Vasiliki A Moragianni

Publications (10)32.08 Total impact

• Article: The impact of length of second stage of labor on shoulder dystocia outcomes: a retrospective cohort study.

  Vasiliki A Moragianni, Michele R Hacker, Frank J Craparo
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  ABSTRACT: To compare obstetrical and neonatal outcomes of vaginal deliveries complicated by shoulder dystocia, according to the length of second stage of labor. We conducted a retrospective cohort study of 177 shoulder dystocia cases that were divided into three categories according to second stage duration (1-20, 21-59, 60-180 min, respectively). The three categories were compared in terms of obstetric characteristics and neonatal outcomes. Statistical analysis utilized the χ2-test and analysis of variance where appropriate. The odds ratios of brachial plexus injury and having a 5-min APGAR score <7 across the second stage duration categories were calculated using logistic regression models that adjusted for potential confounders. The incidence of brachial plexus injury was 5.4% (1st category), 4.4% (2nd category) and 26.9% (3rd category); P<0.01. The higher incidence of brachial plexus injury in the group where second stage lasted >1 h was confirmed by logistic regression, with and without adjusting for confounders. The incidence of brachial plexus injury increases with the length of second stage, even after controlling for confounders.
  Journal of Perinatal Medicine 01/2012; 40(4):463-5. · 1.70 Impact Factor
• Article: Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery form.

  Vasiliki A Moragianni, Michele R Hacker, Frank J Craparo
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  ABSTRACT: Our objective was to evaluate whether using a standardized shoulder dystocia delivery form improved documentation. A standardized delivery form was added to our institution's obstetrical record in August 2003. A retrospective cohort study was conducted comparing 100 vaginal deliveries complicated by shoulder dystocia before, and 81 after implementation of the standardized delivery form. The two groups were compared in terms of obstetric characteristics, neonatal outcomes and documentation components. Charts that included the standardized delivery form were more likely to contain documentation of estimated fetal weight (82.7% vs. 39.0% without the form, P<0.001) and head-to-shoulder delivery interval (76.5% vs. 15.0% without the form, P<0.001). Both groups were statistically similar in terms of documenting estimated blood loss and fetal weight, umbilical cord pH, type and order of maneuvers utilized to relieve the shoulder dystocia, and second stage duration. Inclusion of a standardized form in the delivery record improves the rate of documentation of both shoulder dystocia-specific and general delivery components.
  Journal of Perinatal Medicine 10/2011; 40(1):97-100. · 1.70 Impact Factor
• Article: Short-term energy deprivation alters activin a and follistatin but not inhibin B levels of lean healthy women in a leptin-independent manner.

  Vasiliki A Moragianni, Konstantinos N Aronis, John P Chamberland, Christos S Mantzoros
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  ABSTRACT: Leptin is a potent modulator of the hypothalamic-pituitary-gonadal axis mediating the effect of energy deprivation on several hypothalamic-pituitary-peripheral axes. Activin A, inhibin B, and follistatin (FST) also regulate the hypothalamic-pituitary-gonadal axis in humans. It remains unknown whether energy deprivation affects these hormone levels in a leptin-dependent or -independent manner. We investigated 1) day-night variability patterns of activin, inhibin, and FST in the fed state, 2) whether their levels are affected by fasting, and 3) whether such an effect is mediated by leptin in physiological replacement or pharmacological doses. We conducted two studies in healthy, eumenorrheic females, each comprising three separate admissions. In study 1, six women were maintained for 72 h 1) on isocaloric diet, 2) fasting while receiving placebo, or 3) fasting while receiving metreleptin in physiological replacement doses. In study 2, five women were administered physiological or pharmacological metreleptin doses (0.01, 0.1, or 0.3 mg/kg i.v. four times daily). Neither activin A nor FST had a pulsatile or day-night variability pattern. Inhibin B levels were also nonpulsatile, but a trend toward a day-night pattern was noted. When compared with the fed state, inhibin B levels remained unchanged, whereas FST levels increased (P = 0.01) and activin A decreased (P = 0.01) in the fasting state. These changes were not corrected with metreleptin administered in replacement or pharmacological doses. Short-term energy deprivation alters levels of activin A and FST, but these effects are not mediated by leptin.
  The Journal of clinical endocrinology and metabolism 09/2011; 96(12):3750-8. · 6.50 Impact Factor
• Article: Risk factors associated with retained placenta after cesarean delivery.

  Vasiliki A Moragianni, Konstantinos N Aronis, Frank J Craparo
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  ABSTRACT: Retained placenta after cesarean delivery (RPAC) is a rare phenomenon that has not been previously studied in detail. The objective of our study was to identify potential risk factors that predispose to the development of this obstetrical complication. We performed a retrospective case-control study comparing 20 cases of RPAC with 40 matched controls, using logistic regression models to test likely risk factors. RPAC occurred in 0.16% of cesarean deliveries in our population. The crude odds ratio (OR) of RPAC was increased in patients who had preterm delivery (PTD) (OR=9.06, 95% CI: 2.04-40.29), conceived with artificial reproductive technology (ART) (OR=5.03, 95% CI: 1.24-20.40), and carried multiples (OR=18.89, 95% CI: 2.29-151.23). Conversely, for each week of gestation the odds of RPAC decreased by 0.57 (95% CI: 0.40-0.82). Earlier gestational age, PTD, use of ART and multiples are associated with increased OR of RPAC.
  Journal of Perinatal Medicine 07/2011; 39(6):737-40. · 1.70 Impact Factor
• Article: Biweekly ultrasound assessment of cervical shortening in triplet pregnancies and the effect of cerclage placement.

  V A Moragianni, K N Aronis, F J Craparo
  Ultrasound in Obstetrics and Gynecology 12/2010; 37(5):617-8. · 3.01 Impact Factor
• Article: Follicular fluid-specific distribution of vascular endothelial growth factor isoforms and sFlt-1 in patients undergoing IVF and their correlation with treatment outcomes.

  Stefan I Savchev, Vasiliki A Moragianni, Donald Senger, Alan S Penzias, Kim Thornton, Anny Usheva
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  ABSTRACT: To investigate the distribution of vascular endothelial growth factor (VEGF) isoforms and soluble form of VEGF receptor 1 (sFlt-1) in the follicular fluid (FF) of in vitro fertilization (IVF) patients in relationship to age, body mass index (BMI), diagnosis of polycystic ovary syndrome (PCOS), and their correlation with IVF outcomes. Prospective study. VEGF( 121) and VEGF(165) isoforms were detected using Western blotting and pixel density analysis. The concentration of sFlt-1 was determined by enzyme-linked immunosorbent assay (ELISA). In vitro fertilization outcomes measured included number of oocytes retrieved, fertilization rate, and clinical pregnancy. Statistical analysis used the Kruskal-Wallis and Mann-Whitney U test where appropriate. There was a statistically significant association between higher VEGF(165) levels and the diagnosis of PCOS, BMI ≥ 30, and age ≥40 years. In vitro fertilization cycles resulting in pregnancy were linked to statistically lower VEGF(165) levels in the FF. No statistically significant trend was identified in levels of VEGF(121) or sFlt-1 relative to patient characteristics or IVF outcomes. Our results suggest that elevated VEGF(165) levels are associated with less favorable patient characteristics and clinical IVF outcomes.
  Reproductive sciences (Thousand Oaks, Calif.) 11/2010; 17(11):1036-42. · 2.31 Impact Factor
• Article: Cumulative live-birth rates after assisted reproductive technology.

  Vasiliki A Moragianni, Alan S Penzias
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  ABSTRACT: Despite the promising success rates of IVF, many couples have to undergo several cycles before achieving live birth. In counseling patients faced with subfertility, it is important to provide cumulative live-birth rates. This review evaluates the current knowledge on cumulative rates, summarizing recently published evidence. Existing data have been mostly presented in the form of live-birth rates per IVF cycle as a function of maternal age or reason for subfertility. Recent publications have been reporting IVF success rates in terms of cumulative live-birth rate (CLBR) per woman, thus providing a more realistic estimate that becomes applicable to individual couples. In general, CLBR following IVF has been reported between 45 and 55%. Maternal age has been shown to significantly reduce these rates, as has preimplantation genetic diagnosis. On the contrary, techniques mostly used to decrease the chance of multiple births, such as elective single embryo transfer and natural cycle IVF, do not affect CLBR while achieving a significant reduction in the rates of multiples. Couples should be counseled that CLBR following IVF lies mostly around 50% and that maternal age as well as genetics of transferred embryos remain factors that influence success.
  Current opinion in obstetrics & gynecology 03/2010; 22(3):189-92. · 2.49 Impact Factor
• Article: Outcomes of day-1, day-3, and blastocyst cryopreserved embryo transfers.

  Vasiliki A Moragianni, Jerry D Cohen, Scott E Smith, Jay S Schinfeld, Stephen G Somkuti, Annette Lee, Larry I Barmat
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  ABSTRACT: The optimal developmental stage for cryopreserving embryos in IVF-ET remains controversial. Our study demonstrates that besides an improvement in postthaw survival rate for day-1 and blastocyst cryopreserved ET over day-3, all three groups attained statistically similar implantation, clinical pregnancy, multiple, twinning, and male gender rates.
  Fertility and sterility 10/2009; 93(4):1353-5. · 3.97 Impact Factor
• Article: Effect of macroscopic or microscopic blood and mucus on the success rates of embryo transfers.

  Vasiliki A Moragianni, Jerry D Cohen, Scott E Smith, Jay S Schinfeld, Stephen G Somkuti, Annette Lee, Larry I Barmat
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  ABSTRACT: To assess the effect of microscopic and macroscopic contamination of embryo transfer (ET) catheters with blood or mucus on in vitro fertilization (IVF)-ET success rates. Retrospective cohort study. Infertility practice in teaching community hospital. Four hundred seventy patients undergoing IVF-ET. Controlled ovarian hyperstimulation and IVF-ET. Implantation rate (IR) and clinical pregnancy rate (CPR). The IR and CPR of IVF-ETs were comparable regardless of the presence (26.59% and 48.78%, respectively) or absence (23.49% and 44.44%, respectively) of any type of contamination. Even when analyzing specific contamination categories (i.e., macroscopic blood, microscopic blood on the outer catheter, microscopic blood on the inner catheter, blood anywhere without mucus, mucus only, or blood and mucus combined), there was no statistical significance in IR (range: 21.17% to 26.69%) or CPR (range: 32.69% to 49.5%). In general, IR and CPR appear to be unaffected by ET catheter contamination, whether it is macroscopic or microscopic presence of blood or mucus.
  Fertility and sterility 01/2009; 93(2):570-3. · 3.97 Impact Factor
• Article: Profound hypothyroidism-induced acute menorrhagia resulting in life-threatening anemia.

  Vasiliki A Moragianni, Stephen G Somkuti
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  ABSTRACT: Menorrhagia is a very common gynecologic entity with a broad differential diagnosis which includes both hypothyroidism and hyperthyroidism. We present the case of a 31-year-old patient with acute menorrhagia causing life-threatening anemia that resulted from profound hypothyroidism. Despite timely institution of thyroid replacement, the patient required emergent embolization of a uterine arteriovenous malformation after dilatation and curettage failed to control her bleeding. She was stabilized and discharged to home on the sixth hospital day. Three years later, she successfully conceived and delivered a healthy infant. Our case demonstrates the importance of thyroid evaluation in the patient who presents with menorrhagia. Timely management with medical treatment as well as conservative surgical or radiological interventions can facilitate resolution of symptoms and preserve the patient's fertility potential.
  Obstetrics and Gynecology 09/2007; 110(2 Pt 2):515-7. · 4.73 Impact Factor