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.

Long-term Outcomes of Twins Based on Gestational Age at Delivery

Twin pregnancies have a high rate of preterm birth.  It is well known that prematurity is a risk factor for many adverse outcomes in newborns.  However, most studies focus on short-term outcomes such as NICU admission, infections, and need for respiratory support.  However, long-term outcomes are usually more relevant to expectant parents.   In this study, we examined long-term outcomes of twins, based on the gestational age at delivery.   We found that fortunately, the likelihood of major adverse outcomes was low, even for very premature twins.  The rates of less severe outcomes was higher, but that was true even amongst the twins born at term, suggesting that children nowadays are receiving more services and more diagnoses in general for less severe issues.  2017 twin long term GA at delivery 

Antenatal Testing for Women With Preexisting Medical Conditions Using Only the Ultrasonographic Portion of the Biophysical Profile

Women with certain medical conditions are at increased risk of stillbirth and require regular, scheduled fetal monitoring. In this study we demonstrated excellent outcomes with the sonographic portion of the Biophysical Profile, which is an ultrasound test to assess fetal well-being.

Optimal Timing of Delivery in Women with Higher Order Cesareans: A Cohort Study

For women with multiple prior cesarean deliveries, it is currently unknown when is the optimal gestational age to schedule a repeat cesarean delivery. Waiting until 39 weeks could have potential benefit to the newborn, but puts both the mother and baby at risk if labor begins spontaneously prior to 39 weeks. In this study, we found that planned cesarean delivery at approximately 37 weeks was associated with certain improved outcomes and no adverse neonatal outcomes.

Long-Term Outcomes of Small for Gestational Age Twins Born at 34 Weeks or Later

Twin pregnancies are at an increased risk of fetal growth restriction. In this long-term follow-up of twins with fetal growth restriction, we found that for twins born at 34 weeks or later, long-term outcomes were very favorable, even for those twins with severe growth restriction.

The association between obstetrical history and preterm birth in women with uterine anomalies

This study helps clarify the risk of preterm birth for women with uterine anomalies, based on their prior pregnancy history.

Association Between Senior Obstetrician Supervision of Resident Deliveries and Mode of Delivery

This study, which was selected by Obstetrics and Gynecology (the leading US journal for OBGYN research) as one of the winners of the 2017 Roy M. Pitkin Award, which was established in 1998 to honor departments of obstetrics and gynecology that promote and demonstrate excellence in research. In this study we demonstrated that Having senior obstetricians supervise resident deliveries is significantly associated with an increased rate of forceps deliveries and a decreased rate of cesarean deliveries. This supports our active role in resident and medical school education.

Long-term outcomes of twins based on the intended mode of delivery

For women with twin pregnancies >34 weeks, planned vaginal delivery was associated with similar long-term outcomes as planned cesarean delivery. This article supports recent research that demonstrated similar newborn outcomes for vaginal delivery of twins as compared to cesarean delivery.

Mild Fetal Ventriculomegaly: Diagnosis, Evaluation, and Management

See the recent SMFM Consult Series on Mild Fetal Ventriculomegaly, co-authored by Dr. Nathan Fox and Dr. Ana Monteagudo.