Washington University Department of OBGYN, Professor and Director, Division Ultrasound and Genetics, Dr. Anthony Odibo was highlighted in this months Record Magazine. The article discusses how he helps families by managing high-risk pregnancies and repairing defects through fetal surgery. http://news.wustl.edu/news/Pages/26004.aspx
Washington University Department of OBGYN is pleased to announce a digital handbook for women's healthcare providers: the WUSM OB GUIDE v1.0 is now available in the iTUNES app store: http://itunes.apple.com/us/app/wusm-ob-guide/id501198276?mt=8
This project is a collaborative effort across the WUSTL, WUSM system including members of the computer science department and WUSTL Student technology group on main campus. The goal is to replace the existing paper guidebook with an electronic product in order to take advantage of the exponential growth of mobile technology.
The cost of the app is $4.99. All proceeds from the application go towards updating and expanding the content within the application.
Please check it out: http://itunes.apple.com/us/app/wusm-ob-guide/id501198276?mt=8
Please provide a review and feeback. If you have any other ideas please do not hesitate to reach out individually to the co-creators: Anthony Shanks, MD Assistant Professor in OBGYN or Kenan Omurtag, MD Fellow, Reproductive Endocrinology and Infertility.
November 15, 2011
The Fertility and Sterility Journal publishes "The ART of Social networking: how SART member clinics are connecting with patients online" http://www.fertstert.org/article/S0015-0282(11)02667-7/fulltext; by Drs. Kenan Omurtag, Patricia Jimenez; Valerie Ratts, Randall Odem and Amber Cooper.
October 20, 2011
The March of Dimes recognized Sarah England, PhD, Professor of Obstetrics and Gynecology; Kelle Moley, MD, The James P. Crane Professor of Obstetrics and Gynecology and Vice Chair for Basic Research; and Indira Mysorekar, PhD, Assistant Professor of Obstetrics and Gynecology, at the St. Louis Signature Chefs Auction, held Oct. 20 at the Ritz-Carlton St. Louis.
Dr. England received the March of Dimes Prematurity Initiative Grant for her research on the changes that occur when a woman has a preterm birth. Dr. Moley is a March of Dimes grant recipient for her research to determine if changes in the maternal metabolism, which may occur before conception and during the time the oocyte or egg is preparing to ovulate, have long-term effects on the embryo, fetus and outcome of the offspring and Dr. Mysorekar received the Burroughs Welcome Preterm Birth Initiative Grant for her study of the biological mechanisms and causes of preterm birth.
See photo of (from l-r) Amanda Lewis, PhD; Sarah K. England, PhD; Julie England (Dr. England’s sister-in-law) and Joan K. Riley, PhD, at the March of Dimes auction. See also photo 22 of 69 featuring OB/GYN Center for Advanced Medicine Office Manager Teresa Bieg and OB/GYN Division of Clinical Research Office Manager Monica Anderson.
October 19, 2011
States with fertility treatment insurance coverage have fewer births
By Diane Duke Williams
Fourteen states now mandate partial or comprehensive health insurance coverage of fertility treatment. These mandates have resulted in more women using assisted reproductive technologies (ART).
Studies have shown that ART is associated with lower live birth rates and lower risk of multiple gestation pregnancies in states with mandated insurance coverage.
Emily Jungheim, MD, assistant professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis, is studying how insurance coverage and mandates influence ART practice patterns and outcomes.
Because of its location, the School of Medicine provides in vitro fertilization (IVF) services to a dichotomous patient population. Many patients from Illinois have mandated comprehensive IVF coverage through their employers, while most patients living in Missouri do not. This provides a unique research environment because few academic IVF centers with a large number of patients have access to this mix.
“We think it’s important to determine if insurance could be changing how doctors treat patients and how physicians talk to patients about their choices,” Jungheim says.
Staff Participates in Tread the Med.
September 29, 2011
A Walk in the Park. Members of Women's Reproductive Sciences Research Labs join Tread the Med: (from left-right), Ray Tsai, PhD, Postdoctoral Research, Reproductive Sciences T32 Training Program; Maggie Chi, Manager of the Molecular Reproductive Endocrinology Lab; and Paula Hampton, Executive Assistant to Kelle H. Moley, MD, Vice Chair for Basic Research in the Department of Obstetrics and Gynecology, were among the employees who participated in a walk and kickoff of the School of Medicine's Tread the Med at Hudlin Park on September 28. The goal of Tread the Med, sponsored by the School of Medicine's Wellness Committee, is to help employees incorporate more walking into their daily life. See story in the Record.
Silent infections may play a role in preterm birth
April 21, 2011
Every day, 1,500 babies in the United States are born too early, according to the March of Dimes. Even babies born just a few weeks too soon can face serious health problems and are at risk of lifelong disabilities, such as cerebral palsy, blindness and hearing loss.
“Preterm birth is a major health problem,” says Indira Mysorekar, PhD, assistant professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis. “Little is known about the mechanisms of birth, and even less is known about what causes preterm birth.”
Mysorekar is a recipient of a four-year grant from the Burroughs Wellcome Fund. The grant is one of five nationwide that will explore the biological mechanisms and causes of preterm birth.
Mysorekar and a team of researchers at the School of Medicine are studying asymptomatic infections in the placenta and uterine lining to see if they may play a role in preterm birth.
Specifically, the scientists are looking for new mechanisms by which microorganisms are harbored in these tissues and potentially induce women to deliver babies before 37 weeks.
Mysorekar, who studies recurrent urinary tract infections (UTIs), has determined that bacteria hiding in the bladder lining can cause recurrent UTIs.
She will bring her expertise on the urinary tract to bear on similar issues in the placenta and uterine lining.
“I decided to see if bacteria during pregnancy could act in a related way and trigger preterm birth,” Mysorekar says.
Mysorekar will be working with a team of other experts on this initiative, including George Macones, MD, the Mitchell and Elaine Yanow Professor and chair of the Department of Obstetrics and Gynecology, an expert in the prediction and prevention of preterm birth; D. Michael Nelson, MD, PhD, the Virginia Lang Professor of Obstetrics and Gynecology, who researches how human placental dysfunction contributes to abnormal pregnancy outcomes; Herbert “Skip” Virgin, MD, PhD, the Mallinckrodt Professor and chair of the Department of Pathology and Immunology, who directs a Center for Pathogen Discovery to identify new pathogens.
“Preterm birth is the most pressing issue in perinatal medicine, and we have made little progress over the past 20 years in understanding its etiology,” Macones says. “Indira Mysorekar brings a fresh perspective and brilliant mind to this issue, and I think this research will be a major contribution.”
Others involved in the project include Jenifer Allsworth, PhD, assistant professor in obstetrics and gynecology, who studies the epidemiology of bacterial vaginosis and its association with preterm birth; David Hunstad, PhD, assistant professor of pediatrics and of molecular microbiology, an expert on how some bacteria modulate elements of host immunity using both in vivo and in vitro models of infection; and Jeffrey Henderson, MD, PhD, assistant professor of medicine, of molecular microbiology, who uses mass spectrometry in the Center for Women’s Infectious Disease Research to identify pathogen-associated secondary metabolites in patient samples.
Three faculty receive Children’s Discovery Institute grants
January 19, 2011
The Children’s Discovery Institute is a partnership between Washington University School of Medicine and St. Louis Children’s Hospital to accelerate better treatments, cures and preventions for childhood diseases.
Todd Druley, MD, PhD, received a CDI Faculty Scholar Award for his research into the genetic basis of a fast-growing cancer of the white blood cells called high-risk acute lymphoblastic leukemia (ALL) that primarily affects teenagers .
Through his work in the Center for Genome Sciences and Systems Biology, Druley developed a method in 2009 for surveying many genes in a pool of DNA from more than 1,000 people using next-generation sequencing. This work was published in Nature Methods. Now, he is applying that method to children with high-risk ALL looking for genetic mutations that may be behind the cancer.
“It is unlikely that there will be one or two mutations in DNA that cause children to get ALL,” he says. “We predict that there will be a lot of different mutations in a lot of different genes that have little consequence individually, but can have a synergistic effect that results in a serious problem.”
By targeting genes already identified from genome-wide arrays done on children with high-risk ALL, Druley will study several hundred genes in about 450 DNA samples from children enrolled in nationwide high-risk ALL trials.
High-risk leukemia affects about one in 100,000 children, but unlike standard-risk ALL, is curable only about 65 percent to 75 percent of the time. Unfortunately, physicians haven’t made much progress in treating the disease with chemotherapy, so many patients require bone marrow transplants, which can be difficult physically and emotionally for these teens.
“We hope to understand how high-risk ALL is coming about in the first place so we can design more effective treatments,” says Druley, an assistant professor of pediatrics and of genetics at the School of Medicine who also treats patients at St. Louis Children’s Hospital.
Druley began the work as a postdoctoral researcher in the Washington University lab of Robi Mitra, PhD, assistant professor of genetics, in the Center for Genome Sciences and will continue the work with the CDI grant through at least 2013.
Kelle Moley, MD, has received a grant from the Children’s Discovery Institute to facilitate research among Washington University researchers on pregnancy, maternal-fetal interaction and pediatric diseases.
The project, the Women and Infants Health Specimen Consortium (WIHSC), will collect tissue samples such as cord blood and amniotic fluid from mothers and their infants and link them with a clinical database. Participants will be recruited from the Washington University Reproductive Endocrinology and Infertility Clinic and the Center for Advanced Medicine. This project is unique, Moley says, because individual mother-infant pairs will be followed before, during and after pregnancy.
“Washington University has many researchers who study women and infants’ health, disease, fertility, pregnancy and the neonatal period,” says Moley, the James P. Crane Professor of Obstetrics and Gynecology. “The pooling of resources could lead to increased access to a collection of specimens from pregnant and nonpregnant women, which would undoubtedly help facilitate research.”
Samples collected through the WIHSC will be available to School of Medicine investigators to study areas such as fetal and developmental origins of childhood diseases; the interaction and communication between the fetus and mother in utero; and to possibly identify biomarkers that predict poor pregnancy and poor infant outcomes, such as miscarriage and pre-term births.
“This consortium has the potential to become a vital source of tissue and patient data, from both mother and child, needed to accelerate new pathways to discovery in childhood disease,” Moley says.
Ann Gronowski, PhD, associate professor of pathology and immunology, and Marwan Shinawi, MD, assistant professor of pediatrics, are co-principal investigators of the WIHSC.
Sheila Stewart, PhD, received a grant to expand a library of molecular tools that can selectively turn off every gene in the mouse genome.
Called an shRNA library, it is a resource that allows researchers to “knock down” or deplete a gene of interest. By turning off a gene and observing the consequences, scientists can gain insight into that gene’s role in the biological process. This library will provide the Washington University research community with the tools to study human disease in a mouse model at a much lower cost.
Deleting or inserting a gene and observing the consequences is not a new research technique. While this technology has changed the way researchers ask important questions, standard methods can be cumbersome, time-consuming and expensive. An shRNA library, however, takes advantage of RNA interference (RNAi), a more recently discovered mechanism for turning off the expression of genes. Normally, a gene codes a strand of messenger RNA, which then codes for a protein. Traditionally, scientists would remove the gene, eliminating its messenger RNA and the resulting protein. With RNA interference, instead of going through the difficult process of removing the gene, scientists use shRNA strands that interfere with the messenger RNA and prevent it from creating the protein.
“Because of the way we created this system, we can introduce our RNAi construct to any kind of cell,” Stewart says. “This approach uses the RNAi machinery that is naturally in cells to take out the gene we tell it to. Once there is none of that gene’s protein left, we can look at the function of the protein in the context of the disease we’re studying. Did removing the protein make the disease better or worse or change anything?”
Elaine Mardis, PhD, co-director of The Genome Center and director of technology development, and David Piwnica-Worms, MD, PhD, professor of developmental biology and of radiology, are collaborating with Stewart on the CDI grant.
Researchers at The Genome Center, led by Mardis, also associate professor of genetics and of molecular microbiology, are making DNA that is usable for researchers studying disease, and Stewart's group is turning it into an infectious virus that can be used to screen for genes that impact a wide variety of human diseases.
It’s very expensive to make usable DNA and introduce it into a cell, Stewart says, but by turning it into an infectious virus, researchers can get it into almost all cells. These libraries represent an opportunity for WUSTL researchers to study any type of cell, especially those most relevant to the disease a researcher is interested in, Stewart says.
Stewart’s lab is also training other researchers on how to use the library. Earlier, Stewart received a CDI grant to expand the human genome library.
Caring for moms in crisis
July 13, 2010
By Diane Duke Williams
George Macones, MD (left), and Molly Henson, a nurse in obstetrics and gynecology, review a patient's sonogram in the Ob/Gyn Clinic at the Center for Advanced Medicine. “He has a terrific vision for our ob/gyn department,” says Jeff Peipert, MD, the Robert J. Terry Professor of Obstetrics, who trained Macones at Pennsylvania Hospital. “He simply wants us to be the best. He wants us to have the best residency training program, the best clinical research program, the best basic research program and to provide the best patient care."
When George Macones, MD, was a resident at Pennsylvania Hospital, his 25-year-old patient died of a blood clot two days after delivering a healthy baby girl by cesarean section.
“She got sicker and sicker after delivery, and multiple people were trying to figure out why she wasn’t getting better,” says Macones, WUSTL's Mitchell and Elaine Yanow Professor and head of the Department of Obstetrics and Gynecology. “I was in her room when she died.”
This patient’s death made Macones want to understand how to care for extremely sick pregnant women.
He now cares for women who have had previous complicated pregnancies, have lost a fetus during pregnancy or are carrying twins or triplets. He also sees patients with pre-existing medical conditions such as high blood pressure or lupus.
Additionally, Macones is internationally renowned for his research on the safety of vaginal birth after cesarean (VBAC) and has published new guidelines on monitoring fetuses during labor.
His clinical and research skills are just two of the attributes faculty in his department mention when they’re describing Macones, who joined Washington University from the University of Pennsylvania in 2005. They also herald his leadership, citing his foresight, willingness to make tough decisions and zeal for administrative duties.
“He has a terrific vision for our ob/gyn department,” says Jeff Peipert, MD, the Robert J. Terry Professor of Obstetrics, who trained Macones at Pennsylvania Hospital. “He simply wants us to be the best. He wants us to have the best residency training program, the best clinical research program, the best basic research program and to provide the best patient care. I can’t believe he was my junior resident!”
David Mutch, MD, the Ira C. and Judith Gall Professor of Obstetrics and Gynecology, says that Macones is thoughtful, nonjudgmental and sees the good in everyone. “And he is keenly committed to the academic mission of patient care, teaching and research,” Mutch says.
The son of a judge and a nurse, Macones grew up in Philadelphia. He wasn’t interested in science until high school, but his mother encouraged him to pursue medicine as a career.
He had no interest in obstetrics and gynecology until his third-year clinical rotation in the specialty during medical school at Jefferson Medical College in Philadelphia.
“I then knew there was nothing else for me,” says Macones, who also serves as chief of obstetrics and gynecology at Barnes-Jewish Hospital. “I fell in love with the labor floor and thought pregnancy was very interesting.”
After earning his medical degree in 1988, Macones completed a fellowship in maternal-fetal medicine at Jefferson Medical College in 1994 and earned a master of science degree in clinical epidemiology from the University of Pennsylvania in 1996.
Macones was in the first generation of maternal/fetal specialists to conduct clinical research on obstetrical practices that had been in use for decades. These practices range from fetal monitoring to labor induction to methods to prevent preterm birth.
Allowing a woman to try to give birth vaginally after cesarean, commonly called VBAC, gained widespread acceptance in the 1980s. But according to Macones, a mix of concerns about the possibility of the previous uterine incision breaking open, patient preferences and fear of liability, among other factors, has caused a shift. Currently, more and more hospitals do not allow women to try to give birth vaginally after a previous C-section.
“It’s a complex and concerning trend,” he says. “Research clearly shows that a woman’s health risk increases progressively with each repeat cesarean delivery. The effect on maternal health can be profound.”
Macones conducted one of two large observational studies in the United States in the past decade that have looked at the efficacy and safety of allowing a women to try to give birth vaginally after a prior C-section. In the study Macones led, which reviewed the records of approximately 25,000 women, the rates of the previous uterine incision breaking open were less than 1 percent.
“The rates are quite low and are comparable to, if not lower than, the complication rates of most other obstetrical procedures we perform on a daily basis,” Macones says. “It’s important to share this data with patients.”
This year, he served on an expert panel convened by the National Institutes of Health that affirmed that allowing women to try to give birth vaginally after a prior C-section is a reasonable option. The panel also recommended that current VBAC guidelines be reconsidered and more research conducted.
Helping drive change
In the early 1970s, electronic fetal monitoring during labor and delivery was introduced to keep an eye on the fetus and intervene surgically if necessary. The monitors continually measure the fetal heart rate and produce tracings on a screen and paper that can let a doctor know if a baby is doing poorly during labor.
Today, more than 85 percent of the 4 million babies born alive in the United States annually are monitored electronically, but there is ongoing controversy about whether the practice does more harm than good.
“The technology got rolled out before we knew if it worked or not,” Macones says.
Macones published new guidelines in 2009 to provide more consistency on how doctors should decide when to intervene and when to let the mother deliver naturally.
Previous guidelines divided readings into two categories — reassuring and nonreassuring. Because of the threat of liability, many babies with nonreassuring readings who might have been OK after a vaginal delivery are being delivered surgically or with forceps, according to Macones.
The Macones family: (From right) George Macones, MD, and sons Cameron and Colin visit the Jefferson National Expansion Memorial and the Gateway Arch in St. Louis. Daughter Caroline is not pictured.
The new guidelines divide monitor readings into three new categories and recommend more specific actions. In particular, physicians will closely monitor the baby’s heart rate, and if it becomes abnormal, they can look at other factors, such as the mother’s blood pressure and heart rate and how fast labor is progressing. A doctor might give the mother oxygen or treat her low blood pressure. If these efforts do not improve the baby’s heart rate, the new guidelines call for immediate delivery.
“Our hope is that these new guidelines will help all health-care providers ‘speak the same language’ and also move forward a research agenda,” Macones says.
Macones’ clinical research also has earned him the respect of peers at other academic medical centers.
Haywood Brown, MD, the Roy T. Parker Professor and chair of the Department of Obsetrics and Gynecology at Duke University Medical Center, calls Macones a respected national leader in the field of obstetrics and gynecology.
“He is an outstanding clinician, researcher, educator and mentor and exemplifies the definition of an academic physician,” he says.
At the School of Medicine, Kelle Moley, MD, the James P. Crane Professor of Obstetrics and Gynecology, says Macones has taken the department to a new level in the past five years. “There are so many good things I could say about George,” she says. “He brought very strong faculty with him and recruited the best and brightest residents, in addition to taking an active role in the development of junior faculty. He’s a role model for all of us.”
Facts about George Macones, MD
Education: BA in biology, University of Pennsylvania, 1984; MD, Jefferson Medical College, 1988; MSCE, University of Pennsylvania, 1996.
Family: Daughter Caroline, 18, psychology student at the University of Utah; son Colin, 14, student at Mary Institute and Saint Louis Country Day School; son Cameron, 11, student at Rohan Woods School.
Supports opera: Some of his favorites are Rusalka by Dvorak, La Sonnambula by Bellini and Semiramide by Rossini.
Enjoys hitting the links: “I’m an avid and perhaps overly competitive golfer.”
Camps throughout Missouri and Illinois: “It’s great one-on-one time with my boys. I actually never camped until my boys got into Boy Scouts.”