Search Our Scientific Publications & Authors

Pregnancy Hypertens 2016 Oct 18;6(4):300-305. Epub 2016 Jun 18.

Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.

Objective: The aim is to evaluate if maternal cardiovascular indices, in the first trimester of pregnancy, might be useful to differentiate women who develop different hypertensive disorders of pregnancy (HDP).

Study Design: Method: 1399 pregnant women attending screening for chromosomal aneuploidies were recruited. The following parameters were measured: Doppler Velocimetry of uterine arteries; Peripheral blood pressure; Aortic Pressure derived from applanation tonometry. Read More

West J Emerg Med 2016 Jul 5;17(4):460-3. Epub 2016 Jul 5.

West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia.

Background: Early pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. Read More

J Emerg Med 2013 Sep 27;45(3):348-51. Epub 2013 Jun 27.

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

Background: Ovarian torsion (OT) is one of the most common gynecologic surgical emergencies. All age groups can be affected, but ovarian stimulation, as found during early pregnancy or infertility treatment, is a major risk factor.

Objective: Diagnosing OT in early pregnancy can be challenging. Read More

Crit Ultrasound J 2012 Dec 6;4(1):22. Epub 2012 Dec 6.

Department of Emergency Medicine, Emergency Ultrasound Division, St, Luke's/Roosevelt Hospital Center, 1000 10th Avenue, New York, NY 10019, USA.

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Background: Patient reported menstrual history, physician clinical evaluation, and ultrasonography are used to determine gestational age in the pregnant female. Previous studies have shown that pregnancy dating by last menstrual period (LMP) and physical examination findings can be inaccurate. An ultrasound performed in the radiology department is considered the standard for determining an accurate gestational age. Read More

Emerg Med Australas 2012 Oct;24(5):573-6

Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Pregnant women frequently present to the ED for complaints related to the first trimester of pregnancy. The emergency physician must confirm the presence of an intrauterine pregnancy for many such complaints. Bedside ultrasound with well-delineated criteria has become standard practice for many emergency physicians for this purpose. Read More

Am J Emerg Med 2012 Oct 4;30(8):1627-9. Epub 2012 Feb 4.

Department of Emergency Medicine, Alameda County Medical Center, Oakland, CA 94602, USA.

Study Objective: The objective of this study is to evaluate the accuracy of emergency providers (EPs) of various levels of training in determination of gestational age (GA) in pregnant patients using bedside ultrasound measurement of crown-rump length (CRL).

Methods: We conducted a prospective, cross-sectional, observational study of patients in obstetrical care at an urban county hospital. We enrolled a convenience sample of women at 6 to 14 weeks gestation as estimated by last menstrual period. Read More

Ann Emerg Med 2011 Jul 18;58(1):12-20. Epub 2011 Feb 18.

Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.

Study Objective: We seek to assess the performance of the β human chorionic gonadotropin (β-hCG) "discriminatory zone" when using bedside pelvic ultrasonography in the evaluation of symptomatic pregnant emergency department (ED) patients.

Methods: This was a cross-sectional study of bedside pelvic ultrasonography performed on consecutive pregnant patients in the first trimester who presented to the ED with abdominal pain or vaginal bleeding. Patients received pelvic ultrasonography, serum β-hCG testing, and blinded formal radiologic ultrasonography. Read More

J Ultrasound Med 2010 Oct;29(10):1423-8

Department of Emergency Medicine, David Geffen School of Medicine, Olive View Medical Center and UCLA Medical Center, Sylmar, CA 91342, USA.

Objective: The purpose of this study was to prospectively assess the learning curve of emergency physician training in emergency bedside sonography (EBS) for first-trimester pregnancy complications.

Methods: This was a prospective study at an urban academic emergency department from August 1999 through July 2006. Patients with first-trimester vaginal bleeding or pain underwent EBS followed by pelvic sonography (PS) by the Department of Radiology. Read More

Ann Emerg Med 2010 Dec 15;56(6):674-83. Epub 2010 Sep 15.

Department of Emergency Medicine, University of California, San Francisco, CA 94143, USA.

Study Objective: Ectopic pregnancy is a common concern in emergency departments (EDs) and remains the leading cause of first-trimester mortality. Pelvic ultrasonography by emergency physicians has been investigated as a diagnostic test for ectopic pregnancy. We present a meta-analysis of the use of emergency physician ultrasonography in the evaluation of patients at risk of ectopic pregnancy. Read More

Am J Emerg Med 2010 Feb;28(2):213-6

Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, NJ 08103, USA.

Objective: This study examines the necessity of a formal pelvic examination in patients with early pregnancy-related complaints and an intrauterine pregnancy on bedside ultrasound (US).

Methods: Data were prospectively collected on emergency department (ED) patients presenting with early pregnancy complaints and bedside US evidence of intrauterine pregnancy. All patients received a formal pelvic examination with cervical testing for sexually transmitted pathogens. Read More

Ultrasound Obstet Gynecol 2009 Dec;34(6):629-33

Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.

Objectives: To construct tables for 'bedside' estimation of Down syndrome risk based on maternal age and ultrasound prenasal thickness (PT) measurements.

Methods: Likelihood ratios were calculated using a log Gaussian model of the PT distribution in multiples of the gestational age-specific median (MoM). The model parameters were derived from 80 Down syndrome and 850 unaffected pregnancies scanned at 14-27 weeks; these data had been published previously, in three series, except for 18 Down syndrome and 119 affected pregnancies. Read More

Acad Emerg Med 2009 Sep 6;16(9):919. Epub 2009 Aug 6.

Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA.

Aust N Z J Obstet Gynaecol 2009 Feb;49(1):110-4

Department of Obstetrics and Gynaecology, The Canberra Hospital, Woden, Australian Capital Territory, Australia.

Background: Early pregnancy assessment clinics (EPAC) have been introduced and accepted as the gold standard for management of early pregnancy problems (EPP). However, EPAC are not universally available and management of EPP within the emergency department (ED) can result in prolonged waiting times, inappropriate use of resources and no clear treatment or follow-up plan being implemented.

Aim: To assess the effect of an early pregnancy assessment protocol (EPAP) in the ED, designed to create a cultural change among doctors in relation to EPP in order to minimise use of resources, improve treatment times for patients and establish a clear management plan where dedicated EPAC services are not available. Read More

J Emerg Med 2010 Aug 27;39(2):e105-8. Epub 2008 Dec 27.

Department of Emergency Medicine, Montefiore Hospital, Bronx, New York 10467, USA.

Background: The evaluation of vaginal bleeding and pelvic pain in the first trimester of pregnancy is an important component of emergency physician training. The increased use of bedside sonography by emergency physicians in the evaluation of these patients requires knowledge about the normal anatomy, variants, abnormal findings and their appearance on sonography.

Objectives: To highlight the importance of a thorough pelvic and abdominal sonographic examination during a routine evaluation in the emergency department (ED). Read More

Pediatrics 2008 May;121(5):e1404-12

Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.

Bedside emergency ultrasound has been used by emergency physicians for >20 years for a variety of conditions. In adult centers, emergency ultrasound is routinely used in the management of victims of blunt abdominal trauma, in patients with abdominal aortic aneurysm and biliary disease, and in women with first-trimester pregnancy complications. Although its use has grown dramatically in the last decade in adult emergency departments, only recently has this tool been embraced by pediatric emergency physicians. Read More

J Emerg Med 2009 Jan 20;36(1):34-6. Epub 2007 Jul 20.

Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York 11215, USA.

The evaluation of first trimester vaginal bleeding or pelvic pain is an important task for the emergency physician. The early identification of an ectopic pregnancy can help prevent significant morbidity and mortality for patients seeking emergency care. The increased use of bedside sonography by the emergency physician in the evaluation of these patients requires an increased knowledge about the variants and their appearance on sonogram. Read More

Am J Emerg Med 2007 Jul;25(6):591-6

Section of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA.

Objectives: The objective of this study was to describe diagnosis and management of ectopic pregnancy using bedside transvaginal ultrasound (US) in an established emergency US program.

Methods: This was a retrospective study on patients presenting over a 2-year period performed at a level I urban academic emergency department (ED). The ED sees 78,000 patients annually and has a residency and active US program. Read More

Acad Emerg Med 2007 Aug 6;14(8):755-8. Epub 2007 Jun 6.

Section of Emergency Medicine, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.

Background: Ectopic pregnancies are frequently present in women who present to the emergency department with pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention.

Objectives: To prospectively determine if emergency physician (EP)-performed transabdominal pelvic ultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted the need for operative intervention.

Methods: Patients who were suspected to have an ectopic pregnancy were prospectively enrolled over a ten-month period. Read More

Ultrasound Obstet Gynecol 2002 Nov;20(5):468-75

Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Objective: To construct tables for 'bedside' estimation of Down syndrome risk based on maternal age and nuchal translucency measurements.

Methods: Likelihood ratios were calculated using the log multiple of median Gaussian model. The parameters for the model (mean and standard deviation) were derived from 5560 normal and 51 Down syndrome-affected pregnancies scanned during the first trimester in three different centers. Read More

J Emerg Med 2002 May;22(4):379-84

Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York 11030, USA.

Pregnant patients with first trimester complications are a common presentation in many Emergency Departments (EDs). The burden of disproving the existence of an ectopic pregnancy falls on the Emergency Physician (EP). This may be a difficult task depending on the availability of specialty backup and radiologic services. Read More

Acad Emerg Med 2000 Sep;7(9):988-93

Department of Emergency Medicine, Christ Hospital and Medical Center, Oak Lawn, IL, USA.

Objective: To determine whether patients presenting to the emergency department (ED) with first-trimester pregnancy complications have a decreased length of stay (LOS) when a live intrauterine pregnancy (IUP) is diagnosed by emergency physicians (EPs).

Methods: This study was performed at an urban community ED with a residency program and an annual census of 65,000. A retrospective chart review from October 1995 to August 1998 identified 1,419 patients who received ultrasound examinations confirming live IUP in the first trimester with pain and/or bleeding. Read More

Acad Emerg Med 1998 Aug;5(8):802-7

Emergency Medicine Department, Naval Medical Center Portsmouth, VA 23708, USA.

Objectives: An important argument for emergency physician use of ultrasonography is that it results in more rapid patient disposition, but there are few articles to support this position. This study sought to demonstrate a significant decrease in the time spent in the ED when emergency physicians performed transvaginal ultrasonography (TVUS), as compared with when TVUS was performed by consultants, in the evaluation of first-trimester pelvic pain or vaginal bleeding.

Methods: A retrospective analysis was conducted of the time spent in the ED (time placed in gynecologic examination room to time released from ED) by patients with first-trimester pelvic pain or vaginal bleeding necessitating further evaluation with TVUS. Read More