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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.
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.
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.
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.
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.
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.
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.
At Carnegie Imaging, women undergoing aneuploidy risk assessment (screening for Down Syndrome and other genetic conditions) have the option of Instant Risk Assessment (IRA), which allows women to receive their final results and counseling by one of our Maternal Fetal Medicine specialists on the day of their 11-13 week nuchal translucency ultrasound at Carnegie Imaging. With traditional aneuploidy screening, patients do not receive their results until a week later, generally from their referring provider’s office. In this 2010 publication in the American Journal of Perinatology, we demonstrated that women undergoing IRA had better understanding of aneuploidy screening, less anxiety, and more satisfaction than women who underwent traditional aneuploidy screening.
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.
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.
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