Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies
Subchorionic hematomas, or subchorionic hemorrhages, are common ultrasound findings in early pregnancy. However, their significance is uncertain. Some believe they increase the risk of many pregnancy complications, including pregnancy loss / miscarriage. In this study of almost 3000 women, we found that Subchorionic hematoma does not increase the risk of pregnancy loss prior to 20 weeks. This information is reassuring as nearly 20% of women will have this finding on ultrasound.
Cervical Length, Cervical Dilation, and Gestational Age at Cerclage Placement and the Risk of Preterm Birth in Women Undergoing Ultrasound or Exam Indicated Shirodkar Cerclage
Certain high-risk women require cerclage placement in pregnancy to lower the risk of a pregnancy loss or preterm birth and we have previously published our vast experience with this procedure (https://www.mfmnyc.com/blog/mfm-publications/ultrasound-indicated-cerclage-shirodkar-vs-mcdonald/) and (https://www.mfmnyc.com/blog/mfm-publications/outcomes-of-emergency-or-physical-examination-indicated-cerclage-in-twin-pregnancies-compared-to-singleton-pregnancies/). In this study we examined if there were any differences in cerclage outcomes, based on the cervical length, cervical dilation, or gestational age at the time of the procedure.
Weight Gain and Pregnancy Outcomes in Underweight Women with Twin Gestations
We have previously shown the critical importance of adequate pregnancy weight gain for women with twin pregnancies (https://www.mfmnyc.com/blog/mfm-publications/weight-gain-in-twin-pregnancies-and-adverse-outcomes/) and (https://www.mfmnyc.com/blog/mfm-publications/the-association-between-maternal-weight-gain-and-spontaneous-preterm-birth-in-twin-pregnancies/). However, most data has been for women who enter pregnancy with a normal weight, as defined by the pre-pregnancy body mass index (BMI). In this study, we found that women who enter pregnancy underweight should be recommended the same weight gain as women with normal pre-pregnancy weight.
The Association Between High-Normal Blood Pressure and the Development of Preeclampsia in Twin Pregnancies
Women with twin pregnancies are at increased risk of preeclampsia. In this study we found that women with twin pregnancies and blood pressure readings that were normal, but in the upper range of normal, are at significantly increased risk of developing preeclampsia and need to be monitored carefully.
The Association Between Intended Mode of Delviery and Maternal Morbidity in Twin Pregnancies
We have published several studies demonstrating that planned vaginal delivery of twins is associated with similar neonatal outcomes as compared to planned cesarean delivery (https://www.mfmnyc.com/blog/mfm-publications/long-term-outcomes-twins-based-intended-mode-delivery/) and (https://www.mfmnyc.com/blog/mfm-publications/active-second-stage-management-in-twin-pregnancies-undergoing-planned-vaginal-delivery-in-a-u-s-population/). In this study, we demonstrate that maternal outcomes are similar or better with planned vaginal delivery, as compared to planned cesarean delivery. This gives further support to women with twin pregnancies attempting a vaginal delivery, if clinically appropriate.
Risk Factors for Positive Postpartum Depression Screen in Women With Private Health Insurance and Access to Care
Postpartum depression is a common and potentially devastating condition for a new mother. There are many known risk factors for postpartum depression, but many of them are related to poor access to health care . In this study, we sought to find risk factors for postpartum depression amongst a large cohort of women with private health insurance and excellent access to care.
Minimally Invasive Treatment of Cesarean Scar and Cervical Pregnancies Using a Cervical Ripening Double Balloon Catheter
Cesarean scar ectopic is a life-threatening condition in early pregnancy with an increasing prevalence. We originally described a novel, outpatient, minimally-invasive approach to this potentially devastating condition. As a follow-up to our original study ng this approach (https://www.mfmnyc.com/blog/mfm-publications/new-minimally-invasive-treatment-cesarean-scar-pregnancy-cervical-pregnancy/), we published an expanded case series describing excellent outcomes in 38 women treated by several medical centers.
Time to Delivery After Scheduled Shirodkar Cerclage Removal in Singleton Gestations Based on the Original Indication for Cerclage Placement
The best timing of cerclage removal is unknown. In this study, we examined time of cerclage removal to delivery to try to help establish the ideal gestational age window to schedule cerclage removal.
Glycemic Control in Twin Pregnancies With Gestational Diabetes: Are we Improving or Worsening Outcomes?
Twin pregnancies are at increased risk of gestational diabetes. However, although diagnosis and treatment of gestational diabetes has been shown to be useful in singleton pregnancies, it is unclear if this is true in twin pregnancies as well. For example, one of the risks of gestational diabetes is fetal macrosomia, or a very large fetus, which is extremely uncommon in twin pregnancies, even those with gestational diabetes. In this study we found that stricter control of gestational diabetes in twin pregnancies was actually associated with worse outcomes. We suggest that more research needs to be done to determine the optimal treatment of gestational diabetes in twin pregnancies.
Accuracy of Sonographic Estimated Fetal Weight in Suspected Macrosomia: The Likelihood of Overestimating and Underestimating the True Birthweight
Prior to delivery, the fetal weight is often estimated either by feeling the maternal abdomen or by ultrasound. There are many studies describing the accuracy of these methods. In this study, we took a unique look at this issue and calculated the likelihood an ultrasound showing a large fetal weight was over- or under-estimating the true weight. As the estimated weight got larger, the chance ultrasound over-estimates also increases. This can be useful clinically when receiving an ultrasound report of a large fetal weight.