Papers by faezeh aghajani
American Journal of Obstetrics & Gynecology MFM
American Journal of Obstetrics and Gynecology, 2022
other vaccines during pregnancy associated with higher rate of intent to receive the COVID-19 vac... more other vaccines during pregnancy associated with higher rate of intent to receive the COVID-19 vaccine (OR¼3.03; 95% CI:1.37e6.73; P 0.006). CONCLUSION: The intent to receive COVID-19 vaccine is relatively low among women who are pregnant and substantially varies based on country of residence. In our meta-analysis, intent of women who were pregnant to receive the COVID-19 vaccine was significantly associated history of receiving of other vaccines during pregnancy. Given that in every country only a minority of gravidae have received the COVID-19 vaccine, despite known risks of maternal morbidity and mortality with no evidence of risks of vaccination, highlights the importance of revised approaches at shared decision making and focused public health messaging by national and international advisories.
American Journal of Obstetrics and Gynecology, 2022
OBJECTIVE To identify risk factors for single fetal demise (recipient and donor twin) following f... more OBJECTIVE To identify risk factors for single fetal demise (recipient and donor twin) following fetoscopic laser photocoagulation (FLP) for twin-to-twin transfusion syndrome (TTTS) DATA SOURCES: We searched PubMed, Scopus, and Web of Science systematically from inception of the database up to June, 2020 STUDY ELIGIBILITY CRITERIA: Studies investigating risk factors for fetal demise (donor and/or recipient) following FLP in monochorionic pregnancies complicated with TTTS. METHODS Initially, we investigated the cohort of TTTS pregnancies that underwent FLP at our two high volume fetal centers between 2012 and 2020 to identify risk factors for donor and recipient demise. Then, we conducted systematic review of the literature to better characterize these factors. Among studies that met entry criteria, multiple preoperative and operative factors were tabulated. The random-effect model was used to pool the standardized mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 value. RESULTS present cohort: Total of 514 TTTS pregnancies managed with FLP were included in the final analysis. Following the logistic regression, factors that remained significant for donor demise were selective fetal growth restriction (sFGR) (OR:1.9 (95% CI 1.3-2.8), p=0.001), and donor UA absent/reversed end diastolic velocity (AREDV) (OR: 2.06 (95% CI 1.2-3.4), p=0.004). Significant factor associated with recipient demise was ductus venosus absent/reversed (DV AR) a-wave in recipient (OR: 1.74 (95% CI 1.07-3.13), p=0.04). Systematic review: Data from twenty three studies and our present cohort were included. Total of 4892 TTTS cases managed with FLP were analyzed for risk factors of donor demise and 4594 such TTTS cases were analyzed for recipient demise. Incidence of overall donor demise ranged from 10.9 to 35.8%, and ranged from 7.3 to 24.5% for recipient demise among studies. Significant risk factors for donor demise were inter-twin EFW discordance >25% (OR:1.86, 95% CI 1.44-2.4, I2 0.0%), sFGR (OR:1.78, 95% CI 1.4-2.27, I2 0.0%), TTTS stage III (OR: 2.18, 95% CI 1.53-3.12, I2 0.0%), donor UA AREDV (OR: 2.31, 95% CI 1.9-2.8, I2 23.7%), donor DV AR a-wave (OR: 1.83, 95% CO 1.45-2.3, I2 0.0%), and presence of AA anastomoses (OR: 2.81, 95% CI 1.35-5.85, I2 90.7%). Sequential selective coagulation was protective against donor demise (OR: 0.31, 95% CI 0.16-0.58, I2 0.0%). Significant risk factors for recipient demise were TTTS stage IV (OR: 2.18, 95% CI 1.01-4.6, I2 16.5%), recipient UA AREDV (OR: 2.68, 95% CI 1.91-3.74, I2 0.0%), recipient DV AR a-wave (OR: 2.37, 95% CI 1.55-3.64, I2 60.2%), and middle cerebral artery peak systolic velocity (MCA PSV)>1.5 MoM (OR: 3.06, 95% CI 1.36-6.88, I2 0.0%). CONCLUSION Abnormal blood flow patterns represented by abnormal Doppler studies, and low fetal weight are associated with single fetal demise in TTTS pregnancies undergoing laser therapy. While sequential selective coagulation was protective against donor demise, presence of AA anastomoses was significantly associated with donor demise. This is the first meta-analysis to extensively investigate the association of wide range of preoperative and operative factors with fetal demise. These findings may be important in patient counseling, in furthering understanding of the disease, and perhaps in improving surgical technique.
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Papers by faezeh aghajani