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Elizabeth Snyder, Ahmet Baschat, Thierry A G M Huisman, Aylin Tekes
OBJECTIVE: The purpose of this article is to present illustrative cases highlighting the value of fetal MRI as a problem-solving tool in evaluating anomalies of the fetal chest, abdomen, and pelvis that are being evaluated for fetal therapy. CONCLUSION: Fetal MRI is an increasingly valuable noninvasive tool for evaluating fetal anomalies in the age of fetal therapy. Although ultrasound remains the primary diagnostic imaging modality, MRI can provide additional information to assist parental counseling and patient care...
March 12, 2018: AJR. American Journal of Roentgenology
Shai Shrot, Clark T Johnson, W Christopher Golden, Ahmet A Baschat, Janine E Bullard, Aylin Tekes, Andrea Poretti, Emily Dunn, Thierry A G M Huisman
BACKGROUND AND PURPOSE: Persistent hyperextension of the fetal craniocervical junction or neck is one of several fetal positions commonly observed on prenatal imaging. Underlying fetal structural etiologies such as fetal neck masses and iniencephaly can be detected as causes of hyperextension. Caesarean delivery is considered in cases of vaginal delivery or obstructed labor for fear of cervical spinal cord injury. In this case series, we describe the prenatal magnetic resonance imaging (MRI) findings and their potential role in obstetric management and discuss postnatal outcomes in fetuses demonstrating prenatal imaging findings of persistent extreme hyperextension of the neck...
February 5, 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Jeremy Sugarman, Jean Anderson, Ahmet A Baschat, Jaime Herrera Beutler, Jessica L Bienstock, Timothy E Bunchman, Niraj M Desai, Elena Gates, Aviva Goldberg, Paul C Grimm, Leslie Meltzer Henry, Eric B Jelin, Emily Johnson, Christine B Hertenstein, Anna C Mastroianni, Mark R Mercurio, Alicia Neu, Lawrence M Nogee, William J Polzin, Steven J Ralston, Ronald M Ramus, Megan Kasimatis Singleton, Michael J G Somers, Karen C Wang, Renee Boss
Congenital bilateral renal agenesis has been considered a uniformly fatal condition. However, the report of using serial amnioinfusions followed by the live birth in 2012 and ongoing survival of a child with bilateral renal agenesis has generated hope, but also considerable controversy over an array of complex clinical and ethical concerns. To assess the ethical concerns associated with using serial amnioinfusions for bilateral renal agenesis, we assembled a multidisciplinary group to map the ethical issues relevant to this novel intervention...
January 2018: Obstetrics and Gynecology
Viola Seravalli, Eric B Jelin, Jena L Miller, Aylin Tekes, Luca Vricella, Ahmet A Baschat
Fetoscopic endotracheal occlusion (FETO) is a prenatal treatment that may increase survival in severe congenital diaphragmatic hernia (CDH). In the USA, FETO is offered for isolated severe left-sided CDH in the context of an FDA-approved feasibility study. FETO in non-isolated cases of severe CDH is only performed with a compassionate use exemption from US regulatory bodies. Anomalies frequently associated with CDH include congenital cystic lesions of the lung and cardiac defects. We describe two cases of non-isolated severe left-sided CDH that underwent prenatal FETO, survived after birth and underwent postnatal surgical repair...
October 2017: Prenatal Diagnosis
N Andescavage, A duPlessis, M Metzler, D Bulas, G Vezina, M Jacobs, S N Iqbal, A Baschat, C Limperopoulos
OBJECTIVE: The relationship between placental and fetal brain growth is poorly understood and difficult to assess. The objective of this study was to interrogate placental and fetal brain growth in healthy pregnancies and those complicated by fetal growth restriction (FGR). STUDY DESIGN: In a prospective, observational study, pregnant women with normal pregnancies or pregnancies complicated by FGR underwent fetal magnetic resonance imaging (MRI). Placental, global and regional brain volumes were calculated...
December 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
Asma Khalil, Helen Perry, James Duffy, Keith Reed, Ahmet Baschat, Jan Deprest, Kurt Hecher, Liesbeth Lewi, Enrico Lopriore, Dick Oepkes
BACKGROUND: Twin-Twin Transfusion Syndrome (TTTS) is associated with an increased risk of perinatal mortality and morbidity. Several treatment interventions have been described for TTTS, including fetoscopic laser surgery, amnioreduction, septostomy, expectant management, and pregnancy termination. Over the last decade, fetoscopic laser surgery has become the primary treatment. The literature to date reports on many different outcomes, making it difficult to compare results or combine data from individual studies, limiting the value of research to guide clinical practice...
July 14, 2017: Trials
Viola Seravalli, Dana Block-Abraham, Cyrethia McShane, Sarah Millard, Ahmet Baschat, Jena Miller
OBJECTIVE: To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins. METHODS: Normal and complicated MC pregnancies were prospectively enrolled. The relationship of isthmus flow index (IFI) with Doppler parameters of umbilical artery (UA), descending aorta, middle cerebral artery, and ductus venosus and with left and right ventricular cardiac output and stroke volume was studied. RESULTS: The IFI was obtained in 180 examinations from 48 pregnancies (24 twin-twin transfusion syndrome, TTTS; 4 selective intrauterine growth restriction, sIUGR; 12 TTTS + sIUGR; and 8 uncomplicated)...
July 11, 2017: Prenatal Diagnosis
A M Panaitescu, A A Baschat, R Akolekar, A Syngelaki, K H Nicolaides
OBJECTIVE: To examine the effect of chronic hypertension (CH), with and without superimposed pre-eclampsia (PE), on the incidence of a small-for-gestational-age (SGA) neonate and to explore the possible mechanism for such association. METHODS: Data for this study were derived from prospective screening for adverse pregnancy outcomes in women with singleton pregnancy attending their first routine hospital visit at 11-13 weeks' gestation, which included recording of maternal characteristics and medical history and measurement of mean arterial pressure (MAP)...
September 2017: Ultrasound in Obstetrics & Gynecology
Anita J Moon-Grady, Ahmet Baschat, Darrell Cass, Mahesh Choolani, Joshua A Copel, Timothy M Crombleholme, Jan Deprest, Stephen P Emery, Mark I Evans, Francois I Luks, Mary E Norton, Greg Ryan, Kuojen Tsao, Ross Welch, Michael Harrison
More than 3 decades ago, a small group of physicians and other practitioners active in what they called "fetal treatment" authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful reassessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of fetal treatment, with a brief discussion of the necessary minimum expertise and systems base for the provision of different types of interventions for both the mother and fetus...
2017: Fetal Diagnosis and Therapy
Birgit Arabin, Ahmet A Baschat
Physiologic adaptations during pregnancy unmask a woman's predisposition to diseases. Complications are increasingly predicted by first-trimester algorithms, amplify a pre-existing maternal phenotype and accelerate risks for chronic diseases in the offspring up to adulthood (Barker hypothesis). Recent evidence suggests that vice versa, pregnancy diseases also indicate maternal and even grandparent's risks for chronic diseases (reverse Barker hypothesis). Pub-Med and Embase were reviewed for Mesh terms "fetal programming" and "pregnancy complications combined with maternal disease" until January 2017...
2017: Frontiers in Pediatrics
Melanie A McNally, Julia Johnson, Thierry A Huisman, Andrea Poretti, Kristin W Baranano, Ahmet A Baschat, Carl E Stafstrom
BACKGROUND: SCN8A mutations are rare and cause a phenotypically heterogeneous early onset epilepsy known as early infantile epileptic encephalopathy type 13 (EIEE13, OMIM #614558). There are currently no clear genotype-phenotype correlations to help guide patient counseling and management. PATIENT DESCRIPTION: We describe a patient with EIEE13 (de novo heterozygous pathogenic mutation in SCN8A - p.Ile240Val (ATT>GTT)) who presented prenatally with maternally reported intermittent, rhythmic movements that, when observed on ultrasound, were concerning for fetal seizures...
November 2016: Pediatric Neurology
S P Emery, S K Hasley, J M Catov, R S Miller, A J Moon-Grady, A A Baschat, A Johnson, F Lim, A L Gagnon, R W O'Shaughnessy, T Ozcan, F I Luks
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
V Seravalli, D Block-Abraham, C Mc Shane, S Millard, A A Baschat, J L Miller
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
Sifa Turan, Joshua I Rosenbloom, Mostafa Hussein, Christoph Berg, Ulrich Gembruch, Ahmet A Baschat, Ozhan M Turan
PURPOSE: Fetal head and somatic growth dynamics differs in fetuses with congenital heart defects (CHD). We longitudinally characterized fetal head and somatic growth in relation to the type of CHD. METHODS: Four hundred eleven exams from isolated CHD were compared with 1,219 controls. Head and somatic growth was assessed using head circumference (HC), brain volume (BrV = 1/6 × π × (HC/π)3)/2), fetal cephalization index (FCI = BrV/[estimated fetal weight]), and growth percentile...
February 2017: Journal of Clinical Ultrasound: JCU
Stephen P Emery, Steve K Hasley, Janet M Catov, Russell S Miller, Anita J Moon-Grady, Ahmet A Baschat, Anthony Johnson, Foong-Yen Lim, Alain L Gagnon, Richard W O'Shaughnessy, Tulin Ozcan, Francois I Luks
BACKGROUND: Stage I twin-twin transfusion syndrome presents a management dilemma. Intervention may lead to procedure-related complications while expectant management risks deterioration. Insufficient data exist to inform decision-making. OBJECTIVE: The aim of this retrospective observational study was to describe the natural history of stage I twin-twin transfusion syndrome, to assess for predictors of disease behavior, and to compare pregnancy outcomes after intervention at stage I vs expectant management...
September 2016: American Journal of Obstetrics and Gynecology
Dana M Block-Abraham, Dasha Adamovich, Ozhan M Turan, Lauren E Doyle, Miriam G Blitzer, Ahmet A Baschat
OBJECTIVE: To determine the relationship between maternal blood pressures throughout pregnancy and the risk of delivering a small-for-gestational-age (SGA) neonate. METHODS: Women were prospectively enrolled at 9-14 weeks and had serial blood pressure measurements throughout pregnancy. SGA prevalence was compared to maternal blood pressure at enrollment, average blood pressure during each trimester, and blood pressure trends throughout gestation. Blood pressure was categorized as normotension, prehypertension, or hypertension using Joint National Committee on Hypertension-7 (JNC-7) definitions...
August 2016: Hypertension in Pregnancy
Viola Seravalli, Jena L Miller, Dana Block-Abraham, Ahmet A Baschat
The ductus venosus has a central role in the distribution of highly oxygenated umbilical venous blood to the heart. Its waveform is related to the pressure-volume changes in the cardiac atria and it is therefore important in the monitoring of any fetal condition that may affect forward cardiac function. The cardiovascular parameters that can influence forward cardiac function include afterload, myocardial performance and preload. Decreased forward flow during atrial systole (a-wave) is the most sensitive and ubiquitous finding when any of these parameters is affected...
June 2016: Acta Obstetricia et Gynecologica Scandinavica
Viola Seravalli, Yael Inna Grimpel, Hamutal Meiri, Miriam Blitzer, Ahmet A Baschat
OBJECTIVE: To examine potential correlations between maternal serum placental protein-13 (PP-13) and first trimester maternal and placental factors, and to evaluate the association of this marker with adverse pregnancy outcome. METHODS: Serum samples from prospectively enrolled patients between 11 and 13 weeks and 6 days were analyzed for PP-13 using an ELISA assay. The relationships between maternal serum PP-13 levels and gestational age, maternal age, ethnicity, parity, smoking status, body mass index (BMI), mean arterial blood pressure, uterine and umbilical artery Doppler parameters were examined...
July 1, 2016: Journal of Perinatal Medicine
S J Gordijn, I M Beune, B Thilaganathan, A Papageorghiou, A A Baschat, P N Baker, R M Silver, K Wynia, W Ganzevoort
OBJECTIVE: To determine, by expert consensus, a definition for early and late fetal growth restriction (FGR) through a Delphi procedure. METHOD: A Delphi survey was conducted among an international panel of experts on FGR. Panel members were provided with 18 literature-based parameters for defining FGR and were asked to rate the importance of these parameters for the diagnosis of both early and late FGR on a 5-point Likert scale. Parameters were described as solitary parameters (parameters that are sufficient to diagnose FGR, even if all other parameters are normal) and contributory parameters (parameters that require other abnormal parameter(s) to be present for the diagnosis of FGR)...
September 2016: Ultrasound in Obstetrics & Gynecology
R Gabbay-Benziv, N Oliveira, A A Baschat
OBJECTIVE: To compare performance of multimarker algorithm, risk profiles and their sequential application in prediction of preeclampsia and determining potential intervention targets. STUDY DESIGN: Maternal characteristics, ultrasound variables and serum biomarkers were collected prospectively at first trimester. Univariate analysis identified preeclampsia associated variables followed by logistic regression analysis to determine the prediction rule. Combined characteristics of the cardiovascular, metabolic and the personal risk factors were compared to the multimarker algorithm and the sequential application of both methods...
January 2016: Prenatal Diagnosis
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