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 ( and (  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 (, 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.

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.