Pamela Foy | The Ohio State University (original) (raw)

Papers by Pamela Foy

American Journal of Obstetrics and Gynecology, 2022

American Journal of Obstetrics and Gynecology, Dec 1, 2009

In patients at risk for PTD, women who deliver prior to 34 weeks have shorter CL at all stages an... more In patients at risk for PTD, women who deliver prior to 34 weeks have shorter CL at all stages and a different pattern of CL change between 15-34 weeks as compared to women that deliver after 34 weeks.

Journal of Maternal-fetal & Neonatal Medicine, Apr 18, 2011

To determine the influence of maternal body mass index (BMI) and gestational age on the accuracy ... more To determine the influence of maternal body mass index (BMI) and gestational age on the accuracy of image acquisition, first trimester fetal gender determination, and correct assignment. Women presenting for first trimester aneuploidy risk assessment at 11(0) to 13(6) weeks were prospectively enrolled. A mid-sagittal view of the fetus including the genital tubercle was obtained. The angle of the genital tubercle was measured with male assigned for angle >30°, female <10°, and indeterminate if 10-30°. This was compared with gender at birth. The influence of maternal and pregnancy characteristics on both image acquisition and correct gender assignment were evaluated. A total of 256 women with 260 fetuses undergoing first trimester risk assessment were enrolled. The genital tubercle was identified in 247/260 (95%) of cases. Image acquisition was negatively influenced by increasing maternal BMI and early gestational age (34.8 ± 7.7 vs. 27.0 ± 6.1 kg/m(2), p < 0.0001 and 12.3 ± 0.5 vs. 12.6 ± 0.5 weeks, p = 0.02). Gender was assigned in 93.1% and correctly matched in 85.8% of fetuses. Positive predictive value (PPV) for male and female fetuses were 88.9% and 79.8%, respectively. Correct gender assignment was more likely in male compared with female fetuses (91.4 vs. 80.5%, p = 0.02). Increasing maternal BMI negatively influences image acquisition during the first trimester for gender determination, but does not decrease the accuracy of correct gender assignment if the image is obtained.

Journal of Diagnostic Medical Sonography, Mar 30, 2018

Journal of Ultrasound in Medicine, Jun 1, 1983

American Journal of Obstetrics and Gynecology, 2020

American Journal of Perinatology, Apr 16, 2019

Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using... more Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using screening methods including a combination of elevated hemoglobin A1c, detailed anatomy ultrasound, and fetal echocardiography. Study Design This is a retrospective cohort study of all pregnancies complicated by pregestational diabetes from January 2012 to December 2016. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each screening regimen. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen with effectiveness defined as additional CHD diagnosed. Results A total of 378 patients met inclusion criteria with an overall prevalence of CHD of 4.0% (n = 15). When compared with a detailed ultrasound, fetal echocardiography had a higher sensitivity (73.3 vs. 40.0%). However, all cases of major CHD were detected by detailed ultrasound (n = 6). Using an elevated early A1c > 7.7% and a detailed ultrasound resulted in a sensitivity and specificity of 60.0 and 99.4%, respectively. The use of selective fetal echocardiography for an A1c > 7.7% or abnormal detailed anatomy ultrasound would result in a 63.3% reduction in cost per each additional minor CHD diagnosed (ICER: 18,290.52vs.18,290.52 vs. 18,290.52vs.28,875.67). Conclusion Fetal echocardiography appears to have limited diagnostic value in women with pregestational diabetes. However, these results may not be generalizable outside of a high-volume academic setting.

Ultrasound in Obstetrics & Gynecology, Dec 1, 2022

ABSTRACTObjectivesTo compare the ability of three fetal growth charts (Fetal Medicine Foundation ... more ABSTRACTObjectivesTo compare the ability of three fetal growth charts (Fetal Medicine Foundation (FMF), Hadlock and National Institutes of Child Health and Human Development (NICHD) race/ethnicity‐specific) to predict large‐for‐gestational age (LGA) at birth in pregnant individuals with pregestational diabetes, and to determine whether inclusion of hemoglobin A1c (HbA1c) level improves the predictive performance of the growth charts.MethodsThis was a retrospective analysis of individuals with Type‐1 or Type‐2 diabetes with a singleton pregnancy that resulted in a non‐anomalous live birth. Fetal biometry was performed between 28 + 0 and 36 + 6 weeks of gestation. The primary exposure was suspected LGA, defined as estimated fetal weight ≥ 90th percentile using the Hadlock (Formula C), FMF and NICHD growth charts. The primary outcome was LGA at birth, defined as birth weight ≥ 90th percentile, using 2017 USA natality reference data. The performance of the three growth charts to predict LGA at birth, alone and in combination with HbA1c as a continuous measure, was assessed using the area under the receiver‐operating‐characteristics curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value.ResultsOf 358 assessed pregnant individuals with pregestational diabetes (34% with Type 1 and 66% with Type 2), 147 (41%) had a LGA infant at birth. Suspected LGA was identified in 123 (34.4%) by the Hadlock, 152 (42.5%) by the FMF and 152 (42.5%) by the NICHD growth chart. The FMF growth chart had the highest sensitivity (77% vs 69% (NICHD) vs 63% (Hadlock)) and the Hadlock growth chart had the highest specificity (86% vs 76% (NICHD) and 82% (FMF)) for predicting LGA at birth. The FMF growth chart had a significantly higher AUC (0.79 (95% CI, 0.74–0.84)) for LGA at birth compared with the NICHD (AUC, 0.72 (95% CI, 0.68–0.77); P < 0.001) and Hadlock (AUC, 0.75 (95% CI, 0.70–0.79); P < 0.01) growth charts. Prediction of LGA improved for all three growth charts with the inclusion of HbA1c measurement in comparison to each growth chart alone (P < 0.001 for all); the FMF growth chart remained more predictive of LGA at birth (AUC, 0.85 (95% CI, 0.81–0.90)) compared with the NICHD (AUC, 0.79 (95% CI, 0.73–0.84)) and Hadlock (AUC, 0.81 (95% CI, 0.76–0.86)) growth charts.ConclusionsThe FMF fetal growth chart had the best predictive performance for LGA at birth in comparison with the Hadlock and NICHD race/ethnicity‐specific growth charts in pregnant individuals with pregestational diabetes. Inclusion of HbA1c improved further the prediction of LGA for all three charts. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Journal of Clinical Ultrasound, Apr 1, 1982

Journal of Ultrasound in Medicine, Oct 1, 2013

Journal of Ultrasound in Medicine, Nov 1, 1995

Journal of Ultrasound in Medicine, 1984

Inaccuracies in total intmuterine volumes calculated using the prolate el~ lipse equation have be... more Inaccuracies in total intmuterine volumes calculated using the prolate el~ lipse equation have been reported. No previous study has examined all the sources of error. In this study, a comprehensive approach was undertaken. Measurements were obtained from scans of the pregnant uterus in the prone position using an automated water-path scanner (Octoson) and in the supine position using standard static B-mode scanners. Several conclusions could be drawn : 1) From the Octoson prone scans, uterine volumes obtained using the prolate ellipse formula were markedly different from the true uterine volumes obtained by the summation of stepped areas. This showed that the prolate ellipse formula was inaccurate. 2) From the static supine scans, many observer inconsistencies were found in uterine volumes obtained from the prolate ellipse formula. This made the prolate ellipse formula unreliable. 3) Previously published graphs calculated from the prolate ellipse equation, comparing fetal age with total intrauterine volume, were found to vary accuracy, presumably as a result of 1 and 2. A more accurate approach is proposed. Using the outer uterine wall as the boundary, the stepped areato-volume values of transverse scans taken at 3-cm intervals were found to closely approximate true volumes, with an average error ofonly 3.5 per cent. Since these measurements encompass the intrauterine contents and the myometrium , it is suggested that the term •'total uterine volume'" be used instead of "total intrauterine volume." (Key words: ultrasound; uterus ; volume) The calculation of total intrauterine volume (TIUV) was first described in 1977 and reexamined in 1979. l-'l The uterine volume calculated from a prolate ellipse formula (TIUV = 0.523 x maximum uterine length, width, and height) was found

Journal of Diagnostic Medical Sonography, 1996

American Journal of Obstetrics and Gynecology, 2011

studied, a ROC curve was generated to determine optimal test cutoff and test performance characte... more studied, a ROC curve was generated to determine optimal test cutoff and test performance characteristics. RESULTS: 27 cases of prenatally-diagnosed omphalocele were evaluated during the study period. Of these, 23 (85.2%) delivered live neonates. Primary closure was achieved in 49% of cases. With an optimal test cutoff of Ն 0.21, the O/HC ratio best predicted failure to achieve primary closure. Classification of a GO either Ͻ 24 wks or at any GA was the poorest predictor of surgical outcome. CONCLUSIONS: An O/HC ratio cutoff of Ն 0.21 best predicts inability to achieve primary operative omphalocele repair. All GA standardized predictors of surgical outcome perform better than GO designation.

American Journal of Obstetrics and Gynecology, 2020

Journal of Diagnostic Medical Sonography, 2018

American Journal of Perinatology, 2019

Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using... more Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using screening methods including a combination of elevated hemoglobin A1c, detailed anatomy ultrasound, and fetal echocardiography. Study Design This is a retrospective cohort study of all pregnancies complicated by pregestational diabetes from January 2012 to December 2016. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each screening regimen. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen with effectiveness defined as additional CHD diagnosed. Results A total of 378 patients met inclusion criteria with an overall prevalence of CHD of 4.0% (n = 15). When compared with a detailed ultrasound, fetal echocardiography had a higher sensitivity (73.3 vs. 40.0%). However, all cases of major CHD were detected by detailed ultrasound (n = 6). Using an elevated early A1c > 7.7% and a detailed ultrasound resu...

Textbook of Diagnostic Sonography, 2012

The Journal of Maternal-Fetal & Neonatal Medicine, 2010

We seek to determine whether (1) mean abdominal circumference (AC) of fetuses with gastroschisis ... more We seek to determine whether (1) mean abdominal circumference (AC) of fetuses with gastroschisis is smaller than published normative values, (2) diagnosis of AC ≤ 2.5th percentile is supported by postnatal diagnosis of small-for-gestational age (SGA) and (3) adverse neonatal outcomes are more common in fetuses affected by gastroschisis with a sonographically measured small AC. Retrospective review of pregnancies complicated with gastroschisis between 2000 and 2008. Patient demographics, method of closure, length of stay, use of ventilator support and gastrointestinal complications were compared. Seventy-four fetuses were identified with 368 ultrasound observations. Mean AC of fetuses with gastroschisis fell between the 2.5th and 50th percentile for gestational age. Thirty patients had AC measurements ≤ 2.5th of which 50% were SGA at delivery. Eleven of the 74 fetuses were diagnosed with intrauterine growth restriction (IUGR) and all were SGA. Birth weight was lower in those with a small AC (2104 g vs. 2665 g, p<0.001). There were no other differences in outcomes. AC values fell within the normal range of normative curves. Fifty percent of fetuses with small AC were SGA at birth. Neonatal outcomes in patients with small AC are similar to those with a normal AC.

American Journal of Obstetrics and Gynecology, 2022

American Journal of Obstetrics and Gynecology, Dec 1, 2009

In patients at risk for PTD, women who deliver prior to 34 weeks have shorter CL at all stages an... more In patients at risk for PTD, women who deliver prior to 34 weeks have shorter CL at all stages and a different pattern of CL change between 15-34 weeks as compared to women that deliver after 34 weeks.

Journal of Maternal-fetal & Neonatal Medicine, Apr 18, 2011

To determine the influence of maternal body mass index (BMI) and gestational age on the accuracy ... more To determine the influence of maternal body mass index (BMI) and gestational age on the accuracy of image acquisition, first trimester fetal gender determination, and correct assignment. Women presenting for first trimester aneuploidy risk assessment at 11(0) to 13(6) weeks were prospectively enrolled. A mid-sagittal view of the fetus including the genital tubercle was obtained. The angle of the genital tubercle was measured with male assigned for angle >30°, female <10°, and indeterminate if 10-30°. This was compared with gender at birth. The influence of maternal and pregnancy characteristics on both image acquisition and correct gender assignment were evaluated. A total of 256 women with 260 fetuses undergoing first trimester risk assessment were enrolled. The genital tubercle was identified in 247/260 (95%) of cases. Image acquisition was negatively influenced by increasing maternal BMI and early gestational age (34.8 ± 7.7 vs. 27.0 ± 6.1 kg/m(2), p < 0.0001 and 12.3 ± 0.5 vs. 12.6 ± 0.5 weeks, p = 0.02). Gender was assigned in 93.1% and correctly matched in 85.8% of fetuses. Positive predictive value (PPV) for male and female fetuses were 88.9% and 79.8%, respectively. Correct gender assignment was more likely in male compared with female fetuses (91.4 vs. 80.5%, p = 0.02). Increasing maternal BMI negatively influences image acquisition during the first trimester for gender determination, but does not decrease the accuracy of correct gender assignment if the image is obtained.

Journal of Diagnostic Medical Sonography, Mar 30, 2018

Journal of Ultrasound in Medicine, Jun 1, 1983

American Journal of Obstetrics and Gynecology, 2020

American Journal of Perinatology, Apr 16, 2019

Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using... more Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using screening methods including a combination of elevated hemoglobin A1c, detailed anatomy ultrasound, and fetal echocardiography. Study Design This is a retrospective cohort study of all pregnancies complicated by pregestational diabetes from January 2012 to December 2016. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each screening regimen. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen with effectiveness defined as additional CHD diagnosed. Results A total of 378 patients met inclusion criteria with an overall prevalence of CHD of 4.0% (n = 15). When compared with a detailed ultrasound, fetal echocardiography had a higher sensitivity (73.3 vs. 40.0%). However, all cases of major CHD were detected by detailed ultrasound (n = 6). Using an elevated early A1c > 7.7% and a detailed ultrasound resulted in a sensitivity and specificity of 60.0 and 99.4%, respectively. The use of selective fetal echocardiography for an A1c > 7.7% or abnormal detailed anatomy ultrasound would result in a 63.3% reduction in cost per each additional minor CHD diagnosed (ICER: 18,290.52vs.18,290.52 vs. 18,290.52vs.28,875.67). Conclusion Fetal echocardiography appears to have limited diagnostic value in women with pregestational diabetes. However, these results may not be generalizable outside of a high-volume academic setting.

Ultrasound in Obstetrics & Gynecology, Dec 1, 2022

ABSTRACTObjectivesTo compare the ability of three fetal growth charts (Fetal Medicine Foundation ... more ABSTRACTObjectivesTo compare the ability of three fetal growth charts (Fetal Medicine Foundation (FMF), Hadlock and National Institutes of Child Health and Human Development (NICHD) race/ethnicity‐specific) to predict large‐for‐gestational age (LGA) at birth in pregnant individuals with pregestational diabetes, and to determine whether inclusion of hemoglobin A1c (HbA1c) level improves the predictive performance of the growth charts.MethodsThis was a retrospective analysis of individuals with Type‐1 or Type‐2 diabetes with a singleton pregnancy that resulted in a non‐anomalous live birth. Fetal biometry was performed between 28 + 0 and 36 + 6 weeks of gestation. The primary exposure was suspected LGA, defined as estimated fetal weight ≥ 90th percentile using the Hadlock (Formula C), FMF and NICHD growth charts. The primary outcome was LGA at birth, defined as birth weight ≥ 90th percentile, using 2017 USA natality reference data. The performance of the three growth charts to predict LGA at birth, alone and in combination with HbA1c as a continuous measure, was assessed using the area under the receiver‐operating‐characteristics curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value.ResultsOf 358 assessed pregnant individuals with pregestational diabetes (34% with Type 1 and 66% with Type 2), 147 (41%) had a LGA infant at birth. Suspected LGA was identified in 123 (34.4%) by the Hadlock, 152 (42.5%) by the FMF and 152 (42.5%) by the NICHD growth chart. The FMF growth chart had the highest sensitivity (77% vs 69% (NICHD) vs 63% (Hadlock)) and the Hadlock growth chart had the highest specificity (86% vs 76% (NICHD) and 82% (FMF)) for predicting LGA at birth. The FMF growth chart had a significantly higher AUC (0.79 (95% CI, 0.74–0.84)) for LGA at birth compared with the NICHD (AUC, 0.72 (95% CI, 0.68–0.77); P < 0.001) and Hadlock (AUC, 0.75 (95% CI, 0.70–0.79); P < 0.01) growth charts. Prediction of LGA improved for all three growth charts with the inclusion of HbA1c measurement in comparison to each growth chart alone (P < 0.001 for all); the FMF growth chart remained more predictive of LGA at birth (AUC, 0.85 (95% CI, 0.81–0.90)) compared with the NICHD (AUC, 0.79 (95% CI, 0.73–0.84)) and Hadlock (AUC, 0.81 (95% CI, 0.76–0.86)) growth charts.ConclusionsThe FMF fetal growth chart had the best predictive performance for LGA at birth in comparison with the Hadlock and NICHD race/ethnicity‐specific growth charts in pregnant individuals with pregestational diabetes. Inclusion of HbA1c improved further the prediction of LGA for all three charts. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Journal of Clinical Ultrasound, Apr 1, 1982

Journal of Ultrasound in Medicine, Oct 1, 2013

Journal of Ultrasound in Medicine, Nov 1, 1995

Journal of Ultrasound in Medicine, 1984

Inaccuracies in total intmuterine volumes calculated using the prolate el~ lipse equation have be... more Inaccuracies in total intmuterine volumes calculated using the prolate el~ lipse equation have been reported. No previous study has examined all the sources of error. In this study, a comprehensive approach was undertaken. Measurements were obtained from scans of the pregnant uterus in the prone position using an automated water-path scanner (Octoson) and in the supine position using standard static B-mode scanners. Several conclusions could be drawn : 1) From the Octoson prone scans, uterine volumes obtained using the prolate ellipse formula were markedly different from the true uterine volumes obtained by the summation of stepped areas. This showed that the prolate ellipse formula was inaccurate. 2) From the static supine scans, many observer inconsistencies were found in uterine volumes obtained from the prolate ellipse formula. This made the prolate ellipse formula unreliable. 3) Previously published graphs calculated from the prolate ellipse equation, comparing fetal age with total intrauterine volume, were found to vary accuracy, presumably as a result of 1 and 2. A more accurate approach is proposed. Using the outer uterine wall as the boundary, the stepped areato-volume values of transverse scans taken at 3-cm intervals were found to closely approximate true volumes, with an average error ofonly 3.5 per cent. Since these measurements encompass the intrauterine contents and the myometrium , it is suggested that the term •'total uterine volume'" be used instead of "total intrauterine volume." (Key words: ultrasound; uterus ; volume) The calculation of total intrauterine volume (TIUV) was first described in 1977 and reexamined in 1979. l-'l The uterine volume calculated from a prolate ellipse formula (TIUV = 0.523 x maximum uterine length, width, and height) was found

Journal of Diagnostic Medical Sonography, 1996

American Journal of Obstetrics and Gynecology, 2011

studied, a ROC curve was generated to determine optimal test cutoff and test performance characte... more studied, a ROC curve was generated to determine optimal test cutoff and test performance characteristics. RESULTS: 27 cases of prenatally-diagnosed omphalocele were evaluated during the study period. Of these, 23 (85.2%) delivered live neonates. Primary closure was achieved in 49% of cases. With an optimal test cutoff of Ն 0.21, the O/HC ratio best predicted failure to achieve primary closure. Classification of a GO either Ͻ 24 wks or at any GA was the poorest predictor of surgical outcome. CONCLUSIONS: An O/HC ratio cutoff of Ն 0.21 best predicts inability to achieve primary operative omphalocele repair. All GA standardized predictors of surgical outcome perform better than GO designation.

American Journal of Obstetrics and Gynecology, 2020

Journal of Diagnostic Medical Sonography, 2018

American Journal of Perinatology, 2019

Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using... more Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using screening methods including a combination of elevated hemoglobin A1c, detailed anatomy ultrasound, and fetal echocardiography. Study Design This is a retrospective cohort study of all pregnancies complicated by pregestational diabetes from January 2012 to December 2016. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each screening regimen. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen with effectiveness defined as additional CHD diagnosed. Results A total of 378 patients met inclusion criteria with an overall prevalence of CHD of 4.0% (n = 15). When compared with a detailed ultrasound, fetal echocardiography had a higher sensitivity (73.3 vs. 40.0%). However, all cases of major CHD were detected by detailed ultrasound (n = 6). Using an elevated early A1c > 7.7% and a detailed ultrasound resu...

Textbook of Diagnostic Sonography, 2012

The Journal of Maternal-Fetal & Neonatal Medicine, 2010

We seek to determine whether (1) mean abdominal circumference (AC) of fetuses with gastroschisis ... more We seek to determine whether (1) mean abdominal circumference (AC) of fetuses with gastroschisis is smaller than published normative values, (2) diagnosis of AC ≤ 2.5th percentile is supported by postnatal diagnosis of small-for-gestational age (SGA) and (3) adverse neonatal outcomes are more common in fetuses affected by gastroschisis with a sonographically measured small AC. Retrospective review of pregnancies complicated with gastroschisis between 2000 and 2008. Patient demographics, method of closure, length of stay, use of ventilator support and gastrointestinal complications were compared. Seventy-four fetuses were identified with 368 ultrasound observations. Mean AC of fetuses with gastroschisis fell between the 2.5th and 50th percentile for gestational age. Thirty patients had AC measurements ≤ 2.5th of which 50% were SGA at delivery. Eleven of the 74 fetuses were diagnosed with intrauterine growth restriction (IUGR) and all were SGA. Birth weight was lower in those with a small AC (2104 g vs. 2665 g, p<0.001). There were no other differences in outcomes. AC values fell within the normal range of normative curves. Fifty percent of fetuses with small AC were SGA at birth. Neonatal outcomes in patients with small AC are similar to those with a normal AC.