About

Reem Abu-Rustum, MD, is an Associate Professor in the Division of Maternal Fetal Medicine at the University of Florida College of Medicine. She was born and raised in Tripoli, Lebanon, and obtained her medical degree in 1993. She completed her residency training at the University of Florida in 1997. Dr. Abu-Rustum is certified by the Fetal Medicine Foundation in first and second trimester ultrasound. She practiced in Lebanon from 1997 until 2018, during which time she served as the director of the Center for Advanced Fetal Care and was the co-founder and President of SANA Medical NGO, an organization dedicated to obstetrical care within an outreach setting. Her primary areas of interest include the first trimester fetus, fetal heart, education, and global healthcare. She has participated in ISUOG Outreach missions to Sudan and has been actively involved in the integration of ultrasound in medical education. She returned to her alma mater and joined the faculty at the University of Florida in August 2018.

Research topics

• Medicine
• Computer Science
• Pathology
• Family medicine
• Artificial Intelligence
• Political Science
• Psychology
• Medical emergency
• Medical physics
• Virology
• Medical education
• Pedagogy
• Intensive care medicine
• Nursing

Selected publications

• ISUOG Practice Guidelines: point‐of‐care ultrasound in obstetrics and gynecology

  Ultrasound in Obstetrics and Gynecology · 2025-11-03 · 5 citations

  articleOpen access

  The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research, related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has the remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care because interpretation of the evidence that underpins them may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG ([email protected]). The integration of point-of-care ultrasound (PoCUS) has transformed clinical practice by offering an affordable, portable and directly accessible diagnostic tool for bedside use. Unlike screening, targeted or referral ultrasound1-3, PoCUS focuses on answering specific clinical questions or guiding procedures in real time4. PoCUS has been widely adopted in emergency medicine5-7, and its use has expanded to various specialties, including obstetrics and gynecology (Ob/Gyn), in which rapid assessment is critical for effective patient care. Initially introduced in the 1980s with portable machines, PoCUS has proved particularly valuable in low-resource settings8-12, where access to advanced equipment and highly trained operators is limited. Although well-designed studies on the effectiveness of PoCUS in Ob/Gyn are scarce, interest in its use has grown in high-income countries due to its potential to expedite care, improve provider confidence and reduce patient anxiety13, 14. Unlike conventional ultrasound examination performed by a sonographer or other specialist, PoCUS is a readily accessible tool for all providers involved in the care of patients with Ob/Gyn emergencies15, 16, including emergency physicians5-7, family physicians11, residents12 and midwives10. Despite its advantages, PoCUS is not a replacement for comprehensive ultrasound examination performed by a specialist, but rather a complementary tool for addressing Ob/Gyn emergencies, guiding procedures and enhancing clinical decision-making. However, international guidelines are needed to standardize its applications and clarify its benefits and limitations in Ob/Gyn, ensuring optimal patient outcomes across different healthcare settings worldwide. The objective of this Guideline is to provide recommendations regarding the appropriate use of PoCUS in Ob/Gyn in various clinical scenarios encountered by different healthcare professionals (e.g. emergency physicians, obstetrician-gynecologists, midwives, residents and family physicians). The target population consists of patients with Ob/Gyn complications or those needing an interventional procedure for which an immediate bedside sonographic evaluation is helpful. The quality of evidence and the strength of the recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology17-19. This Guideline is reported in accordance with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument20. Full details of the methodological and developmental process are provided in Appendices S1–S12. Briefly, the Promoting Committee of this Guideline appointed two working groups (one for obstetrics and one for gynecology) and a multidisciplinary panel. One member of the Promoting Committee, a methodologist, oversaw the process. The multidisciplinary, multistakeholder panel included a clinician expert in the field of ultrasound in Ob/Gyn, a representative from a low-income country, a midwife, a family physician, two emergency physicians and a patient representative (Appendix S2). All participants involved in the development of this Guideline gave a signed declaration specifying any potential conflicts of interest. Thirteen clinical questions (nine obstetric and four gynecological) were defined following the Patients, Intervention, Comparison, Outcomes (PICO) framework19(Appendix S3). The systematic literature search was developed by an experienced professional librarian. The search results and the selection process were summarized using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020)21 flow diagram (Appendix S4). The two working groups provided the panel with draft recommendations. The panel members were asked to vote on whether they agreed with each recommendation and to express their opinion about the potential conflict of the intervention with the values and expectations of patients, the benefit–risk balance, related costs and/or the use of resources, potential effect on equity of healthcare, acceptability to patients and healthcare decision-makers (at the local level) and feasibility of its application in every context worldwide (Appendices S9 and S10). An adapted version of the GRADE Evidence to Decision framework was used for discussion within the panel to assess domains that may have impacted the formulation of each recommendation22. The development of recommendations followed the GRADE methodology23, considering the balance between the desirable and undesirable effects of various intervention alternatives. When the balance was clearly either in favor of or against the intervention, the recommendation was deemed ‘strong’ (strong positive or strong negative recommendation). In case of uncertainty in evaluating this balance, the panel formulated a ‘conditional’ recommendation in favor of or against the treatment (conditional positive or conditional negative recommendation). However, recommendations, even when considered ‘strong’, should not be considered mandatory standards because their application may be influenced by local resources, different healthcare systems and other factors. When an ultrasound evaluation is performed in early pregnancy, it should include assessment of viability by identification of a fetal heartbeat, and confirmation of the intrauterine location of the pregnancy1. PoCUS can provide timely and valuable information for the management of several complications that may arise during the first trimester of pregnancy and in emergency/urgent cases, improving the identification of pregnancy complications and reducing hospitalization (Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG)13 high-quality guideline; Society of Obstetricians and Gynaecologists of Canada (SOGC)14 high-quality guideline). PoCUS can be used to assess the presence of an intrauterine pregnancy and its viability in patients with early pregnancy complications such as threatened miscarriage, incomplete miscarriage, missed miscarriage or ectopic pregnancy24. It has been estimated that the visualization of an intrauterine pregnancy with PoCUS can rule out an ectopic pregnancy with a sensitivity of 97% (95% CI, 92–99%), a specificity of 71% (95% CI, 60–80%) and a negative predictive value of 99.96% (95% CI, 99.6%–100%)24. A systematic review and meta-analysis examined the impact of PoCUS, performed by emergency physicians at the time of admission, on the length of stay in the clinic or health department, in comparison to comprehensive ultrasound25. There was a strong association between PoCUS in the evaluation of symptomatic women in early pregnancy and decreased length of stay in patients with visualization of an intrauterine pregnancy (mean reduction of 73.8 (95% CI, 49.1–98.6) min)25. Question 1 Could PoCUS improve the care/outcome of symptomatic patients (abdominal pain or bleeding) who present emergently to a clinic or health department in the first trimester of patients in the first trimester of pregnancy who present to a clinic or health department ultrasound and/or Clinical examination of of of management of early pregnancy complications of hospitalization of length of stay in the clinic or health department of 1 PoCUS is in symptomatic patients who present emergently to a clinic or health department in the first trimester of on high-quality members to with the strong positive recommendation by the working However, the recommendation was in of by of the panel members regarding feasibility of this intervention in every context worldwide. All members agreed that the balance between the desirable and undesirable effects was clearly in favor of the intervention, a strong positive during the it that is a of literature on this a is needed to the impact of PoCUS in symptomatic patients who present emergently to a clinic or health department in the first trimester of Question Could PoCUS improve the care/outcome of pregnancy in patients with who present emergently to a clinic or health patients who present to a clinic or health department with ultrasound and/or Clinical examination of of of of of the length of stay in the clinic or health department of or of obstetric complications of PoCUS is in patients with who present emergently to a clinic or health department, particularly to improve the of and on high-quality The its with the using and its should be at the fetal ultrasound In patients with timely can be to rule out or a particularly has been sonographic bedside ultrasound assessment of location may reduce the of of the high-quality guideline). The for and on care evaluation of the by ultrasound in patients with and high-quality guideline). high-quality in patients emergently with in the trimester of pregnancy, PoCUS for the assessment of location should be performed when an trained clinician is not available for a diagnostic sonographic is with and for the of a or a in high-quality guideline). The use of the a of the location in to the in of and the imaging when ultrasound a positive predictive negative predictive value and for in women in this was on ultrasound in the or early reported in a systematic PoCUS has a impact on the management and clinical care of patients, including of and appropriate referral to in healthcare and a reduction in and in and including those by can be by trained and during the and for PoCUS the of when to clinical examination PoCUS their in of and their clinical in following PoCUS However, it should be that may in a of the of of the panel members in with the conditional positive recommendation by the working Although they agreed that the balance between and effects clearly the intervention, the recommendation was not to be strong due to the it is to establish a for and a is this be by of a and by the of Question Could PoCUS, performed in to to fetal improve pregnancy patients at evaluation of fetal Clinical examination of of of in of of PoCUS is in pregnancy to to fetal when it is at the clinical on high-quality ISUOG guidelines on the of obstetric ultrasound examination that a for fetal to or at the time of should be considered are that it can reduce the of However, in countries where ultrasound examination at this of pregnancy is not an assessment for fetal using should be performed at or of as fetal can and management high-quality guideline). When is during a clinical examination or a sonographic examination should be considered to the fetal high-quality guideline; high-quality guideline; high-quality guideline; high-quality guideline). PoCUS is in and in patients with a in clinical examination is particularly The for recommendations is that timely of is critical for optimal A high-quality of The and of Obstetricians and Gynaecologists PoCUS when is first in In this the should with the the regarding emergency or with the and benefits of each to individual However, the evidence for and/or fetal outcomes with the of of a is high-quality guideline; high-quality guideline). guidelines that of version should be to patients with an pregnancy with a with high-quality guideline; high-quality guideline). at timely discussion of and referral to a health professional with in this procedure or referral to a health professional and with in is with a reduction in the of for of the panel members in with the strong positive recommendation by the working during the panel the formulation of this recommendation was to that PoCUS is in to fetal when the fetal clinical Question Could PoCUS, performed to to fetal improve the pregnancy patients with of evaluation of fetal Clinical examination of of of in of of of PoCUS is to to fetal in of uncertainty at clinical on and should be that sonographic assessment of the fetal to is a clinical examination of Obstetricians and Gynaecologists high-quality guideline; guideline). A that ultrasound assessment in to examination to is accurate with examination in the of fetal in ultrasound and in has been to the of guideline). A high-quality addressing recommendations on ultrasound a sonographic examination during the of when an is in the of emergency circumstances, the is of the of the fetal high-quality guideline). The panel agreed that this clinical is specific to the application of PoCUS for practitioners within the field of Ob/Gyn rather across all of the panel members in with the conditional positive recommendation by the working However, the panel members that all evidence the recommendation is from guidelines that are not specific to PoCUS, but rather to in the opinion of the panel was that this specific application of ultrasound should be considered PoCUS when it an assessment made to a clinical is needed to the impact of PoCUS to is a to specific for operators that for use of PoCUS in Question Could PoCUS improve the pregnancy in patients with uncertainty regarding fetal patients with uncertainty regarding fetal evaluation of fetal in of the from fetal of of of PoCUS is in patients with uncertainty regarding fetal particularly on high-quality of defined by identification of a fetal heartbeat, is using patient should be of the and a healthcare professional are about decreased or fetal of the fetal by fetal it not that the pregnancy and it is to provide information on the fetal such as or high-quality guideline). Although is evidence of the benefits of for the it may be reduce and However, it is that the fetal be to a is and to the fetal to this time may be to in that are in In of fetal PoCUS to fetal can whether the is viability is the assessment can fetal is the assessment can reduce and PoCUS has been when identification of fetal by a to the of the and to the fetal high-quality guideline). of the panel members in with the conditional positive recommendation by the working the impact of identification of fetal viability on clinical management and the panel the presence of fetal by when and The between and PoCUS on the and local and other Question Could PoCUS, performed in or pregnancy for the assessment of the improve the pregnancy and pregnancy evaluation of Clinical examination of of in PoCUS is in and pregnancy for the assessment of on high-quality is defined as a pregnancy that has to of pregnancy is defined as one that has to of or to one that is at or of regarding assessment of in or pregnancy are not different The can be using either the or the The for has been in the ISUOG guidelines on the and The is the for as it is with a of of with of is not for fetal assessment in patients with an pregnancy at a of including at an assessment of is between and high-quality guideline). sonographic assessment of the as of the clinical of high-quality guideline). patients who of of it is to including sonographic assessment of the fetal and to at of and ensure timely of when (e.g. The working a strong positive recommendation for this application of PoCUS, considering the of evidence the However, of the panel in the panel regarding the benefit–risk balance, costs and use of resources, feasibility in every context worldwide and equity in healthcare of this it was to a conditional positive Question Could PoCUS, performed in patients who present emergently to a clinic or health department with of improve the pregnancy patients who present emergently to a clinic or health department with of of length Clinical examination of of of hospitalization of the length of stay in the clinic or health department of PoCUS for the of length is in patients who present emergently to a clinic or health department with of on high-quality This recommendation to with a pregnancy with of a as are in clinical practice, and for of the obstetric of care high-quality guideline). in of patients with threatened is a of and of patients at This has an impact on management costs of treatment pregnancy In sonographic assessment of length and point-of-care have been as to in which symptomatic patients are at an of in to their care. There is evidence to the use of sonographic of length in patients at between and with of to those at of high-quality guideline). sonographic in patients with of has been by several with different and of from high-quality between and high-quality and high-quality guideline). Although sonographic of length to in the of care, is guidelines regarding the length values and management such as regarding and The discussion regarding different and management the of this Guideline and can be The working a conditional positive recommendation for this application of PoCUS, considering the of evidence the However, of the panel in the the panel agreed that this clinical is specific to the application of PoCUS for practitioners within the field of Ob/Gyn, including and residents working in this rather across all during the panel discussion regarding the benefit–risk balance, equity in healthcare and feasibility of this intervention in every context panel members agreed on a conditional positive Although evidence to the intervention, it is to establish a for the that the sonographic of length is accurate when with this is of and of fetal by ultrasound have in and The use of sonographic has in are by using the for the of is by and with in the of and are in the of those that are or The practice of is a intervention and can physicians about potential fetal high-quality guideline). In in which fetal are sonographic assessment for fetal and should be considered high-quality guideline). Question Could PoCUS, performed to to the estimated fetal improve the pregnancy patients to evaluation of the estimated fetal Clinical examination of of of in of of of PoCUS is not for fetal when are fetal on clinical on high-quality The working a conditional negative recommendation for this application of members to with this In of a conditional negative the panel regarding the benefit–risk balance, costs and use of and feasibility of this intervention in every context worldwide. Question Could PoCUS, performed in patients with improve the patients with evaluation Clinical examination of of of of intrauterine PoCUS is in patients with on high-quality is that in the first is by that to ultrasound examination is performed in patients with to the presence of of However, the reported of ultrasound in the of widely to a high-quality ultrasound may to the presence of the of is It has been that flow imaging should be included in the evaluation of the in patients with is strong evidence to its The use of flow may the of and which are but may a However, to this evaluation not a of evidence to its use high-quality guideline). of the for is with the of It that in of of an trained clinician may sonographic high-quality guideline). In of to the of an intrauterine or has been to be effective for treatment of The of the or other can be There is evidence on the use of ultrasound to assess the of intrauterine and is evidence that ultrasound performed in patients with improve a high-quality not to a ultrasound assessment in patients with on the working a conditional negative However, of the panel in the panel members in favor of the intervention on the that the benefits the the panel agreed on a conditional positive the it that is a of literature on this a is needed to the impact of PoCUS in patients with Question Could PoCUS improve the care/outcome of symptomatic patients (abdominal or who present emergently to a clinic or health patients (abdominal or who present emergently to a clinic or health department ultrasound Clinical examination of of of hospitalization of the length of stay in the emergency in the for other imaging of of patient PoCUS is in symptomatic patients (abdominal or who present emergently to a clinic or health department, to the identification of and to reduce the length of stay in the on high-quality PoCUS can provide timely and valuable information for the management of symptomatic patients in the emergency It is to the presence of an intrauterine pregnancy, and to and the presence of and in ectopic in the of an experienced PoCUS be used to the presence of and and A high-quality PoCUS in emergency/urgent symptomatic in to the identification of and to reduce their length of stay in A systematic review of the to the use of PoCUS in healthcare such as and in and other There was a of ultrasound examination performed across the different studies used PoCUS for emergency department and were The panel members to with the strong positive recommendation by the working The recommendation was in of the by 71% of the panel members regarding its feasibility in every context worldwide. However, during the discussion all panel members agreed that the balance between the desirable and undesirable effects is clearly in favor of the a a strong positive recommendation was Question Could PoCUS improve the care/outcome of patients who present to an for a clinical who present to an for a clinical examination ultrasound Clinical examination of of in the for standard ultrasound of in the for other imaging of patient PoCUS is in settings when at the clinical on high-quality A high-quality PoCUS in patients who present to an when the clinical examination is not reported in that the available evidence not a of clinical outcomes PoCUS, but the opinion of the multidisciplinary panel was that the of a complementary ultrasound performed by trained may reduce the for imaging and should be In the that complementary ultrasound may the identification of patients who hospitalization and/or emergency or of treatment alternatives. The working a conditional positive recommendation for this application of However, of the panel in the panel regarding the benefit–risk balance, costs and use of resources, equity in healthcare and feasibility in every context worldwide. that are undesirable effects for this PoCUS the panel to the conditional positive Question Could PoCUS, performed during of an intrauterine to its improve the care/outcome of who present for of intrauterine ultrasound ultrasound of of of of complications of intrauterine in the for standard ultrasound of patient PoCUS may be used or not used during of an intrauterine to its on There is evidence that ultrasound performed during or of an intrauterine improve patient However, during the regarding women's access to the panel that such use of PoCUS may be but is not and that the clinician can to the of an even the of The of an intrauterine is with patient related to of may be encountered during and the may to in and in the procedure may be particularly in of A that the use of ultrasound pain during (mean CI, to time (mean CI, to and is with and The use of PoCUS to the location of the is to have a potential in the procedure and improving patient The working a conditional positive recommendation for this application of However, 71% of the panel in the the panel agreed that this clinical is specific to the application of PoCUS for practitioners within the field of Ob/Gyn rather across all The panel agreed that PoCUS during or improve patient However, were during the discussion regarding the feasibility of this intervention in every context which providers from offering the in access to and to an in the panel agreed on a conditional recommendation for either intervention ultrasound for or comparison ultrasound for Question Could PoCUS, performed during a and procedure to of improve the care/outcome of who present for and procedure to of ultrasound ultrasound of in treatment of complications of PoCUS is during and on and with or is a and its is of However, it has been out with an early of early complications include intervention and from a regarding of pregnancy that the was The procedure ultrasound a of in comparison to for procedure performed ultrasound CI, ultrasound was to have a effect in reducing procedure time and PoCUS be an to and ultrasound be valuable for evaluation of and The working a conditional positive recommendation for this application of However, of the panel in the panel regarding the balance, costs and use of resources, equity in healthcare and feasibility of this intervention in every context worldwide. that are undesirable effects for this PoCUS the panel to the conditional positive However, during the a of literature on this a is needed to the impact of PoCUS during This Guideline is to the specific clinical applications of PoCUS in Ob/Gyn, on positive (strong or recommendations effective and to (Appendix it is to establish and establish to in PoCUS within Ob/Gyn The development of the of recommendations was on evidence from the use of ultrasound in Ob/Gyn (Appendix with the that PoCUS This the in the literature regarding applications of PoCUS in This Guideline as a valuable for to of and of representative of the of of Canada of representative of the Society of Ultrasound in Clinical representative of The of Ultrasound in of representative of the of Obstetrics and of Obstetrics and of of and of of Obstetrics and of of not to this as were or during the Full details of and development process of the of Guideline development Patients, Intervention, Comparison, Outcomes (PICO) and and Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation of the by two Evidence of meta-analysis and studies to recommendations. of to the multidisciplinary panel in of to the multidisciplinary panel in S9 results of the multidisciplinary panel in results of the multidisciplinary panel in between recommendations and and of the The is not for the or of any information by the should be to the for the

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• Teratogenic Risk Impact Mitigation (TRIM): Development of Explicit Criteria to Facilitate Decisions Regarding Teratogenic Risk Mitigation Strategies

  Drug Safety · 2025-08-05 · 1 citations

  articleOpen access

  BACKGROUND: Preventing fetal exposure to teratogenic medications is an important target for risk mitigation efforts. Decisions about risk mitigation efforts specific to teratogenic medications are complex. OBJECTIVES: The Teratogenic Risk Impact and Mitigation (TRIM) tool was developed as an innovative decision support tool to facilitate prioritization of teratogenic medications for risk mitigation strategies. METHODS: We employed a modified Delphi study design involving experts across teratology, obstetrics/gynecology, and medication safety. Panelists proposed decision criteria in three focus groups, followed by e-Delphi rounds to reach a consensus on criteria regarding three dimensions: (1) completeness; (2) relevance; and (3) distinctiveness. Aggregated feedback from each round was used to inform revision of the criteria in subsequent rounds. RESULTS: A total of 33 candidate criteria proposed by 32 focus group participants were organized into ten distinct criteria for the Delphi process. Consensus (defined as > 85% agreement on all three dimensions) was reached after three e-Delphi rounds, resulting in six criteria: (1) background use among persons of reproductive potential; (2) overall medication benefit considering severity of the indication and availability of alternatives; (3) seriousness of the teratogenic outcome; (4) risk of the teratogenic outcome; (5) certainty regarding teratogenicity; and (6) the risk of exposure during pregnancy. CONCLUSIONS: We established measurable criteria to inform decisions when prioritizing teratogenic medications for risk mitigation programs. Criteria are consensus based and consistent with relevant regulatory guidance. Future work will operationalize these criteria and determine specific weights to facilitate medication-specific TRIM scores. Through its explicit framework, the TRIM tool may support consistent, transparent, and rational decision making and help optimize the contribution of risk mitigation programs to public health.

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• Prenatal and Postpartum Needs at a Student-Run Clinic [ID 957]

  Obstetrics and Gynecology · 2025-05-15

  article

  INTRODUCTION: Pregnant women without health insurance often experience delayed access to prenatal care and inadequate postpartum care. The Equal Access Clinic Network (EACN) is one of the few student-run clinics that provides prenatal services to uninsured women. This study aimed to assess the perinatal needs of EACN patients to improve interdisciplinary services and address care gaps. METHODS: A retrospective phone survey was conducted with 42 out of 59 contacted participants who received prenatal care from EACN between August 2021 to December 2023. Data collected included demographics, health-related social needs (HRSN screening tool), and experience of perinatal services. The Care Transition Measure (CTM-3) assessed the transition from EACN to the birthing hospital system. Descriptive analysis and Spearman correlation evaluated the relationship between CTM-3 and HRSN score. RESULTS: Most participants were Hispanic/Latino (69%), with 20% delaying prenatal care due to cost. Ninety-three percent of participants received breastfeeding education and 100% received social services. However, only 7% reported being counseled on care transition, and 91% desired more transition support. Regarding family planning, only 11% reported having contraception access, yet 82% wished they had. Mental health resources were notably lacking, with only 9% receiving them and 69% desiring them. There was a negative relationship between transition of care satisfaction and unmet social needs (r=−0.41, P =.039). CONCLUSIONS/IMPLICATIONS: The Equal Access Clinic Network was a crucial service for participants. However, this study highlights gaps in family planning, transition support, and mental health services. Addressing these gaps will improve health equity for uninsured women receiving perinatal care in our student-run clinic.

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• Developing an optimal maternal‐fetal medicine ultrasound practice: A report and recommendations of the workshop of the Society for Maternal‐Fetal Medicine

  Pregnancy · 2025-04-16 · 3 citations

  articleOpen access

  Abstract This article is a report of a 2‐day workshop titled “Developing an Optimal Maternal‐Fetal Medicine Ultrasound Practice,” held during the Society for Maternal‐Fetal Medicine's 2023 Annual Pregnancy Meeting. Participants’ fields of expertise included obstetrics and gynecology, sonography, maternal‐fetal medicine, genetics, and genetic counseling. The American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Registry for Diagnostic Medical Sonography, International Society of Ultrasound in Obstetrics and Gynecology, Gottesfeld‐Hohler Memorial Foundation, and Perinatal Quality Foundation cosponsored the workshop. The workshop included presentations and small group discussions, and its goals were to accomplish the following: Review best practices and emerging technologies for designing and running an efficient obstetrical ultrasound unit Discuss strategies for quality assurance in the setting of obstetrical ultrasound at the individual provider and unit level Identify needs and opportunities for ongoing education and training in ultrasound imaging and ultrasound‐guided procedures for maternal‐fetal medicine fellows, physicians, and sonographers Review current and emerging approaches to managing the pregnant patient with obstetrical ultrasound abnormalities

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• Isn't It Time for the Cardiac Sweep to Span From the Stomach to the Left Brachiocephalic Vein?

  Journal of Ultrasound in Medicine · 2025-03-04 · 1 citations

  articleOpen accessSenior author

  Contemporary guidelines for evaluating the fetal heart, such as The American Institute of Ultrasound in Medicine,1 The International Society of Ultrasound in Obstetrics and Gynecology,2 American Society of Echocardiography,3 and American Heart Association,4 require reporting a 5 standard view approach: 4-chamber, left and right ventricular outflow tracts, 3-vessel trachea view, and sagittal aortic and ductal arches using both real-time grayscale, and color Doppler techniques. These may be accessed through a sweep commencing at the stomach and ending at the level of the 3-vessel and trachea view. None of the above guidelines recommend assessing the upper mediastinum at the level of left brachiocephalic vein (LBCV—innominate vein). Over a decade ago, Sinkovskaya et al established the nomogram for the LBCV, described its normal and anomalous course and its role in the detection of venous anomalies.5, 6 Since then, numerous publications have highlighted the importance of assessing the BCV in the diagnosis of abnormalities of the venous collecting system.5-10 The prevalence of various congenital venous malformations is reported at 1.35%.11 Of those, 48.9% are cardinal vein disorders which include persistent left superior vena cava (PLSVC), absent LBCV, left inferior vena cava (IVC), and interrupted IVC with azygous continuation to superior (SVC). Total anomalous pulmonary venous return (TAPVR) accounts for only 0.07% of all venous anomalies.11 Although the incidence of TAPVR is quite rare, fetuses with TAPVR exhibit the worst outcomes, especially if undiagnosed prenatally, since prenatal detection remains challenging. Despite the various sonographic markers proposed for fetal TAPVR, prenatal diagnosis of isolated TAPVR remains difficult. Reported prenatal detection rates vary depending on the study and year of publication: 1–10%,12, 13 0–50%,14 and 6.7%.15 In addition, associated cardiac defects are reported in up to 57.1% of fetuses with TAPVR and 41.3% of fetuses with cardinal vein anomalies.11 In the absence of a single sonographic sign for the diagnosis of fetal TAPVR, a systematic and sequential approach is crucial to improve the prenatal detection and diagnosis of TAPVR.16 Normal anatomy and abnormal findings of the LBCV can be demonstrated by grayscale and color Doppler during the fetal cardiac examination. The LBCV passes horizontally through the upper mediastinum, anterior and superior to the aortic arch, and posterior to the thymus.9 It can be evaluated by sweeping cephalad from the level of the 3-vessel trachea view to the level of the upper mediastinum with the thymus visualized. Established normative values for LBCV allow for accurate size assessment.6, 17, 18 Congenital anomalies of the brachiocephalic veins are exceedingly rare, accounting for 0.2–1% of all congenital cardiovascular anomalies. Absent, dilated, double, or abnormal courses of LBCV may point toward compensatory changes of other veins and indicate the presence of associated cardiac and extra cardiac anomalies or genetic conditions.6, 7, 13, 19-21 Table 1 represents the various types of LBCV abnormalities and the associated anomalous conditions. Depends on the associated anomaly. Warrants detailed evaluation No associated anomalies in only in 12.5% cases5, 19 Can be associated with heterotaxy syndromes (40%), Left ventricular outflow tract obstruction, aortic coarctation, and conotruncal anomalies Trisomy 21, 18, and others are reported in 9% with PLSVC19 With dilatation of the LBCV, the likelihood of pulmonary venous return anomalies or arteriovenous malformations increases. Researchers and specialists in fetal cardiology have stressed the importance of evaluating the LBCV in improving the prenatal detection rates of venous anomalies. In 2012, Sinkovskaya et al suggested incorporating it into the fetal echocardiographic evaluation. Based on the above, we are recommending that when the current international guidelines pertaining to the evaluation of the fetal heart are revised, the cardiac sweep, which currently extends from the stomach to the 3-vessel trachea view, be expanded to the level of the LBCV in both grayscale and color Doppler. In Videos 1 and 2, sweeps 1 and 2 represent examples of extended sweeps from the stomach to left BCV in grayscale and color. Extending the cardiac sweep to span the area from the fetal stomach to the LBCV will not result in any significant increase to the total examination time. In fact, it may potentially expedite accurate completion of the cardiac examination without the need to obtain additional views. This is especially applicable to cases where there may be a suspected anomaly or the need to confirm questionable sonographic findings pertaining to the venous system. This may also be of potential utility to enable a comprehensive cardiac evaluation particularly with the current increasing need for remote sonographic readings by various specialists. Ultimately, it may enhance the prenatal detection rates of some of the most critical, yet challenging anomalies, and will translate into improved neonatal outcomes. We would like to express our profound gratitude to the Gottesfeld-Hohler Memorial Foundation for the Beryl Benacerraf Fellowship as this manuscript was a result of author collaboration made possible by this fund.

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• A Practical Approach to Incorporating the Detailed First Trimester Ultrasound Examination Into Clinical Practice

  Journal of Ultrasound in Medicine · 2025-09-08 · 1 citations

  articleOpen access1st author

  Tremendous advances in ultrasound equipment and knowledge have expanded possibilities for the first trimester detailed ultrasound examination. Recommendations from national organizations to offer this service to patients with indications, coupled with recent modifications for dual use of the current procedural terminology code 76811 during pregnancy, will result in increased demand from patients and referring physicians. While proper reimbursement may motivate healthcare professionals to incorporate the first trimester detailed ultrasound examination into their practice and raise the standards of care in the first trimester, it can also be a challenging transition. In this article, we present a practical approach and share tips and pearls on how to incorporate the first trimester detailed ultrasound into clinical practice.

  PublisherOA PDFDOI

• Recruiting marijuana-exposed maternal-infant dyads for longitudinal study: a feasibility assessment

  Frontiers in Psychiatry · 2025-09-12

  articleOpen access

  Introduction: marijuana exposures are correlated with adverse neurodevelopmental outcomes in exposed neonates. As rates of marijuana use in pregnancy and postpartum reportedly increase, it is crucial to obtain conclusive, pregnancy-specific safety data through well-designed clinical research studies. The objective of this study is to assess feasibility of recruitment and retention of marijuana-exposed pregnant women for longitudinal study involving biospecimen and imaging collection. Methods: Participants self-reporting marijuana use in pregnancy and controls with no self-reported exposure were recruited from routine prenatal care in a large health-system. Consented participants completed imaging and biological specimen collections during pregnancy, at delivery, and postpartum. Proportions of collected samples/images at each data collection interval were calculated and compared for exposed versus unexposed. Results: 30 participants were recruited over 20 months: 77% (n=23) self-reported as marijuana-exposed and 23% (n=7) reported as unexposed (control). 70% (n=21) of participants completed the study (n=14 marijuana-exposed; n=7 control), while 30% (n=9 marijuana-exposed; 0%, n=0 control) completed some study visits before becoming lost-to-follow-up (LTFU). Discussion: Preliminary findings suggest that it is feasible to recruit and retain pregnant women using marijuana for longitudinal study. Although marijuana-exposed participants were more likely than control participants to miss postpartum visits, become LTFU, and require rescheduling of study visits, marijuana-exposed participants were still found to complete 68% of study visits.

  PublisherOA PDFDOI

• EP21.22: Intramural heterotopic pregnancy: a case report and review of the literature

  Ultrasound in Obstetrics and Gynecology · 2024-09-01

  articleOpen accessSenior author

  Heterotopic pregnancy (HP) is a rare and life-threatening condition in which an ectopic pregnancy occurs with an intrauterine pregnancy (IUP). Intramural HP is when a second gestational sac (GS) is visualised surrounded by myometrium. We report a case of intramural HP in a 24 year old G4 P2012 female, with a history of miscarriage, who presented for evaluation at an outside centre. TVUS revealed an IUP with a CRL of 6mm and FHR of 99bpm, consistent with 6w3d gestation. Her β-hCG was 64,116 mIU/mL. There was also a distinct cystic structure with an echogenic rim and peripheral flow measuring 14x11mm. She was referred to our unit for evaluation. Repeat US at 7w1d confirmed a viable embryo with CRL 16.9mm and an intramural HP with a GS of 8mm. At 8w2d, there was a viable embryo with CRL 22.2mm and 3D US localised the HP to the left lateral inferior uterine wall with a well-demarcated, vascularised 6-7mm GS. Follow-up US at 9w0d revealed an embryo with CRL 22.4mm and complete resorption of the HP. The pregnancy continued without complications. A live-born neonate was delivered at 40w0d, weighing 3680 g. A scoping review of heterotopic and/or intramural pregnancy was conducted using PRISMA-ScR guidelines. PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Reviews were searched. Ten relevant cases were reviewed with ours. Risk factors for intramural HP include history of IVF, uterine trauma, prior Caesarean, PID, adenomyosis, and IUDs. Patients were either asymptomatic or had abdominal pain with gestational ages of 6-32 weeks. Treatments were as follows: 45% expectant management, 36% laparoscopy, 9% hysteroscopy, 9% laparotomy and 9% Caesarean section. Pregnancies resulted in 82% live births, 9% miscarriages, and 9% terminations. In conclusion, treatment options should be individualised. In subsequent conception, patients should be monitored closely. A strong index of suspicion and early diagnosis is crucial to preserving the health and future fertility of the mother.

  PublisherOA PDFDOI

• Issue Information

  Journal of Ultrasound in Medicine · 2024-01-10 · 1 citations

  paratextOpen access
  PublisherOA PDFDOI

• Developmental Changes of the Coronary Sinus Between the First and Second Trimesters

  Journal of Ultrasound in Medicine · 2024-08-08 · 1 citations

  articleOpen access1st authorCorresponding

  OBJECTIVE: To assess the coronary sinus (CS) presence, size, and CS to atrial ratio (CS/A) in the first trimester (FT) compared with the second trimester (ST). METHODS: In this IRB-approved retrospective study, fetuses with adequate FT cardiac sweeps and normal ST hearts were included. Maternal and fetal characteristics were obtained. CS and atrial diameters were measured by a single sonologist. The CS/A ratio was compared between FT and ST. Linear regression assessed the relationship between biparietal diameter (BPD) and CS and atrial diameters. Statistical significance was set at P < .05. RESULTS: Among 99 fetuses, the CS was seen in 42/53 (79.2%) in the FT and 14/32 (43.8%) in the ST. No significant associations were found between CS visualization and the factors analyzed. The CS/A ratio was significantly higher in the FT versus ST (0.43 vs 0.25; P < .0001). Combined FT and ST data revealed positive correlations between BPD and both CS (slope = 0.018, P < .0001) and atrial diameters (slope = 0.135, P < .0001), suggesting differential growth rates, with the atrium exhibiting a faster growth rate as BPD increased. CONCLUSIONS: The CS appears prominent in the FT compared with the ST, likely due to differential growth rates between the CS and atrium. Remnants of embryonic structures, differences in myocardial drainage, and hemodynamics may also be contributing factors. Larger prospective studies are needed to confirm these findings and assess the value of the FT CS/A ratio.

  PublisherOA PDFDOI

Frequent coauthors

• Fouad Ziade

  29 shared

• Sameer Abu-Rustum

  25 shared

• Linda Daou

  Hôtel-Dieu de France

  16 shared

• Beryl R. Benacerraf

  Brigham and Women's Hospital

  8 shared

• Bryann Bromley

  8 shared

• Nicole El Helou

  Lebanese Hospital Geitaoui-University Medical Center

  8 shared

• E. L. Smith

  University of Florida

  8 shared

• Robert Egerman

  University of Florida

  7 shared