Womens Center

Denton, TX, United States

Womens Center

Denton, TX, United States

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Chauhan S.P.,Center for Urban Population Health | Scardo J.A.,Spartanburg Regional Medical Center | Hayes E.,Womens Center | Abuhamad A.Z.,Eastern Virginia Medical School | Berghella V.,Thomas Jefferson Medical School
American Journal of Obstetrics and Gynecology | Year: 2010

The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesisrelated loss at <24 weeks of gestation for twin births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10% of the births occur after preterm premature rupture of membranes. From 1989-2000, the rate of preterm twin births increased, for African American and white women alike, although the perinatal mortality rate has actually decreased. As with singleton births, tocolytics should be used judiciously and only for a limited time (<48 hours) in twin births. Administration of antenatal corticosteroids is an evidence-based recommendation. © 2010 Mosby, Inc. All rights reserved.


Ng Y.S.,Northumbria University | Hardy S.A.,Northumbria University | Shrier V.,Womens Center | Quaghebeur G.,University of Oxford | And 10 more authors.
Neuromuscular Disorders | Year: 2016

Mitochondrial DNA disease is one of the most common groups of inherited neuromuscular disorders and frequently associated with marked phenotypic and genotypic heterogeneity. We describe an adult patient who initially presented with childhood-onset ataxia without a family history and an unremarkable diagnostic muscle biopsy. Subsequent multi-system manifestations included basal ganglia calcification, proteinuria, cataract and retinitis pigmentosa, prompting a repeat muscle biopsy that showed features consistent with mitochondrial myopathy 13 years later. She had a stroke with restricted diffusion change in the basal ganglia and internal capsule at age 44 years. Molecular genetic testing identified a previously-reported pathogenic, heteroplasmic mutation in the mitochondrial-encoded transfer RNA tryptophan (MT-TW) gene which based on family studies was likely to have arisen de novo in our patient. Interestingly, we documented an increase in the mutant mtDNA heteroplasmy level in her second biopsy (72% compared to 56%), reflecting the progression of clinical disease. © 2016 The Authors


Chiodo L.M.,Wayne State University | Delaney-Black V.,Wayne State University | Sokol R.J.,Wayne State University | Janisse J.,Wayne State University | And 2 more authors.
Alcoholism: Clinical and Experimental Research | Year: 2014

Background: Detection of in-pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T-ACE screen was developed for that purpose. We recently reported that increasing the total T-ACE score cut-point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4-year-old children with neurobehavioral effects associated with prenatal alcohol exposure. Methods: In this study, the TACER-3 was further validated in another prospectively identified high-risk urban cohort. Women were categorized as follows: (i) Not At-Risk Group (negative on T-ACE and TACER-3); (ii) At-Risk Group (positive on T-ACE and TACER-3); and (iii) Change Risk Group (positive on T-ACE but negative on TACER-3). Results: The TACER-3 total score cut-point of 3 yielded fewer "false positives" than the T-ACE cut-point of 2. Based on relative risk scores, women in the TACER-3-positive At-Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At-Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At-Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy (RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit (RR = 12.7). For both of these measures, the relative risk of at-risk alcohol consumption in the At-Risk Group was over >10 times that of the Change Risk Group. Conclusions: Thus, the TACER-3 was more effective at selectively identifying women drinking at fetal risk levels than the original T-ACE. The TACER-3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels. © 2014 by the Research Society on Alcoholism.


PubMed | Oxford Genetics, Oxford Eye Hospital, John Radcliffe Hospital, Womens Center and 2 more.
Type: Journal Article | Journal: Neuromuscular disorders : NMD | Year: 2016

Mitochondrial DNA disease is one of the most common groups of inherited neuromuscular disorders and frequently associated with marked phenotypic and genotypic heterogeneity. We describe an adult patient who initially presented with childhood-onset ataxia without a family history and an unremarkable diagnostic muscle biopsy. Subsequent multi-system manifestations included basal ganglia calcification, proteinuria, cataract and retinitis pigmentosa, prompting a repeat muscle biopsy that showed features consistent with mitochondrial myopathy 13 years later. She had a stroke with restricted diffusion change in the basal ganglia and internal capsule at age 44 years. Molecular genetic testing identified a previously-reported pathogenic, heteroplasmic mutation in the mitochondrial-encoded transfer RNA tryptophan (MT-TW) gene which based on family studies was likely to have arisen de novo in our patient. Interestingly, we documented an increase in the mutant mtDNA heteroplasmy level in her second biopsy (72% compared to 56%), reflecting the progression of clinical disease.


Dulemba J.F.,Womens Center | Pelzel C.,Womens Center | Hubert H.B.,Stanford University
Journal of Robotic Surgery | Year: 2013

We examined the feasibility of treating pelvic pain in patients with suspected endometriosis using robot-assisted laparoscopic techniques compared with CO2 laser laparoscopy, in a retrospective review from a single surgeon's practice, including the last 100 standard laparoscopic (December 2004-September 2007) and the first 180 robot-assisted (July 2007-January 2010) surgeries to treat suspected endometriosis. Perioperative outcomes and postoperative pain were compared by technique. Patients in each group were comparable in gravidity, body mass index, prior endometriosis, prior abdominopelvic surgery, American Fertility Society stage, and biopsy rates. Operative time (77 vs. 72 min), blood loss (29 vs. 25 mL), and complication rates (1.1 vs. 0 %) in robot-assisted and standard laparoscopy were low and similar for both approaches. Differences were apparent in biopsies confirming endometriosis (80 % robot-assisted vs. 56.8 % traditional laparoscopy, p < 0.001). Most patients reported improved postoperative pain at the first follow-up visit with no differences between the surgical approaches (85 % vs. 80 %, p = 0.365). Perioperative outcomes with robot-assisted surgery were comparable to outcomes using CO2 laser laparoscopy. Further investigation is needed to ascertain whether robotics provides better visual acuity and excision of endometriosis, as suggested by these data, and if long-term resolution of symptoms and fertility outcomes differ by surgical approach. © 2012 Springer-Verlag London Ltd.


Karthikeyan G.,Womens Center | Jagadeesh S.,Mediscan Systems | Seshadri S.,Mediscan Systems | Haberle J.,University Childrens Hospital
Indian Pediatrics | Year: 2013

Citrullinemia type 1 was diagnosed by tandem mass spectrometry in a full term male neonate who presented with an acute catastrophic collapse on the 3rd day of life. Both parents were identified to be carriers for the exon 15 p Gly390Arg mutation in the argininosuccinate synthetase gene located at chromosome 9q34.1. Chorionic villus sampling and prenatal genetic testing in the subsequent pregnancy revealed an affected fetus resulting in termination of pregnancy. © 2013 Indian Academy of Pediatrics.


PubMed | Womens Center and Stanford University
Type: Journal Article | Journal: Journal of robotic surgery | Year: 2016

We examined the feasibility of treating pelvic pain in patients with suspected endometriosis using robot-assisted laparoscopic techniques compared with CO2 laser laparoscopy, in a retrospective review from a single surgeons practice, including the last 100 standard laparoscopic (December 2004-September 2007) and the first 180 robot-assisted (July 2007-January 2010) surgeries to treat suspected endometriosis. Perioperative outcomes and postoperative pain were compared by technique. Patients in each group were comparable in gravidity, body mass index, prior endometriosis, prior abdominopelvic surgery, American Fertility Society stage, and biopsy rates. Operative time (77 vs. 72min), blood loss (29 vs. 25mL), and complication rates (1.1 vs. 0%) in robot-assisted and standard laparoscopy were low and similar for both approaches. Differences were apparent in biopsies confirming endometriosis (80% robot-assisted vs. 56.8% traditional laparoscopy, p< 0.001). Most patients reported improved postoperative pain at the first follow-up visit with no differences between the surgical approaches (85% vs. 80%, p=0.365). Perioperative outcomes with robot-assisted surgery were comparable to outcomes using CO2 laser laparoscopy. Further investigation is needed to ascertain whether robotics provides better visual acuity and excision of endometriosis, as suggested by these data, and if long-term resolution of symptoms and fertility outcomes differ by surgical approach.

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