Type of Congenital Uterine Anomaly and Adverse Pregnancy Outcomes

A uterine anomaly (also called mullerian anomaly) refers to  a uterus that does not have normal shape (pear-shaped0.  There are several subtypes of uterine anomalies and each can have a different impact pregnancy for women with these uterine abnormalities.  In this study, we report pregnancy complication rates in a large cohort of women with uterine anomalies, based on the whether the defect was minor or major.

The Independent Associations of a Short Cervix, Positive Fetal Fibronextin, Amniotic Fluid Sludge, and Cervical Funneling with Spontaneous Preterm Birth in Twin Pregnancies

In twin pregnancies, a short cervical length on ultrasound, as well as a positive fetal fibronectin test, are both associated with an increased risk of preterm birth.  In this study, we found that the presence of amniotic fluid sludge (particulate matter seen on ultrasound just above the cervix) also increased the risk of preterm birth.

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.