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Does in utero exposure to polybrominated diphenyl ethers affect neurodevelopment? [Meeting Abstract]

Vahanian, Sevan; Peltier, Morgan
ISI:000454249400038
ISSN: 0002-9378
CID: 3574722

Does Excessive Gestational Weight Gain Increase the Risk of Cesarean Delivery? [Meeting Abstract]

Wells, Matthew; John, Nicole; Vahanian, Sevan; Kinzler, Wendy Lyn; Sicuranza, Genevieve B.; Vintzileos, Anthony M.
ISI:000473810000181
ISSN: 0029-7844
CID: 4589762

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

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

Does cesarean delivery increase the risk of preterm birth in a subsequent pregnancy? [Meeting Abstract]

Vahanian, Sevan
ISI:000414256402286
ISSN: 0002-9378
CID: 3444162

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

Placental implantation abnormalities: a modern approach

Vahanian, Sevan A; Vintzileos, Anthony M
PURPOSE OF REVIEW:Placental implantation abnormalities (PIAs) comprise a large group of disorders associated with significant maternal, fetal, and neonatal morbidity. RECENT FINDINGS:Risk factors include prior uterine surgery/myometrial scarring and the presence of placenta previa with or without prior cesarean delivery. Newly identified risk factors include previous prelabor cesarean delivery and previous postpartum hemorrhage. PIAs contribute substantially to preterm birth with prematurity rates ranging from 38 to 82%. Diagnosis is typically made by ultrasound in the second or third trimester; transvaginal ultrasound and color Doppler are useful in evaluating for placental invasion, placental edge thickness, presence of fetal vessels, and cervical length. Suggestive MRI features include increased vascularity, dark T2 bands, uterine bulging, thin or indistinct myometrium, and loss of dark T2 interface. An important first-trimester finding is the implantation of the gestational sac into prior hysterotomy scar (cesarean scar pregnancy). Recommendations for delivery are universally preterm and based on expert opinion. Proposed management strategies are outlined depending on cervical length, distance between internal cervical os and placenta, and placental edge thickness. SUMMARY:There has been a recent shift in focus to individualizing management in order to improve delivery timing and in some cases even decrease risks associated with prematurity. There is a need for larger prospective studies or randomized trials to show that individualizing care can improve outcomes.
PMID: 27661402
ISSN: 1473-656x
CID: 3442772

Vertical transmission of Zika virus (ZIKV) in early pregnancy: two cases, two different courses

Herrera, Kimberly; Bernasko, James; Garry, David; Vahanian, Sevan; Kaplan, Cynthia
Background: Vertical Zika virus (ZIKV) transmission is actively being studied. Prior cases of ZIKV in pregnancy have suggested an association with infection and adverse fetal outcomes. We describe two cases of maternal illness and their respective pregnancy courses.
ISI:000408096600014
ISSN: 2192-8959
CID: 3444152

Does educational intervention affect resident competence in sonographic cervical length measurement?

Vahanian, Sevan A; Gallagher, Kathryn; Chavez, Martin R; Kinzler, Wendy L; Vintzileos, Anthony M
OBJECTIVE: To determine if a structured teaching module improves resident competency in transvaginal sonographic cervical length measurements. METHODS: This was a prospective cohort study involving obstetrics and gynecology residents at a single institution. Residents collected 10 transvaginal cervical images from patients with threatened preterm labor presenting to Labor and Delivery. After initial image acquisition, residents participated in a lecture-based teaching module involving a pre- and post-intervention assessment. Following the didactic session, they collected 10 additional images. All the images were scored independently by two Maternal-Fetal Medicine attending physicians based on the quality and accuracy of the measured cervical length. Pre-and post- intervention test results were compared, as well as pre- and post- intervention image scores. Parametric and nonparametric tests were used as appropriate with p < 0.05 considered significant. RESULTS: Ninety-three percent of the residents (14/15) improved their scores from pre-test to post-test or maintained an already perfect score (p < 0.01). Improvement was most significant with the junior residents. Seventy-nine percent of the residents (11/14) improved their cervical image scores after the educational session. Mean score for total residents was 73.7 + 12.6 pre-intervention and 90.2 + 9.9 post-intervention (p < 0.01) out of a total of 120. CONCLUSIONS: There is an improvement in the competence of resident measured cervical lengths via transvaginal ultrasound when a structured educational module is implemented for resident education.
PMID: 26414432
ISSN: 1476-4954
CID: 2525212

Placental implantation abnormalities and risk of preterm delivery: a systematic review and metaanalysis

Vahanian, Sevan A; Lavery, Jessica A; Ananth, Cande V; Vintzileos, Anthony
We sought to evaluate the extent of the association between placental implantation abnormalities (PIA) and preterm delivery in singleton gestations. We conducted a systematic review of English-language articles published from 1980 onward using PubMed, MEDLINE, EMBASE, CINAHL, LILACS, and Google Scholar, and by identifying studies cited in the references of published articles. Search terms were PIA defined as ≥ 1 of the following: placenta previa, placenta accreta, vasa previa, and velamentous cord insertion. Observational and experimental studies were included for review if data were available regarding any of the aforementioned PIA and regarding gestational age at delivery or preterm delivery. Case reports and case series were excluded. Studies were reviewed and data extracted. The primary outcome was gestational age at delivery or preterm delivery <37 weeks' gestation. Secondary outcomes included birthweight, 1- and 5-minute Apgar scores, neonatal intensive care unit (NICU) admission, neonatal and perinatal death, and small for gestational age. Of the 1421 studies identified, 79 met the defined criteria; 56 studies were descriptive and 23 were comparative. Based on the descriptive studies, the preterm delivery rates for low-lying/marginal placenta, placenta previa, placenta accreta, vasa previa, and velamentous cord insertion were 26.9%, 43.5%, 57.7%, 81.9%, and 37.5%, respectively. Based on the comparative studies using controls, there was decreased pregnancy duration for every PIA; more specifically, there was an increased risk for preterm delivery in patients with placenta previa (risk ratio [RR], 5.32; 95% confidence interval [CI], 4.39-6.45), vasa previa (RR, 3.36; 95% CI, 2.76-4.09), and velamentous cord insertion (RR, 1.95; 95% CI, 1.67-2.28). Risks of NICU admissions (RR, 4.09; 95% CI, 2.80-5.97), neonatal death (RR, 5.44; 95% CI, 3.03-9.78), and perinatal death (RR, 3.01; 95% CI, 1.41-6.43) were higher with placenta previa. Perinatal risks were also higher in patients with vasa previa (perinatal death rate RR, 4.52; 95% CI, 2.77-7.39) and velamentous cord insertion (NICU admissions [RR, 1.76; 95% CI, 1.68-1.84], small for gestational age [RR, 1.69; 95% CI, 1.56-1.82], and perinatal death [RR, 2.15; 95% CI, 1.84-2.52]). In singleton gestations, there is a strong association between PIA and preterm delivery resulting in significant perinatal morbidity and mortality.
PMID: 26428506
ISSN: 1097-6868
CID: 3442732