Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile
Twin pregnancies are at increased for stillbirth and warrant close surveillance, particularly towards the end of pregnancy. In singleton pregnancies, it has been shown that a Biophysical profile (BPP), which is an ultrasound assessment of fetal well-being, is superior to a NonStress Test (NST), which involves 20-40 minutes of fetal heart rate monitoring. In this study, we examined the utility of BPP testing in twin pregnancies and found that a normal test is associated with an extremely low rate of stillbirth and that there are few false positive results (false scares).
Preterm Birth or Small for Gestational Age in a Singleton Pregnancy and Risk of Recurrence in a Subsequent Twin Pregnancy
Prior preterm birth and SGA in a singleton pregnancy increase the risk of the same condition in a subsequent twin pregnancy. We postulate that the extrinsic mechanism responsible for the pathophysiology of adverse outcomes in twin pregnancies overlaps with that in singleton pregnancies.
What is New in Medical Student and Resident Education?
Published in the July issue of Obstetrics and Gynecology, Dr. Fox discusses four recent publications, which are concluded with a “bottom line” meant to be the take-home message. Recent publications include: “National Cluster-Randomized Trial of Duty Hour Flexibility in Surgical Training,” “Preparedness of Obstetrics and Gynecology Residents for Fellowship Training,” “Structured Teaching of Early Pregnancy Counseling,” and “Effectiveness of Labor Cervical Examination Simulation in Medical Student Education.”
Fetal fibronectin, cervical length, and the risk of preterm birth in patients with an ultrasound or physical exam indicated cervical cerclage
In patients with an ultrasound or physical exam indicated cerclage, a positive fFN and a short cervical length are both associated with preterm birth. The risk of preterm birth increase with the number of abnormal biomarkers.
Cervical Pessary and Vaginal Progesterone in Twin Pregnancies with a Short Cervix
For twin pregnancies with a short cervix, the addition of a cervical pessary to vaginal progesterone is associated with prolonged pregnancy and reduced risk of adverse neonatal outcomes. A large randomized trial should be performed to verify these retrospective findings.
Natural History of Vasa Previa Across Gestation Using a Screening Protocol
Vasa previa is a rare condition of pregnancy where a fetal blood vessel crosses over the maternal cervix. If unrecognized, it is extremely dangerous as the blood vessel can rupture during labor when the cervix dilates. Historically, there was less than a 50% newborn survival rate with this condition. However, when diagnosed before delivery, a cesarean delivery can be performed prior to labor, reducing the risk of this dreaded complication. In this study we demonstrated that a targeted ultrasound screening protocol used at Carnegie Imaging yielded a newborn survival rate of 100% in these patients.
Active Second-Stage Management in Twin Pregnancies Undergoing Planned Vaginal Delivery in a U.S. Population
For women with twin pregnancies, safe delivery of the babies is critically important. Recently, many providers have begun recommending cesarean delivery for all or most women with twins. At MFMA, we believe vaginal delivery of twins is a safe and reasonable option for many women with twin pregnancies. In this 2010 publication in Obstetrics and Gynecology, we demonstrated that our protocol for management of twins in labor, including breech extraction of the second twin, was associated with a very high success rate and a low cesarean rate at no additional risk as compared to babies born by cesarean delivery. Based on this publication and our vast experience with twin deliveries, the physicians at MFMA are considered experts in twin deliveries and are invited to speak around the US to other physicians about safe delivery of twin pregnancies.
Successful Bilateral Uterine Artery Embolization During an Ongoing Pregnancy
At Carnegie Imaging, we use the latest and most up to date technology in diagnosing and treating complicated conditions of pregnancy. In this 2009 publication in Obstetrics and Gynecology, we describe a case of a large arteriovenous malformation (AVM) complicating pregnancy. After her obstetrician recommended she terminate the pregnancy and undergo hysterectomy, she came to Carnegie Imaging for a second opinion. We were able to successfully treat the AVM using an experimental procedure of radiofrequency ablation of the AVM during pregnancy, saving her baby and uterus at the same time. She went on to deliver a healthy baby boy. Subsequent to this publication, she delivered healthy twin boys as well as a baby girl with MFMA. This demonstrates how one bold treatment decision by a woman and her doctors can have a tremendous impact on a woman’s health and her opportunity for a large family.
Weight Gain in Twin Pregnancies and Adverse Outcomes
Twin pregnancies are at increased risk of fetal growth restriction, which is when babies are born smaller than expected, usually due to poor transport of nutrients from the mother to the baby (or babies) across the placenta. There are few known interventions to reduce the risk of growth restriction in twin pregnancies, but in this study we demonstrated that improved weight gain was associated with a lower risk of growth restriction in twin pregnancies.
Gestational Age at Cervical Length and Fetal Fibronectin Assessment and the Incidence of Spontaneous Preterm Birth in Twins
At MFMA and Carnegie Imaging, we utilize cervical length and fetal fibronectin (fFN) screening in patients at increased risk for preterm birth, such as twin pregnancies. This 2015 publication in the Journal of Ultrasound in Medicine is the basis for our twin preterm birth calculator (www.mfmnyc.com/twin) and allows patients and doctors to predict the risk of preterm birth in twins using these simple, low-risk tests.