Carl P Weiner

Creighton School of Medicine Phoenix Branch · Obstetrics and Gynecology

The first-trimester prediction of spontaneous preterm birth (sPTB) has been elusive, and current screening is heavily dependent on obstetric history. However, nullipara lack a relevant history and are at higher risk for spontaneous (s)PTB ≤ 32 weeks compared to multipara. No available objective first-trimester screening test has proven a fair predi...

Background Intention-to-treat analyses do not address adherence. Per protocol analyses treat nonadherence as a protocol deviation and assess if the intervention is effective if followed. Objective To determine the rate of early preterm birth (EPTB, <34 weeks gestation) and preterm birth (PTB, <37 weeks gestation) in participants who adhered to a r...

Prenatal trisomy 21 (T21) screening commonly involves testing a maternal blood sample for fetal DNA aneuploidy. It is reliable but poses a cost barrier to universal screening. We hypothesized maternal plasma RNA screening might provide similar reliability but at a lower cost. Discovery experiments used plasma cell-free RNA from 20 women 11–13 weeks...

Detection of embryonic trisomy 21 using maternal cell free RNA.

Preterm birth is the principal contributor to neonatal death and morbidity worldwide. We previously described a plasma cell-free RNA panel that between 16 and 20 weeks of pregnancy had potential to predict spontaneous preterm birth (sPTB) ≤ 32 weeks caused by preterm labor (PTL) or preterm premature rupture of membranes (PPROM). The present study h...

The pathophysiologic origins of obstetrical emergencies are complicated and may well be influenced by events prior to conception. Such problems are not likely to be resolved soon, and in the meantime, high resource countries simply cannot afford to divert more and more money to litigation and the costs of preventable morbidities for either mother o...

Objective: Compare the second trimester plasma cell-free (PCF) transcriptome of women who delivered at term to women with spontaneous preterm birth (sPTB)≦32weeks and identify/validate PCF ribonucleic acid (RNA) markers present by 16weeks. Design: Prospective case-control study. Setting: Academic tertiary care centre. Population: Pregnant wo...

Highlights •FutureBIRTH is a unique test based on the maternal plasma transcriptome. •It was invented by Dr Yafeng Dong and Carl Weiner and is the only validated plasma transcriptome based medical test to date. •It is also the only test validated for use from 11 to 19 weeks to the predict which women are destined to suffer PTB due either to preter...

Background Several meta analyses have concluded n-3 fatty acids, including docosahexaenoic acid (DHA), reduce early preterm birth (EPB, < 34 weeks), however, the amount of DHA required is unclear. We hypothesized that 1000 mg DHA per day would be superior to 200 mg, the amount in most prenatal supplements. Methods This randomised, multicentre, dou...

We were all disappointed the 2020 SRI was canceled. There is an interesting abstract from Prof Ware Branch et al where they randomized women at 19 5/7 to 20 6/7 to either no screening (ie, conventional care) vs screening with Sera's PreTRM with the goal of determining the impact of screening on maternal/neonatal outcomes. Randomization was not blin...

Validation studies from diverse populations sampled 11-20 weeks confirm the reproducibility and very good to excellent predictive accuracy of FutureBIRTH is unmatched by any other validated test.

Rationale: Human umbilical cord blood (hUCB) contains diverse populations of stem/progenitor cells. Whether hUCB-derived nonhematopoietic cells would induce cardiac repair remains unknown. Objective: To examine whether intramyocardial transplantation of hUCB-derived CD45- Lin- nonhematopoietic cellular fraction after a reperfused myocardial infa...

Background: Ovarian cancer is the most lethal gynecological malignancy and the fifth most common cancer in women in the U.S. Patients diagnosed in advanced-stage ovarian cancer have 70-95 % chance of relapse. Additional non-invasive approaches to monitor response to treatment and to predict recurrent disease are urgently needed. Aberrant expression...

Objective: Calmodulin (CaM) plays a key role in the orchestration of Ca2+ signaling events, and its regulation is considered an important component of cellular homeostasis. The control of uterine smooth muscle function is largely dependent on the regulation of Ca2+ and CaM signaling. The objective of this study was to investigate the expression, f...

Objective: To compare the rapid bedside test for placental α microglobulin-1 with the instrumented fetal fibronectin test for prediction of imminent spontaneous preterm delivery among women with symptoms of preterm labor. Methods: We conducted a prospective observational study on pregnant women with signs or symptoms suggestive of preterm labor...

Cambridge Core - Obstetrics and Gynecology, Reproductive Medicine - High-Risk Pregnancy - edited by David James

Twin-twin transfusion syndrome is a complication of monochorionic-diamniotic placentation. Should one twin die, ≈30% of co-twins will also die, and if they survive, ≈30% experience severe morbidity rates, each believed secondary to hemorrhage of the co-twin into the deceased twin. We report apparently the first ultrasound-documented case of perimor...

Background Ovarian cancer is the leading lethal, gynecological malignancy in the United States. No doubt, the continued morbidity and mortality of ovarian cancer reflects a poor understanding of invasive mechanisms. Recent studies reveal that ovarian cancers express aberrant microRNAs (miRNAs or miRs), some of which have oncogenic or tumor suppress...

Background Preterm birth contributes to 0.5 million deliveries in the United States (one of eight pregnancies) and poses a huge burden on public health with costs in the billions. Of particular concern is that the rate of earliest preterm birth (<34 weeks) (ePTB), which has decreased little since 1990 and has the greatest impact on the overall infa...

The guinea pig is a frequently used animal model for human pregnancy complications, such as oxygen deprivation or hypoxia, which result in altered brain development. To investigate the impact of in utero chronic hypoxia on brain development, pregnant guinea pigs underwent either normoxic or hypoxic conditions at about 70 % of 65-day term gestation....

Although much progress is being made in understanding the molecular pathways in the placenta involved in the pathophysiology of pregnancy related disorders, a significant gap exists in utilizing this information for developing new drug therapies to improve pregnancy outcome. On March 5-6, 2015, the Eunice Kennedy Shriver National Institute of Child...

Inertial and magnetic sensors are commonly used to determine orientation as they do not rely on a line of sight [1, 2]. There are many different techniques to fuse inertial measurement unit (IMU) data and obtain useful rotational data [1–3]. This study uses two separate data fusion techniques; a direction cosine matrix-based (DCM) technique and a q...

Objective: Birth is less safe than it can be. We adapted the UK-developed PROMPT™ (PRactical Obstetric Multi-Professional Training) course to local practices and initiated annual training. Study design: This observational study used quality assurance data from University of Kansas Hospital 2 years before and 7 years after intervention encompassi...

Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evi...

Whether the isolated VSD (i-VSD) is associated with aneuploidy to the same degree as a more severe heart anomaly is unclear. Our objective was to determine the likelihood of aneuploidy in pregnancies at a tertiary referral center when an i-VSD is detected before 24 weeks. A retrospective chart review of all detailed anatomy ultrasounds before 24 we...

To investigate the impact of chronic hypoxia on neonatal brains, and follow developmental alterations and adaptations noninvasively in a guinea pig model. Chronic hypoxemia is the prime cause of fetal brain injury and long-term sequelae such as neurodevelopmental compromise, seizures, and cerebral palsy. Thirty guinea pigs underwent either normoxic...

Prostaglandin E2 (PGE2), a major product of cyclooxygenase -2 (COX-2), acts as an immunomodulator at the maternal-fetal interface during pregnancy. It exerts biological function through interaction with E-prostanoid (EP) receptors localized to the placenta. The activation of the COX-2/PGE2/EP signal pathway can alter the expression of the ATP bindi...

Objective To identify the predictors of LV recovery in patients with peripartum cardiomyopathy (PPCM) and record rates of ICD use. Background PPCM is a rare life threatening disease. The use of implantable cardioverter defibrillators (ICD) has not been clearly understood in this population. Identifying the predictors for persistent LV dysfunction...

Multi-professional training for obstetric emergencies in a US hospital over a 7-year interval: an observational study CP Weiner1, L Collins2, S Bentley2, Y Dong1 and CL Satterwhite3 OBJECTIVE: Birth is less safe than it can be. We adapted the UK-developed PROMPT™ (PRactical Obstetric Multi-Professional Training) course to local practices and initia...

During the delivery of a fetus, an obstetrician assists by applying gentle axial downward traction on the head until the shoulders clear the pubic bone followed by catching and supporting the delivered infant body. If the shoulders become lodged behind the maternal pelvis (shoulder dystocia), the physician may be required to perform additional mane...

"Some drugs are harmless to fetuses and babies, but others can wreak havoc. That's why pregnant and breastfeeding moms will gain insight - and great peace of mind - from the careful research and clear guidance Dr. Weiner offers in this superb book." --Harvey Karp, M.D., New York Times bestselling author of The Happiest Baby on the Block and Assista...

Anesthesia and the Fetus integrates into one volume the multidisciplinary components of: • fetal development • fetal pharmacology • assessments of fetal and neonatal outcome • anesthesia and analgesia during pregnancy • anesthesia and analgesia during labor • ethics and law. Written by an internationally renowned group of clinicians and scientists,...

IntroductionStructural features in the placenta relevant to drug transportModes of placental drug transferPlacental drug transportersModels to study placental drug transportReferences

The purpose of this study was to investigate the impact of chronic hypoxia on the nitric oxide synthase isoenzymes in specific brain structures. Time-mated pregnant guinea pigs were exposed to 10.5% molecular oxygen for 14 days (animals with chronic fetal hypoxia; HPX) or room air (control animals; NMX); L-N6-(1-iminoethyl)-lysine (L-NIL; an induci...

Fetal drug exposure is determined by the type and concentration of placental transporters, and their regulation is central to the development of new treatments and delivery strategies for pregnant women and their fetuses. We tested the expression of several clinically important transporters in the human placenta associated with various pregnancy co...

High Risk Pregnancy examines the full range of challenges in general obstetrics, medical complications of pregnancy, prenatal diagnosis, fetal disease, and management of labor and delivery. Drs. David James, Philip J. Steer, Carl P. Weiner, Bernard Gonik, Caroline Crowther, and Stephen Robson present an evidence-based approach to the available mana...

Prolactin (PRL) is a multifunctional hormone with prominent roles in regulating growth and reproduction. The guinea pig (Cavia porcellus) has been extensively used in endocrine and reproduction research. Thus far, the PRL cDNA and protein have not been isolated from the guinea pig. In the present study, we used information derived from the public g...

Distinct processes govern transition from quiescence to activation during term (TL) and preterm labor (PTL). We sought gene sets that are responsible for TL and PTL, along with the effector genes that are necessary for labor independent of gestation and underlying trigger. Expression was analyzed in term and preterm with or without labor (n=6 subje...

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The prevalence of cerebral palsy (CP) shows little temporal or geographic variation and is associated with preterm birth, maternal/fetal infection/inflammation, and fetal growth restriction (IUGR), a potential surrogate for chronic fetal hypoxemia (CHX). We previously demonstrated CHX causes a fetal inflammatory response syndrome (FIRS). Herein, we...

Vaginal delivery may be complicated by either disproportion with the maternal pelvis or fetal malpresentation. Shoulder dystocia with brachial plexus injury is a frequent subject of medical malpractice complaints based on the assumption injury equals excess physician force despite the fact the normal range of force is unknown. Further, cesarean del...

Although estrogen regulates important aspects of maternal cardiovascular physiology, the role of estrogen on uteroplacental and fetal blood flow is incompletely understood. This study tested the hypothesis that chronically suppressing endogenous estrogen production during the second half of baboon pregnancy alters uterine and fetal blood flow dynam...

Preterm premature rupture of the fetal membranes (PPROM) is associated with intra-uterine infection. Early detection of intra-uterine infection may help prevent neonatal sepsis. C-reactive protein (CRP) is an acute phase protein often elevated when inflammation is present. The aim of this review was to assess whether CRP accurately predicts chorioa...

Immune activation represents an adaptive reaction triggered by both noxious exogenous (microbes) and endogenous [high mobility group box-1 protein (HMGB1), S100 calcium binding proteins] inducers of inflammation. Cell stress or necrosis lead the release of HMGB1 and S100 proteins in the extracellular compartment where they act as damage-associated...

Objective: Recent investigation has shown that magnesium stimulates the release of prostacyclin from confluent endothelial cell cultures. The goal of this study was to determine the effect of magnesium sulfate infusion on the peripheral concentrations of prostaglandin E2 (PGE2), prostaglandin F2α (PGF2α) and 6-keto-prostaglandin F1α (6-keto-PGF1α t...

Serotonin augments synergistically the pressor response of the guinea pig to angiotensin II. We hypothesized that serotonin would enhance the effects of other vasoactive agents and that these agents themselves would have synergistic properties similar to serotonin. We tested this hypothesis by administering to chronically instrumented pregnant guin...

Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies. Isolated aviation-based team training programmes have not been associated with improved perinatal outcomes when applied to labour ward settings, whereas ob...

Drugs for Pregnant and Lactating Women, 2nd Edition, by Carl P. Weiner, MD, MBA, FACOG, and Catalin Buhimschi, MD, is a must-have reference that details how virtually all of today’s drugs and herbal supplements interact with pregnancy and lactation. Updated thoroughly and covering nearly 2,000 substances, the new edition explains whether each drug...

The object of the investigation was to determine whether chronic fetal hypoxemia triggers a systemic fetal inflammatory response absent bacterial infection. Chronically hypoxemic (10.5% O(2)) and lipopolysaccharide (LPS; 400 microg/kg of maternal body weight) injected intrauterine (but extra-amniotic) treated pregnant guinea pigs were used with app...

This is the second of a two-part series on the use of medication during pregnancy and lactation. Pregnancy risk factors together with an increased incidence of chronic diseases and the rise in mean maternal age predict an increase in medication use during gestation. However, as highlighted in the first installment of this series, relatively few med...

One of the least-developed areas of clinical pharmacology and drug research is the use of medication during pregnancy and lactation. This article is the first in a two-part series designed to familiarize physicians with many aspects of the drugs they commonly prescribe for pregnant and breast-feeding women. Almost every pregnant woman is exposed to...

We aim to demonstrate that Brain Natriuretic Peptide (BNP) is synthesized and released from the fetal membranes and mediates pregnancy myometrial quiescence. Myometrium and fetal membranes (FM) were obtained from term and preterm pregnancies at the time of cesarean section, either in labor or not in labor. BNP was measured in term and preterm FM, i...

This is the second of a two-part series on the use of medication during pregnancy and lactation. Pregnancy risk factors together with an increased incidence of chronic diseases and the rise in mean maternal age predict an increase in medication use during gestation. However, as highlighted in the first installment of this series, relatively few med...

The maternal abdomen is prepared aseptically. We use acetone to remove the acoustic coupling gel (unsterile), followed by alcohol and povidone-iodine. The sterile-gloved operator prepares all necessary equipment on a sterile tray and drapes the mother. If a linear transducer or needle-guided technique is being used, an assistant also dons sterile g...

Symptomatic fetal viral infection can affect placental and fetal development and may lead to non-immune hydrops or fetal death. All infections are not detectable by clinical history or ultrasound and a background positivity rate exists in asymptomatic patients. We investigated if intraamniotic presence of viral genome at the time of genetic amnioce...