Ultrasound-indicated cerclage: Shirodkar vs. McDonald
Cervical cerclage is a procedure performed to reduce the risk of preterm birth in certain high-risk pregnancies. There are two techniques for this procedure, the McDonald cerclage and the Shirodkar cerclage. Traditionally, it was unknown which procedure type was superior. In this 2012 publication we showed that the Shirodkar type, which is the preferred method in our practice, was associated with superior outcomes.
Outcomes of emergency or physical examination-indicated cerclage in twin pregnancies compared to singleton pregnancies
Cervical cerclage is a procedure performed to reduce the risk of preterm birth in certain high-risk pregnancies. Despite its wide spread use, there is much controversy over which circumstances cerclage is actually beneficial. One such difficult clinical scenario is a patient with a dilated cervix in the second trimester. In this 2014 publication in the European Journal of Obstetrics and Gynecology, we reported our experience with cerclage in a series of patients with singleton and twin pregnancies and a dilated cervix in the second trimester and demonstrated excellent outcomes in this group of patients.
The association between maternal weight gain and spontaneous preterm birth in twin pregnancies
Twin pregnancies are at increased risk of several pregnancy complications, with the two most common being preterm birth and fetal growth restriction. In this study we demonstrated that simple nutritional interventions in twin pregnancies might be able to improve birthweight as well as lower the risk of preterm birth. This is why we place great emphasis on proper maternal nutrition in twin pregnancies.
The effectiveness of antepartum surveillance in reducing the risk of stillbirth in patients with advance maternal age
Stillbirth, which is one of the worst and most feared complications of pregnancy, is usually an unexpected and unpredictable event. However, certain pregnant women, such as women over 35 are at increased risk of stillbirth, but it is unknown what can be done in this group of at-risk women to reduce their risk. In this 2013 publication in the European Journal of Obstetrics and Gynecology, we demonstrated that our protocol of weekly Biophysical Profile (BPP) testing, which is a simple ultrasound performed at Carnegie Imaging, along with delivery by 41 weeks, reduces the risk of stillbirth in women over 35 to that of a low-risk women. This is an example of how large screening protocols in high-risk groups can reduce the overall risk of complications.
Routine cervical length and fetal fibronectin screening in asymptomatic twin pregnancies: is there clinical benefit?
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. Our twin calculator (www.mfmnyc.com/twin) allows patients and doctors to predict the risk of preterm birth in twins using these simple, low-risk tests. In this 2013 publication in the Journal of Maternal-Fetal and Neonatal Medicine, we demonstrated that the use of these tests was associated with improved administration and timing of antenatal corticosteroids, which is the single most important intervention in improving outcomes among preterm babies.
Chromosomal Microarray versus Karotyping for Prenatal Diagnosis
When performing chorionic villous sampling (CVS) or amniocentesis, the traditional laboratory analysis performed is a karyotype, which essentially views and counts the 46 chromosomes to diagnose conditions such as Down Syndrome, Trisomy 18, Trisomy 13, as well as establish the fetal gender. As co-investigators in this landmark 2012 publication in the New England Journal of Medicine and co-authors of this study, we were able to help establish non-invasive microarray testing as a reliable alternative to traditional invasive karyotype analysis.