Cell-free DNA screening for trisomy 21 in twin pregnancy: a large multicenter cohort study.

Background: Analysis of cell-free DNA from maternal blood provides effective screening for trisomy 21 in singleton pregnancies. Data on cell-free DNA screening in twin gestations are promising although limited. In previous twin studies, cell-free DNA screening was primarily performed in the second trimester and many studies did not report chorionicity.

Is Amniocentesis after CVS Risky?

Objective: Approximately, 2% of women who undergo chorionic villi sampling (CVS) will subsequently undergo amniocentesis due to placental mosaicism or sampling/laboratory issues. Our objective was to compare obstetric outcomes in women who underwent both procedures with those who had CVS alone.

Study Design: Retrospective case-control study of patients with singleton pregnancies undergoing invasive testing from 2010 to 2020 was performed.

Potentially Preventable Primary Cesarean Sections in Future Placenta Accreta Spectrum.

Objective: Prior cesarean delivery is a well-known risk factor for placenta accreta spectrum disorders. While primary cesarean section is unavoidable in some patients, in others it may not be clearly indicated. The aim of the study is to determine the proportion of patients with placenta accreta spectrum who had a potentially preventable primary cesarean section and to identify factors associated with preventable placenta accreta spectrum.

Ultrasound detection rates of the placenta accreta spectrum with prior myomectomy.

Objective: To describe the performance of ultrasound in detecting placenta accreta spectrum (PAS) in patients with history of prior myomectomy.

Methods: A retrospective cohort study of patients who were referred for sonographic evaluation of the placenta and delivered at a tertiary academic center from 2012 to 2019. Demographic, obstetric, sonographic findings, and pathology information were collected and analyzed using Chi-square, -tests, and ANOVA analysis.

Prenatally diagnosed vasa previa: association with adverse obstetrical and neonatal outcomes.

Background: Vasa previa represents a rare prenatal finding with potentially life-threatening risk to the fetus.

Objective: This study aimed to describe the natural history of prenatally diagnosed vasa previa and evaluate the association between antenatally diagnosed vasa previa and adverse obstetrical and neonatal outcomes.

Study Design: This was a multicenter descriptive and retrospective study of patients diagnosed prenatally with vasa previa on transvaginal ultrasound in the New York City Maternal-Fetal Medicine Research Consortium centers between 2012 and 2018.

Obstetrical Complications and Long-Term Cardiovascular Outcomes.

Purpose Of Review: Obstetrical complications including indicated preterm birth (PTB), hypertension (HTN), IUGR, and GDM are risk factors for future cardiovascular disease. To identify patients at risk, the American Heart Association recommends obtaining a detailed obstetric history. Our objective was to determine if non-OB-GYN physicians-in-training obtain an obstetric history when assessing a risk profile for cardiovascular disease and to identify differences based on level of training.

Suspected Placenta Accreta: Using Imaging to Stratify Risk of Morbidity.

Objective: This study was aimed to compare clinical outcomes and use of interventions in women with suspected accreta based on the degree of antenatal suspicion.

Study Design: This was a retrospective cohort study of women with suspected accreta from 2007 to 2019. Included patients had one or more imaging studies suggestive of accreta.

Preeclampsia and low sodium (PALS): A case and systematic review.

Normal physiologic changes in pregnancy include mild hyponatremia. In some cases of preeclampsia, more significant hyponatremia has been associated with syndrome of inappropriate antidiuretic hormone secretion and hypervolemic hyponatremia. A 45-year-old gravida 2, para 0010 with a dichorionic twin gestation was diagnosed with preeclampsia at 30 weeks 6 days and noted to have concomitant hyponatremia of 125 mEq/L at our institution.

Abortion for Fetal Genetic Abnormalities: Type of Abnormality and Gestational Age at Diagnosis.

 Advances in genetic screening can identify patients at high risk for common genetic conditions early in pregnancy and can facilitate early diagnosis and early abortion. Less common abnormalities might only be diagnosed with invasive testing is performed after structural abnormalities are identified.  Our objective was to compare gestational age (GA) at diagnosis and abortion for genetic abnormalities identified based on screening with abnormalities that were not discovered after screening.

Abortion for fetal indications: Timing of prenatal diagnosis and abortion for structural and genetic abnormalities.

Objective: To compare diagnoses in patients undergoing abortion for fetal indications at 15-0/7 to 21-6/7 vs. ≥22-0/7 weeks' gestation.

Study Design: This retrospective cohort study included women undergoing abortion at ≥15-0/7 weeks' gestation for fetal indications from 2012 to 2018 at our institution.

Maternal morbidity of induction of labor compared to planned cesarean delivery in twin gestations.

Objective: To compare maternal morbidity associated with induction of labor (IOL) with planned cesarean delivery (CD) in twin gestations.

Methods: This was a retrospective cohort study of vertex-presenting twin pregnancies ≥24-week gestation delivering at our institution from 2016 to 2017. We compared patients undergoing IOL with patients undergoing planned CD.

Pregnancy Outcomes in Women with Incidentally Detected Unicornuate Uteri.

Objective: To estimate the incidence of adverse pregnancy outcomes in women with incidentally detected unicornuate uteri.

Study Design: This is a descriptive study. Database review identified patients with unicornuate uteri and singleton pregnancies at ≥12 weeks' gestation.

Diagnostic accuracy of isolated clubfoot in twin compared to singleton gestations.

Background Our objective was to determine the predictive value of the prenatal diagnosis of isolated clubfoot in twin gestations compared to singleton gestations. Methods A prospectively entered ultrasound database was reviewed for all pregnancies scanned at our institution from 2002 to 2014. Cases of suspected clubfoot were identified.

Abnormal nuchal translucency: residual risk with normal cell-free DNA screening.

To determine the proportion of genetic abnormalities that could be identified by cell-free DNA screening in pregnancies with an abnormal nuchal translucency. From 2015-2017, pregnancies with nuchal translucency ≥ 3.0 mm on ultrasounds were identified.

Isolated Fetal Cardiac Abnormalities: Are They Really Isolated?

 To determine the rate of unsuspected noncardiac abnormalities in newborns suspected to have isolated cardiac abnormalities in the second trimester.  A review of the ultrasound database from the Weill Cornell Medical Center identified fetuses with a suspected cardiac abnormality from January 2006 to November 2016. Cases with prenatally suspected noncardiac structural abnormalities, abnormal fetal or neonatal karyotype or microarray, and those who delivered at an outside institution or underwent abortion were excluded.

The Use of Ultrasound as a Potential Adjunct to Cell-Free Fetal DNA Screening for Aneuploidy at Weill Cornell Medical College, New York, USA.

 To evaluate the utility of ultrasound in identifying fetuses with uncommon chromosomal abnormalities that would be considered not detectable by cell-free fetal deoxyribonucleic acid (cfDNA).  We performed a retrospective study of fetuses with chromosomal abnormalities that would be undetectable by cfDNA, who underwent an 11- to 14-week ultrasound from 2006 to 2016.  There were 43 pregnancies included.

Testing for Noonan syndrome after increased nuchal translucency.

Objective: The aim of this study was to report the prevalence of Noonan syndrome (NS) in a cohort of fetuses that presented with increased nuchal translucency (NT) thickness in the first trimester of pregnancy.

Methods: This is a retrospective chart review.

Inclusion Criteria: (1) first trimester NT measurement ≥3 mm, (2) normal karyotype by either a CVS or an amniocentesis procedure, and (3) prenatal molecular genetic testing for NS completed.

Amniotic Band Syndrome, Perinatal Hospice, and Palliative Care versus Active Management.

. Amniotic band syndrome and sequence are a relatively rare condition in which congenital anomalies occur as a result of the adherence and entrapment of fetal parts with coarse fibrous bands of the amniotic membrane. A large percentage of reported cases have an atypical gestational history.

Planned home birth and the association with neonatal hypoxic ischemic encephalopathy.

Objective: To evaluate the association between planned home birth and neonatal hypoxic ischemic encephalopathy (HIE).

Methods: This is a case-control study in which a database of neonates who underwent head cooling for HIE at our institution from 2007 to 2011 was linked to New York City (NYC) vital records. Four normal controls per case were then randomly selected from the birth certificate data after matching for year of birth, geographic location, and gestational age.

Preterm delivery in triplet pregnancies.

Purpose: The purpose of this study is to assess the rate of spontaneous preterm birth (SPTB) versus indicated preterm birth (IPTB) in triplet pregnancies and determine factors associated with these outcomes.

Materials And Methods: This is a review of triplet pregnancies delivering at our institution from 2003 to 2015. Patients delivering prior to 24 weeks gestational age (GA) were excluded.