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Does educational intervention improve sonographer awareness of ultrasound safety? [Meeting Abstract]
Martinelli, Vanessa T.; Kantorowska, Agata; Murphy, Jean; Chavez, Martin; Kinzler, Wendy; Vintzileos, Anthony
ISI:000454249403219
ISSN: 0002-9378
CID: 3574612
Is First Trimester Maternal Serum Alpha Fetoprotein Predictive of Adverse Pregnancy Outcomes? [Meeting Abstract]
Dinglas, Cheryl; Afsar, Nur; Davis, Jay; Kim, Sara; Herrera, Kimberly; Chavez, Martin
ISI:000473810000470
ISSN: 0029-7844
CID: 4599322
Selective laser ablation followed by a delayed Solomon technique for Twin–twin transfusion syndrome may improve dual survival [Meeting Abstract]
Dingals, Cheryl L; Davis, J; Heiselman, C; Chavez, M; Vintzileos, A
ORIGINAL:0014332
ISSN: 0960-7692
CID: 4141022
Author's Reply [Letter]
Vahanian, Sevan A; Chavez, Martin R; Murphy, Jean; Vetere, Patrick; Nezhat, Farr; Vintzileos, Anthony M
PMID: 29763653
ISSN: 1553-4669
CID: 3442892
Second trimester marginal cord insertion is associated with adverse perinatal outcomes
Allaf, M Baraa; Andrikopoulou, Maria; Crnosija, Natalie; Muscat, Jolene; Chavez, Martin R; Vintzileos, Anthony M
OBJECTIVES/OBJECTIVE:To determine the feasibility in visualizing placental cord insertion (PCI) during second-trimester fetal anatomical survey and the association between marginal cord insertion (MCI) and preterm delivery (PTD) and low birth weight (LBW). Our secondary objectives were to evaluate the association of MCI with adverse composite obstetrical and neonatal outcomes. METHODS:A prospective cohort study was performed over a 28-month period. Women with singleton pregnancies presenting for routine anatomical survey between 18 and 22 weeks' gestation were included. PCI site was visualized on 2D grayscale and color Doppler and the shortest distance from the sagittal and transverse planes to the placental edge were recorded. MCI was diagnosed when any of measured distances was ≤2 cm. Correlations were assessed via bivariate chi-squared, independent t-test analyses and Fisher's exact tests. Regression models evaluated associations between MCI and adverse composite outcomes. RESULTS:Three hundred one women were included and PCI was feasible in all cases. The incidence of MCI was 11.3% (n = 34). Baseline characteristics between those with and without MCI were similar, except for story of prior PTD, which was greater among those with MCI (17.65 versus 7.17%, p = .04). MCI was associated with increased likelihood of LBW (RR four; 95%CI, 1.46-10.99) and PTD (RR 3.2; 95%CI, 1.53-6.68); in multivariate analysis, we found associations between MCI and composite adverse obstetrical (RR 2.33; 95%CI, 1.30-4.19) and neonatal (RR 2.46; 95%CI, 1.26-4.81) outcomes. CONCLUSIONS:Evaluation of PCI is feasible in all cases. Second-trimester MCI is associated with increased likelihood for LBW, PTD, and composite adverse obstetrical and neonatal outcomes.
PMID: 29544383
ISSN: 1476-4954
CID: 3442882
Ultrasound-Guided Laparoscopic-Assisted Abdominal Cerclage in Pregnancy
Vahanian, Sevan A; Chavez, Martin R; Murphy, Jean; Vetere, Patrick; Nezhat, Farr R; Vintzileos, Anthony M
PMID: 28602787
ISSN: 1553-4669
CID: 3442842
Improving the ultrasound detection of isolated fetal limb abnormalities
Andrikopoulou, Maria; Vahanian, Sevan A; Chavez, Martin R; Murphy, Jean; Hanna, Nazeeh; Vintzileos, Anthony M
OBJECTIVE: The prenatal detection rate of isolated fetal limb abnormalities ranges from 4 to 29.5%. Our aim was to determine the accuracy of a detailed ultrasound protocol in detecting isolated fetal limb abnormalities Methods: This is a retrospective study of infants born at our institution with isolated limb defects from 2009 to 2014. Antepartum and postpartum records were reviewed for genetic testing results. We routinely image both upper and lower extremities, including all long bones, hands, feet, fingers and toes. Posturing, muscular tone and movement are also noted. RESULTS: During the study period, there were 52 neonates born with isolated fetal limb abnormalities who had received a fetal anatomic survey in our ultrasound unit and 15 930 sonograms performed with normal findings; 36 out of the 52 had been prenatally diagnosed (detection rate 69%). The specificity of the protocol was 100% as there were no false positive cases, the positive predictive value was 100% and negative predictive value 99.8%. Forty-three of 52 neonates had normal genetic testing either prenatally or postnatally; 9 neonates did not undergo genetic testing. The average additional time required for this detailed protocol was <5 min for second trimester sonogram. CONCLUSION: A minimal investment in time for detailed evaluation of fetal limbs more than doubles the previously reported prenatal detection rate.
PMID: 26932755
ISSN: 1476-4954
CID: 2525172
Counseling and Management of a Conservatively Managed Second Trimester Cesarean Scar Pregnancy: A Case Report [Case Report]
Kunzier, Nadia B; Sharma, Shefali; Chavez, Martin R; Vintzileos, Anthony M
Background:Cesarean scar ectopic pregnancies (CSPs) are becoming more prevalent and can have an extremely poor prognosis, with high morbidity and mortality. Management guidelines for patients desiring conservative treatment should be established to improve outcomes. Case:A 33-year-old woman with a conservatively managed CSP now in the second trimester presented from an outside institution. After thorough counseling regarding potential maternal morbidity and extreme prematurity in the newborn based on clinical findings of progressive cervical shortening and vaginal spotting with a significant drop in hemoglobin, she abandoned conservative therapy and underwent a hysterectomy with the previable fetus in situ. Conclusion:As pregnancy progresses, danger to the mother and fetus can become severe and imminent. Progressive cervical shortening may be associated with much more significant bleeding than evidenced by spotting, indicating the importance of using cervical shortening in abandonment of conservative management to reduce impending morbidity and mortality.
PMID: 30226733
ISSN: 0024-7758
CID: 3442932
The use of cervical sonography to differentiate true from false labor in term patients presenting for labor check
Kunzier, Nadia B; Kinzler, Wendy L; Chavez, Martin R; Adams, Tracy M; Brand, Donald A; Vintzileos, Anthony M
BACKGROUND: Cervical length by transvaginal ultrasound to predict preterm labor is widely used in clinical practice. Virtually no data exist on cervical length measurement to differentiate true from false labor in term patients who present for labor check. False-positive diagnosis of true labor at term may lead to unnecessary hospital admissions, obstetrical interventions, resource utilization, and cost. OBJECTIVE: We sought to determine if cervical length by transvaginal ultrasound can differentiate true from false labor in term patients presenting for labor check. STUDY DESIGN: This is a prospective observational study of women presenting to labor and delivery with labor symptoms at 37-42 weeks, singleton cephalic gestation, regular uterine contractions (>/=4/20 min), intact membranes, and cervix =4 cm dilated and =80% effaced. Those patients with placenta previa and indications for immediate delivery were excluded. The shortest best cervical length of 3 collected images was used for analysis. Providers managing labor were blinded to the cervical length. True labor was defined as spontaneous rupture of membranes or spontaneous cervical dilation >/=4 cm and >/=80% effaced within 24 hours of cervical length measurement. In the absence of these outcomes, labor status was determined as false labor. Receiver operating characteristic curves were generated to assess the predictive ability of cervical length to differentiate true from false labor and were analyzed separately for primiparous and multiparous patients. The diagnostic accuracies of various cervical length cutoffs were determined. The relationship of cervical length and time to delivery was also analyzed including both use and nonuse of oxytocin. RESULTS: In all, 77 patients were included in the study; the prevalence of true labor was 58.4% (45/77). Patients who were in true labor had shorter cervical length as compared to those in false labor: median 1.3 cm (range 0.5-4.1) vs 2.4 cm (range 1.0-5.0), respectively (P < .001). The area under the receiver operating characteristic curve for primiparous patients was 0.88 (P < .001) and for multiparous patients was 0.76 (P < .01), both demonstrating good correlation. The area under the receiver operating characteristic curves were not significantly different between primiparous and multiparous (P = .23). The area under the receiver operating characteristic curve for primiparous and multiparous patients combined was 0.8 (P < .0001), indicating a good overall correlation between cervical length and its ability to differentiate true from false labor. Overall, a cervical length cutoff of =1.5 cm to predict true labor had the highest specificity (81%), positive predictive value (83%), and positive likelihood ratio (4.2). There were no differences in cervical length prediction between primiparous and multiparous patients. Cervical length was positively correlated with time to delivery, regardless of the use of oxytocin. CONCLUSION: In differentiating true from false labor in term patients who present for labor check, a cervical length of =1.5 cm was the most clinically optimal cutoff with the lowest false positive rate-due to its highest specificity-and highest positive predictive value and positive likelihood ratios. Its use to decide admission in patients at term with labor symptoms may prevent unnecessary admissions, obstetrical interventions, resource utilization, and cost.
PMID: 27018468
ISSN: 1097-6868
CID: 2525182
The use of cervical sonography to differentiate true verses false labor at term [Meeting Abstract]
Kunzier, Nadia N; Kinzler, Wendy L; Chavez, Martin R; Brand, Donald; Vintzileos, Anthony M
ISI:000367092800400
ISSN: 1097-6868
CID: 2530282