Mariam Naqvi

Chromosomal microarray use among women undergoing invasive prenatal diagnosis

To study the offer and uptake of chromosomal microarray analysis (CMA) among women undergoing invasive prenatal testing.

Adnexal masses in pregnancy.

With the advent of routine obstetrical ultrasound, the diagnosis of an adnexal mass in pregnancy has become increasingly common. Although the reported incidence and expected clinical course varies based on the gestational age at the time of diagnosis and the criteria used to define an adnexal mass, the majority of adnexal masses diagnosed in pregnancy are benign and are likely to resolve without complication or intervention. This review will discuss the epidemiology of adnexal masses in pregnancy, diagnostic tools, potential complications, and management options during pregnancy.

Emergency Cerclage: Outcomes, Patient Selection, and Operative Considerations.

Emergency cerclage refers to a cerclage placed during the second trimester in a woman noted to have painless cervical dilation. Although randomized-controlled trials are limited, observational studies suggest an improvement in neonatal outcomes in selected patients undergoing an emergency cerclage. Labor and chorioamniontis are contraindications for cerclage placement. Advanced dilation (>3 to 4 cm) and a later gestational age (22 to 24 wk) are associated with poorer outcomes. This chapter reviews the indications, outcomes and perioperative management strategies for cerclage placement in this setting.

Impaired right ventricular reserve predicts adverse cardiac outcomes in adults with congenital right heart disease

Objective The prevalence of heart failure (HF) among adult patients with congenital heart disease (ACHD) is rising. Right ventricle (RV) exercise reserve and its relationship to outcomes have not been characterised. We aim to evaluate the prognostic impact of impaired RV reserve in an ACHD population referred for cardiopulmonary exercise testing (CPET). Methods This retrospective study evaluates patients with ACHD who underwent CPET (n=147) with first-pass radionuclide ventriculography at a single tertiary care centre. RV reserve was categorised as normal, mild to moderately or severely impaired. The primary composite clinical outcome included clinical right HF, arrhythmia, transplantation or death. Results Patients were median age 41±13 years, 50% were female and median follow-up was 1.1 (IQR: 0.7–2.0) years. Exercise RV reserve was impaired in 103 patients (70%), of whom 32% were asymptomatic. Resting RV systolic function poorly predicted RV reserve, with 52% of patients with severe impairment having a qualitatively normal echocardiographic assessment. The severely impaired reserve group had lower peak oxygen consumption (VO2)(17.2 vs 22.5 mL/kg/min, p<0.0001) compared with the normal reserve group, and was more likely to develop the composite outcome (48% vs 9%, log-rank p<0.001). Severely impaired RV reserve predicted event-free survival after adjusting for peak VO2, age, sex, RV pathology, QRS duration, New York Heart Association class, resting RV ejection fraction and RV dilation by echocardiography or MRI (HR 3.7, 95% CI 1.1 to 13.0, p=0.039). Conclusion Impaired RV reserve, occurred in asymptomatic patients, was not well predicted by resting systolic function assessment, and strongly predicted adverse cardiovascular outcomes.