Cervical Pessary and Vaginal Progesterone in Twin Pregnancies With a Short Cervix.

Objective: To evaluate cervical pessary as an intervention to prevent preterm birth in twin pregnancies with a short cervix.

Methods: This was a retrospective cohort study of twin pregnancies managed by a single maternal-fetal medicine practice from 2005 to 2015. We included patients at 28 weeks of gestation or less who were diagnosed with a cervical length less than 20 mm.

A comparison of cervical length measurement techniques for the prediction of spontaneous preterm birth.

Objective: To evaluate the clinical utility of a novel means of assessing the cervix by measuring the angle of the curvature and to evaluate the performance of this technique as well as two other commonly used techniques of cervical length assessment in predicting spontaneous preterm birth (SPTB).

Methods: This was a retrospective cohort analysis of singleton gestations with a history of SPTB. Transvaginal ultrasound images of cervical length obtained between 20 and 23 6/7 weeks were re-measured using three techniques: (1) straight linear distance between the internal and external os, (2) sum of two contiguous linear segments tracing the internal to the external os, and (3) measurement of the angle of the curve within the cervix using an electronic protractor.

The association between maternal height and pregnancy outcomes in twin gestations.

Objective: We sought to assess the association between maternal height and the risk of preterm birth, fetal growth restriction and mode of delivery in twin gestations.

Study Design: Cohort study of patients with twin pregnancies delivered from 2005 to 2014. We compared pregnancy outcomes between patients of short stature ≤159 cm to those of normal stature ≥160 cm.

Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile.

Objectives-The nonstress test is currently the most widely used modality for antenatal surveillance in twin pregnancies, with a quoted false-positive rate of 11%-12%. Our objective was to report our experience with the sonographic portion of the biophysical profile in twin pregnancies as the primary screening modality.Methods-Women with twin pregnancies delivered by a single maternal-fetal medicine practice from 2005 to 2013 were included.

Abnormal Biochemical Analytes Used for Aneuploidy Screening and Adverse Pregnancy Outcomes in Twin Gestations.

Objective: The objective of this study was to determine if first- and second-trimester biochemical markers for aneuploidy have an association with adverse pregnancy outcomes in twin gestations.

Study Design: A retrospective cohort study of patients who presented with dichorionic diamniotic twin gestations was performed. Patients with first-trimester low pregnancy-associated plasma protein A (PAPP-A) or low free β human chorionic gonadotropin (β-hCG), or second-trimester elevated α-fetoprotein (AFP), elevated inhibin A, elevated hCG, or low unconjugated estradiol were identified.

Outcomes in twin pregnancies reduced to singleton pregnancies compared with ongoing twin pregnancies.

Objective: Multifetal pregnancy reduction has been shown to improve outcomes in triplet and higher-order multiple pregnancies. The data for fetal reduction of twin pregnancies are limited. The purpose of this study was to compare adverse pregnancy outcomes in ongoing twin pregnancies compared with twin pregnancies reduced to singletons.

Gestational age at cervical length and fetal fibronectin assessment and the incidence of spontaneous preterm birth in twins.

Objectives: To estimate the risk of spontaneous preterm birth in twin pregnancies based on transvaginal sonographic cervical length, fetal fibronectin (fFN) testing, and the gestational age at which these tests were performed.

Methods: Women with twin pregnancies, cervical length assessment, and fFN testing between 22 weeks and 31 weeks 6 days in a single maternal-fetal medicine practice from 2005 to 2013 were included. All testing was done on asymptomatic women on an out-patient basis.

Glycemic control in twin pregnancies with gestational diabetes: are we improving or worsening outcomes?

Objective: To estimate the association between glycemic control and adverse outcomes in twin pregnancies with gestational diabetes (GDM).

Study Design: A cohort of patients with twin pregnancies and GDM were identified from one maternal-fetal medicine practice from 2005 to 2014. Patients with prepregnancy diabetes were excluded.

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.

Tocolysis in women with advanced preterm labor: a secondary analysis of a randomized clinical trial.

Objective: To compare the efficacy of tocolytic treatment with indomethacin (I), magnesium sulfate (M) and nifedipine (N) for acute tocolysis in women with advanced cervical dilation (4-6 cm).

Methods: A single center, randomized trial was carried out involving patients in preterm labor (cervix 1-6 cm). Secondary analysis of women with advanced cervical dilation (cervix 4-6 cm) at 24-32 weeks' gestation who received intravenous M, oral N or I suppositories comprised this study population.

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.

Risk factors for cesarean delivery in twin pregnancies attempting vaginal delivery.

Objective: The purpose of this study was to estimate independent risk factors for cesarean delivery in patients with twin pregnancies who attempt vaginal delivery.

Study Design: This was an historic cohort of twin pregnancies that were delivered in 1 practice from June 2005 to February 2014. Baseline characteristics were compared between women who delivered vaginally and women who underwent cesarean delivery in labor.

The effect of maternal obesity on outcomes in patients undergoing tertiary or higher cesarean delivery.

Objective: To estimate the association between maternal obesity and adverse outcomes in patients without placenta previa or accreta undergoing a tertiary or higher cesarean delivery.

Study Design: Retrospective cohort of patients cared for by a single MFM practice undergoing a tertiary or higher cesarean delivery from 2005 to 2013. Patients attempting vaginal delivery and patients with placenta accreta and/or placenta previa were excluded.

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 α-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.

The relationship between preeclampsia and intrauterine growth restriction in twin pregnancies.

Objective: Preeclampsia and intrauterine growth restriction (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 1 maternal fetal medicine practice from 2005-2013.

The association between maternal biomarkers and pathways to preterm birth in twin pregnancies.

Objective: We sought to estimate the association between cervical length (CL) and fetal fibronectin (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 to 32 weeks in one maternal fetal medicine practice during 2005-2013. We calculated the association between a short CL (≤20 mm) or positive fFN with overall preterm birth <32 weeks, and then subdivided the analysis into preterm birth <32 weeks from preterm labor, preterm premature rupture of membranes (PPROM) and indicated causes.

Pregnancy outcomes in patients with prior uterine rupture or dehiscence.

Objective: To report obstetric outcomes in a series of women with prior uterine rupture or prior uterine dehiscence managed with a standardized protocol.

Methods: Series of patients delivered by a single maternal-fetal medicine practice from 2005 to 2013 with a history of uterine rupture or uterine dehiscence. Uterine rupture was defined as a clinically apparent, complete scar separation in labor or before labor.

Effect of oocyte donation on pregnancy outcomes in in vitro fertilization twin gestations.

Objective: To estimate the effect of oocyte donation on pregnancy outcomes in patients with twin pregnancies conceived via IVF.

Design: Retrospective cohort study.

Setting: Patients with IVF twin pregnancies delivered by one maternal-fetal medicine practice from 2005 to 2013.

The association between maternal weight gain and spontaneous preterm birth in twin pregnancies.

Objective: To estimate the association between maternal weight gain and SPTB in twin pregnancies.

Methods: A case-control study of patients with twin pregnancies and a normal prepregnancy BMI (18.5-24.

The use of 17-hydroxy progesterone in women with arrested preterm labor: a randomized clinical trial.

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.

Natural history of vasa previa across gestation using a screening protocol.

Objectives: The purpose of this study was to estimate the prevalence and persistence rate of vasa previa in at-risk pregnancies using a standardized screening protocol.

Methods: We conducted a descriptive study of patients with a diagnosis of vasa previa from a single ultrasound unit between June 2005 and June 2012. Vasa previa was defined as a fetal vessel within 2 cm of the internal cervical os on transvaginal sonography.

Outcomes of emergency or physical examination-indicated cerclage in twin pregnancies compared to singleton pregnancies.

Objective: To report the obstetrical outcomes in patients with twin pregnancies who underwent an emergency/physical exam-indicated cerclage and to compare them to patients with singleton pregnancies undergoing the same procedure.

Study Design: Patients who underwent emergency/physical exam-indicated cerclage in the second trimester in one maternal-fetal medicine practice from July 1997 to March 2012 were reviewed. We defined an emergency/physical exam-indicated cerclage as any cerclage placed in a patient with a dilated cervix on examination or membranes visible at the external cervical os on speculum examination.

Biochemical screening for aneuploidy in patients with donor oocyte pregnancies compared with autologous pregnancies.

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.

A comparison of three tocolytics for preterm labor: a randomized clinical trial.

Objective: To compare the efficacy and maternal side effects of nifedipine (N), magnesium sulfate (M), and indomethacin (I) for acute tocolysis.

Methods: In this single center randomized trial, women in preterm labor 24-32 weeks' gestation received intravenous M, oral N, or I suppositories. The primary outcomes of interest were arrest of preterm labor (>48 h, ≥7 days), gestational age at delivery, and maternal side effects.

The effectiveness of antepartum surveillance in reducing the risk of stillbirth in patients with advanced maternal age.

Objective: To estimate the effectiveness of antepartum surveillance and delivery at 41 weeks in reducing the risk of stillbirth in advanced maternal age (AMA) patients.

Study Design: Retrospective cohort study of all patients managed in one maternal-fetal medicine practice from June 2005 to May 2012. We included all singleton pregnancies delivered at ≥ 20 weeks of gestation.