Martha Rac

United States Food and Drug Administration

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Diane M. Twickler

The University of Texas Southwestern Medical Center

Donald D. McIntire

The University of Texas Southwestern Medical Center

Elysia Moschos

The University of Texas Southwestern Medical Center

Michael A. Belfort

Baylor College of Medicine

Jodi S. Dashe

Columbia College - South Carolina

C. Edward Wells

The University of Texas Southwestern Medical Center

Karin A. Fox

The University of Texas Medical Branch at Galveston

Catherine Eppes

Baylor College of Medicine

Alireza A. Shamshirsaz

Boston Children's Hospital

Steven L. Clark

Baylor College of Medicine

Cooperative Institutions

United States Food and Drug Administration

103

Baylor College of Medicine

Texas Children's Hospital

The University of Texas Southwestern Medical Center

Harvard University

Community Link

Health and Human Development (2HD) Research Network

National University of Singapore

RELX Group (United States)

University of Pennsylvania

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Clinical Importance of Placental Testing among Suspected Cases of Congenital Zika Syndrome

International Journal of Molecular Sciences (2019)

Maxim D. Seferovic Michelle Turley Gregory C. Valentine Martha Rac Eumenia Castro

Contemporaneous Zika virus (ZIKV) strains can cause congenital Zika syndrome (CZS). Current ZIKV clinical laboratory testing strategies are limited and include IgM serology (which may wane 12 weeks after initial exposure) and nucleic acid testing (NAT) of maternal serum, urine, and placenta for (+) strand ZIKV RNA (which is often transient). The objectives of this study were to determine if use of additional molecular tools, such as quantitative PCR and microscopy, would add to the diagnostic value of current standard placental ZIKV testing in cases with maternal endemic exposure and indeterminate testing. ZIKV RNA was quantified from dissected sections of placental villi, chorioamnion sections, and full cross-sections of umbilical cord in all cases examined. Quantitation with high-resolution automated electrophoresis determined relative amounts of precisely verified ZIKV (74-nt amplicons). In order to localize and visualize stable and actively replicating placental ZIKV in situ, labeling of flaviviridae glycoprotein, RNA ISH against both (+) and (⁻) ZIKV-specific ssRNA strands, and independent histologic examination for significant pathologic changes were employed. We demonstrate that the use of these molecular tools added to the diagnostic value of placental ZIKV testing among suspected cases of congenital Zika syndrome with poorly ascribed maternal endemic exposure.

Zika Virus

Microcephaly

10.3390/ijms20030712

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Citations (9)

189: Predictive factors for coagulopathy in the management of morbidly adherent placenta

American Journal of Obstetrics and Gynecology (2018)

Bahram Salmanian Hadi Erfani Karin A. Fox Steven L. Clark Martha Rac

Univariate analysis

10.1016/j.ajog.2017.10.066

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Citations (0)

Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time

American Journal of Obstetrics and Gynecology (2017)

Alireza A. Shamshirsaz Karin A. Fox Hadi Erfani Steven L. Clark Bahram Salmanian

Interquartile range

Placenta Accreta

Placenta Percreta

10.1016/j.ajog.2017.02.016

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Citations (191)

245: Posterior placentation in morbidly adherent placenta: a nested case-control study of characteristics and outcomes

American Journal of Obstetrics and Gynecology (2016)

Bahram Salmanian Karin A. Fox Hadi Erfani Zhoobin H. Bateni Amir A. Shamshirsaz

Placentation

Placenta previa

Placenta Accreta

10.1016/j.ajog.2016.11.150

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Citations (0)

Corrigendum to ‘SMFM Fetal Anomalies Consult Series #2: Extremities’ [American Journal of Obstetrics and Gynecology 221/6 (2019) B2-B18]

American Journal of Obstetrics and Gynecology (2021)

Jennifer McKinney Martha Rac Manisha Gandhi

Maternal-fetal medicine

10.1016/j.ajog.2021.09.036

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Citations (0)

Genitourinary Tuberculosis: A Rare Cause of Obstructive Uropathy in Pregnancy

Case Reports in Obstetrics and Gynecology (2014)

Emily H. Adhikari Elaine L. Duryea Martha Rac Jeanne S. Sheffield

Background . A rare but morbid form of extrapulmonary tuberculosis (TB), genitourinary TB is an important cause of obstructive uropathy and is likely underdiagnosed in pregnancy. Case . A 30-year-old primigravida undergoing treatment for active pulmonary TB presented with anuria at 13-14-weeks gestation. Bilateral ureteral strictures above the level of the ureterovesicular junctions were seen on imaging studies. Given her pulmonary disease, her obstructive uropathy was attributed to genitourinary TB. Bilateral percutaneous nephrostomy tubes were placed during pregnancy with successful ureteral reimplantation postpartum. Conclusion . Genitourinary TB should be considered as an etiology of urinary tract pathology during pregnancy, especially in foreign-born and immunocompromised persons. Early recognition resulting in prompt treatment can prevent further deterioration of maternal renal function and optimize pregnancy outcomes.

Obstructive uropathy

Anuria

Etiology

Percutaneous nephrostomy

Rare disease

10.1155/2014/985682

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Citations (4)

226: Ultrasound predictors of placental invasion: the accreta index

American Journal of Obstetrics and Gynecology (2013)

Martha Rac Jodi S. Dashe C. Edward Wells Elysia Moschos Don D. McIntire

Placenta Accreta

Placenta previa

10.1016/j.ajog.2013.10.259

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Citations (2)

863: Low implantation on first trimester ultrasound and subsequent placenta previa and accreta

American Journal of Obstetrics and Gynecology (2015)

Martha Rac Elysia Moschos C. Edward Wells Donald D. McIntire Sarah K. Happe

Placenta Accreta

Placenta previa

10.1016/j.ajog.2015.10.913

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Citations (1)

Cervical Length in Patients at Risk for Placenta Accreta

Journal of Ultrasound in Medicine (2017)

Martha Rac Donald D. McIntire C. Edward Wells Elysia Moschos Diane D. Twickler

To evaluate cervical length measurements in women with placenta accreta compared to women with a nonadherent low-lying placenta or placenta previa and evaluate this relationship in terms of vaginal bleeding, preterm labor, and preterm birth.We conducted a retrospective cohort study between 1997 and 2011 of gravidas with more than 1 prior cesarean delivery who had a transvaginal ultrasound examination between 24 and 34 weeks for a low-lying placenta or placenta previa. Cervical length was measured from archived images in accordance with national guidelines by a single investigator, who was blinded to outcomes and ultrasound reports. The diagnosis of placental accreta was based on histologic confirmation. For study purposes, preterm birth was defined as less than 36 weeks, and cervical lengths of 3 cm or less were considered short. Standard statistical analyses were used.A total of 125 patients met inclusion criteria. The cohort was divided into patients with (n = 43 [34%]) and without (n = 82 [66%]) placenta accreta and stratified by gestational age at the ultrasound examinations. Women with placenta accreta had shorter cervical length measurements during their 32- to 34-week ultrasound examinations (mean ± SD, 3.23 ± 0.98 versus 3.95 ± 1.0 cm; P < .01) and were more likely to have a short cervix of 3 cm or less (P = .001). However, these findings did not correlate with the degree of invasion (P = .3), or higher rates of vaginal bleeding and preterm labor (P = .19) resulting in preterm birth before 36 weeks (P = .64).Women with placenta accreta had shorter cervical lengths at 32 to 34 weeks than women with a nonadherent low-lying placenta or placenta previa, but this finding did not correlate with a higher risk of vaginal bleeding or preterm labor resulting in preterm birth before 36 weeks.

Placenta Accreta

Placenta previa

10.7863/ultra.16.05059

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Citations (13)

Primary Human Placental Trophoblasts are Permissive for Zika Virus (ZIKV) Replication

Scientific Reports (2017)

Kjersti M. Aagaard Anismrita Lahon Melissa Suter Ravi Prakash Arya Maxim D. Seferovic

Abstract Zika virus (ZIKV) is an emerging mosquito-borne ( Aedes genus) arbovirus of the Flaviviridae family. Although ZIKV has been predominately associated with a mild or asymptomatic dengue-like disease, its appearance in the Americas has been accompanied by a multi-fold increase in reported incidence of fetal microcephaly and brain malformations. The source and mode of vertical transmission from mother to fetus is presumptively transplacental, although a causal link explaining the interval delay between maternal symptoms and observed fetal malformations following infection has been missing. In this study, we show that primary human placental trophoblasts from non-exposed donors ( n = 20) can be infected by primary passage ZIKV-FLR isolate, and uniquely allowed for ZIKV viral RNA replication when compared to dengue virus (DENV). Consistent with their being permissive for ZIKV infection, primary trophoblasts expressed multiple putative ZIKV cell entry receptors, and cellular function and differentiation were preserved. These findings suggest that ZIKV-FLR strain can replicate in human placental trophoblasts without host cell destruction, thereby serving as a likely permissive reservoir and portal of fetal transmission with risk of latent microcephaly and malformations.

Zika Virus

Microcephaly

Transplacental

Permissive

Flavivirus

10.1038/srep41389

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Citations (117)