Faculty Bibliography

BACKGROUND:The Journal has had a profound influence in nearly 150 years of publishing. A bibliometric analysis, which uses citation analyses to evaluate the impact of articles, can be used to identify the most impactful papers in the Journal's history. OBJECTIVE:The objective was to identify and characterize the top-cited articles published in the Journal since 1920. STUDY DESIGN:We used the Web of Science and Scopus databases to identify the most frequently cited articles of the Journal from 1920 through 2018. The top 100 articles from each database were included in our analysis. Articles were evaluated for several characteristics including year of publication, article type, topic, open access, and country of origin. Using the Scopus data, we performed an unadjusted categorical analysis to characterize the articles and a 2 time point analysis to compare articles before and after 1995, the median year of publication from each database list. RESULTS:The top 100 articles from each database were included in the analysis. This included 120 total articles: 80 articles listed in both and 20 unique in each database. More than half (52%) were observational studies, 9% were RCTs, and 75% were from US authors. When the post-1995 studies were compared with the articles published before 1995, articles were more frequently cited (median 27 vs 13 citations per year, P < .001), more likely to be randomized (14.0% vs 4.8%, P = .009), and more likely to originate from international authors (33.3% vs 17.5%, P = .045). CONCLUSION:Slightly more than half of the top-cited papers in the Journal since 1920 were observational studies and three quarters of all papers were from US authors. Compared with top-cited papers before 1995, the Journal's top-cited papers after 1995 were more likely to be randomized and to originate from international authors.

Advanced paternal age (APA) is associated with infertility and other reproductive risks. Studies looking at APA and outcomes have used different paternal age cut-offs, which has complicated systematic evaluations of reproductive risk associated with paternal aging. This review of the literature suggests that the impact of paternal aging on adverse reproductive outcomes is small, but significant. Studies suggest the incidence of paternal age effect disorders attributed to de novo autosomal dominant mutations is less than 0.5%. Other risks associated with APA include infertility, miscarriage, birth defects, poor neurodevelopmental outcomes, and childhood cancer. Although the increasing prevalence of APA has mirrored the rise in maternal age, this topic has not received similar attention. In this review, we summarize the available literature on the reproductive risks associated with APA to provide a framework for comprehensive genetic counseling and evidence-based management of APA pregnancies.

OBJECTIVES/OBJECTIVE:Previous studies have demonstrated an association between adverse obstetric outcomes, such as preterm birth, and in utero inflammation. The fetal thymus, which can be visualized in the anterior mediastinum on obstetric sonography, may involute in response to such inflammation and thus may identify pregnancies at increased risk for these outcomes. We therefore sought to determine whether second-trimester fetal thymus measurements are associated with preterm birth. METHODS:Transabdominal fetal thymus measurements were prospectively obtained in singleton pregnancies at gestational ages of 18 weeks to 23 weeks 6 days during a 5-month period. The transverse and anterorposterior thymus diameters and the thymic-thoracic ratio were measured. Delivery outcomes were collected from our clinical database. The primary outcome was preterm birth, which we defined as delivery between 24 weeks and 36 weeks 6 days. Small for gestational age (SGA) and pregnancy-related hypertension, which are adverse obstetric outcomes that may also be associated with in utero inflammation, were included as secondary outcomes. RESULTS:We included 520 patients with thymus measurements and obstetric outcome data. The prevalence of preterm birth was 12.3% (n = 64). None of the thymus measurements were associated with preterm birth. Similarly, there was no association between thymus measurements and SGA or pregnancy-related hypertension. CONCLUSIONS:Sonographic assessment of the second-trimester fetal thymus did not identify patients at increased risk for preterm birth, SGA, and pregnancy-related hypertension. Routine thymus measurements during the second-trimester anatomic scan are not clinically useful for prediction of preterm birth and other adverse outcomes.

OBJECTIVES/OBJECTIVE:Prenatal diagnosis of congenital heart disease can improve neonatal outcomes. The purpose of this study was to evaluate the utility of an isolated 3-vessel view image in evaluating the ventricular outflow tracts. METHODS:Three-vessel view images were prospectively collected from consecutive patients referred to a regional fetal heart center for fetal echocardiography between gestational ages of 18 weeks and 23 weeks 6 days. Cardiac malformations were categorized as anomalies of the outflow tracts, the 4-chamber view, or combined lesions. A single representative still-frame 3-vessel view image was reviewed by 2 independent and blinded observers who were asked to label each image as "normal" or "abnormal." Test characteristics of the isolated 3-vessel view were calculated. RESULTS:During the study period, 122 consecutive patients (139 fetuses) underwent fetal echocardiography. Eight fetuses with fetal chest anomalies and 12 fetuses with oblique images were excluded. Thirty-four of 119 fetuses (28.6%) had abnormal echocardiograms, including 11 outflow tract anomalies and 16 combined anomalies. Using the 3-vessel view alone, both reviewers achieved 91% sensitivity for the detection of isolated outflow tract anomalies and mean sensitivity of 88% for combined anomalies. All cases of tetralogy of Fallot and transposition of the great arteries were identified in the 3-vessel view. CONCLUSIONS:A single 3-vessel view image can serve as a representative view of the outflow tracts and can show ventricular outflow tract anomalies with high sensitivity. Given that the conventional outflow tract views can be difficult to obtain, the 3-vessel view may serve as an effective first-line view when evaluating the ventricular outflow tracts for congenital heart disease.

OBJECTIVE:Maternal morbidity is increasing in the United States. Our objectives were to examine whether a labor and delivery (L&D) provider model with regular maternal-fetal medicine (MFM) coverage decreases the rates of maternal morbidity during delivery hospitalizations and has an impact on obstetrician-gynecologist residents' perceptions of safety and education. STUDY DESIGN/METHODS:We performed a retrospective cohort study to compare the rates of maternal morbidity before and after the implementation of an MFM-centered coverage model on L&D. Outcomes were identified using International Classification of Diseases, ninth revision, codes. The primary outcome was a composite of severe maternal morbidity. Additionally, obstetrician-gynecologist residents completed an anonymous survey asking them to compare coverage models, and their Council on Resident Education in Obstetrics and Gynecology examination scores were compared. RESULTS:Data from 4715 deliveries were included. There were no differences in composite morbidity or individual adverse outcomes. Most residents (81.3%) preferred the new provider model, with median 5-point Likert scores indicating perceived increases in safety and education. Mean Council on Resident Education in Obstetrics and Gynecology scores improved in the 18 residents exposed to both models. CONCLUSION/CONCLUSIONS:Although the MFM-centered provider model appears to have had a positive impact on residents' perceptions of safety and education, it was not associated with significant changes in severe maternal morbidity.