalities such as persistent left superior vena cava draining into the coronary sinus, membranous ventricular septal defect, overriding aorta, pulmonary valve with two cusps and three sinuses, and the origin of the left subclavian artery distal to the junction of ductus arteriosus and aortic arch. Complete trisomy 9 may result in a wide spectrum of congenital abnormalities, and the presented case series contributes further details on the phenotype of this rare aneuploidy. Copyright © 2014. Published by Elsevier B.V.
    Taiwanese journal of obstetrics & gynecology 12/2014; 53(4):592-7. DOI:10.1016/j.tjog.2014.01.005 · 0.99 Impact Factor
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    ABSTRACT: To determine the incidence of temporal lobe dysplasia (TLD) detected on prenatal ultrasound in thanatophoric dysplasia (TD) over an 11-year period in a tertiary referral centre. An 11-year retrospective review of perinatal autopsies was performed from 2002 to 2013 to identify cases of TD. The ultrasound images and corresponding reports of all TD cases were reviewed for TLD. The same set of images subsequently underwent a retrospective review by a perinatal radiologist with knowledge of the TLD feature to determine whether they could be identified. There were 31 TD cases that underwent perinatal autopsy. Prenatal ultrasound imaging was available to review in 24/31 (77%) cases. Mean gestational age (GA) of TD diagnosis was 21.3 weeks (range: 18-36 weeks). TLD was identified and reported in 6/24 (25%) cases; all six cases occurred after 2007. Retrospective interpretation of the ultrasound images identified features of TLD in 10 additional cases. In total, 16/24 (67%) cases displayed sonographic evidence of TLD. Temporal trends show that TLD features were present in 50% (5/10) of all TD cases from 2002-2006 and in 79% (11/14) of the cases from 2007-2013. Currently, the detection rate of TLD by ultrasound is low but may be increased by modified brain images that enhance visualization of the temporal lobes. Prenatal identification of TLD may help in the prenatal diagnosis of TD and thus provide more accurate prenatal counseling and guide molecular investigations to confirm the specific diagnosis of TD.
    Ultrasound in Obstetrics and Gynecology 11/2014; 44(5). DOI:10.1002/uog.13337 · 3.85 Impact Factor

  • Placenta 09/2014; 35(9):A60. DOI:10.1016/j.placenta.2014.06.195 · 2.71 Impact Factor
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    Anne Guo · David Chitayat · Susan Blaser · Sarah Keating · Patrick Shannon ·
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    ABSTRACT: We explored the prevalence of syringomyelia in a series of 113 cases of fetal dysraphism and hindbrain crowding, of gestational age ranging from 17.5 to 34 weeks with the vast majority less than 26 weeks gestational age. We found syringomyelia in 13 cases of Chiari II malformations, 5 cases of Omphalocele/Exostrophy/Imperforate anus/Spinal abnormality (OEIS), 2 cases of Meckel Gruber syndrome and in a single pair of pyopagus conjoined twins. Secondary injury was not uncommon, with vernicomyelia in Chiari malformations, infarct like histology, or old hemorrhage in 8 cases of syringomyelia. Vernicomyelia did not occur in the absence of syrinx formation. The syringes extended from the sites of dysraphism, in ascending or descending patterns. The syringes were usually in a major proportion anatomically distinct from a dilated or denuded central canal and tended to be dorsal and paramedian or median. We suggest that fetal syringomyelia in Chiari II malformation and other dysraphic states is often established prior to midgestation, has contributions from the primary malformation as well as from secondary in utero injury and is anatomically and pathophysiologically distinct from post natal syringomyelia secondary to hindbrain crowding.
    08/2014; 2(1):91. DOI:10.1186/PREACCEPT-1099742865133283
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    ABSTRACT: The pulmonary neuroendocrine cells (PNEC) are located in the epithelial lining of the airways and consist of solitary neuroendocrine cells (NEC) and NEC clusters, the neuroepithelial bodies (NEB). During fetal life, PNEC are the first to differentiate within the primitive airway epithelium, and bombesin expression favors branching of the respiratory tree. We investigated PNEC in Down syndrome (DS), where the lungs often show enlarged and reduced number of alveoli. Immunohistochemistry for bombesin and synaptophysin, PNEC markers, was evaluated in fetal lungs from 15 cases of DS and 11 age-matched controls from the 17th to 23rd week of gestation. Morphometric analysis assessed PNEC in the mucosal lining of each lung, expressed as number/mm. Nonparametric Mann-Whitney U test showed no statistical difference in frequency of PNEC in DS and controls. Our findings suggest that, at least in late second trimester, the distribution and frequency of PNEC in DS fetuses is not altered.
    Fetal and pediatric pathology 06/2014; 33(3):157-65. DOI:10.3109/15513815.2014.886001 · 0.48 Impact Factor
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    ABSTRACT: Fetal skeletal dysplasias are a heterogeneous group of rare genetic disorders, affecting approximately 2.4-4.5/10,000 births. We performed a retrospective review of the perinatal autopsies conducted between the years 2002-2011at our centre. The study population consisted of fetuses diagnosed with skeletal dysplasia with subsequent termination, stillbirth and live-born who died shortly after birth. Of the 2,002 autopsies performed, 112 (5.6%) were diagnosed with skeletal dysplasia. These 112 cases encompassed 17 of the 40 groups of Nosology 2010. The two most common nosology groups were osteogenesis imperfecta [27/112 (24%)] and the FGFR3 chondrodysplasias [27/112 (24%)]. The most common specific diagnoses were thanatophoric dysplasia (TD) type 1 [20(17.9%)], and osteogenesis imperfecta (OI) type 2 [20 (17.9%)]. The combined radiology, pathology, and genetic investigations and grouping the cases using Nosology 2010 resulted in a specific diagnosis in 96/112 of the cases.
    Clinical Genetics 05/2014; 87(4). DOI:10.1111/cge.12434 · 3.93 Impact Factor

  • American Journal of Obstetrics and Gynecology 01/2014; 210(1):S311. DOI:10.1016/j.ajog.2013.10.667 · 4.70 Impact Factor

  • American Journal of Obstetrics and Gynecology 01/2014; 210(1):S241. DOI:10.1016/j.ajog.2013.10.515 · 4.70 Impact Factor
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    ABSTRACT: Introduction Decidual leukocytes are critical to the development of the fetomaternal interface, regulating tolerance to the semi-allogeneic fetus and vascular transformation of the uterine spiral arteries. Despite the continuation of these processes beyond the first trimester of pregnancy, the second trimester has largely been unstudied, with investigation focusing on early gestation and term tissues. We sought to characterize changes in decidual leukocyte populations from first to second trimester. Methods Multicolour flow cytometry was performed on isolated decidual leukocytes from elective terminations of pregnancy between 6 and 20 weeks of gestation for study of first (6-12 weeks) and second trimesters (13-20 weeks). Specific subpopulations were identified by comparison to isotype and fluorescent-minus-one (FMO) controls. Results Decidual natural killer cells (CD56+CD16-CD3-) did not change in number, although a population of dNK with decreased CD56 brightness was observed in second trimester decidua. CD14+HLA-DR+ macrophage numbers declined from first to second trimester (p = 0.031), yet a CD163+CD206+ subset designating alternatively activated M2-like macrophages increased during the same period (p = 0.015). Intermediate CD205+ dendritic cells demonstrated significant decline (p = 0.022), but immature CD209+ and mature CD83+ dendritic cells did not differ between trimesters. Total CD3+ and CD3+CD4+ T lymphocytes increased (p = 0.0079, p = 0.0028); CD3+CD8+ T cells trended towards increase but did not differ significantly. Conclusion Several changes in leukocyte subsets are observed in the second trimester that promote a tolerogenic and angiogenic decidual microenvironment through mid-gestation.
    Placenta 01/2014; · 2.71 Impact Factor
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    ABSTRACT: To describe the prenatal sonographic features and the results of DNA analysis on three fetuses with Dyssegmental Dysplasia, Silverman-Handmaker Type (DD-SH). A retrospective review of three fetuses with confirmed DD-SH was conducted. The fetal ultrasound findings, radiological characteristics and results of the mutation analysis of the HSPG2 gene were reviewed. There were 3 cases in two families with DD-SH diagnosed prenatally. The main prenatal ultrasound and radiological features of DD-SH were severe limb shortening and vertebral segmentation and fusion defects (anisospondyly). DNA analysis of the HSPG2 gene showed that the two affected fetuses in a non-consanguineous family had a compound heterozygote for the c.646G > T transversion in exon 7 and a c.5788C > T transition in exon 46. The fetus born to the consanguineous couple had a homozygous mutation c.1356-27_1507 + 59del. DD-SH can be diagnosed prenatally using fetal ultrasound as early as 13 weeks. Fetal X-rays and DNA analysis of the HSPG2 gene are important for confirmation of the diagnosis and for pre-implantation and prenatal diagnosis in pregnancies at risk. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 11/2013; 33(11). DOI:10.1002/pd.4193 · 3.27 Impact Factor
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    ABSTRACT: Objective To report three different antenatal therapeutic approaches for fetal lung masses associated with hydrops. Methods Three prospectively followed cases are described, and all 30 previously published minimally invasive cases of fetal therapy for hydropic lung masses are reviewed. ResultsThree hydropic fetuses with large intrathoracic lung masses presented at 17, 25 and 21 weeks of gestation, respectively. An aortic feeding vessel was identified in each case and thus a bronchopulmonary sequestration (BPS) was suspected. Under ultrasound guidance, the feeding vessel was successfully occluded with interstitial laser (Case 1), radiofrequency ablation (RFA) (Case 2) and thrombogenic coil embolization (Case 3). Complete (Cases 1 and 2) or partial (Case 3) resolution of the lung mass and hydrops was observed. A healthy infant was born at term after laser therapy (Case 1), and the involved lung lobe was resected on day 2 of postnatal life. In Case 2, hydrops resolved completely following RFA, but an iatrogenic congenital diaphragmatic hernia and abdominal wall defect became apparent 4 weeks later. The neonate died from sepsis following spontaneous preterm labor at 33 weeks. In Case 3, despite technical success in complete vascular occlusion with coils, a stillbirth ensued 2 days after embolization. Conclusions The prognosis of large microcystic or echogenic fetal chest masses associated with hydrops is dismal. This has prompted attempts at treatment by open fetal surgery, with mixed results, high risk of premature labor and consequences for future pregnancies. We have demonstrated the possibility of improved outcome following ultrasound-guided laser ablation of the systemic arterial supply. Despite technical success, RFA and coil embolization led to procedure-related complications and need further evaluation. Copyright (c) 2013 ISUOG. Published by John Wiley & Sons Ltd.
    Ultrasound in Obstetrics and Gynecology 09/2013; 42(4). DOI:10.1002/uog.12515 · 3.85 Impact Factor
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    ABSTRACT: Objectives: To determine the pathologic basis and clinical associations of excessively thick placentas observed at second-trimester ultrasound examinations. Methods: Maximum sonographic placental thickness was correlated with clinical outcomes, maximum placental thickness after delivery and placental pathologic findings in a retrospective cohort of 19 singleton high-risk pregnancies noted to have a placental length to thickness ratio ≤ 2.0, in the second trimester. Findings were compared with an intermediate group of 21 high risk pregnancies, and a control group of 18 low-risk pregnancies. Increased maximum placental thickness (>28 mm) and abnormal placental deflation following delivery (pathology-sonography maximum thickness below -2mm) were defined by the upper and lower quartile values respectively in the control group. Results: The study group exhibited significantly more adverse outcomes and gross pathological placental features as compared to both the intermediate and control groups. Despite increased sonographic placental thickness (median 55mm [range 41 to 75] vs. 27 [21.7 to 41], p<0.0001 vs. 26 [23 to 36], p<0.0001) study and control placentas had similar maximal thickness following delivery (median 24mm [range 10 to 50] vs. 27 [15 to 40], p=0.82 vs. 28.5 [18 to 44], p=0.42). Placental pathology-sonography difference (<-2mm) in the study group (median -30 [-41 to 0]) was significantly greater than either the intermediate (-2 [-11 to 9], p<0.0001) or control (1.5 [-10 to 18], p<0.0001) groups and was significantly associated with abnormal development of the gas-exchanging placental villi (distal villous hypoplasia) (p=0.0001). Conclusions: Increased second trimester sonographic placental thickness represents a pathologic finding associated with severe adverse perinatal outcomes. This observation is due to over-inflation of the inter-villous space by maternal blood rather than by adaptive formation of functional placental tissue. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
    Ultrasound in Obstetrics and Gynecology 09/2013; 42(3). DOI:10.1002/uog.12386 · 3.85 Impact Factor

  • Placenta 09/2013; 34(9):A12. DOI:10.1016/j.placenta.2013.06.040 · 2.71 Impact Factor
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    ABSTRACT: Nephronophthisis associated ciliopathies (NPHP-AC) are a group of phenotypically related conditions that include Joubert syndrome, Meckel syndrome, nephronophthisis (NPHP), and Senior-Loken syndrome. We report on a male fetus with prenatal ultrasound findings at 24 weeks of gestation of anhydramnios, large and echogenic kidneys and situs inversus totalis. Histopathology revealed nephronophthisis and tracheal mucosa electron microscopy revealed ciliary dysgenesis. DNA analysis of the NPHP genes showed a previously unreported homozygous mutation, p.Arg603* (c.1078+1G>A), in the INVS/NPHP2 gene. This mutation is thought to abolish the splice donor site for exon 8, which likely disrupts the normal splicing of the INVS/NPHP2 gene. © 2013 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part A 07/2013; 161(7). DOI:10.1002/ajmg.a.36036 · 2.16 Impact Factor
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    ABSTRACT: Objectives: To review the association between ultrasound findings, placental pathology, and prognosis in pregnancies complicated by massive subchorionic thrombohematoma (MTH)/Breus' mole. Method: We identified 14 cases of MTH from January 2004 to December 2012. MTH was defined by >1 cm thickness hematoma and extensive (≥50%) involvement of the fetal surface of the placenta. Patient information, details of initial presentation, and perinatal outcome were obtained from the manual and electronic chart records. Ultrasound findings were related to pregnancy outcomes and associated placental pathology. Participants were stratified on the basis of birth outcome into survivors (live births, n = 7) and nonsurvivors (neonatal deaths or intrauterine fetal deaths/termination of pregnancy, n = 7). Results: All 14 cases of MTH were suspected on ultrasound and confirmed by pathology assessment. All cases in the nonsurvivor group had abnormal umbilical artery (UA) Doppler waveforms compared with none in the survivors (p = 0.02). All cases in the nonsurvivor group had extreme preterm deliveries (p = 0.02). Birth weight was significantly reduced in the nonsurvivor group (p = 0.001), and 5/7 cases were diagnosed with severe intrauterine growth restriction, compared with none in the survivor group (p = 0.02). Conclusion: Massive subchorionic thrombohematoma/Breus' mole may be diagnosed in the second trimester by ultrasound assessment of the placenta. Normal fetal growth and UA Doppler waveforms are associated with perinatal survival.
    Prenatal Diagnosis 07/2013; 33(10). DOI:10.1002/pd.4176 · 3.27 Impact Factor

Publication Stats

711 Citations
169.74 Total Impact Points


  • 2005-2015
    • University of Toronto
      • • Department of Laboratory Medicine and Pathobiology
      • • Department of Obstetrics and Gynaecology
      Toronto, Ontario, Canada
  • 2005-2014
    • Mount Sinai Hospital, Toronto
      • • Department of Pathology and Laboratory Medicine
      • • Department of Obstetrics and Gynecology
      Toronto, Ontario, Canada
  • 2004
    • Mount Sinai Hospital
      New York City, New York, United States