Daniel F Roshan, M.D.

Does Chorionic Villus Sampling Increase the Incidence of Echogenic Bowel on Second Trimester Ultrasound
Petrikovsky, B; Monga, S; Klapper, A; Jaffe, I; Roshan, D
2010 MAR ;17(3):101A-101A, Reproductive sciences (Thousand Oaks, Calif.)
— id: 110126, year: 2010, vol: 17, page: 101A, stat: Journal Article,

Antenatal treatment of fetal goiter: a therapeutic challenge
Hanono, Anat; Shah, Bina; David, Raphael; Buterman, Irving; Roshan, Daniel; Shah, Shetal; Lam, Leslie; Timor-Tritsch, Ilan
2009 Jan;22(1):76-80, Journal of maternal-fetal & neonatal medicine
OBJECTIVE: Pre-natal ultrasonography presents an opportunity for in-utero therapy of a fetal goiter. Because of the morbidity associated with a large goiter and the risks of repeated intra-amniotic injections, controversy arose about the precise indications of this mode of treatment. We describe our observations in treating a 22-week-old fetus with a large goiter because of dyshormogenesis, monitored with serial 3D high frequency, high resolution ultrasonography and amniotic hormonal measurements. Fetal hypothyroidism was confirmed by cordocentesis and amniotic hormone levels. After assessment of relevant risk factors and the criteria for in-utero intervention, including goiter volume, amniotic fluid index, polyhydramnios and tracheal compression, we determined that hormonal therapy was warranted. Levothyroxine was injected every 7-10 days, and its efficacy monitored by ultrasound changes and amniotic hormone sampling. RESULTS: Reduction in goiter volume restored normal neck flexion relieving the pressure on the trachea, polyhydramnios was prevented and amniotic hormone levels were normalised. The infant was euthyroid at birth, however, by age 4 days hypothyroidism was diagnosed, and treatment with l-thyroxine started. CONCLUSION: Advances in fetal ultrasonography permit judicious therapy of an enlarging goiter in a hypothyroid fetus, which may contribute to enhancing cognitive development. We discuss the value of amniotic hormone sampling, the objectives and risks of in-utero intervention in the light of recent literature and our own observations
— id: 96296, year: 2009, vol: 22, page: 76, stat: Journal Article,

Successful pregnancy outcome in Ehlers-Danlos syndrome, vascular type
Palmquist, Maria; Pappas, John G; Petrikovsky, Boris; Blakemore, Karin; Roshan, Daniel
2009 Oct;22(10):924-927, Journal of maternal-fetal & neonatal medicine
BACKGROUND: Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder characterized by tissue fragility, translucent skin and joint hypermobility. Patients with the vascular type of EDS are prone to spontaneous arterial and visceral rupture. Pregnancy for women with vascular EDS can be life-threatening. Mortality rates are high due to the increased risk for uterine and arterial rupture in the peripartum period. CASE: We describe the counseling, multidisciplinary management, protocol, and successful pregnancy outcome of a 32-year-old woman with vascular EDS. CONCLUSION: There is no consensus in the literature on the timing and mode of delivery for pregnant women with vascular EDS. The management undertaken in our patient may assist others in optimizing the perinatal outcome in other women who elect to continue their pregnancy despite the risks of this severe medical condition
— id: 145548, year: 2009, vol: 22, page: 924, stat: Journal Article,

Bradycardias following cordocenteses: are they always ominous?
Most OL; Petrikovsky BM; Roshan D
2007 ;20(3):25-7 May-Jun, Neonatal intensive care
— id: 73079, year: 2007, vol: 20, page: 25, stat: Journal Article,

Predictive values of modified biophysical profile
Roshan, D; Petrikovsky, B
2006 FEB ;13(2):221A-222A, Journal of the Society for Gynecologic Investigation
— id: 62830, year: 2006, vol: 13, page: 221A, stat: Journal Article,

Predictive values of modified biophysical profile
Roshan, D; Petrikovsky, B
2006 APR ;107(4):97S-98S, Obstetrics & gynecology
— id: 70618, year: 2006, vol: 107, page: 97S, stat: Journal Article,

Pregnancy outcomes after failed abortion
Roshan, D; Petrikovsky, B
2006 APR ;107(4):97S-97S, Obstetrics & gynecology
— id: 70617, year: 2006, vol: 107, page: 97S, stat: Journal Article,

Does nuchal cord compromise jugular blood flow
Petrikovsky, B; Roman, A; Rebarber, A; Bender, S; Roshan, D
2005 FEB ;12(2):247A-247A, Journal of the Society for Gynecologic Investigation
— id: 73615, year: 2005, vol: 12, page: 247A, stat: Journal Article,

Is cervical index a useful predictory value for successful induction of labor in nulliparous patients?
Petrikovsky, B; Roshan, D
2005 DEC ;193(6):S156-S156, American journal of obstetrics & gynecology
— id: 73614, year: 2005, vol: 193, page: S156, stat: Journal Article,

Update on chorionic villus sampling
Roshan D
2005 ;?:?-?, Journal of the Bellevue Obstetrical & Gynecological Society
— id: 73677, year: 2005, vol: ?, page: ?, stat: Journal Article,

Soft forceps
Roshan, D F; Petrikovsky, B; Sichinava, L; Rudick, B J; Rebarber, A; Bender, S D
2005 Mar;88(3):249-252, International journal of gynaecology & obstetrics
OBJECTIVE: The risk of maternal and fetal trauma and, chiefly, the fear of law suits, have contributed to a significant decline in rates of forceps-assisted deliveries and an increase in rates of cesarean sections, especially in the United States. Our experience with gas-sterilized forceps blades covered with a soft rubber coating--the 'soft' forceps--is described. METHOD: Ninety-six women who required a forceps-assisted delivery for standard indications were randomly allocated to 2 groups. There were 51 women in the regular forceps group and 45 women in the soft forceps group. Low forceps delivery with a Simpson instrument was used in all cases. The groups were compared for fetal injury. RESULTS: The rates of severe facial abrasion and minimal marking were 4.1% and 61%, respectively, in the regular forceps group and 1.9% and 34% in the soft forceps group. CONCLUSION: The soft forceps may reduce the rates of neonatal facial abrasion and skin bruises. The forceps should be further perfected, as well as vacuum extractors; they should both continue to be part of the obstetrician's armamentarium
— id: 56342, year: 2005, vol: 88, page: 249, stat: Journal Article,

The accuracy and usefulness of three-dimensional color power fetal echocardiography
Roshan, D; Petrikovsky, B; Challenger, M
2005 APR ;105(4):52S-52S, Obstetrics & gynecology
— id: 52639, year: 2005, vol: 105, page: 52S, stat: Journal Article,

The risk of aneuploidy in fetuses with cystic hygroma diagnosed in first trimester in advanced maternal age compared with women younger than 35 years
Roshan, D; Salas, J; Perle, MA; Roman, A; Petrikovsky, B; Rebarber, A
2005 APR ;105(4):41S-41S, Obstetrics & gynecology
— id: 52638, year: 2005, vol: 105, page: 41S, stat: Journal Article,

Downward trend in pubs at a single tertiary care center
Petrikovsky, B; Rebarber, A; Roman, A; Saltzman, D; Bender, S; Roshan, D
2004 DEC ;191(6):S153-S153, American journal of obstetrics & gynecology
— id: 73616, year: 2004, vol: 191, page: S153, stat: Journal Article,

Obstetric management of Klippel-Trenaunay syndrome
Rebarber, Andrei; Roman, Ashley S; Roshan, Daniel; Blei, Francine
2004 Nov;104(5 Pt 2):1205-1208, Obstetrics & gynecology
BACKGROUND: Klippel-Trenaunay syndrome is a rare congenital disease characterized by extensive cutaneous vascular malformations, venous varicosities, focal abnormalities of the deep venous system, and underlying soft tissue or bony hypertrophy. Given the rarity of the disease, there is little information available to counsel patients with Klippel-Trenaunay syndrome regarding obstetric outcome. CASES: We report our experience with 3 patients in whom Klippel-Trenaunay syndrome complicated 4 pregnancies. Successful delivery of a healthy infant at or beyond 36 weeks of gestation was achieved in all pregnancies. One of the 4 pregnancies was complicated by pulmonary embolism. CONCLUSION: Klippel-Trenaunay syndrome was once thought to be a contraindication to pregnancy. With careful management, successful pregnancies can be achieved
— id: 47771, year: 2004, vol: 104, page: 1205, stat: Journal Article,

"Blind" vaginal fetal fibronectin as a predictor of spontaneous preterm delivery: A novel sampling technique
Roman, AS; Koklanaris, N; Roshan, D; Paidas, M; Mulholland, J; Levitz, M; Rebarber, A
2004 FEB ;11(2):204A-205A, Journal of the Society for Gynecologic Investigation
— id: 46675, year: 2004, vol: 11, page: 204A, stat: Journal Article,

Predicting preterm premature rupture of membranes in patients with shirodkar cerclage
Roman, AS; Koklanaris, N; Saltzman, D; Roshan, D; Bender, S; Rebarber, A
2004 FEB ;11(2):168A-169A, Journal of the Society for Gynecologic Investigation
— id: 46671, year: 2004, vol: 11, page: 168A, stat: Journal Article,

Vaginal fetal fibronectin as a predictor of spontaneous preterm delivery after multifetal pregnancy reduction
Roman, Ashley S; Rebarber, Andrei; Lipkind, Heather; Mulholland, Jeanine; Minior, Victoria; Roshan, Daniel
2004 Jan;190(1):142-146, American journal of obstetrics & gynecology
OBJECTIVE: The study was undertaken to assess the validity of vaginal fetal fibronectin assay as a screening test for spontaneous preterm delivery in asymptomatic patients who have undergone multifetal pregnancy reduction (MFPR). STUDY DESIGN: A historic cohort of 63 patients who underwent MFPR between 10 and 14 weeks of gestation was identified. All patients underwent serial vaginal fetal fibronectin sampling every 2 to 3 weeks from 22 weeks of gestation until delivery or 32 weeks of gestation. The fetal fibronectin concentration was measured by enzyme-linked immunosorbent assay, with 50 ng/mL or greater indicating a positive result. Charts were reviewed for fetal fibronectin results and pregnancy outcome data. Groups were compared by use of Fisher exact test. RESULTS: There were 13 singleton and 50 twin gestations after MFPR. A median of 4 fetal fibronectin assays were performed per patient. A total of 234 fetal fibronectin assays were performed with 222 (94.9%) negative results and 12 (5.1%) positive results. Overall, 41.3% of gestations were delivered spontaneously before 37 weeks; 7.9% were delivered before 34 weeks. The mean interval between tests was 17.8 days (+/-7.2 days). For delivery within 2 and 3 weeks of a single test, fetal fibronectin had a sensitivity of 66.7% and 50%, a specificity of 95.7% and 96.1%, a positive predictive value of 16.7% and 25%, and a negative predictive value of 99.5% and 98.6%, respectively. CONCLUSION: The fetal fibronectin test has similar validity to predict spontaneous preterm delivery in these high-risk pregnancies as in previously published cohorts
— id: 42603, year: 2004, vol: 190, page: 142, stat: Journal Article,

Soluble monocyte cluster domain 163, a new global marker of anti-inflamatory reponse, is elevated in the first trimester of pregnancy
Paidas M; Roshan D; et al
2003 ;187(6):?-? #648, American journal of obstetrics & gynecology
— id: 73671, year: 2003, vol: 187, page: ?, stat: Journal Article,

Reinvented Soft Forceps, should they be applied?
Petrikovsky B; Sichinava L; Roshanfekr D
2003 ;187(6):?-? #160, American journal of obstetrics & gynecology
— id: 73670, year: 2003, vol: 187, page: ?, stat: Journal Article,

The impact of cervical cerclage on labor morbidity
Rebarber, A; Roman, A; Saltzman, D; Mulholland, J; Bender, S; Koklanaris, N; Roshan, D
2003 DEC ;189(6):S209-S209, American journal of obstetrics & gynecology
— id: 73617, year: 2003, vol: 189, page: S209, stat: Journal Article,

Outcome of multiple gestations with advanced maternal age
Saltzman D; Dunham S; Lee MJ; Rebarber A; Roshanfekr D; Paidas M
2003 ;187(6):?-? #127, American journal of obstetrics & gynecology
— id: 73669, year: 2003, vol: 187, page: ?, stat: Journal Article,

First trimester maternal Protein Z levels are lower in patients with complicated pregnancies and patients with thrombophilia and subsequent adverse pregnancy outcomes
Paidas, MJ; Ku, DHW; Arkel, YS; Rebarber, A; Lee, MJ; Roshan, D; Mulholland, J; Shah, M; O'Neil, L; Davidson, B; Ku, V; Thurston, A; Lockwood, CJ
2002 NOV 16 ;100(11):267A-267A, Blood
— id: 37105, year: 2002, vol: 100, page: 267A, stat: Journal Article,

Mode of delivery in diamniotic twins from 24 to 41 weeks of gestation
Roshanfekr D; Rebarber A; Saltzman D; Paidas M; Lockwood C
2002 ;99(4S):?-?, Obstetrics & gynecology
— id: 73675, year: 2002, vol: 99, page: ?, stat: Journal Article,

Glutathione-dependent formaldehyde dehydrogenase (ADH III) is expressed by human trophoblast and is down-regulated by hypoxia
Funai, EF; Kadner, S; Lee, MJ; Gillen-Goldstein, J; Lipkind, H; Roshanfekr, D; Finlay, T
2001 DEC ;185(6):S168-S168, American journal of obstetrics & gynecology
— id: 55341, year: 2001, vol: 185, page: S168, stat: Journal Article,

Fetal fibronectin is a valid predictor of spontaneous preterm delivery in patients with cervical cerclages
Rebarber A; Roshanfekr D; et al
2001 ;185(6):?-? #173, American journal of obstetrics & gynecology
— id: 73668, year: 2001, vol: 185, page: ?, stat: Journal Article,

Ultrasound indicated Shirodkar cerclage placement versus expectant management in singleton gestations: A comparison of outcomes
Rebarber, A; Sfakianaki, AK; Kuczynski, E; Paidas, M; Maturi, J; Russo, K; Roshanfekr, D; Carreno, C; Lockwood, C
2001 DEC ;185(6):S128-S128, American journal of obstetrics & gynecology
— id: 73611, year: 2001, vol: 185, page: S128, stat: Journal Article,

Review of monoamniotic gestations reported in English language literature from 1988 to 1999
Roque H; Goldstein J; Abdelhak Y; Roshanfekr D; Lockwood C; Young B
2001 ;184(1):?-? #0605, American journal of obstetrics & gynecology
— id: 73667, year: 2001, vol: 184, page: ?, stat: Journal Article,

Incidence of false positive Triple screens for Down Syndrome in two consecutive pregnancies in non-advanced maternal age patients who underwent amniocentesis for each pregnancy
Roshanfekr, D; Kester, M; Grier, R; Mackenzie, A; Funai, E; Rebarber, A
2001 DEC ;185(6):S225-S225, American journal of obstetrics & gynecology
— id: 73612, year: 2001, vol: 185, page: S225, stat: Journal Article,

Analysis of antepartum fetal heart rate tracing by physician and computer
Bracero, L A; Roshanfekr, D; Byrne, D W
2000 May-Jun;9(3):181-185, Journal of maternal-fetal medicine
OBJECTIVE: To compare the interpretation of fetal heart rate (FHR) tracings by three obstetricians with that of a computer analysis program. METHODS: Our study population consisted of high-risk pregnant women referred as outpatients for antepartum FHR monitoring. A total of 121 FHR tracings, from a series of 54 consecutive women, were interpreted by three physicians and a computer program (Oxford Sonicaid System 8000, Oxford Sonicaid Ltd., Chichester, UK). The physicians used a modified FHR scoring system to interpret the tracings. Total scores were categorized as 0-4: abnormal, 5-7: questionable, and 8-10: normal. The computer program used overall variation, categorized as normal: longer than 30 ms, abnormal: shorter than 20 ms, and questionable: 20-30 ms. RESULTS: Significant differences were found among the physicians and between the physicians and the computer analysis for the individual elements of FHR tracings. There was very good agreement between two physicians and the computer in the assessment of the FHR baseline. When physicians used a FHR scoring system to classify the tracings as normal, questionable, or abnormal, the agreement was poor (kappa values ranged from -0.037 to 0.28). The computerized analysis identified two FHR tracings as questionable but both were classified as normal by all three physicians. CONCLUSIONS: The level of agreement in the interpretation of FHR tracings was poor among physicians and between physicians and the computer analysis. A FHR scoring system did not improve the level of agreement between physicians
— id: 73606, year: 2000, vol: 9, page: 181, stat: Journal Article,

Normal level II sonogram in advanced maternal age patients (AMA, 35 and older) and risk of aneuploidy
Roshanfekr D; Cassidy E; Petrikovsky B
2000 ;95(4):72S-72S, Journal of Obstetrics & Gynaecology
— id: 73674, year: 2000, vol: 95, page: 72S, stat: Journal Article,

Severity of isolated fetal pyelectasis and risk of aneuploidy
Roshanfekr D; VonPechman W; Petrikovsky B
2000 ;95(4):72S-72S, Journal of Obstetrics & Gynaecology
— id: 73673, year: 2000, vol: 95, page: 72S, stat: Journal Article,

Fourth-degree lacerations and epidural anesthesia
Ural, S H; Roshanfekr, D; Witter, F R
2000 Dec;71(3):231-233, International journal of gynaecology & obstetrics
— id: 73605, year: 2000, vol: 71, page: 231, stat: Journal Article,

Exogenous luteinizing hormone (LH) increases estradiol response patterns in poor responders with low serum LH concentrations
Phelps, J Y; Figueira-Armada, L; Levine, A S; Vlahos, N P; Roshanfekr, D; Zacur, H A; Garcia, J E
1999 Aug;16(7):363-368, Journal of assisted reproduction & genetics
PURPOSE: Our purpose was to investigate whether the addition of exogenous leuteinizing hormone (LH) increases estradiol secretion in LH-depleted women undergoing controlled ovarian hyperstimulation (COH) with purified follicle stimulating hormone (FSH). METHODS: We carried out case series and retrospective analysis of midfollicular serum LH concentrations and estradiol response patterns in COH cycles. All patients initially received gonadotropins containing purified FSH. Human menopausal gonadotropin containing LH was added to poor responders with low midfollicular LH concentrations. RESULTS: The addition of exogenous LH to the COH regimen significantly increased estradiol secretion in poor responders with low midfollicular endogenous LH concentrations. This was confirmed statistically by an average change in the slope of the estradiol patterns from 27.54 to 85.49 after the addition of exogenous LH. Furthermore, patients with midfollicular serum LH concentrations < 3.0 mIU/ml had significantly lower midfollicular and peak estradiol (E2) concentrations compared to patients with LH concentrations > or = 3.0 mIU/ml (352.3 and 2094.3 vs 855.6 and 3757.1 pg/ml, respectively). CONCLUSIONS: The addition of exogenous LH increases E2 response patterns in poor responders with low midfollicular serum LH concentrations. Low midfollicular serum LH concentrations are associated with significantly lower midfollicular and peak E2 concentrations
— id: 73608, year: 1999, vol: 16, page: 363, stat: Journal Article,

Outcome of pregnancies with true knots in the umbilical cord
Roshanfeker D; Blakemore K; Witter F
1999 ;93(4):41S-41S, Journal of Obstetrics & Gynaecology
— id: 73672, year: 1999, vol: 93, page: 41S, stat: Journal Article,

Station at onset of active phase in nulliparous patients and risk of cesarean delivery - In reply
Roshanfekr, D
1999 JUL ;94(1):161-161, Obstetrics & gynecology
— id: 73613, year: 1999, vol: 94, page: 161, stat: Journal Article,

Station at onset of active labor in nulliparous patients and risk of cesarean delivery
Roshanfekr, D; Blakemore, K J; Lee, J; Hueppchen, N A; Witter, F R
1999 Mar;93(3):329-331, Obstetrics & gynecology
OBJECTIVE: To determine whether term nulliparas with an unengaged vertex presentation at onset of active labor have a higher risk for cesarean delivery. METHODS: A retrospective cohort of 1250 randomly chosen nulliparous patients at 37-42 weeks' gestation who delivered between 1988 and 1989 were selected. Four hundred forty-seven patients were excluded because of nonvertex presentation, cesarean delivery before active phase of labor, multiple gestation, delivery at less than 37 weeks' or greater than 42 weeks' gestation, induction of labor, or missing charts. For the purpose of this study, active labor was defined as regular contractions with cervical dilatation of at least 3 cm. The station at onset of active labor was recorded. Engagement was considered to be at station 0 or below. RESULTS: Of the 803 patients in the study group, 567 presented unengaged and 236 patients presented engaged. The cesarean rates differed significantly between the two groups: 14% of those unengaged compared with 5% of those engaged (chi2 = 11.9, P < .001). After adjusting for confounding variables, engagement at the time of onset of active labor was associated with lower risk of cesarean delivery (odds ratio .512, 95% confidence interval .285, .922). CONCLUSION: Eighty-six percent of nulliparas with an unengaged vertex at onset of active labor delivered vaginally. Engaged vertex at the onset of active labor was associated with a lower risk of cesarean delivery
— id: 73609, year: 1999, vol: 93, page: 329, stat: Journal Article,

Twin-twin feal movement dysynchrony as a marker for fetal growth abnormalities
Hueppchen N; Martin S; Roshanfekr D; Blakemore K; DiPietro J; Bienstock J
1998 Feb;178:?-? #455, American journal of obstetrics & gynecology
— id: 73666, year: 1998, vol: 178, page: ?, stat: Journal Article,

Accuracy and intraobserver variability of simulated cervical dilatation and effacement measurements
Phelps JY; Lambrou N; Roshanfekr D
1998 Jul 1;5(4):185-185, Primary care update for ob/gyns
Objective: To assess the accuracy and intraobserver variability of clinical cervical diameter measurements among obstetric health care providers.Methods: Cervical dilatation and effacement simulators consisting of pelvic blocks composed of synthetic rubber were used for the study. The examiners had to rely solely on proprioception to determine dilatation and effacement.Results: A total of 828 simulated cervical diameter and effacement measurements were obtained from 69 different examiners. The overall accuracy for determining the exact diameter was 48.6%, which improved to 88.8% when an error of +/- 1 cm was allowed. Intraobserver variability for a given diameter measurement was 39.9%, which decreased to 14.0% when an error of +/- 1 cm was allowed. The overall accuracy for determining the exact effacement was 52.9%, which improved to 85.8% when an error of +/- 25% was allowed. Intraobserver variability for a given effacement measurement was 37.0%, which decreased to 7.3% when an error of +/- 25% was allowed.Conclusions: Cervical diameter and effacement measurements obtained by digital exam are precise when an error of +/- 1 cm in diameter and +/- 25% effacement is allowed. Intraobserver variability is > 35% and is an important consideration when evaluating dysfunctional labor
— id: 73607, year: 1998, vol: 5, page: 185, stat: Journal Article,

Comparison of computerized versus standard visual interpretation of antepartum fetal heart rate monitoring, a randomized prospective study
Roshanfekr D; Bracero L
1998 Feb;178:?-? #454, American journal of obstetrics & gynecology
— id: 73664, year: 1998, vol: 178, page: ?, stat: Journal Article,

Station at onset of active labor in nulliparous patients and risk of cesarean section
Roshanfekr D; Hueppchen N; Blakemore K; Witter F
1998 Feb;178:?-? #324, American journal of obstetrics & gynecology
— id: 73665, year: 1998, vol: 178, page: ?, stat: Journal Article,

Update on Tocolysis
Roshanfekr D; Nagey D
1998 ;18(14):?-? July, Postgraduate obstetrics & gynecology
— id: 73676, year: 1998, vol: 18, page: ?, stat: Journal Article,

Complete trisomy 9 in a term fetus: a case report
Roshanfekr, D; Dahl-Lyons, C; Pressman, E; Ural, S; Blakemore, K
1998 Sep-Oct;7(5):247-249, Journal of maternal-fetal medicine
Complete trisomy 9 was diagnosed in a 35-week fetus by amniocentesis. Several sonograms had revealed only a two-vessel cord and intrauterine growth restriction. No other abnormalities were noted. A stillborn infant was delivered at 37 weeks gestation after induction of labor
— id: 73610, year: 1998, vol: 7, page: 247, stat: Journal Article,