Publications (13)33.93 Total impact
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Article: Fetal Abnormal Growth Associated With Substance Abuse.
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ABSTRACT: Substance abuse remains a major concern in pregnancy. The current review summarizes the best available literature on the subject. The findings of most studies are confounded by multiple drug use and environmental and social factors that by themselves are known to adversely affect the pregnancy outcomes of interest. Overall, however, substance abuse during pregnancy was associated with negative effects on birth weight and head circumference.Clinical obstetrics and gynecology 01/2013; · 2.06 Impact Factor -
Article: Should bilateral uterine artery notching be used in the risk assessment for preeclampsia, small-for-gestational-age, and gestational hypertension?
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ABSTRACT: The purpose of this study was to determine the value of bilateral uterine artery notching in the second trimester in the risk assessment for preeclampsia, gestational hypertension, and small-for-gestational-age (SGA) without preeclampsia. This prospective cohort study included 4190 singleton pregnancies that underwent ultrasound examination between 23 and 25 weeks' gestation. The 95th percentiles of the mean pulsatility index (PI) and resistive index (RI) of both uterine arteries were calculated. Multivariable logistic regression analyses were performed to determine if bilateral uterine artery notching is an independent explanatory variable for the occurrence of preeclampsia, early-onset preeclampsia (<or=34 weeks), late-onset preeclampsia (>34 weeks), gestational hypertension, and delivery of an SGA neonate without preeclampsia, while controlling for confounding factors. (1) The prevalence of preeclampsia, early-onset preeclampsia, late-onset preeclampsia, SGA, and gestational hypertension were 3.4%, 0.5%, 2.9%, 10%, and 7.9%, respectively; (2) 7.2% of the study population had bilateral uterine artery notching; and (3) bilateral uterine artery notching was an independent explanatory variable for the development of preeclampsia (odds ratio [OR], 2.1; 95% confidence interval [CI],1.28-3.36), early-onset preeclampsia (OR, 4.47; 95% CI, 1.50-13.35), and gestational hypertension (OR, 1.50; 95% CI, 1.02-2.26), but not for late-onset preeclampsia or SGA. Bilateral uterine notching between 23 and 25 weeks' gestation is an independent risk factor for the development of early-onset preeclampsia and gestational hypertension. Thus, bilateral uterine artery notching should be considered in the assessment of risk for the development of these pregnancy complications.Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2010; 29(7):1103-15. · 1.25 Impact Factor -
Article: Incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy: a 17-year experience from a single institution.
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ABSTRACT: To review the incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy (CH) in our institution. Retrospective study of 158 women who had CH at the Detroit Medical Center during a 17 period. During the study period, 158 of 202,356 deliveries were CH, giving an overall incidence of 0.78 per 1,000 deliveries. Of the 158 cases, 14 were elective while 144 were emergently performed due to complications encountered at cesarean section. Analysis of the eligible 144 cases showed that the commonest risk factors were previous cesarean delivery (76%) and placenta previa (35%). Abnormal placenta adherence was the indication for CH in 50.7%, followed by uterine atony in 34.7% and uterine rupture in 16.7% of the cases. Febrile morbidity (44.4%) and disseminated intravascular coagulopathy (22.9%) were the most common postoperative complications. Most complications occurred in patients with parity greater than two. Compared to the last decade, CH performed more recently were less likely to be complicated by bowel injury or disseminated intravascular coagulopathy. Morbidly adherent placenta has replaced uterine atony as the leading indication for emergent CH in our institution. High parity remains a risk factor for complications; however, we recorded a reduction in bowel injury and disseminated intravascular coagulopathy in recent years.Archives of Gynecology 03/2009; 280(4):619-23. · 0.91 Impact Factor -
Chapter: Prelabor Rupture of the Membranes
01/2008: pages 1130 - 1188; , ISBN: 9780470753293 -
Article: A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome.
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ABSTRACT: The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS). This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients. There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) (P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) (P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) (P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) (P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) (P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (P = .055, OR 3.025/point) by logistic regression analysis. The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.American journal of obstetrics and gynecology 11/2007; 197(4):396.e1-9. · 3.28 Impact Factor -
Article: Fetal thrombocytopenia secondary to parvovirus infection.
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ABSTRACT: The aim of this study was to determine the platelet count in fetuses undergoing cordocentesis for hydrops caused by parvovirus infection. Fetal platelets were measured at cordocentesis in 11 pregnant women who underwent the procedure because of fetal ascites and/or hydrops caused by parvovirus infection. Thrombocytopenia was defined as mild (platelet count < 150 x 10(9)/L), moderate (platelet count < or = 100 x 10(9)/L), or severe (platelet count to < or = 50 x 10(9)/L). Paired Student t test was performed to compare the platelet count before and after the transfusion. The fetuses underwent 20 cordocenteses. They were thrombocytopenic in 17 and anemic in 15 occasions. The platelet count was reduced after the transfusion (P < .05). Demises occurred after the first transfusion in 2 fetuses. The first occurred within 5 minutes from the procedure and the second within 24 hours. Both were attributed to exsanguination from the umbilical cord puncture site (platelet count 2 and 24 x 10(9)/L, respectively). Thrombocytopenia is common in fetuses with hydrops caused by parvovirus infection, and can cause exsanguination from the umbilical cord puncture site. We recommend platelet transfusion during cordocentesis when there is severe thrombocytopenia.American journal of obstetrics and gynecology 02/2007; 196(1):61.e1-4. · 3.28 Impact Factor -
Article: A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery.
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ABSTRACT: Matrix metalloproteinase-8 (MMP-8) is an enzyme that is released during neutrophil activation. MMP-8 amniotic fluid concentrations are elevated not only in patients with intra-amniotic infection, but also in patients with negative amniotic fluid cultures who deliver preterm neonates. The objective of this study was to determine whether the results of a rapid MMP-8 bedside test predict imminent preterm delivery. This test can be performed in 15 minutes and without laboratory equipment. Amniotic fluid was retrieved from 331 patients admitted with increased preterm uterine contractions and intact membranes who met the inclusion criteria. Amniotic fluid was processed for microbial cultures, Gram stain, glucose concentration, and white blood cell count. Amniotic fluid samples were stored, and the MMP-8 rapid test was performed after delivery. End points included spontaneous preterm delivery within 48 hours, 7 days, and 14 days. Diagnostic indices, predictive values, and likelihood ratios were calculated. The prevalence of spontaneous preterm delivery within 48 hours, 7 days, and 14 days was 11.6% (38/327), 20.2% (66/327), and 24.5% (80/327), respectively (4 patients with augmentation of labor were excluded). A positive MMP-8 rapid test had a positive predictive value of 70% (23/33) for the identification of patients who delivered spontaneously within 48 hours, and 94% (31/33) for patients who were delivered within 7 days and 14 days (likelihood ratios: 17.5 [95% CI, 9-33.9], 61.3 [95% CI, 15.1-250], and 50 [95% CI, 12-196], respectively). The MMP-8 rapid test can identify patients at risk for preterm delivery within 7 days and 14 days. Moreover, a positive MMP-8 rapid test result can identify patients with intra-amniotic infection/inflammation with a high sensitivity and specificity. This rapid test will give clinicians a fast and accurate assessment of the inflammatory status of the amniotic cavity and allow for better identification of patients at risk for impending preterm delivery.American journal of obstetrics and gynecology 11/2006; 195(4):1025-30. · 3.28 Impact Factor -
Article: Sequential pathways of testing after first-trimester screening for trisomy 21.
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ABSTRACT: To evaluate the performance and use of second-trimester multiple-marker maternal serum screening for trisomy 21 by women who had previously undergone first-trimester combined screening (nuchal translucency, pregnancy-associated plasma protein A, and free beta-hCG), with disclosure of risk estimates. In a multicenter, first-trimester screening study sponsored by the National Institute of Child Health and Human Development, multiple-marker maternal serum screening with alpha-fetoprotein, unconjugated estriol, and total hCG was performed in 4,145 (7 with trisomy 21) of 7,392 (9 with trisomy 21) women who were first-trimester screen-negative and 180 (7 with trisomy 21) of 813 (52 with trisomy 21) who were first-trimester screen-positive. Second-trimester risks were calculated using multiples of the median and a standardized risk algorithm with a cutoff risk of 1:270. Among the first-trimester screen-negative cohort, 6 of 7 (86%) trisomy 21 cases were detected by second-trimester multiple-marker maternal serum screening with a false-positive rate of 8.9%. Among the first-trimester screen-positive cohort, all 7 trisomy 21 cases were also detected in the second trimester, albeit with a 38.7% false-positive rate. Our data demonstrate that a sequential screening program that provides patients with first-trimester results and offers the option for early invasive testing or additional serum screening in the second trimester can detect 98% of trisomy 21-affected pregnancies. However, such an approach will result in 17% of patients being considered at risk and, hence, potentially having an invasive test. II-2Obstetrics and Gynecology 11/2004; 104(4):661-6. · 4.73 Impact Factor -
Article: Intrapartum management of severe fetal airway obstruction.
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ABSTRACT: To review our experience with the planned intrapartum management of fetuses with suspected severe airway obstruction. Retrospective review of prenatal presentations, intrapartum airway procurement methods, outcomes, and complications. All cases (N = 11) at our tertiary airway referral institution between 1995 and 2002 were reviewed. Obstruction was secondary to giant cervicofacial lymphangiomas (5), teratomas (2), epignathis (1), epulis (1), conjoined fetus (1), and tracheal foreign body (1). Elective cesarean delivery of the entire fetus was performed while maintaining fetal-placental circulation as long as possible. We found it necessary to deliver the entire fetus to improve airway exposure and decrease maternal hemorrhage. The airway was secured effectively in all cases. Although full cesarean delivery of the fetus significantly reduces fetal-placental circulation times, in comparison with the formal ex utero intrapartum treatment (EXIT) procedure, airway access is improved, maternal complications may be decreased, and high airway procurement success is still safely achieved.The Journal of otolaryngology 11/2004; 33(5):283-8. · 0.50 Impact Factor -
Article: Combined serum and ultrasound screening for detection of fetal aneuploidy.
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ABSTRACT: Experience gathered over the last decade from high-risk centers provide strong evidence that mid-trimester sonographic markers are sensitive for Down syndrome prediction. More recent data indicate that combining mid trimester sonography with traditional serum markers significantly improves diagnostic accuracy over either group of markers by themselves.Seminars in Perinatology 05/2003; 27(2):145-51. · 2.99 Impact Factor -
Article: Noninvasive diagnosis by Doppler ultrasonography of fetal anemia resulting from parvovirus infection.
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ABSTRACT: The purpose of this study was to evaluate the feasibility of the middle cerebral artery peak systolic velocity for the detection of fetal anemia in pregnancies that are complicated by parvovirus B19 infection. Doppler measurements of the middle cerebral artery peak systolic velocity were performed weekly in 32 fetuses at risk for anemia because of maternal parvovirus infection documented by the presence of serum immunoglobulin M antibody. The values of the middle cerebral artery peak systolic velocity and hemoglobin were expressed as multiples of the median. These values were plotted on reference ranges that had been established previously. A cordocentesis was performed either because of fetal ascites or when the middle cerebral artery peak systolic velocity values suggested anemia (middle cerebral artery peak systolic velocity, >1.50 multiples of the median). Gestational age at study entry ranged from 15.1 to 37 weeks. There were 17 fetuses with middle cerebral artery peak systolic velocity of >1.50 MoM (group 1). Sixteen cordocenteses were performed in these fetuses. All 16 fetuses were anemic (15 severely and 1 mildly). Thirteen fetuses had signs of hydrops (12 with severe and 1 with mild anemia). Group 2 included 15 fetuses with the middle cerebral artery peak systolic velocity values <1.50 MoM. Two cordocenteses were performed. One fetus was mildly anemic; the second fetus was not anemic. The remaining 13 fetuses of this group did not have any complications and were not anemic at birth. The sensitivity of the middle cerebral artery peak systolic velocity (>1.50 MoM) for the prediction of anemia because of parvovirus infection was 94.1%; the specificity was 93.3 %; the positive and negative predictive values were 94.1% and 93.3%, respectively. Fetal anemia caused by parvovirus infection can be detected noninvasively by Doppler ultrasonography on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery.American Journal of Obstetrics and Gynecology 11/2002; 187(5):1290-3. · 3.47 Impact Factor -
Article: The comprehensive midtrimester test: high-sensitivity Down syndrome test.
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ABSTRACT: The purpose of this study was to develop a highly sensitive algorithm for midtrimester Down syndrome detection. Urine (hyperglycosylated human chorionic gonadotropin, beta-core fragment of human chorionic gonadotropin), serum (alpha-fetoprotein, human chorionic gonadotropin and unconjugated estriol [uE(3)]), and ultrasound biometry (nuchal thickness, humerus length, the presence of gross ultrasonographic anomalies), and maternal age were measured at genetic amniocentesis. Stepwise logistic regression analysis was used to identify the most significant markers. A multivariate Gaussian algorithm plus age was used to derive patient-specific Down syndrome risk. Sensitivity and false-positive rates at different risk thresholds and the area under the receiver-operating characteristic curve were determined. A probability value of <.05 was significant. There were 568 study cases with 17 Down syndrome cases (3.0%). The mean (+/-SD) maternal and gestational ages for the study group were 36.9 (+/-3.5) years and 16.2 (+/-1.4) weeks, respectively. The significant markers were nuchal thickness (P =.0001), hyperglycosylated human chorionic gonadotropin(P <.001), and beta-core fragment (P <.002). Neither maternal age nor gross sonographic anomaly contributed significantly to Down syndrome detection. The comprehensive midtrimester test was extremely efficient for Down syndrome detection in advanced maternal age only cases with a sensitivity of 92.3% at a 0.8% false-positive rate. In women <35 years old, all the Down syndrome cases were detected at 2.2% false positive rate. For the overall population, the sensitivity was 93.7% at 5% false-positive rate. In a preliminary study, the comprehensive midtrimester test appeared highly sensitive in different age groups. Gross anomaly detection was not required for high performance, which makes the comprehensive midtrimester test potentially suitable for low-risk screening and as an alternative to amniocentesis in women who wish to avoid the procedure. This was a small study; thus, the clinical value of this test can only be established in large trials.American Journal of Obstetrics and Gynecology 04/2002; 186(4):803-8. · 3.47 Impact Factor -
Article: Maternal Urine [beta]-core hCG Fragment Level and Small for Gestational Age Neonates
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ABSTRACT: Objective: To determine whether second-trimester urine β-core fragments of hCG predict small for gestational age (SGA) neonates. Methods: Spot urine β-core levels were measured in 733 nonhypertensive women with singleton pregnancies who presented for amniocentesis and had karyotypically normal fetuses. The β-core level was standardized to urine creatinine and expressed as multiples of the median. The area under a receiver operating characteristics curve was used to determine the screening efficiency of the urine analyte for prediction of small for gestational age (SGA) births. In a subgroup of cases, serum markers (alpha-fetoprotein [AFP], hCG, and unconjugated estriol) were compared using stepwise regression analysis to urine β-core fragment for SGA prediction. Results: There were 23 (3.0%) SGA neonates. The mean ± standard deviation (SD) gestation at urine collection was 16.4 ± 1.3 weeks and collection to delivery interval was 23.0 ± 2.2 weeks. Mean β-core (± SD) fragment levels were significantly higher in those who later had SGA infants compared with appropriately grown infants (2982.8 ng/mg creatinine versus 1447.4 ng/mg creatinine, P < .001). Stepwise logistic regression found that urine β-core fragment and serum AFP were the only significant predictors of SGA, with statistically significant χ2 values (P < .001 and P = .038, respectively). The urine analyte was significantly superior. Second-trimester urine β-core fragment had a 78.3% sensitivity and 70% specificity for SGA prediction. Exclusion of preeclamptic cases resulted in a sensitivity of 84.2% and a specificity of 71.2%. Conclusion: Second-trimester elevated maternal urine β-core fragment of hCG predicted SGA infants, and was superior to other serum analytes in that prediction. The terminal metabolite of hCG is the β-core fragment, which accumulates in maternal urine. We reported preliminary evidence that β-core fragment of hCG might be useful as a marker of trophoblast activity.1 Second-trimester urine β-core fragment was elevated in clinically normal women who eventually became preeclamptic. In the present study, we hypothesized that as a marker of trophoblastic function, second-trimester urine β-core fragment might predict small for gestational age (SGA) neonates.Obstetrics and Gynecology 04/2000; 95(5):662-666. · 4.73 Impact Factor
Top co-authors
Top Journals
Institutions
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2009–2013
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Wayne State University
- Department of Obstetrics and Gynecology
Detroit, MI, USA
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2002–2003
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University of Cincinnati
- Department of Obstetrics and Gynecology
Cincinnati, OH, USA -
Yale University
New Haven, CT, USA
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