Contact Us  Glossary  Mission   Sweet Success

 San Gabriel Valley Perinatal Medical Group
  Specialists in High Risk Pregnancy
  For Providers


     Reference Ranges


    Lectures (Powerpoint)

Guidelines ( Word format) and

 Guidelines (to be updated)

Reference Articles

Antenatal and Intrapartum Fetal Monitoring

  • Signore C, et. al., Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol. 2009 Mar;113(3):687-701.PMID:19300336
  • Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles. ACOG Practice Bulletin No. 106. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114:192–202. PMID:19546798
  • Clark SL, et. al., Intrapartum management of category II fetal heart rate tracings: towards standardization of care.
    Am J Obstet Gynecol. 2013 Aug;209(2):89-97. PMID:23628263

Antenatal Steroids

All fetuses between 24 and 34 weeks' gestation at risk of preterm delivery within 7 days  In preterm premature rupture of membranes at less than 32 weeks' gestation in the absence of clinical chorioamnionitis, antenatal corticosteroid use is recommended. A single rescue course of antenatal corticosteroids may given if more than two weeks have elapsed since the last course of antenatal steroids , the fetus is less than 32 6/7 weeks, and the fetus is likely to deliver within the next week

  • Antenatal corticosteroid therapy for fetal maturation. Committee Opinion No. 475. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:422–4. PMID:21252775

Borderline AFI

Pregnancies with AFI 5.0 cm or less were diagnosed with oligohydramnios. Pregnancies with AFI 5.1 to 8.0 cm  were considered to have borderline amniotic fluid  volume

  • Petrozella LN, et al.,Clinical Significance of Borderline Amniotic Fluid Index and Oligohydramnios in  Preterm Pregnancy Obstet Gynecol. 2011 Feb;117(2 Pt 1):338-42. PMID:21252747

Congenital Diaphragmatic Hernia

  • Jani JC, et al., Lung-to-head ratio: a need to unify the technique.Ultrasound Obstet Gynecol. 2012 Jan;39(1):2-6. doi: 10.1002/uog.11065. PMID:22213615
  • Quintero RA, et al The quantitative lung index (QLI): a gestational age-independent sonographic predictor of fetal lung growth. Am J Obstet Gynecol. 2011 Dec;205(6):544.e1-8. Epub 2011 Jul 22. PMID:21944224
  • . Lipshutz GS, et al. . Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 1997 Nov;32(11):1634-6 PMID: PMID:9396544
  • Metkus AP, et al. Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg. 1996 Jan;31(1):148-51; PMID:8632269
  • Loh KC, et al., Microcystic congenital pulmonary airway malformation with hydrops fetalis: steroids vs open fetal resection. J Pediatr Surg. 2012 Jan;47(1):36-9. doi: 10.1016/j.jpedsurg.2011.10.015.
  • Kotecha S,Antenatal and postnatal management of congenital cystic adenomatoid malformation.Paediatr Respir Rev. 2012 Sep;13(3):162-70; 22726873
  • Hüsler MR, et al., Prenatally diagnosed fetal lung lesions with associated conotruncal heart defects: is there a genetic association? Prenat Diagn. 2007 Dec;27(12):1123-8. 21778702
  • Cass DL, et al. Prenatal diagnosis and outcome of fetal lung masses. J Pediatr Surg. 2011 Feb;46(2):292-8. 21292076
  • Di Prima FA, Bet al., Antenatally diagnosed congenital cystic adenomatoid malformations (CCAM): Research Review.J Prenat Med. 2012 Apr;6(2):22-30.


Fetal and neonatal alloimmune thrombocytopenia

  • Pacheco LD, et. al., Fetal and neonatal alloimmune thrombocytopenia: a management algorithm based on risk stratification. Obstet Gynecol. 2011 Nov;118(5):1157-63. PMID:22015886

Fetal Growth Restriction

"When Doppler abnormalities are detected in the fetal arterial circulation, weekly follow-up Doppler studies are considered usually sufficient if forward umbilical artery end-diastolic flow persists. In the absence of specific data regarding the optimal frequency of testing, experts have recommended Doppler surveillance up to 2-3 times per week when IUGR is complicated by oligohydramnios, or absent or reversed umbilical artery end-diastolic flow."

  • Society for Maternal-Fetal Medicine Publications Committee, Berkley E, Chauhan SP, Abuhamad A.Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol. 2012 Apr;206(4):300-8. PMID:22464066
  • ACOG Practice bulletin no. 134: fetal growth restriction. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013 May;121(5):1122-33. PMID:23635765
  • Boers KE, et. al., DIGITAT Study Group. Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT. Am J Obstet Gynecol. 2012 Apr;206(4):344.e1-7. PMID:2234289
  • Weisz B, et. al., 20. Perinatal outcome of monochorionic twins with selective IUGR compared with uncomplicated monochorionic twins. Twin Res Hum Genet. 2011 Oct;14(5):457-62. PMID:21962139
  • Wallenstein MB, et al., Fetal congenital heart disease and intrauterine growth restriction: a retrospective cohort study.
    J Matern Fetal Neonatal Med. 2012 Jun;25(6):662-5. PMID:21823904

Fetal Echocardiogram and Arrhythmia

  • Donofrio MT. et. al., Diagnosis and Treatment of Fetal Cardiac Disease
    A Scientific Statement From the American Heart Association Circulation. 2014 May 13;129:00-00
  • American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of fetal echocardiography . J Ultrasound Med 2013; 32: 1067–1082. doi:10.7863/ultra.32.6.1067
  • Liu S, et. al., Association between maternal chronic conditions and congenital heart defects: a population-based cohort study.Circulation. 2013 Aug 6;128(6):583-9. PMID:23812182
  • Prepregnancy body mass index and congenital heart defects among offspring: a population-based study.
    Madsen NL, et. al., Congenit Heart Dis. 2013 Mar-Apr;8(2):131-41. PMID:22967199
  • Miller A, et. al., Maternal age and prevalence of isolated congenital heart defects in an urban area of the United States.
    Am J Med Genet A. 2011 Sep;155A(9):2137-45. PMID:21815253
  • Øyen N, et al., Recurrence of congenital heart defects in families. Circulation. 2009 Jul 28;120(4):295-301. PMID: 19597048

Fetal heart Block with SSA/SSB Antibodies

  • "If a mother is known to have anti-SSA/Ro antibodies and no prior child with congenital heart block (CHB) or rash, the risk of CHB is only 2%.
  • If the mother has both anti-SSA/Ro and SSB/La antibodies, the risk is slightly higher at 5%.
  • If the mother has antibodies and a prior child with CHB or rash, the risk of CHB in a subsequent pregnancy rises to nearly 20%."
  • The presence of maternal antibody is necessary but not sufficient to cause disease. 
  • Most pregnant women with anti-Ro/La antibodies do not deliver infants with CHB
  • When CHB occurs in the fetus of a woman known to have anti-SSA/Ro and SSB/La antibodies CHB presents before 30 weeks in the majority of cases.
    • If abnormalities are detected on echocardiogram, echocardiograms should be used to follow disease with the goals of reversing a newly diagnosed block and ameliorating an associated myocarditis.
    • Fetal AV prolongation does not predict progressive heart block to birth
  • Buyon JP, Clancy RM, Friedman DM: Autoimmune associated congenital heart block: integration of clinical and research clues in the management of the maternal/foetal dyad at risk. J Intern Med 2009; 265:653. PMID:19493059
  • Buyon JP,  et al. Autoimmune-associated congenital heart block: demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J Am Coll Cardiol. 1998;31:1658–66 PMID:9626848
  • Cimaz R, et.lal., Incidence and spectrum of neonatal lupus erythematosus: a prospective study of infants born to mothers with anti-Ro autoantibodies. J Pediatr. 2003 Jun;142(6):678-83. PMID:12838197
  • Cooley HM, et. al., : Monozygotic twins discordant for congenital heart block. Arthritis Rheum 1997, 40:381-4 PMID:9041950
  • Brucato A, et. al., Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum. 2001 Aug;44(8):1832-5.PMID:11508435
  • Gladman G, et. al., Fetal echocardiographic screening of pregnancies of mothers with anti-Ro and/or anti-La antibodies. Am J Perinatol. 2002 Feb;19(2):73-80.PMID:11938480
  • Ayed K, et al., [Congenital heart block associated with maternal anti SSA/SSB antibodies :a report of four cases]. Pathol Biol (Paris). 2004 Apr;52(3):138-47. PMID:15063933
  • Jaeggi ET, et. al., Prolongation of the atrioventricular conduction in fetuses exposed to maternal anti-Ro/SSA and anti-La/SSB antibodies did not predict progressive heart block. A prospective observational study on the effects of maternal antibodies on 165 fetuses.
    J Am Coll Cardiol. 2011 Mar 29;57(13):1487-92. PMID:21435519



Bowel lumen was considered dilated for diameters >6 mm.

  • Contro E, et. al., Prenatal ultrasound in the prediction of bowel obstruction in infants with gastroschisis. Ultrasound Obstet Gynecol. 2010 Jun;35(6):702-7  PMID:20069663

Gestational Diabetes

The American College of Obstetricians and Gynecologists supports NIH recommendations and recommends that before the testing approach and diagnostic criteria for GDM are changed, implications of such changes should be studied.

  • Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care 2010;33:676–82. PMID:20587717
  •  Guidelines for Diagnosis of Hyperglycemia in Pregnancy – 2011 Algorithm-7-18-11.pdf
    Accessed 4/4/2014
  • Vandorsten JP, NIH consensus development conference: diagnosing gestational diabetes mellitus.NIH Consens State Sci Statements. 2013 Mar 6;29(1):1-31.PMID:23748438
  • Gestational diabetes mellitus. Practice Bulletin No. 137. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 122:406–16. PMID:23748438
  • Leung AS, et. al., Experience with patients with gestational diabetes established by the international association of the diabetes and pregnancy study groups.
    Obstet Gynecol. 2014 May;123 Suppl 1:66S PMID:24770245
  • Leung AS, et. al., Difference in birth weight among patients with gestational diabetes established by the international association of the diabetes and pregnancy study groups.
    Obstet Gynecol. 2014 May;123 Suppl 1:65S. PMID:24770244

Hypertension in Pregnancy


  • Stagnaro-Green A, ert al. American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum.Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011 Oct;21(10):1081-125. PMID:21787128
  • Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012;366(6):493-501. PMID:22316443
  • Brent GA. The debate over thyroid-function screening in pregnancy. N Engl J Med. 2012;366(6):562-563.PMID:22316450

Immune Thrombocytopenia

  •  Neunert C, et al., The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011 Apr 21;117(16):4190-207. Epub 2011 Feb 16. PMID:21325604
Lower Urinary Tract Obstruction

Patients with normal fetal karyotypes and urine values less than the following thresholds are candidates for possible prenatal therapy.. Sodium < 100 mmol/L Chloride < 90 mmol/L, Calcium < 8 mg/dL, Osmolality < 200 mOsm/L; β2-microglobulin < 6 mg/ dL Total protein < 20 mg/dL
  • Dommergues M, Muller F, Ngo S, et al: Fetal serum beta2-microglobulin predicts postnatal renal function in bilateral uropathies. Kidney Int. 2000 Jul;58(1):312-6. PMID:10886576
  • Muller F, Dommergues M, Mandelbrot L, et al: Fetal urinary biochemistry predicts postnatal renal function in children with bilateral obstructive uropathies. Obstet Gynecol. 1993 Nov;82(5):813-20. PMID:8414330
  • Johnson MP, Corsi P, Bradfield W, et al: Sequential urinalysis improves evaluation of fetal renal function in obstructive uropathy.Am J Obstet Gynecol. 1995 Jul;173(1):59-65. PMID:7631728
  • Morris RK, et. al., The Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction. Health Technol Assess. 2013 Dec;17(59):1-232. PMID:2433102
  • Morris RK, et. al., Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013 Nov 2;382(9903):1496-506. doi: 10.1016/S0140-6736(13)60992-7. PMID:23953766
  • Haeri S, et. al., Prenatal cytogenetic diagnosis from fetal urine in lower urinary tract obstruction. Congenit Anom (Kyoto). 2013 Jun;53(2):89-91. doi: 10.1111/cga.12007. PMID:23751043

Magnesium Sulfate

Neurological Disorders



  • Obesity in pregnancy. Committee Opinion No. 549. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013:121;213–7. PMID:23262963
  • Gilboa SM, et al. Association between prepregnancy body mass index and congenital heart defects.Am J Obstet Gynecol. 2010 Jan;202(1):51.e1-51.e10. PMID:19796755
  • Mills JL, et al. Maternal obesity and congenital heart defects: a population-based study.Am J Clin Nutr. 2010 Jun;91(6):1543-9. Epub 2010 Apr 7. PMID:20375192
  • Oddy WH, et al. Association of maternal pre-pregnancy weight with birth defects: evidence from a case-control study in Western Australia.Aust N Z J Obstet Gynaecol. 2009 Feb;49(1):11-5. PMID:19281573
  • Cedergren MI, Källén BA.Maternal obesity and infant heart defects.Obes Res. 2003 Sep;11(9):1065-71. PMID:12972676
  • Watkins ML,et. al., Maternal obesity and risk for birth defects. Pediatrics 2003;111:1152-8. PMID:12728129
  • Rasmussen SA, et al .Maternal obesity and risk of neural tube defects: a metaanalysis.Am J Obstet Gynecol. 2008 Jun;198(6):611-9. PMID:18538144

Placenta Accreta

Pregestational Diabetes Mellitus

  • Pregestational diabetes mellitus. ACOG Practice Bulletin No. 60. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;105:675–85. PMID:15738045

Pregnancies Conceived by in Vitro Fertilization

  • Perinatal risks associated with assisted reproductive technology. ACOG Committee Opinion No. 324. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005; 106:1143–6. 16260548
  • Wisborg K, et al., IVF and stillbirth: a prospective follow-up study.
    Hum Reprod. 2010 May;25(5):1312-6. doi: 10.1093/humrep/deq023. Epub 2010 Feb 23. 20179321
  • Donofrio MT. et. al., Diagnosis and Treatment of Fetal Cardiac Disease
    A Scientific Statement From the American Heart Association Circulation. 2014 May 13;129:00-00
  • Hansen M, et. al., The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med. 2002 Mar 7;346(10):725-30. 11882727

Premature Rupture of Membranes

  • ACOG Practice bulletins No. 139: premature rupture of membranes.Obstet Gynecol. 2013 Oct;122(4):918-30. doi: 10.1097/01.AOG.0000435415.21944.8f.PMID: 24084566
  • Mercer BM, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. AMA 1997;278:989–95 PMID:9307346
  • Yudin MH, et al., Society of Obstetricians and Gynaecologists of Canada.Antibiotic therapy in preterm premature rupture of the membranes.
    J Obstet Gynaecol Can. 2009 Sep;31(9):863-7, 868-74. PMID:19941711
  • Gelber S. et. al., 690: Equivalence of erythromycin and azithromycin for treatment of PPROM
    Am J Obstet Gynecol. 2013 Jan;208(1):Supplement, Page S291 [ABSTRACT]
  • Seibel-Seamon. et. al., 695: Comparison of erythromycin and azithromycin in the management of PPROM
    Am J Obstet Gynecol. 2007 Dec; 197 (6):Supplement, Page S198 [ABSTRACT]

Preterm Delivery, Prevention

  • Prediction and prevention of preterm birth. Practice Bulletin No. 130. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:964–73 PMID:22996126
  • ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency.American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014 Feb;123(2 Pt 1):372-9. doi: 10.1097/ PMID:244516743
  • Owen J, et. al., Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length.Am J Obstet Gynecol. 2009 Oct;201(4):375.e1-8. doi: 10.1016/j.ajog.2009.08.015. PMID:19788970
  • Hassan SS, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. PREGNANT Trial. Ultrasound Obstet Gynecol 2011;38:18–31PMID:21472815

Preterm Labor

  • Management of preterm labor. Practice Bulletin No. 127. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;119:1308–17. PMID:22617615

Rh disease and Alloimmunization

Single Umbilical Artery

  • Bryan EM, Kohler HG.The missing umbilical artery. I. Prospective study based on a maternity unit.
    Arch Dis Child. 1974 Nov;49(11):844-52. PMID: 4474841
  • Heifetz SA.Single umbilical artery. A statistical analysis of 237 autopsy cases and review of the literature.
    Perspect Pediatr Pathol. 1984 Winter;8(4):345-78.PMID: 6514541
  • Bhagat M. VACTERL association-type anomalies in a male neonate with a Y-chromosome abnormality.Oxf Med Case Reports. 2015 Jan 10;2015(1):164-6. doi: 10.1093/omcr/omu062. eCollection 2015 Jan.
    PMID: 25988067
  • Wu YP, et al., Prenatal sonographic diagnosis of single umbilical artery: Emphasis on the absent side and its relation to associated anomalies.aiwan J Obstet Gynecol. 2014 Jun;53(2):197-201. doi: 10.1016/j.tjog.2014.04.013.PMID: 25017266
  • Chow JS, Frequency and nature of structural anomalies in fetuses with single umbilical arteries.
    J Ultrasound Med. 1998 Dec;17(12):765-8. PMID: 9849950
  • Budorick NE,et al., The single umbilical artery in a high-risk patient population: what should be offered?
    J Ultrasound Med. 2001 Jun;20(6):619-27; PMID: 11400936
  • Dagklis T, et al., Isolated single umbilical artery and fetal karyotype. Ultrasound Obstet Gynecol. 2010 Sep;36(3):291-5. doi: 10.1002/uog.7717.PMID: 20549772
  • Donofrio MT. et. al., Diagnosis and Treatment of Fetal Cardiac Disease
    A Scientific Statement From the American Heart Association Circulation. 2014 May 13;129:00-00
  • Voskamp BJ, et. al., Relationship of isolated single umbilical artery to fetal growth, aneuploidy and perinatal mortality: systematic review and meta-analysis.Ultrasound Obstet Gynecol. 2013 Dec;42(6):622-8. doi: 10.1002/uog.12541. Epub 2013 Oct 24. PMID: 23775879
  • Khalil MI, et al., Outcomes of an isolated single umbilical artery in singleton pregnancy: a large study from the Middle East and Gulf region. Eur J Obstet Gynecol Reprod Biol. 2013 Dec;171(2):277-80. doi: 10.1016/j.ejogrb.2013.09.028. Epub 2013 Oct 1.PMID: 24139889
  • Klatt J, Kuhn A, Baumann M, Raio L.Single umbilical artery in twin pregnancies.Ultrasound Obstet Gynecol. 2012 May;39(5):505-9. doi: 10.1002/uog.9085. PMID: 21728208
  • Burshtein S, ert. al., Is single umbilical artery an independent risk factor for perinatal mortality?
    Arch Gynecol Obstet. 2011 Feb;283(2):191-4. doi: 10.1007/s00404-009-1326-3. Epub 2009 Dec 19. PMID: 20024571
  • Naveiro-Fuentes Perinatal outcomes in singleton pregnancies with a single umbilical artery.
    J Matern Fetal Neonatal Med. 2015 Jun 30:1-4. PMID: 26115231
  • Mailath-Pokorny M, et. al., Isolated single umbilical artery: evaluating the risk of adverse pregnancy outcome
    Eur J Obstet Gynecol Reprod Biol. 2015 Jan;184:80-3. doi: 10.1016/j.ejogrb.2014.11.007. Epub 2014 Nov 20. PMID: 25463640
  • Martínez-Payo C,et. al., Perinatal results following the prenatal ultrasound diagnosis of single umbilical artery.
    Acta Obstet Gynecol Scand. 2005 Nov;84(11):1068-74. PMID: 16232174
  • Bombrys AE, Neiger R, Hawkins S, Sonek J, Croom C, McKenna D, Ventolini G, Habli M, How H, Sibai B.Pregnancy outcome in isolated single umbilical artery.Am J Perinatol. 2008 Apr;25(4):239-42.PMID: 18548398
  • Murphy-Kaulbeck L, et. al., Single umbilical artery risk factors and pregnancy outcomes.
    Obstet Gynecol. 2010 Oct;116(4):843-50. doi: 10.1097/AOG.0b013e3181f0bc08. PMID: 20859147


Spina Bifida

  • Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011;364:993–1004.
  • Maternal–fetal surgery for myelomeningocele. Committee Opinion No. 550. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:218–9.
  • Neural tube defects. ACOG Practice Bulletin No. 44. American College of Obstetricians and Gynecologists. Obstet Gynecol 2003; 102:203–13.


Timing of Delivery


  • Herskind AM, et . al., Increased prevalence of congenital heart defects in monozygotic and dizygotic twins.Circulation. 2013 Sep 10;128(11):1182-8. PMID:23929909
  • Thorson HL, et al. Optimal interval for ultrasound surveillance in monochorionic twin gestations.
    Obstet Gynecol. 2011 Jan;117(1):131-5. PMID:21173654
  • WAPM Consensus Group on Twin-to-Twin Transfusion, Baschat A, et. al. Twin-to-twin transfusion syndrome (TTTS). J Perinat Med. 2011 Mar;39(2):107-12. Epub 2010 Dec 13. PMID:21142846
  • Goodnight W, et al. Optimal nutrition for improved twin pregnancy outcome. Obstet Gynecol. 2009 PMID:20168116
  • Murata M, et. al., Perinatal outcome and clinical features of monochorionic monoamniotic twin gestation. J Obstet Gynaecol Res. 2013 May;39(5):922-5. PMID:23510453

Twin-twin transfusion syndrome

  • Roberts D, et. al., Interventions for the treatment of twin-twin transfusion syndrome.
    Cochrane Database Syst Rev. 2014 Jan 30;1:CD002073. doi: 10.1002/14651858.CD002073.pub3.
  • Twin-twin transfusion syndrome. Society for Maternal-Fetal Medicine, Simpson LL.
    Am J Obstet Gynecol. 2013 Jan;208(1):3-18.  PMID:2320016


Ultrasound-established dates should take preference over menstrual dates when the discrepancy is greater than 7 days in the first trimester and greater than 10 days in the second trimester.

  • American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance
    of obstetric ultrasound examinations. J Ultrasound Med 2010; 29:157–166
  • Society for Maternal Fetal Medicine, Coding Committee White Paper on Ultrasound Code 76811
  • American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 101: Ultrasonography in pregnancy. Obstet Gynecol. 2009 Feb;113(2 Pt 1):451-61. PMID:19155920
  • Hendler I, et. al., The impact of maternal obesity on midtrimester sonographic visualization of fetal cardiac and craniospinal structures.Int J Obes Relat Metab Disord. 2004 Dec;28(12):1607-11. PMID:15303105
  • Aagaard-Tillery KM, Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenat Diagn. 2010 Jan;30(1):14-22. doi: 10.1002/pd.2399. PMID:19918963

  • Cervical length screening
    • Cahill AG, et. al., Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis. Am J Obstet Gynecol. 2010 Jun;202(6):548.e1-8. PMID:20079888
    • Facco FL, Simhan HN.Short ultrasonographic cervical length in women with low-risk obstetric history. Obstet Gynecol. 2013 Oct;122(4):858-62. PMID:24084545
    • Miller ES, Grobman WA.Cost-effectiveness of transabdominal ultrasound for cervical length screening for preterm birth prevention.Am J Obstet Gynecol. 2013 Dec;209(6):546.e1-6. PMID: 23954533
    • Prediction and prevention of preterm birth. Practice Bulletin No. 130. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:964–73. PMID:22996126
    • Berghella V.Universal cervical length screening for prediction and prevention of preterm birth.
      Obstet Gynecol Surv. 2012 Oct;67(10):653-8. PMID:23112072
    • Parry S, Universal maternal cervical length screening during the second trimester: pros and cons of a strategy to identify women at risk of spontaneous preterm delivery. Am J Obstet Gynecol. 2012 Aug;207(2):101-6. PMID:22633270
    • Facco FL, Simhan HN.Short ultrasonographic cervical length in women with low-risk obstetric history.
      Obstet Gynecol. 2013 Oct;122(4):858-62. PMID: PMID:24084545


  • Soft markers
    "...the presence of isolated echogenic intracardiac foci or pyelectasis is unlikely to be of clinical consequence, and further risk adjustment is not required if the patient already had screening. If not, then serum screening or cell-free fetal DNA testing should be offered ."
  • Placenta Previa
    • The panel agreed to a revised classification, eliminating the terms partial and marginal and only retaining the terms placenta previa and low-lying placenta, with the description of the location of the edge of the placenta being important to document in the report.
    • "If the placental edge is less than 2 cm from the internal os but not covering the internal os, the placenta should be labeled as low-lying, and follow-up ultrasonography is recommended at 32 weeks of gestation. "
    • "If the placental edge covers the internal cervical os, the placenta should be labeled as placenta previa, and follow-up ultrasonography is recommended at 32 weeks of gestation. "
    • Reddy UM, etr. al. Fetal imaging: executive summary of a joint eunice kennedy shriver national institute of child health and human development, society for maternal-fetal medicine, american institute of ultrasound in medicine, american college of obstetricians and gynecologists, american college of radiology, society for pediatric radiology, and society of radiologists in ultrasound fetal imaging workshop. J Ultrasound Med. 2014 May;33(5):745-57.

Vasa Previa

  • Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. RCOG Green-top Guideline No. 27. Royal College of Obstetricians and Gynaecologists, 2011
  • Gagnon R, et. al., Maternal Fetal Medicine Committee.Guidelines for the management of vasa previa J Obstet Gynaecol Can. 2009 Aug;31(8):748-60. PMID: 19772710
  • Hull AD and Resnick R. Placenta Previa, Placenta Accreta, Abruptio Placenta, and Vasa Previa. In: Creasy RK, Resnik R, Iams JD, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 6th ed. Philadelphia, Pa.: Saunders/Elsevier; 2009:729-730.
  • Robinson BK, Grobman WA. Effectiveness of timing strategies for delivery of individuals with vasa previa. Obstet Gynecol. 2011 Mar;117(3):542-9.PMID:21343756


Join us on Facebook