Alfred Abuhamad - Academia.edu (original) (raw)

Papers by Alfred Abuhamad

Research paper thumbnail of Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Many medical schools are implementing point-of-care ultrasound in their curricula to help augment... more Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed. An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires. Th...

Research paper thumbnail of The Z Technique: An Easy Approach to the Display of the Midcoronal Plane of the Uterus in Volume Sonography

Journal of Ultrasound in Medicine, May 1, 2006

Objective. The purpose of our study was to evaluate the ease of learning and clinical applicabili... more Objective. The purpose of our study was to evaluate the ease of learning and clinical applicability of a technique (Z technique) for display of the midcoronal plane of the uterus in volume sonography. Methods. Eight physicians were randomly assigned to 2 groups, A and B, after being instructed on the basic principles of post processing of sonographic volumes. Physicians in group A were asked to individually display the midcoronal plane of the uterus in each of five 3-dimensional volumes of uteri. Physicians in group B were instructed on the Z technique and were then asked to individually display the midcoronal plane of the uterus in the same volumes as group A. The time needed for display of the midcoronal plane of the uterus and the quality of the midcoronal plane image retrieved were recorded for each volume. Results. The mean time required to display the midcoronal plane of the uterus for all volumes was 47.7 seconds in group B compared with 110.7 seconds in group A (P = .002). Furthermore, a significant improvement in time performance was seen for physicians in group A after learning the Z technique (23.2 seconds after compared with 110.7 seconds before; P = .0001). The quality of the image produced was notably better for all physicians after learning the Z technique. Conclusions. The Z technique is an easy technique to learn. Physicians who learn this technique are able to retrieve the midcoronal plane of the uterus faster and improve its image quality in volume sonography.

Research paper thumbnail of Sonography of Adenomyosis

Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine, May 1, 2012

Research paper thumbnail of Familial recurrence of pulmonary sequestration

Obstetrics and Gynecology, 1996

Pulmonary sequestration is not believed to be familial. We report two male infants with this anom... more Pulmonary sequestration is not believed to be familial. We report two male infants with this anomaly who were born to the same parents.The prenatal diagnosis of pulmonary sequestration was made in a woman's two consecutive pregnancies by demonstrating systemic arterial supply to an echogenic mass located in the left lower lung of each fetus. Postnatal radiographic evaluation confirmed the prenatal diagnoses.Recurrent pulmonary sequestration in two male offspring from the same parents raises the possibility of a genetic predisposition for this condition.

Research paper thumbnail of 669 Doppler ultrasonography of the middle cerebral artery peak systolic velocity in the fetus: Reproducibility of measurement

Amer J Obstet Gynecol, 2001

OBJECTIVE: Measurement of the Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV) in the fetu... more OBJECTIVE: Measurement of the Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV) in the fetus has been shown to predict fetal anemia in pregnancies at risk because of red blood cell alloimmunization and decrease the need for invasive procedures in such pregnancies. The objective of this investigation was to study the reproducibility of MCA-PSV measm'ements in two different institutions.

Research paper thumbnail of Use of the Combined First-Trimester Screen in High- and Low-Risk Patient Populations After Introduction of Noninvasive Prenatal Testing

Journal of Ultrasound in Medicine, 2015

To report changes in the use of the combined first-trimester screen (FTS) in patients classified ... more To report changes in the use of the combined first-trimester screen (FTS) in patients classified as high and low risk for fetal aneuploidy, including after introduction of noninvasive prenatal testing (NIPT). A prospectively collected database was reviewed to investigate changes in FTS use before and after American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 77 (Obstet Gynecol 2007; 109:217-227), which recommended that all patients be offered aneuploidy screening, and after NIPT introduction. High-risk patients were classified as 35 years or older at the estimated time of delivery or those with an abnormal prior screen, abnormal ultrasound findings, or family history of aneuploidy. Data were normalized per 100 morphologic ultrasound examinations to account for changes in patient number over time. Statistical significance was defined as P < .05. A total of 10,125 FTSs were recorded during the 88-month study period, including 2962 in high-risk patients and 7163 in low-risk patients. The total number of FTSs performed per 100 morphologic ultrasound examinations significantly increased after ACOG Practice Bulletin No. 77 and significantly decreased after NIPT introduction. In high-risk patients, the total number of FTSs performed per 100 morphologic ultrasound examinations significantly increased after ACOG Practice Bulletin No. 77 but significantly decreased after NIPT introduction. In contrast, in low-risk patients, the total number of FTSs performed per 100 morphologic ultrasound examinations significantly increased after ACOG Practice Bulletin No.77 but was not statistically different after NIPT introduction. American College of Obstetricians and Gynecologists Practice Bulletin No. 77 significantly increased patient use of FTS. The introduction of NIPT significantly decreased FTS use in the high-risk population but not in the low-risk population.

Research paper thumbnail of Fetal Biometry in Early Pregnancy

First-Trimester Ultrasound, 2016

Research paper thumbnail of Adnexal Mass during Pregnancy: A Review

American Journal of Perinatology, 2015

Objective The purpose of this review was to determine the likelihood of malignancy or complicatio... more Objective The purpose of this review was to determine the likelihood of malignancy or complications with ultrasonographic diagnosis of adnexal masses in pregnancy and to evaluate the obstetrical outcomes. Materials and Methods A review of literature was performed using keywords "adnexal mass and pregnancy" or "ovarian mass and pregnancy." Results Out of the 340 abstracts reviewed, 313 were excluded. The incidence of adnexal mass in pregnancy varied from 0.1 to 2.4%, with an average of 0.02%. Regarding the likelihood of malignancy, in seven publications, there were 557 women with 563 adnexal masses. Of these 563 masses, 48% were classified as simple and 52% as complex. Among the simple masses, 1% were malignant. Among the complex masses, 9% were malignant. When comparing laparoscopy and laparotomy, the rate of preterm contractions was found to be higher in patients undergoing laparotomy and this was statistically significant. Other measures, such as spontaneous abortion, vaginal bleeding, < 37 week delivery, and intrauterine fetal demise, were not found to have a significant difference. Conclusion Adnexal masses in pregnancy occur infrequently and depending on whether the surgery was performed emergently or electively, via laparoscopy or laparotomy, the outcomes will vary.

Research paper thumbnail of Overview of the Impact of Noninvasive Prenatal Testing on Diagnostic Procedures

Prenatal diagnosis, Jan 14, 2015

Noninvasive prenatal testing (NIPT) has had a profound influence in the field of prenatal diagnos... more Noninvasive prenatal testing (NIPT) has had a profound influence in the field of prenatal diagnosis since the 1997 discovery of cell free fetal DNA in maternal blood. Research has progressed rapidly, with clinical data supporting laboratory studies showing that NIPT is highly sensitive and specific for fetal aneuploidy, resulting in marked uptake in the high risk patient population. The superior accuracy of NIPT compared to conventional screening methods has led to significant decreases in the number of invasive diagnostic procedures, in addition to a concomitant decrease in the number of procedure-related fetal losses. Yet, NIPT has been described as a "disruptive innovation" due to the considerable changes the technology has commanded on current prenatal screening and diagnostic practices. This review summarizes both institutional and global experience with NIPT uptake, its effect on reducing diagnostic invasive procedures, and the unique challenges that reduced procedur...

Research paper thumbnail of Sonography of adenomyosis

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2012

Research paper thumbnail of Uptake of noninvasive prenatal testing at a large academic referral center

American Journal of Obstetrics and Gynecology, 2014

Noninvasive prenatal testing (NIPT) is a recently developed risk-assessment technique with high s... more Noninvasive prenatal testing (NIPT) is a recently developed risk-assessment technique with high sensitivity and specificity for fetal aneuploidy. The effect NIPT has had on traditional screening and diagnostic testing has not been clearly demonstrated. In this study, NIPT uptake and subsequent changes in the utilization of first-trimester screen (FTS), chorionic villus sampling (CVS), and amniocentesis in a single referral center is reported. Monthly numbers of NIPT (in high-risk patients), FTS, CVS, and amniocentesis were compared between a 35-month baseline period (April 2009 through February 2012) before introduction of NIPT, and the initial 16 months following NIPT introduction divided in 4-month quarters beginning in March 2012 through June 2013. A total of 1265 NIPT, 6637 FTS, 251 CVS, and 1134 amniocentesis were recorded over the 51-month study period in singleton pregnancies of women who desired prenatal screening and diagnostic testing. NIPT became the predominant FTS method by the second quarter following its introduction, increasing by 55.0% over the course of the study period. Total first-trimester risk assessments (NIPT+FTS) were not statistically different following NIPT (P = .312), but average monthly FTS procedures significantly decreased following NIPT introduction, decreasing by 48.7% over the course of the study period. Average monthly CVS and amniocentesis procedures significantly decreased following NIPT introduction, representing a 77.2% and 52.5% decrease in testing, respectively. Screening and testing per 100 morphological ultrasounds followed a similar trend. NIPT was quickly adopted by our high-risk patient population, and significantly decreased alternate prenatal screening and diagnostic testing in a short period of time.

Research paper thumbnail of 869: Combined first trimester screen use in high and low risk patient populations after noninvasive prenatal testing introduction

American Journal of Obstetrics and Gynecology, 2015

Research paper thumbnail of Observer's Performance and Perceptual Sensitivity for Detecting Critical Patterns in Static Maternal-Fetal Heart Rate Images

Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2013

ABSTRACT The present study examined detection performance and perceptual sensitivity for critical... more ABSTRACT The present study examined detection performance and perceptual sensitivity for critical patterns in maternal-fetal heart rate (MFHR) signals in single and combined formats. Forty-one undergraduate students viewed simulated images of MFHR signals under four different signal-to-noise (S/N) ratios. The images contained an acceleration, early deceleration, late deceleration, or no deviation. Further, the deviations varied in amplitude. The results showed that as variability increased and amplitude decreased perceptual sensitivity also decreased and participants experienced reduced ability to detect signals and committed more false alarms. These effects were more pronounced when performing the combined condition compared to the single condition. These findings highlight that interpretation of MFHR signals is subject to misinterpretation and underscores the need for countermeasures.

Research paper thumbnail of Detecting Critical Patterns in Maternal-Fetal Heart Rate Signals

Research paper thumbnail of P05.25: Timing of delivery of IUGR fetuses on the basis of hemodynamic changes

Ultrasound in Obstetrics and Gynecology, 2004

Objective: to evaluate the morbidity and mortality rate of IUGR fetuses correlated to Doppler vel... more Objective: to evaluate the morbidity and mortality rate of IUGR fetuses correlated to Doppler velocimetry, FHR tracing, BPP and AFI. Methods: a multicenter prospective study of 246 fetuses with ultrasound diagnosis of IUGR. Among them 186 met the study entry criteria. The study group underwent Doppler velocimetry study of UA, MCA, DV and UV twice weekly, BPP and AFI twice weekly and FHR tracing daily. IUGR fetuses were divided into two groups: Group 1 IUGR fetuses with Doppler velocimetry abnormality; Group 2 with normal Doppler velocimetry. In Group 1 the type and time passing from Doppler alteration to birth were documented. Apgar score, pH at birth, need of intubation, RDS, IVH, PVL, days of NICU hospitalization were available and related to neonatal outcome. Results: Gestational age at time of admission ranged from 16.1 to 40 weeks. One hundred IUGR fetuses showed Doppler velocimetry alteration while sixty-eight fetuses did not show Doppler alteration (Group 2). In Group 1 morbidity and mortality rate were significantly correlated with the type of Doppler velocimetry abnormality and with time passing from the latter finding and delivery being higher in fetuses with AEDF, RF in UA with a time > 72 hours from the Doppler abnormality and delivery. Conclusions: Doppler velocimetry should be performed in IUGR fetuses as its findings help to reduce morbidity and mortality rate. There is a significant correlation between the type of alteration and time passing from alteration to birth.

Research paper thumbnail of P05.03: Longitudinal antenatal testing alterations in severe IUGR fetuses

Ultrasound in Obstetrics and Gynecology, 2004

Objective: To assess the longitudinal changes in Doppler velocimetry, FHR tracing and BPP in comp... more Objective: To assess the longitudinal changes in Doppler velocimetry, FHR tracing and BPP in compromised IUGR fetuses. Methods: A prospective longitudinal study of 186 IUGR fetuses. All fetuses were enrolled in the study in the moment abdominal circumference was < 10 percentile, plotted on the population growth curve. In all fetuses a daily FHR tracing, Doppler velocimetry twice weekly has been performed to assess the umbelical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) blood flow. The BPP and Amniotic fluid index was evaluated twice weekly. Results: Of 186 fetuses enrolled in the study 86 did not showed Doppler alteration and were not enrolled in the study. Gestational age at time of admission ranged from 19 to 39 weeks of gestation. 100 IUGR fetuses showed Doppler velocimetry alteration in the moment or after the enrollment. In all fetuses the first antenatal testing to show alteration was increased resistance of the UA (100%); UA AEDF (52%), UA RF (26%); brain sparing effect in the MCA (38%); abnormality in the DV (absent or reversed diastolic flow) and UV pulsations (20%). BPP and FHR tracing was abnormal in 30% of the fetuses and in all of them these changes occurred after Doppler velocimetry alterations with a mean time of 3.8 days. AFI was below the normal ranges in 42% of fetuses. Conclusions: Severe IUGR fetuses show a specific temporal sequence antenatal testing alterations consisting in Doppler velocimetry alterations FHR tracing become abnormal too late, and are the last changes seen in IUGR fetuses as well as the BPP and AFI.

Research paper thumbnail of Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization

Ultrasound in Obstetrics and Gynecology, 1995

We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic vel... more We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic velocity can be used to detect fetal anemia in pregnancies complicated by maternal blood group immunization. We first studied normal values for the middle cerebral artery peak systolic velocity in 135 fetuses (Group A), and also in 23 fetuses at risk for anemia who underwent 56 cordocenteses to assess the fetal hematocrit (Group B). A test to detect fetal anemia, based on the middle cerebral artery peak systolic velocity, was developed by using the data of the fetuses of Group A and Group B. Successively, the middle cerebral artery peak systolic velocity was prospectively determined in 16 fetuses at risk for anemia who underwent 42 cordocenteses (Group C) to assess the test developed, in a multicenter prospective fashion, by using the data of Group A and Group B. In the normal fetuses an exponential model expressed the increase of the middle cerebral artery peak systolic velocity values with advancing gestation. By using the data of the fetuses of Group A and Group B, four zones of anemia risk were identified. In Group C, none of the anemic fetuses had the middle cerebral artery peak velocity below the normal mean value, whereas all of the anemic fetuses had the peak velocity above the normal mean. The middle cerebral artery blood velocity increases with advancing gestation and is a non-invasive method of detecting anemia in pregnancies complicated by maternal blood group immunization.

Research paper thumbnail of OP01.20: The effect of incorporating ultrasonographic risk assessment for Down syndrome (URAD), with maternal age and serum screening on rate of amniocentesis

Ultrasound in Obstetrics and Gynecology, 2006

Objective: To evaluate the correlation of trisomy 21 with ventriculomegaly diagnosed between 15 a... more Objective: To evaluate the correlation of trisomy 21 with ventriculomegaly diagnosed between 15 and 25 weeks. Methods: This study included 140 fetuses with cytogenetic diagnosis of trisomy 21 and detailed mid-trimester ultrasound examination in our prenatal center. This was a retrospective review of cases diagnosed between 1999 and 2006. Prenatal or postnatal karyotyping, ultrasound video and DVD recordings, still frames and ultrasound reports were analyzed in all included cases. Results: Six cases (4.3%) of mild ventriculomegaly (10-12 mm) were detected among 140 fetuses with Down's syndrome. Five of these fetuses had additional soft marker: mild nuchal edema (3 cases), short nasal bone (4 cases), short femur and humerus (2 cases), echogenic intracardiac focus (2 cases). In three fetuses additional major anomalies were diagnosed: one case with VSD, one case with AVSD, one case with nonimmune hydrops. Only one fetus had isolated ventriculomegaly and no other signs of trisomy 21. No case of severe degree of ventriculomegaly (> 12 mm ventricular atrial diameter) was found in our collective of trisomy 21 fetuses. Conclusions: Since 4.3% of the fetuses with trisomy 21 were affected by mild ventriculomegaly the risk for trisomy 21 is increased above average when sonographic examination reveals this marker. We diagnosed 151 cases of mild ventriculomegaly in 43.490 US examinations in our center, the prevalence for all fetuses was 0.35%. However ventriculomegaly as isolated observation is rarely found. Associated anomalies involving other organs are common in cases with trisomy 21. Nevertheless we conclude that karyotyping is recommended in all cases with ventriculomegaly.

Research paper thumbnail of Prenatal diagnosis of fetal nephrolithiasis

Ultrasound in Obstetrics and Gynecology, 2000

Research paper thumbnail of Association of labor induction or stimulation with infant mortality in women with failed versus successful trial of labor after prior cesarean*

Journal of Maternal-Fetal and Neonatal Medicine, 2013

Objective: To compare infant mortality rates among women with a failed versus successful trial of... more Objective: To compare infant mortality rates among women with a failed versus successful trial of labor after cesarean (TOLAC) following labor induction or stimulation. Study design: Using US linked birth and infant death cohort data (2000)(2001)(2002)(2003)(2004), we identified women who delivered non-anomalous singleton births at 34-41 weeks with TOLAC whose labors were induced or stimulated. Multivariable log-binomial regression models were fitted to estimate the association between TOLAC success and infant mortality. Results: Of the 164,113 women who underwent TOLAC, 41% were unsuccessful. After adjustment for potential confounding factors, a failed TOLAC was associated with a 1.4 fold (95% confidence interval [CI] 1.1, 1.7) increased risk of infant mortality. Conclusions: Among women undergoing labor induction or stimulation, a failed TOLAC is associated with higher likelihood of infant mortality.

Research paper thumbnail of Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016

Many medical schools are implementing point-of-care ultrasound in their curricula to help augment... more Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed. An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires. Th...

Research paper thumbnail of The Z Technique: An Easy Approach to the Display of the Midcoronal Plane of the Uterus in Volume Sonography

Journal of Ultrasound in Medicine, May 1, 2006

Objective. The purpose of our study was to evaluate the ease of learning and clinical applicabili... more Objective. The purpose of our study was to evaluate the ease of learning and clinical applicability of a technique (Z technique) for display of the midcoronal plane of the uterus in volume sonography. Methods. Eight physicians were randomly assigned to 2 groups, A and B, after being instructed on the basic principles of post processing of sonographic volumes. Physicians in group A were asked to individually display the midcoronal plane of the uterus in each of five 3-dimensional volumes of uteri. Physicians in group B were instructed on the Z technique and were then asked to individually display the midcoronal plane of the uterus in the same volumes as group A. The time needed for display of the midcoronal plane of the uterus and the quality of the midcoronal plane image retrieved were recorded for each volume. Results. The mean time required to display the midcoronal plane of the uterus for all volumes was 47.7 seconds in group B compared with 110.7 seconds in group A (P = .002). Furthermore, a significant improvement in time performance was seen for physicians in group A after learning the Z technique (23.2 seconds after compared with 110.7 seconds before; P = .0001). The quality of the image produced was notably better for all physicians after learning the Z technique. Conclusions. The Z technique is an easy technique to learn. Physicians who learn this technique are able to retrieve the midcoronal plane of the uterus faster and improve its image quality in volume sonography.

Research paper thumbnail of Sonography of Adenomyosis

Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine, May 1, 2012

Research paper thumbnail of Familial recurrence of pulmonary sequestration

Obstetrics and Gynecology, 1996

Pulmonary sequestration is not believed to be familial. We report two male infants with this anom... more Pulmonary sequestration is not believed to be familial. We report two male infants with this anomaly who were born to the same parents.The prenatal diagnosis of pulmonary sequestration was made in a woman's two consecutive pregnancies by demonstrating systemic arterial supply to an echogenic mass located in the left lower lung of each fetus. Postnatal radiographic evaluation confirmed the prenatal diagnoses.Recurrent pulmonary sequestration in two male offspring from the same parents raises the possibility of a genetic predisposition for this condition.

Research paper thumbnail of 669 Doppler ultrasonography of the middle cerebral artery peak systolic velocity in the fetus: Reproducibility of measurement

Amer J Obstet Gynecol, 2001

OBJECTIVE: Measurement of the Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV) in the fetu... more OBJECTIVE: Measurement of the Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV) in the fetus has been shown to predict fetal anemia in pregnancies at risk because of red blood cell alloimmunization and decrease the need for invasive procedures in such pregnancies. The objective of this investigation was to study the reproducibility of MCA-PSV measm'ements in two different institutions.

Research paper thumbnail of Use of the Combined First-Trimester Screen in High- and Low-Risk Patient Populations After Introduction of Noninvasive Prenatal Testing

Journal of Ultrasound in Medicine, 2015

To report changes in the use of the combined first-trimester screen (FTS) in patients classified ... more To report changes in the use of the combined first-trimester screen (FTS) in patients classified as high and low risk for fetal aneuploidy, including after introduction of noninvasive prenatal testing (NIPT). A prospectively collected database was reviewed to investigate changes in FTS use before and after American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 77 (Obstet Gynecol 2007; 109:217-227), which recommended that all patients be offered aneuploidy screening, and after NIPT introduction. High-risk patients were classified as 35 years or older at the estimated time of delivery or those with an abnormal prior screen, abnormal ultrasound findings, or family history of aneuploidy. Data were normalized per 100 morphologic ultrasound examinations to account for changes in patient number over time. Statistical significance was defined as P &amp;amp;amp;amp;amp;amp;amp;amp;lt; .05. A total of 10,125 FTSs were recorded during the 88-month study period, including 2962 in high-risk patients and 7163 in low-risk patients. The total number of FTSs performed per 100 morphologic ultrasound examinations significantly increased after ACOG Practice Bulletin No. 77 and significantly decreased after NIPT introduction. In high-risk patients, the total number of FTSs performed per 100 morphologic ultrasound examinations significantly increased after ACOG Practice Bulletin No. 77 but significantly decreased after NIPT introduction. In contrast, in low-risk patients, the total number of FTSs performed per 100 morphologic ultrasound examinations significantly increased after ACOG Practice Bulletin No.77 but was not statistically different after NIPT introduction. American College of Obstetricians and Gynecologists Practice Bulletin No. 77 significantly increased patient use of FTS. The introduction of NIPT significantly decreased FTS use in the high-risk population but not in the low-risk population.

Research paper thumbnail of Fetal Biometry in Early Pregnancy

First-Trimester Ultrasound, 2016

Research paper thumbnail of Adnexal Mass during Pregnancy: A Review

American Journal of Perinatology, 2015

Objective The purpose of this review was to determine the likelihood of malignancy or complicatio... more Objective The purpose of this review was to determine the likelihood of malignancy or complications with ultrasonographic diagnosis of adnexal masses in pregnancy and to evaluate the obstetrical outcomes. Materials and Methods A review of literature was performed using keywords &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;adnexal mass and pregnancy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;ovarian mass and pregnancy.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Results Out of the 340 abstracts reviewed, 313 were excluded. The incidence of adnexal mass in pregnancy varied from 0.1 to 2.4%, with an average of 0.02%. Regarding the likelihood of malignancy, in seven publications, there were 557 women with 563 adnexal masses. Of these 563 masses, 48% were classified as simple and 52% as complex. Among the simple masses, 1% were malignant. Among the complex masses, 9% were malignant. When comparing laparoscopy and laparotomy, the rate of preterm contractions was found to be higher in patients undergoing laparotomy and this was statistically significant. Other measures, such as spontaneous abortion, vaginal bleeding, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 37 week delivery, and intrauterine fetal demise, were not found to have a significant difference. Conclusion Adnexal masses in pregnancy occur infrequently and depending on whether the surgery was performed emergently or electively, via laparoscopy or laparotomy, the outcomes will vary.

Research paper thumbnail of Overview of the Impact of Noninvasive Prenatal Testing on Diagnostic Procedures

Prenatal diagnosis, Jan 14, 2015

Noninvasive prenatal testing (NIPT) has had a profound influence in the field of prenatal diagnos... more Noninvasive prenatal testing (NIPT) has had a profound influence in the field of prenatal diagnosis since the 1997 discovery of cell free fetal DNA in maternal blood. Research has progressed rapidly, with clinical data supporting laboratory studies showing that NIPT is highly sensitive and specific for fetal aneuploidy, resulting in marked uptake in the high risk patient population. The superior accuracy of NIPT compared to conventional screening methods has led to significant decreases in the number of invasive diagnostic procedures, in addition to a concomitant decrease in the number of procedure-related fetal losses. Yet, NIPT has been described as a "disruptive innovation" due to the considerable changes the technology has commanded on current prenatal screening and diagnostic practices. This review summarizes both institutional and global experience with NIPT uptake, its effect on reducing diagnostic invasive procedures, and the unique challenges that reduced procedur...

Research paper thumbnail of Sonography of adenomyosis

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2012

Research paper thumbnail of Uptake of noninvasive prenatal testing at a large academic referral center

American Journal of Obstetrics and Gynecology, 2014

Noninvasive prenatal testing (NIPT) is a recently developed risk-assessment technique with high s... more Noninvasive prenatal testing (NIPT) is a recently developed risk-assessment technique with high sensitivity and specificity for fetal aneuploidy. The effect NIPT has had on traditional screening and diagnostic testing has not been clearly demonstrated. In this study, NIPT uptake and subsequent changes in the utilization of first-trimester screen (FTS), chorionic villus sampling (CVS), and amniocentesis in a single referral center is reported. Monthly numbers of NIPT (in high-risk patients), FTS, CVS, and amniocentesis were compared between a 35-month baseline period (April 2009 through February 2012) before introduction of NIPT, and the initial 16 months following NIPT introduction divided in 4-month quarters beginning in March 2012 through June 2013. A total of 1265 NIPT, 6637 FTS, 251 CVS, and 1134 amniocentesis were recorded over the 51-month study period in singleton pregnancies of women who desired prenatal screening and diagnostic testing. NIPT became the predominant FTS method by the second quarter following its introduction, increasing by 55.0% over the course of the study period. Total first-trimester risk assessments (NIPT+FTS) were not statistically different following NIPT (P = .312), but average monthly FTS procedures significantly decreased following NIPT introduction, decreasing by 48.7% over the course of the study period. Average monthly CVS and amniocentesis procedures significantly decreased following NIPT introduction, representing a 77.2% and 52.5% decrease in testing, respectively. Screening and testing per 100 morphological ultrasounds followed a similar trend. NIPT was quickly adopted by our high-risk patient population, and significantly decreased alternate prenatal screening and diagnostic testing in a short period of time.

Research paper thumbnail of 869: Combined first trimester screen use in high and low risk patient populations after noninvasive prenatal testing introduction

American Journal of Obstetrics and Gynecology, 2015

Research paper thumbnail of Observer's Performance and Perceptual Sensitivity for Detecting Critical Patterns in Static Maternal-Fetal Heart Rate Images

Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2013

ABSTRACT The present study examined detection performance and perceptual sensitivity for critical... more ABSTRACT The present study examined detection performance and perceptual sensitivity for critical patterns in maternal-fetal heart rate (MFHR) signals in single and combined formats. Forty-one undergraduate students viewed simulated images of MFHR signals under four different signal-to-noise (S/N) ratios. The images contained an acceleration, early deceleration, late deceleration, or no deviation. Further, the deviations varied in amplitude. The results showed that as variability increased and amplitude decreased perceptual sensitivity also decreased and participants experienced reduced ability to detect signals and committed more false alarms. These effects were more pronounced when performing the combined condition compared to the single condition. These findings highlight that interpretation of MFHR signals is subject to misinterpretation and underscores the need for countermeasures.

Research paper thumbnail of Detecting Critical Patterns in Maternal-Fetal Heart Rate Signals

Research paper thumbnail of P05.25: Timing of delivery of IUGR fetuses on the basis of hemodynamic changes

Ultrasound in Obstetrics and Gynecology, 2004

Objective: to evaluate the morbidity and mortality rate of IUGR fetuses correlated to Doppler vel... more Objective: to evaluate the morbidity and mortality rate of IUGR fetuses correlated to Doppler velocimetry, FHR tracing, BPP and AFI. Methods: a multicenter prospective study of 246 fetuses with ultrasound diagnosis of IUGR. Among them 186 met the study entry criteria. The study group underwent Doppler velocimetry study of UA, MCA, DV and UV twice weekly, BPP and AFI twice weekly and FHR tracing daily. IUGR fetuses were divided into two groups: Group 1 IUGR fetuses with Doppler velocimetry abnormality; Group 2 with normal Doppler velocimetry. In Group 1 the type and time passing from Doppler alteration to birth were documented. Apgar score, pH at birth, need of intubation, RDS, IVH, PVL, days of NICU hospitalization were available and related to neonatal outcome. Results: Gestational age at time of admission ranged from 16.1 to 40 weeks. One hundred IUGR fetuses showed Doppler velocimetry alteration while sixty-eight fetuses did not show Doppler alteration (Group 2). In Group 1 morbidity and mortality rate were significantly correlated with the type of Doppler velocimetry abnormality and with time passing from the latter finding and delivery being higher in fetuses with AEDF, RF in UA with a time > 72 hours from the Doppler abnormality and delivery. Conclusions: Doppler velocimetry should be performed in IUGR fetuses as its findings help to reduce morbidity and mortality rate. There is a significant correlation between the type of alteration and time passing from alteration to birth.

Research paper thumbnail of P05.03: Longitudinal antenatal testing alterations in severe IUGR fetuses

Ultrasound in Obstetrics and Gynecology, 2004

Objective: To assess the longitudinal changes in Doppler velocimetry, FHR tracing and BPP in comp... more Objective: To assess the longitudinal changes in Doppler velocimetry, FHR tracing and BPP in compromised IUGR fetuses. Methods: A prospective longitudinal study of 186 IUGR fetuses. All fetuses were enrolled in the study in the moment abdominal circumference was < 10 percentile, plotted on the population growth curve. In all fetuses a daily FHR tracing, Doppler velocimetry twice weekly has been performed to assess the umbelical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and umbilical vein (UV) blood flow. The BPP and Amniotic fluid index was evaluated twice weekly. Results: Of 186 fetuses enrolled in the study 86 did not showed Doppler alteration and were not enrolled in the study. Gestational age at time of admission ranged from 19 to 39 weeks of gestation. 100 IUGR fetuses showed Doppler velocimetry alteration in the moment or after the enrollment. In all fetuses the first antenatal testing to show alteration was increased resistance of the UA (100%); UA AEDF (52%), UA RF (26%); brain sparing effect in the MCA (38%); abnormality in the DV (absent or reversed diastolic flow) and UV pulsations (20%). BPP and FHR tracing was abnormal in 30% of the fetuses and in all of them these changes occurred after Doppler velocimetry alterations with a mean time of 3.8 days. AFI was below the normal ranges in 42% of fetuses. Conclusions: Severe IUGR fetuses show a specific temporal sequence antenatal testing alterations consisting in Doppler velocimetry alterations FHR tracing become abnormal too late, and are the last changes seen in IUGR fetuses as well as the BPP and AFI.

Research paper thumbnail of Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization

Ultrasound in Obstetrics and Gynecology, 1995

We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic vel... more We investigated whether Doppler measurement of the fetal middle cerebral artery peak systolic velocity can be used to detect fetal anemia in pregnancies complicated by maternal blood group immunization. We first studied normal values for the middle cerebral artery peak systolic velocity in 135 fetuses (Group A), and also in 23 fetuses at risk for anemia who underwent 56 cordocenteses to assess the fetal hematocrit (Group B). A test to detect fetal anemia, based on the middle cerebral artery peak systolic velocity, was developed by using the data of the fetuses of Group A and Group B. Successively, the middle cerebral artery peak systolic velocity was prospectively determined in 16 fetuses at risk for anemia who underwent 42 cordocenteses (Group C) to assess the test developed, in a multicenter prospective fashion, by using the data of Group A and Group B. In the normal fetuses an exponential model expressed the increase of the middle cerebral artery peak systolic velocity values with advancing gestation. By using the data of the fetuses of Group A and Group B, four zones of anemia risk were identified. In Group C, none of the anemic fetuses had the middle cerebral artery peak velocity below the normal mean value, whereas all of the anemic fetuses had the peak velocity above the normal mean. The middle cerebral artery blood velocity increases with advancing gestation and is a non-invasive method of detecting anemia in pregnancies complicated by maternal blood group immunization.

Research paper thumbnail of OP01.20: The effect of incorporating ultrasonographic risk assessment for Down syndrome (URAD), with maternal age and serum screening on rate of amniocentesis

Ultrasound in Obstetrics and Gynecology, 2006

Objective: To evaluate the correlation of trisomy 21 with ventriculomegaly diagnosed between 15 a... more Objective: To evaluate the correlation of trisomy 21 with ventriculomegaly diagnosed between 15 and 25 weeks. Methods: This study included 140 fetuses with cytogenetic diagnosis of trisomy 21 and detailed mid-trimester ultrasound examination in our prenatal center. This was a retrospective review of cases diagnosed between 1999 and 2006. Prenatal or postnatal karyotyping, ultrasound video and DVD recordings, still frames and ultrasound reports were analyzed in all included cases. Results: Six cases (4.3%) of mild ventriculomegaly (10-12 mm) were detected among 140 fetuses with Down's syndrome. Five of these fetuses had additional soft marker: mild nuchal edema (3 cases), short nasal bone (4 cases), short femur and humerus (2 cases), echogenic intracardiac focus (2 cases). In three fetuses additional major anomalies were diagnosed: one case with VSD, one case with AVSD, one case with nonimmune hydrops. Only one fetus had isolated ventriculomegaly and no other signs of trisomy 21. No case of severe degree of ventriculomegaly (> 12 mm ventricular atrial diameter) was found in our collective of trisomy 21 fetuses. Conclusions: Since 4.3% of the fetuses with trisomy 21 were affected by mild ventriculomegaly the risk for trisomy 21 is increased above average when sonographic examination reveals this marker. We diagnosed 151 cases of mild ventriculomegaly in 43.490 US examinations in our center, the prevalence for all fetuses was 0.35%. However ventriculomegaly as isolated observation is rarely found. Associated anomalies involving other organs are common in cases with trisomy 21. Nevertheless we conclude that karyotyping is recommended in all cases with ventriculomegaly.

Research paper thumbnail of Prenatal diagnosis of fetal nephrolithiasis

Ultrasound in Obstetrics and Gynecology, 2000

Research paper thumbnail of Association of labor induction or stimulation with infant mortality in women with failed versus successful trial of labor after prior cesarean*

Journal of Maternal-Fetal and Neonatal Medicine, 2013

Objective: To compare infant mortality rates among women with a failed versus successful trial of... more Objective: To compare infant mortality rates among women with a failed versus successful trial of labor after cesarean (TOLAC) following labor induction or stimulation. Study design: Using US linked birth and infant death cohort data (2000)(2001)(2002)(2003)(2004), we identified women who delivered non-anomalous singleton births at 34-41 weeks with TOLAC whose labors were induced or stimulated. Multivariable log-binomial regression models were fitted to estimate the association between TOLAC success and infant mortality. Results: Of the 164,113 women who underwent TOLAC, 41% were unsuccessful. After adjustment for potential confounding factors, a failed TOLAC was associated with a 1.4 fold (95% confidence interval [CI] 1.1, 1.7) increased risk of infant mortality. Conclusions: Among women undergoing labor induction or stimulation, a failed TOLAC is associated with higher likelihood of infant mortality.