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.

Outcomes in patients with early-onset fetal growth restriction without fetal or genetic anomalies

Early-onset poor fetal growth is associated with poor pregnancy outcomes but frequently is due to fetal structural and/or chromosomal abnormalities. We sought to determine outcomes in patients with early-onset fetal growth restriction without diagnosed fetal or genetic anomalies and to identify additional risk factors for poor outcomes in these patients. This was retrospective cohort study of singleton pregnancies in women with early-onset growth restriction defined as a sonographic estimated fetal weight <10% diagnosed between 16–28 weeks’ gestation. One hundred forty-two patients were identified who met inclusion and exclusion criteria and 20 patients were found to have fetal structural or chromosomal abnormalities. In the remaining 122 patients, the incidence of intrauterine fetal demise was 5.7% and there were high rates of preterm birth <37 weeks (20%), birth weight <10% (59.3%), and gestational hypertension (14.1%). Later gestational age at diagnosis and the presence of echogenic bowel and abnormal initial umbilical artery Dopplers were associated with poor pregnancy outcome. We concluded that patients with early-onset fetal growth restriction with no fetal structural or genetic abnormality have a high risk of poor pregnancy outcomes. Gestational age at diagnosis and certain ultrasound findings are associated with a higher risk for poor pregnancy outcome.

Risk Factors for Blood Transfusion in patients undergoing high-order Cesarean delivery

For patients undergoing cesarean delivery, the risk of the operation usually increases with each successive cesarean delivery.  At Maternal Fetal Medicine Associates we care for many women with several prior cesarean deliveries and therefore perform many “high-order” cesarean deliveries (3rd or higher cesarean delivery).

Emergent Primary Cesarean Delivery and Maternal Operative Morbidity

Sometimes women in labor require a cesarean delivery.  These deliveries can be categorized as nonurgent, urgent, or emergent, based on the circumstances.  Emergent (also known as “stat”) cesarean deliveries are usually performed when concerns over the health of the fetus are so significant that every minute counts.  In these situations, the operation itself it performed very quickly from the first incision until delivery of the baby, which can be as quick as one to two minutes.   One potential concern with this type of surgical technique is whether there is an increased risk to the mother when performing an emergent cesarean delivery.

Vaginal Birth After Cesarean Delivery for Arrest of Descent

Many pregnant women with a prior cesarean delivery have the option to attempt a vaginal birth after cesarean (VBAC), also known as TOLAC (trial of labor after cesarean).  The decision whether to attempt VBAC or to schedule a repeat cesarean delivery depends on the woman’s preferences, as well as two clinical factors:  the risk of VBAC and the likelihood of a successful VBAC. The risk of VBAC depends on several factors regarding the original cesarean delivery, as well as the overall health of the mother and her pregnancy.  Regarding the likelihood of success, one important variable is the reason for the previous cesarean.  For women who achieved full cervical dilation and began pushing but had a cesarean for “arrest of descent” (the baby did not descend into the pelvis), they were traditionally told that the likelihood of a successful VBAC was 50% or less.

A new minimally invasive treatment for cesarean scar pregnancy and cervical pregnancy

Dr. Monteagudo, a Maternal Fetal Medicine Specialist at MFMA, is internationally renowned for her expertise in OBGYN ultrasound. Furthermore, she has helped pioneer a minimally invasive method for the treatment of cesarean scar pregnancy through her cooperative research with the American Journal of Obstetrics & Gynecology. In this study, A new minimally invasive treatment for cesarean scar pregnancy and cervical pregnancy, the use of a cervical ripening double-balloon catheter is proposed as a minimally invasive method for inducing pregnancy; while also safely preventing excessive bleeding.