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Research and Education Fall 2014

Education

  • Pedro Argoti, M.D.,completed his fetal intervention fellowship with The Fetal Center and began his fellowship in genetics and maternal-fetal medicine at Johns Hopkins University School of Medicine. Dr. Argoti was the Center’s first fetal intervention fellow.
  • Roopali Donepudi, M.D.,began her fetal intervention fellowship at The Fetal Center at Children’s Memorial Hermann Hospital in July. She joins The Fetal Center following completion of her maternal-fetal medicine fellowship at Albert Einstein College of Medicine.
  • Saul Snowise, M.D.,a second-year maternal-fetal medicine fellow at McGovern Medical School at UTHealth, joined The Fetal Center at Children’s Memorial Hermann Hospital to concentrate on research and clinical training in fetal intervention for the next two years of his fellowship training.

Clinical Trials

  • Ramesha Papanna, M.D., M.P.H., continues to investigate the causes of preterm labor and preterm premature rupture of membranes in twin-twin transfusion syndrome. Basic science investigations are under way to study changes in the fetal membranes and amniotic fluid that occur in TTTS that may contribute to preterm delivery.
  • Dr. Papanna, in collaboration with Kenneth Moise Jr., M.D., is continuing an investigation in a swine model to address the sealing of the site of fetoscopic entry at the time of fetal intervention. This work is funded by an RO1 grant from the National Institutes of Health in collaboration with Russell Stewart, Ph.D., of the University of Utah.
  • Dr. Papanna and Dr. Moise, in collaboration with Stephen Fletcher, D.O., in the division of Pediatric Neurosurgery at McGovern Medical School, continue to investigate methods in the development of a minimally invasive approach to in utero repair of myelomeningocele. In collaboration with Scheffer Tseng, M.D., Ph.D., of the Ocular Surface Center, P.A., preliminary results in an ovine model for MMC indicate that the processed outer covering of human umbilical cord has substantial regenerative properties as a patch for in utero repair. Additional experiments are planned for spring 2015.
  • Dr. Moise, in collaboration with Judith Smith, Pharm.D., is studying the transplacental passage of remifentanil in patients undergoing intrauterine transfusion.
  • Saul Snowise, M.D., visited Children’s Hospital of Philadelphia to learn the methodology of a rat model for fetal myelomeningocele (MMC). This fall, experiments are planned at McGovern Medical School to study various patch materials that can be utilized for the minimally invasive repair of fetal MMC.
  • Dr. Snowise has initiated a prospective trial on fetal thigh volume determined by ultrasound in the prediction of subsequent ambulation in fetuses affected with spina bifida.
  • Helena Gardiner, M.D., Ph.D., has secured specialized software for the study of myocardial stress forces in an effort to detect early cardiac changes in monochorionic twins that will eventually develop twin-twin transfusion. Human IRB approval is pending for a prospective trial.

Publications

The American Journal of Perinatology will publish a monograph of articles sponsored by The Fetal Center at Children’s Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Sciences at McGovern Medical School. The monograph is a summarization of articles based on presentations by invited speakers at the Complicated Monochorionic Twins workshop, hosted by The Fetal Center in 2013. Kenneth Moise Jr., M.D., serves as the guest editor for the special edition.

Presentations at national and international meetings

Several physicians affiliated with The Fetal Center at Children’s Memorial Hermann Hospital presented abstracts at the 24th World Congress on Ultrasound in Obstetrics and Gynecology in mid-September, 2014, in Barcelona, Spain.

  • Gardiner HM, Boudreaux D, Moise KJ, Johnson A, Papanna R, Bebbington M. Are ductus venosus time intervals a practical method to verify early twin-twin transfusion syndrome in monochorionic pregnancies?
  • Gardiner HM, Kovacevic A, Mellander M, Tulzer G, Roughton M, Öhman A, Dangel JH, Herberg U. Does fetal aortic valvuloplasty alter outcomes in aortic valve stenosis? Results of a retrospective European multinational multicentre study.
  • Gardiner HM, Kovacevic A, Mellander M, Öhman A, Roughton M, Dangel JH, Mair R, Magee A, Ghez O, Tulzer G, Fetal aortic valvuloplasty: investigating institutional bias in multicenter contributions to studies.
  • Bebbington MW, Moise KJ, Johnson AJ, Papanna R, Tsao K. Laparoscopic-assisted selective laser photocoagulation therapy (LA-SLPT) for twin-to-twin transfusion syndrome (TTTS).
  • Bebbington MW, Moise KJ, Johnson AJ, Tsao K. Open fetal surgery for myelomeningocele: outcome in a post MOMs trial cohort.

Members of The Fetal Center presented abstracts at the 33rd International Fetal Medicine and Surgery Society held in Cape Cod in mid-September, 2014.

  • Putnam LR, Johnson A, Moise KJ, Bebbington MW, Papanna R, Garcia EI, Weir JW, Tsao K. Generalizability of a randomized- controlled trial: Can we maintain equipoise outside of the Management of Myelomeningocele Study (MOMS) trial?
  • Gardiner, HM, Boudreaux D, Moise KJ, Johnson A, Papanna R, Bebbington M. Can ductus venosus time intervals identify early twin-twin transfusion syndrome in monochorionic pregnancies?
  • Gardiner HM, Kovacevic A, Mellander M, Tulzer G, Roughton M, Öhman A, Dangel JH, Herberg U. Do current fetal aortic valvuloplasty selection criteria predict natural history outcomes? Results from a retrospective European multinational multicenter study.
  • Mann LK, Khan A, Jagannath C, Taegtmeyer, Moise KJ, Johnson A, Papanna R. Amniodilution/amnioinfusion induced autophagy and cell death in amniotic epithelial cells (AEC): A novel mechanism for preterm premature rupture of membranes after fetal surgery.
  • Papanna R, Mann LK, Baschat AR, Bebbington MW, Snowise S, Khalek N, Johnson A, Moise KJ. 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, Bebbington MW, Khalek N, Johnson A, Moise KJ, Baschat A. Preterm delivery after fetoscopic laser surgery for twin-twin transfusion syndrome: Etiology and risk factors.
  • Moise KJ, Papanna R, Mann LM, Fletcher S, Tsao K, Argoti P, Snowise S, Schniederjan R, Bhattacharjee M, Stewart RJ, Tseng SCG. Evaluation of different patch materials for in-utero repair of myelomeningocele.
  • Snowise S, Argoti P, Moise K, Johnson A, Bebbington M, Papanna R. Fractional limb volume (FLV) of the fetal thigh for intrauterine assessment of neurological deficit of the lower extremities in fetuses affected by spina bifida.

Members of The Fetal Center have submitted six abstracts for consideration for presentation at the 35th annual meeting of the Society for Maternal-Fetal Medicine scheduled for February 2015 in San Diego.

Helena Gardiner, M.D., Ph.D., will be presenting an abstract at the annual meeting of the American Heart Association scheduled for November in Chicago. She will present on behalf of the Association for European Paediatric Cardiology fetal working group. Does fetal aortic valvuloplasty alter the natural history of aortic valve stenosis?

Invitations

  • The Fetal Center at Children’s Memorial Hermann Hospital was well represented at the 24th World Congress of Ultrasound in Obstetrics and Gynecology (ISUOG) in September, 2014, in Barcelona, Spain.
    • Anthony Johnson,D.O., chaired the session on ISUOG Outreach: Supporting ultrasound training in the field. He will also chair a session about Multiple Gestations.
    • Michael Bebbington, M.D., M.H.Sc., chaired the oral communication and oral poster presentation sessions on Fetal Therapy. He also served as a content expert in a Meet the Professor session at the ISUOG annual meeting.
    • Helena Gardiner, M.D., Ph.D., chaired the oral communication session on fetal cardiac function and the oral poster session on cardiac function in the assessment of fetal outcome. In addition, she chaired a workshop on cardiac function and will host a Meet the Professor session.
  • Helena Gardiner, M.D., Ph.D., is an invited speaker at the 10th Annual Symposium, Advances in Perinatal Cardiology, scheduled for October in St. Petersburg, Florida.
  • Dr. Gardiner, M.D., Ph.D., was invited to be the section editor on cardiology for Ultrasound in Obstetrics and Gynecology.