Research and Education Fall 2013
Parental Decision-Making for an Unborn Child with Spina Bifida
Principal Investigator: Lynnette J. Mazur, M.D., M.P.H.
Co-Investigators: Anthony Johnson, D.O.,Kenneth Moise Jr., M.D., KuoJen Tsao, M.D., Co-Directors, The Fetal Center; Karen Moise, RN, Nurse Coordinator, The Fetal Center; Rebecca Carter, CGS, Genetic Counselor, and Sangbum Choi, Ph.D., Statistician,
The University of Texas School of Public Health
Lynette Mazur, M.D., pediatric spina bifida consultant affiliated with The Fetal Center at Children's Memorial Hermann Hospital, along with members of The Fetal Center team, was successful in obtaining a $10,000 grant from The Program of Interprofesional Ethics at McGovern Medical School at UTHealth to look into various aspects of decision-making faced by parents of an unborn child with spina bifida, including frequency of pursuing or not pursuing surgical repair and factors involved in decision-making.
Spina bifida is a defect of the spine that affects a child’s cognitive development, bladder and bowel continence, and ability to walk, and fetal repair of the defect has been shown to markedly improve a child’s quality of life in these areas. Since the first repair at Children’s Memorial Hermann Hospital in March, 2011, many families have traveled from across the country and around the world to The Fetal Center to be evaluated by the team to determine if they are a candidate for fetal repair. All families are provided with objective information about the condition and the treatment options, better equipping each family to reach its own decision.
To better understand what factors are important to parents when deciding between pre- or post-natal surgery or a termination of the pregnancy, the parents of all patients who have already been evaluated at the Center will be mailed a questionnaire to determine:
- The frequency of parents who pursued fetal surgery, postnatal surgery, or termination of the pregnancy after presenting for
consultation at the The Fetal Center
- The importance of factors involved in the decision-making process, such as:
- Parental age
- Education level
- Perception of the severity of the disability
- Distance from the subspecialty care such as neurosurgery, orthopedics or urology
- Financial and insurance concerns
- Religious affiliation
- Number of children in the family
Their responses will rate each of these factors as unimportant, neutral or most important, and the answers for each group of parents will be compared. The questionnaire will also determine if parents would make the same decision again.
For more information about this study, email firstname.lastname@example.org or call (832) 325-7288.
Ongoing Research Projects
- Ramesha Papanna, M.D., assistant professor at McGovern Medical School, is beginning to establish his laboratory to study the various factors associated with preterm premature rupture of the membranes and premature labor after fetal intervention.
He has recently submitted an application for a Society for Maternal-Fetal Medicine (SMFM)/American Gynecological and
Obstetrical Society (AGOS) training grant to support his investigation.
- Dr. Papanna is in the early planning stages of a multi-center randomized trial to study the use of vaginal progesterone to prevent
preterm labor after laser therapy for twin-twin transfusion syndrome.
- Kenneth Moise Jr., M.D., is collaborating with Kuojen Tsao, M.D., UTHealth department of Pediatric Surgery, Stephen Fletcher, D.O.,
and David Sandberg, M.D., UTHealth department of Pediatric Neurosurgery, and Russell Stewart, Ph.D., of the University of Utah,
to study the use of underwater glue to patch fetal myelomeningocele (MMC). Early results for ovine experiments indicate that a
laser activated version of the glue can be used to successfully attach the patch to the fetus. Additional experiments are planned
for the fall of this year.
- Pedro Argoti, M.D., a second-year fetal intervention fellow at McGovern Medical School, has collaborated with Judith Smith,
Pharm.D., to complete a study of the maternal pharmacokinetics of a remifentanil infusion in pregnant women undergoing fetal
intervention procedures. Using data from this unique investigation, Dr. Argoti is beginning to evaluate the fetal levels of remifentanil
in an in vitro placental model.
- Anthony Johnson, D.O., has enrolled the first patient from McGovern Medical School in an international randomized clinical trial to
study the role of laser therapy vs. conservative management for stage 1 twin-twin transfusion syndrome.
In Print and Publication
Argoti PS, Bebbington M, Johnson A, Moise Jr. KJ. Sonographic capture of acute exsanguination in a case of developing monochorionic co-twin demise. Ultrasound Obstet Gynecol 2013;42:119-20.
Moise Jr. KJ, Bebbington MW, Johnson A, Walker M, Johnson M. The benefit of laser therapy for severe twin-twin transfusion: which metaanalysis do you pick? Am J Obstet Gynecol 2013;209:158-9.
Papanna R, Mann LK, Moise KY, Johnson A, Moise Jr. KJ. Absorbable gelatin plug does not prevent iatrogenic preterm premature rupture of the membranes after fetoscopic laser surgery for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol.(Epub ahead of print 4/18/2013)
Papanna R, Bebbington M, Moise Jr. KJ. Novel findings of an iatrogenic fetal membrane defect after previous fetoscopy for twin-twin transfusion. Ultrasound Obstet Gynecol 2013;42:118-9.
Argoti PS, Bebbington M, Adler M, Johnson A, Moise Jr. KJ. Serial intrauterine transfusions for a hydropic fetus with severe anemia and thrombocytopenia caused by parvovirus: Lessons learned. Am J Perinatal (in press).
Hui L, Wick HC, Moise Jr. KJ, Johnson A, Luks F, Haeri S, Johnson KL, Bianchi DW. Global gene expression analysis of amniotic fluidcell-free RNA from recipient twins with twin-twin transfusion syndrome. Prenat Diagn 2013; 33:873-83.
Argoti PS, Bebbington MW, Johnson A, Moise Jr. KJ. Indirect pump: unique presentation of a monochorionic-triamniotic triplet gestation complicated by TRAP sequence and successfully managed with radiofrequency ablation of the acardiac fetus. Ultrasound Obstet Gynecol 2013;42:115-7.
Connell JP, Augustini E, Moise Jr. KJ, Johnson A, Jacot JG. Formation of gap junctions in amniotic fluid-derived stem cells induced by transmembrane co-culture with neonatal rat cardiomyocytes. J Cell Mol Med 2013;17:774-81.
Bebbington MW. Fetal therapy: the need for well designed collaborative research trials. Ultrasound Obstet Gynecol 2013;42:1-3.
Papanna R, Block-Abraham D, Buhimschi IA, Bebbington MW, Garcia E, Khalek N, Harman C, Johnson A, Baschat A, Moise Jr. KJ. Risk factors associated with preterm delivery after fetoscopic laser surgery for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol (in press).
Bebbington MW. Selective reduction in multiple pregnancies. Clin Obstet Gynecol (in press).
Chaoui R, Gardiner H. Perinatal cardiology 2013. Semin Fetal Neonatal Med (Epub ahead of print 7/1/2013).
Gardiner H, Chaoui R. The fetal three-vessel and tracheal view revisited. Semin Fetal Neonatal Med (Epub ahead of print 3/2/2013).
Taylor-Clarke MC, Matsui H, Roughton M, Wimalasundera RC, Gardiner HM. Ventricular strain changes in monochorionic twins with and without twin to twin Transfusion syndrome. Am J Obstet Gynecol 2013;208:462e1-6.
Gardiner HM, Kovacevic A, van der Heijden LB, Pfeiffer PW, Franklin RC, Gibbs JL, Averiss IE, LaRovere JM. Prenatal screening for major congenital heart disease: assessing performance by combining national cardiac audit with maternity data. Heart (in press).
Gardiner HM. Commentary on: Zidere V, Pushparajah K, Allan LD, Simpson JM. Three-dimensional fetal echocardiography for prediction of the postnatal surgical approach in double outlet right ventricle: a pilot study. Ultrasound Obstet Gynecol (in press).
Presentations at National and International Meetings
Several members presented abstracts at the 23rd World Congress on Ultrasound in Obstetrics and Gynecology meeting
scheduled for October, 2013, in Sydney, Australia.
Several members of the Center have submitted abstracts for consideration for presentation at the 34th Annual Meeting of the Society for Maternal-Fetal Medicine (SMFM) scheduled for February, 2014 in New Orleans:
- Argoti PS, Tabbah SM, Thung S, Papanna R, Moise Jr. KJ. Circulating cell free fetal (ccff) DNA for RHD typing to determine the need
of RhD immunoglobulin (IgG). Is this cost-effective?
- Argoti PS, Garcia EI, Coffer L, Giezentanner A, Johnson A, Smith JA, Moise Jr. KJ. Pharmacokinetic profile of remifentanil in patients
undergoing laser therapy for twin-to-twin transfusion Syndrome (TTTS).
- Papanna R, Mann LK, Baschat AR, Garcia E, Moise K, Bebbington MW, Snowise S, Khalek N, Moise Jr. KJ, Johnson A. Preoperative
cervical length below the 20th percentile is an independent indicator of spontaneous preterm birth after fetoscopic laser surgery
for twin-twin transfusion syndrome.
- Papanna R, Mann LK, Tseng, SCG, Stewart RJ, Kaur S, Swindle M, Pedro A, Garcia E, Tatevian N, Buhimschi IA, Kyriakides T,
Moise Jr. KJ. Cryopreserved human amniotic membrane with underwater adhesive coacerviates to seal and promote healing of
iatrogenic fetal membrane defect site in a swine model.
- Papanna R, Mann LK, Garcia E, Ward A, Boring N, Bebbington MW, Khalek N, Harman C, Johnson A, Moise Jr. KJ,
Baschat A. Preterm delivery after fetoscopic laser surgery for twin-twin transfusion syndrome: Etiology and risk factors.
- Papanna R, Mann LK, Bebbington MW, Johnson A, Garcia E, Moise Jr. KJ, Buhimschi CB, Buhimschi IA. Amnioinfusion induced
amniotic membrane apoptosis and autophagy: Novel insights into the mechanisms of preterm premature rupture of membranes
after fetoscopic laser surgery for twin-twin transfusion syndrome.
- Kenneth Moise Jr., M.D., was invited as a participant in a workshop on Autosomal Recessive Kidney Disease sponsored by the
Polycystic Kidney Disease Foundation held in May, 2013, in Washington, D.C.
- Michael Bebbington, M.D., chaired a Fetal Therapy Workshop at the 23rd World Congress of Ultrasound in Obstetrics and
Gynecology held in October, 2013, in Sydney, Australia. He also presented a lecture entitled: The aftermath of the MOMS trial:
Current status on open fetal surgery for myelomeningocele.
- Helena Gardiner, M.D., chaired a session entitled Cardiac function in assessment and prediction of disease at the 23rd World
Congress of Ultrasound in Obstetrics and Gynecology held in October, 2013, in Sydney, Australia. She also presented a lecture
entitled Cardiac therapy in utero.