Faculty Bibliography
Searched for:
person:klausc01
Total Results:
73
Preterm birth or small for gestational age in a singleton pregnancy and risk of recurrence in a subsequent twin pregnancy
OBJECTIVE:To evaluate whether a history of preterm birth or small for gestational age (SGA) in a singleton pregnancy is associated with an increased risk of recurrence of the same condition in a subsequent twin pregnancy. METHODS:Retrospective cohort study of twin pregnancies delivered in one maternal-fetal medicine practice from 2005 to 2014. Patients with a history of singleton preterm birth at less than 37 weeks of gestation were compared with patients with a history of singleton term birth and nulliparous patients. A similar analysis was performed for a history of SGA (birth weight less than 10%). RESULTS:Six hundred forty-seven twin pregnancies were included. The prior singleton gestational age at delivery was significantly positively correlated with the twin gestational age at delivery (P<.001), and the prior singleton birth weight was significantly positively correlated with the birth weight of the larger twin (P<.001) and the smaller twin (P<.001). The rate of twin preterm birth before 32 weeks of gestation was 3.5% in patients with a prior term birth, 9.2% in nulliparous patients, and 26% in patients with a prior preterm birth (P<.001). The rate of SGA in patients with a prior birth not complicated by SGA was 42.1%, in nulliparous women it was 54.4%, and in patients with a history of SGA it was 65.2% (P=.007). On regression analysis, prior preterm birth and SGA of a singleton pregnancy were independently associated with recurrence of the same condition in a subsequent twin pregnancy. CONCLUSION/CONCLUSIONS: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.
PMID: 25751219
ISSN: 1873-233x
CID: 3115802
The association between maternal biomarkers and pathways to preterm birth in twin pregnancies
Abstract Objective: We sought to estimate the association between CL and fFN and each pathway leading to preterm birth in twin pregnancies. Methods: Cohort study of 560 patients with twin pregnancies who underwent routine serial CL and fFN screening from 22-32 weeks in one maternal fetal medicine practice from 2005-2013. We calculated the association between a short CL (
PMID: 24849127
ISSN: 1476-4954
CID: 1012922
Risk factors for cesarean delivery in twin pregnancies attempting vaginal delivery
OBJECTIVE: To estimate independent risk factors for cesarean delivery in patients with twin pregnancies attempting vaginal delivery. METHODS: Historical cohort of twin pregnancies delivered in one practice between June 2005 and February 2014. Baseline characteristics were compared between women who delivered vaginally and women who underwent cesarean delivery in labor. Logistic regression analysis was performed to estimate independent risk factors for cesarean delivery. RESULTS: 286 women with twin pregnancies attempting vaginal delivery were included in the study. The overall modes of delivery were: vaginal delivery 82.2%, cesarean delivery 17.8%, and combined vaginal-cesarean delivery 0%. The most common indication for cesarean delivery in labor was an arrest disorder (82.4%). The risk factors independently associated with cesarean delivery were nulliparity (aOR 5.78, 95% CI 2.24, 14.88) and advanced maternal age >/=35 years (aOR 2.36, 95% CI 1.16, 4.80). The patients at highest risk for cesarean delivery (nulliparous, AMA, induced labor) still had a 48.6% likelihood of vaginal delivery. CONCLUSIONS: In patients with twin pregnancies attempting labor, nulliparity and advanced maternal age are independently associated with cesarean delivery in labor. However, even the patients at highest risk for cesarean delivery have nearly a 50% likelihood of successful vaginal delivery and therefore should be allowed to attempt vaginal delivery if desired and not otherwise contraindicated.
PMID: 25088861
ISSN: 0002-9378
CID: 1105212
Abnormal biochemical analytes used for aneuploidy screening and adverse pregnancy outcomes in twins [Meeting Abstract]
ISI:000361140900482
ISSN: 1097-6868
CID: 1794912
Is MSAFP Still a Useful Test for Detecting Open Neural Tube Defects and Ventral Wall Defects in the Era of First-Trimester and Early Second-Trimester Fetal Anatomical Ultrasounds?
Introduction: To evaluate whether maternal serum alpha-fetoprotein (MSAFP) improves the detection rate for open neural tube defects (ONTDs) and ventral wall defects (VWD) in patients undergoing first-trimester and early second-trimester fetal anatomical survey. Material and Methods: A cohort of women undergoing screening between 2005 and 2012 was identified. All patients were offered an ultrasound at between 11 weeks and 13 weeks and 6 days of gestational age for nuchal translucency/fetal anatomy followed by an early second-trimester ultrasound at between 15 weeks and 17 weeks and 6 days of gestational age for fetal anatomy and MSAFP screening. All cases of ONTD and VWD were identified via query of billing and reporting software. Sensitivity and specificity for detection of ONTD/VWD were calculated, and groups were compared using the Fisher exact test, with p < 0.05 as significance. Results: A total of 23,790 women met the criteria for inclusion. Overall, 15 cases of ONTD and 17 cases of VWD were identified; 100% of cases were diagnosed by ultrasound prior to 18 weeks' gestation; none were diagnosed via MSAFP screening (p < 0.001). First-trimester and early second-trimester ultrasound had 100% sensitivity and 100% specificity for diagnosing ONTD/VWD. Discussion: Ultrasound for fetal anatomy during the first and early second trimester detected 100% of ONTD/VWD in our population. MSAFP is not useful as a screening tool for ONTD and VWD in the setting of this ultrasound screening protocol. (c) 2014 S. Karger AG, Basel.
PMID: 25034077
ISSN: 1015-3837
CID: 1073622
The use of 17-hydroxy progesterone in women with arrested preterm labor: a randomized clinical trial
Abstract Background: The use of 17-alpha-hydroxyprogesterone caproate (17 P) has been shown to reduce preterm delivery in women who have had a prior preterm birth. The role of 17 P in women with arrested preterm labor is less certain. Aims: To compare the preterm birth rate and neonatal outcome in women with arrested preterm labor randomized to receive 17 P or placebo. Materials and methods: Women with arrested preterm labor were randomized to weekly injections of either 17 P (250 mg) or placebo. Maternal and neonatal outcome were evaluated. Results: Forty-five singleton pregnancies were randomized after successful tocolysis; 22 received 17 P while 23 got placebo. Gestational age at delivery (p = 0.067) and the interval from treatment to delivery (p = 0.233) were not affected by 17 P. Significantly less women in the 17 P group delivered at <34 weeks (14 versus 21, p = 0.035). There was also a significant reduction in the risk of neonatal sepsis (p = 0.047) and gr III/IV intraventricular hemorrhage (IVH) (p = 0.022) in the 17 P group. Conclusion: In this study, 17 P did not delay the interval to delivery after successful preterm labor, but births <34 weeks as well as neonatal sepsis and IVH were reduced by 17 P treatment.
PMID: 24512252
ISSN: 1476-4954
CID: 922372
Screening approach for gestational diabetes in twin pregnancies
OBJECTIVE: The objective of this study was to evaluate the ideal cutoff for the glucose challenge test (GCT) in twin pregnancies undergoing screening for gestational diabetes mellitus (GDM). STUDY DESIGN: A historical cohort of patients with twin pregnancies were identified from 1 maternal-fetal medicine practice from 2005 through 2013. All patients were administered a 1-hour, 50-g GCT between 24-28 weeks' gestation. All patients with a GCT of >/=130 mg/dL underwent a 3-hour, 100-g oral glucose tolerance test. The diagnosis of GDM was made if 2 of the 4 values on the oral glucose tolerance test were abnormal (Carpenter and Coustan). The testing characteristics of the GCT for diagnosis of GDM were evaluated using 3 selected cutoffs: >/=130, >/=135, and >/=140 mg/dL. We excluded all patients diagnosed with GDM <24 weeks. RESULTS: In all, 475 patients with twin pregnancies underwent a GCT between 24-28 weeks. The incidence of GDM was 6.5%. The positive screen rate using the 3 selected cutoffs were: >/=130 mg/dL, 34.7%; >/=135 mg/dL, 28.6%; and >/=140 mg/dL, 23.4%. A GCT cutoff of >/=135 mg/dL maintained 100% sensitivity, with a specificity of 76.4%. Using this cutoff, the positive predictive value was 22.8% and the negative predictive value was 100%. Compared to a cutoff of >/=130 mg/dL, a cutoff of >/=135 mg/dL resulted in 6.1% less patients testing positive while maintaining the same 100% sensitivity. CONCLUSION: In twin pregnancies, the optimal 1-hour, 50-g GCT screening cutoff appears to be >/=135 mg/dL.
PMID: 25439813
ISSN: 0002-9378
CID: 1369212
The association between maternal weight gain and spontaneous preterm birth in twin pregnancies
Abstract Objective: To estimate the association between maternal weight gain and spontaneous preterm birth (SPTB) in twin pregnancies. Methods: A case-control study of patients with twin pregnancies and a normal prepregnancy BMI (18.5 - 24.9 kg/m2) in one maternal-fetal medicine practice from 2005-2013. We reviewed maternal weight in 6 time periods: prepregnancy, 12-15 6/7 weeks, 16 - 19 6/7 weeks, 20 - 23 6/7 weeks, 24 - 27 6/7 weeks, and 28 - 31 6/7 weeks. We compared maternal weight gain patterns across pregnancy between patients who did and did not have SPTB <32 weeks. Student's t-test and chi-square were used for analysis. Results: 382 patients were included, 29 (7.6%) of whom had SPTB <32 weeks. The baseline height, weight, and BMI did not differ between the groups, nor did maternal age, IVF status, race, or chorionicity. Patients with SPTB <32 weeks had significantly less weight gain as early as 15 6/7 weeks (2.9 +/- 4.6 vs. 7.3 +/- 6.6 lbs, p<0.001), and this continued until 31 6/7 weeks (25.3 +/- 8.7 vs. 30.8 +/- 10.9 lbs, p=0.037). Conclusions: In twin pregnancies with a normal prepregnancy BMI, there is a significant association between SPTB <32 weeks and lower maternal weight gain, particularly prior to 16 weeks. Future studies are needed to test if prepregnancy or early nutritional interventions in twin pregnancies can reduce the risk of preterm birth and improve neonatal outcomes in this high-risk population.
PMID: 24593699
ISSN: 1476-4954
CID: 922382
The relationship between preeclampsia and intrauterine growth restriction in twin pregnancies
OBJECTIVE: Preeclampsia and IUGR are correlated in singleton pregnancies. The objective of this study was to estimate their relationship in twin pregnancies. STUDY DESIGN: Cohort of 578 patients with twin pregnancies delivered by one maternal fetal medicine practice from 2005-2013. Patients with chronic hypertension, monochorionic-monoamniotic placentation, twin-twin transfusion, and major congenital anomalies were excluded. Standard definitions were used for gestational hypertension and preeclampsia. We defined IUGR as any twin birth weight less than the 5th percentile for gestational age, as well as any twin birth weight less than the 10th percentile for gestational age. RESULTS: The incidence of preeclampsia was 14.9%, the incidence of birth weight <10% was 50.0%, and the incidence of birth weight <5% was 27.5%. Comparing patients with and without preeclampsia, the rate of birth weight <5th percentile did not differ (27.9% vs. 27.4%, p=0.929), nor did the rate of birth weight <10th percentile (48.8% vs. 50.2%, p=0.815). We had 80% power with an alpha error of 5% to show a difference in the likelihood of IUGR <10th percentile from 50% to 66% and a difference in the likelihood of IUGR <5th percentile from 27% to 42% in patients without and with preeclampsia. CONCLUSIONS: In patients with twin pregnancy, there is no correlation between preeclampsia and IUGR. This suggests that in twin pregnancies, as opposed to singleton pregnancies, the pathophysiology may differ between these two common conditions.
PMID: 24881822
ISSN: 0002-9378
CID: 1030522
Journal of maternal-fetal & neonatal medicine. 2014:27(14):1418-21.DOI: 10.3109/14767058.2013.866644
Biochemical screening for aneuploidy in patients with donor oocyte pregnancies compared with autologous pregnancies
Abstract Objective: The objective was to determine if the rate of abnormal biochemical markers is different in pregnancies conceived by donor oocyte versus those conceived by autologous oocytes. Methods: This is a retrospective cohort study of patients who underwent risk assessment for aneuploidy. Pregnancies conceived by egg donation were matched with control groups who conceived using their own eggs. The primary outcomes were incidence of low PAPP-A or free bHCG in the first trimester or elevated MSAFP, free bHCG or Inhibin A, or low uE3 in the second trimester. Results: 260 singleton gestations were identified who conceived via oocyte donor. There was a significantly higher rate of unexplained elevated MSAFP in pregnancies conceived by egg donation (8% versus 2%, p = 0.028) compared to a control group matched by maternal age. There was also a significantly higher rate of unexplained elevated MSAFP in pregnancies conceived by egg donation (7% versus 2%, p = 0.01) compared to a control group matched by age of the egg donor. Conclusion: Pregnancies conceived by egg donation are more likely to have an unexplained elevation in MSAFP compared to pregnancies not conceived by egg donation regardless of age. Egg donation itself is not associated with other biochemical abnormalities.
PMID: 24228730
ISSN: 1476-4954
CID: 778392
