Center for Abnormal Placentation

Center for Abnormal P lacentation

2HackensackUMCCenter for Abnormal Placentation (CAP)


A Message from the Director

AbdullA Al-KhAn, M.d., F.A.C.S., F.A.C.O.G. Director, Center for Abnormal PlacentationSection Chief, Maternal Fetal Medicine and Surgery

I am pleased to introduce the Center for Abnormal Placentation (CAP), the first

center in the nation dedicated to the diagnosis, management and research of placental

pathology.

Our team of medical experts employs a multidisciplinary approach to the comprehensive

management of placenta accreta, a major cause of obstetric hemorrhage and maternal

mortality. In the pursuit of excellence, we strive to deliver the highest quality care, with a

proven track record of success.

We at CAP have entered into unchartered territory, embarking upon innovative initiatives to

ensure the best care for our patients. We work closely with our renowned scientists, who

continue to shape the future of research in obstetrics and gynecology through their national

Institutes of health (nIh) grant-funded projects.

CAP is a sanctuary for women with placental abnormalities, as well as for their obstetricians,

who already recognize the significant advantages of co-managing or transferring their

patients’ care to such a unique, specialized program. hackensackuMC has set the standard

for comprehensive abnormal placentation care nationally and internationally.

We welcome the opportunity to collaborate with you and your patients.

Sincerely,

A SurgicAl PreciSionAccreta surgery at CAP goes beyond traditional approaches.

Innovative procedures developed by our surgeons are utilized to

maximize excellent outcomes.



“ There are no incurable diseases — only the lack of will” Ibn Sina (Ad 980 - 1037)

The Center for Abnormal Placentation at hackensackuMC is the first established center in the nation to specialize in the diagnosis and surgical management of placenta accreta. Our team of medical experts is dedicated to the well-being of the mother and baby.

Given the significant increase in cesarean deliveries each year, which directly

contributes to problems with placental formation in subsequent pregnancies, the

incidence of placenta accreta will continue to rise, as will morbidity and mortality

rates for pregnant women. hackensackuMC has the largest volume of deliveries

as a single institution in the tri-state area (in excess of 6,300 births in 2011). We

have become an active referral center for mothers with special needs.

Mission and Vision

CAP provides much-needed comprehensive services to women who currently

have few alternatives for expert care. This innovative program has been developed

and designed to serve as a template for regional, national and international

institutions. We extend our services to collaborate with obstetricians to ensure

high-quality care and services for the patient.

center for AbnormAl PlAcentAtion


What is Placenta Accreta?

during a typical pregnancy, the placenta attaches itself to the lining of the uterus. In some cases

(about one in every 2,500), the placenta invades the uterine wall. This condition is known as

placenta accreta and is classified into three categories, depending on the severity of attachment.

The term “placenta accreta” technically refers to a superficial (less than 50 percent) invasion of the

uterine wall. If the placenta invades deeper than 50 percent, it is a placenta increta;

if the placenta fully invades the uterine wall and attaches itself to other pelvic organs like the

bladder or bowel, it is called a placenta percreta. In fact, one out of 533 repeat cesarean sections

results in an accreta. This sobering number was published by the American Journal of Obstetrics

and Gynecology in 2005 after a 20-year analysis.

Placenta accreta is one of the leading causes of maternal death in the united States. What

exactly makes the condition so dire? When a placenta accreta forms, it triggers a process known

as neovascularization, which is the excessive formation of new blood vessels around the affected

area. We at hackensackuMC were the first to describe this phenomenon.

These extra blood vessels can cause a woman to hemorrhage uncontrollably when her baby is

delivered and the doctor attempts to remove the placenta. The bleeding that can occur during

accreta surgeries is similar to that of cancer surgeries and is totally different from any other kind

of obstetrical bleeding, so even the most talented doctors are often unprepared to deal with it.

What Are The Risk Factors?

Surgical procedures that disrupt the integrity of the uterus, including cesarean section, dilation

and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta.

According to a study in The Journal of Maternal-Fetal and Neonatal Medicine, if primary and

secondary cesarean rates continue to rise, by 2020 the cesarean delivery rate will be 56.2 percent,

and there will be an additional 6,236 placenta previas, 4,504 placenta accretas, and 130 maternal

deaths annually. The rise in these complications will lag behind the rise in cesareans by

approximately six years.


We GO beyOnd TrAdITIOnAl ThInKInG

whAt we doIn the history of medical practice, we have never known so much about the human

body or had so much power to heal. Our challenge is to rethink the way we deliver

care so that our patients always benefit from the latest in medical discovery.



How Is Placenta Accreta Diagnosed?

When a placenta accreta is suspected, we immediately conduct tests, such as ultrasounds

with doppler studies, magnetic resonance imaging (MrIs), and occasionally computerized axial

tomography (CT) scans to determine how far the placenta has invaded.

Are There Risks For The Baby?

There’s usually very little risk to the baby. At 32 weeks we can prepare a baby for preterm birth.

The neonatal physicians’ expertise at the Joseph M. Sanzari Children’s hospital allows for the skilled

and safe handling of babies. In fact, all of our accreta babies have done very well to date. Of course,

the mother’s care has to be very carefully managed, since the neovascularization usually gets worse

as the pregnancy progresses. delivering early, between 32 and 34 weeks, is almost always in the

mother’s best interest.

What Is Involved In Surgical Management?

At hackensackuMC, our team has found that the best maternal outcomes occur when severe

accreta surgeries are done in three stages (for patients with extensive disease, i.e., percreta). First,

the baby is delivered via cesarean section—but unlike traditional cesareans, the placenta is left

behind. Two to four days later, a vascular surgeon performs an embolization to attempt to occlude

the extra blood vessels angiographically. This minimizes the risk of hemorrhage when the placenta

is eventually removed. The mother then waits 12 to 14 days for the blood vessels to shrink, at which

point the surgical team does one final operation to evacuate the placenta. A hysterectomy is usually

performed during this surgery, since that is the definitive therapy.

It takes a multidisciplinary team to treat placenta accreta. When we perform accreta surgeries, we

always have a urologist (in many cases the bladder is involved), a vascular surgeon and a plastic

surgeon standing by along with a skilled anesthesiologist capable of aggressively resuscitating the

mother if necessary, and an incredible nursing and operating room staff. Although it may be hard to

imagine, all of these surgeries followed by a hysterectomy are a desirable result. When we consider

the very real life-threatening potential of placenta accreta, it is a victory for a patient to simply

recover and go home to her family and newborn baby. Our excellent nursing staff prepares these

vulnerable patients socially and psychologically for their upcoming staged surgeries.

What is Involved in the Program at CAP?

being diagnosed with placenta accreta can be terrifying, which is why it is important to be treated

by the most experienced doctors available. We are treating an average of 12 to 16 accreta cases

annually, which is perhaps the highest volume of cases across the country, all with excellent

outcomes. Since accreta patients often have several large incisions, a plastic surgeon often performs

the closure. Women also receive extensive presurgical counseling and comprehensive after-care at

hackensackuMC. Our pain management team is highly experienced in this area and many of

our patient counselors are former accreta patients.

diAgnoSiS & treAtment

how we do it

We don’t just keep up with the state-of-the-art in

technology and treatment. Thanks to the research

and clinical trials that we conduct at the david and

Alice Jurist Institute for research, we push ahead,

perfecting new procedures, new protocols and new

devices that create better outcomes for our patients.



The research division is focused on building CAP as the site of major translational efforts within the department of Obstetrics and Gynecology. This involves several research ventures, the most important of which are the program to investigate placenta accreta-related pathologies and a program examining the effects of hypoxia (low oxygen) on fetal growth.

Placenta Accreta-Related Pathologies:

The accreta-related pathologies are pregnancy problems in which the trophoblast cells of the

placenta invade deeper into the uterus than in normal pregnancy, sometimes even breaching the

uterine barrier. The incidence of these pathologies is increasing steeply in the united States, due

in part to aggressive surgical interventions involving the uterus. As a result, hemorrhage-related

deaths are also on the rise. beyond the potentially disastrous consequences of this problem are the

significant costs of treatment, averaging more than $450,000 per case. There is no consensus on

protocols for patient care and almost no basic science efforts have been made to understand the

pathophysiology and thereby develop treatment or prevention modalities. CAP is moving forward

aggressively with a three-pronged research approach:

Retrospective study of all accreta cases over a ten-year period to evaluate whether CAP has

improved maternal outcomes, which has proven to be true. In addition, develop a staging

system, which will be predictive of surgical complications and maternal morbidity in the future.

In order to test how well the staging system works, all future cases will be evaluated and

assigned a stage.

Collaboration with physicians at Oxford University in england (the John radcliffe hospital)

to develop a 3-d imaging technique that will allow us to model the blood vessels within the

placenta. This will assist in predicting the site of the greatest risk of hemorrhage prior to surgery.

We will also be able to determine how deeply the placenta has invaded into the uterus,

to date - can only be determined after surgery. It is crucial to determine the severity of the

disease, because the perinatologist needs to prepare the patient’s course of treatment well

ahead of surgery.

Integrated physiological approach (molecular through bedside) to develop knowledge of the

causes of abnormal placentation, to investigate the mechanisms of trophoblast “over-invasion,”

and to eventually develop therapies for the prevention of abnormal placentation in high-risk

women (placenta previa and prior uterine scarring due to cesarean delivery, d & C,

myomectomy, etc.).

cAP reSeArch diviSion

The most important research project being undertaken by the team of physicians and basic

scientists at CAP is the investigation of placenta accreta-related pathologies. The illustration

below shows the relationship between the placenta and the uterus in a normal pregnancy and in

accreta-related pathologies. In a normal pregnancy, cells from the placenta called trophoblasts invade

into the decidual layer of the uterus (1). This invasion

anchors the placenta to the uterus and brings the

mother’s blood close to the fetal circulation. The

invading placental cells travel far enough into the

uterus to allow these actions, but usually no further.

Placenta accreta (2) and its more extreme variants,

placenta increta and percreta (3 and 4), occur when

there is excessive trophoblast invasion past the

decidual layer into the muscular layer of the uterus

(the myometrium), or in percreta cases up to and

even through the uterine wall.

With all forms of placenta accreta, there is an

increased risk of hemorrhage at delivery. Typically,

in placenta percreta there can be major uterine damage as well as increased risk of invasion and

damage to the bladder, bowel and other structures in the abdominal cavity. even with early diagnosis

and expert clinical care, placenta increta and percreta result in significant blood loss, hysterectomy

and frequently intricate surgical procedures to repair the damage produced by invasion of the

placenta into the pelvis.

At CAP we are undertaking a number of projects designed to explore accreta-related pathologies.

We are developing a classification system tied to tissue pathology. This will allow clinicians and

scientists to compare and communicate findings in a standardized manner. We are developing

ultrasound tools that will help obstetricians not only identify these problems early in pregnancy,

but also allow them to predict the course of the disease. We are investigating the basic mechanisms

that control placental invasion in accreta-related pathologies for the purpose of finding new

therapies, which can prevent or limit these problems.

As a referral center for these pathologies, CAP is ideally positioned to carry out

research on this growing problem. Just as importantly, we are able to deliver clinical

care informed by frontline research.


CAP scientists have two national Institutes of health (nIh)-funded grants

from the eunice Kennedy Shriver national Institute of Child health and

human development.

The first project, “Evolved Placental Response to Hypoxia,” is a study of placental

dnA from various populations around the world subjected to hypoxic stress

(pregnant women living at high altitude). It is designed to identify novel gene

variants (mutations or polymorphisms) that evolution has favored and which

may protect the fetus and placenta from the adverse effects of hypoxia. It could

reveal targets for therapy in fetal growth restriction and pre-eclampsia, two

of the most common and costly complications of pregnancy.

The second project, “A Murine Model for Placental Metabolic Reprogramming,”

involves the development of a mouse model that will allow placenta-specific up-or

down-regulation of genes of interest at specific time periods in pregnancy. being

able to manipulate genes within the placenta without affecting the fetus is an important step forward

in placental science. The project is designed to test mechanisms we have already identified in human

pregnancies under conditions of chronic (altitude-induced) hypoxia that preserve fetal oxygen

supply, but can lead to reduced fetal growth. This unique model will also allow testing of how

and whether specific genes, identified in the accreta-related pathologies studies, contribute to

over-invasion of the placenta. It will permit the testing of novel genes/polymorphisms discovered in

the evolved hypoxia response project in order to learn how they affect placental development or

function to protect the fetus from lack of oxygen.

hyPoxiA & fetAl growth



Graph A shows a suspicious doppler blood flow pattern

(red = blood moving away from the probe, blue = blood

coming towards the probe). notice how much blood is

very close to the bladder in A. When surgery is performed

(b), we can see large dilated blood vessels on the lower

part of the uterus.

how iS PlAcentA AccretA diAgnoSed?

Accreta

Est

imate

d b

loo

d lo

ss (

liters

)

Increta Percreta

* *

*Statistically lower after CAP

BLOOD LOSS DURING SURGERY

DECREASED AFTER CAP

THE PERCENTAGE OF PATIENTS WHO

WERE ADMITTED TO THE INTENSIVE

CARE UNIT (ICU) SIGNIFICANTLY

DECREASED AFTER THE INITIATION

OF CAP

CASES OF ACCRETA TREATED PER YEAR -

INCLUDES ONLY CASES CONFIRMED BY PATHOLOGICAL

EXAMINATION OF PLACENTA, TOTAL = 76

1

0

2

3

Accreta

Pre-CAP After CAP

Pre-CAP After CAP

Pre-CAP After CAP

Un

its

of

blo

od

tra

nsf

use

d

Increta Percreta

* *

*Statistically lower after CAP p<0.05

TOTAL UNITS OF BLOOD TRANSFUSED PER

CASE DECREASED AFTER CAP

0

10

8

6

4

2

All patients

ICU

Ad

mis

sio

ns

(% o

f p

ati

en

ts)

Percreta

* *


25

0

50

75

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

5

0

10

15

A b


We also use MrIs to evaluate the severity of disease

(C, d, e). This will sometimes permit us to detect

whether or not the placenta has gone through the

wall of the uterus (percreta) and invaded other

organs in the abdomen. In the case shown here,

which the CAP team doctors considered very

high-risk for placenta percreta, the placenta had

invaded to within 1/16th inch of the uterine wall,

and was therefore considered a deep increta.

Accreta

Est

imate

d b

loo

d lo

ss (

liters

)

Increta Percreta

* *

*Statistically lower after CAP

BLOOD LOSS DURING SURGERY

DECREASED AFTER CAP

THE PERCENTAGE OF PATIENTS WHO

WERE ADMITTED TO THE INTENSIVE

CARE UNIT (ICU) SIGNIFICANTLY

DECREASED AFTER THE INITIATION

OF CAP

CASES OF ACCRETA TREATED PER YEAR -

INCLUDES ONLY CASES CONFIRMED BY PATHOLOGICAL

EXAMINATION OF PLACENTA, TOTAL = 76

1

0

2

3

Accreta

Pre-CAP After CAP

Pre-CAP After CAP

Pre-CAP After CAP

Un

its

of

blo

od

tra

nsf

use

d

Increta Percreta

* *


TOTAL UNITS OF BLOOD TRANSFUSED PER

CASE DECREASED AFTER CAP

0

10

8

6

4

2

All patients

ICU

Ad

mis

sio

ns

(% o

f p

ati

en

ts)

Percreta

* *


25

0

50

75

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

5

0

10

15

d

Focal myometrial interruptions

Normal 3-layer

myometrial

C

Placenta previa Cervix

(External Os)

e

Bladder wall irregularity

The numbers make a difference. According to Abdulla Al-Khan, M.d., Section Chief of

the division of Maternal Fetal Medicine and Surgery, there were more than 6,300 births at

hackensackuMC, the most in new Jersey. As a result, dr. Al-Khan and his colleagues

see more surgical and medical complications in the course of treating these patients than

most other physicians, and they have developed a deep and sympathetic understanding

of the difficult decisions that young families face.

Jenny’s story

Jenny Stambolus learned that she was diagnosed with placenta percreta.

“not that long ago I sat opposite a series of doctors who offered me little

hope. That is such a difficult position - to be holding life in your womb with

the knowledge that death is such a real possibility,” says Jenny.

All of this changed when Jenny began to receive treatments under the

care of dr. Al-Khan at the Center for Abnormal Placentation.

“This was a very emotional time for her,” says dr. Al-Khan. “because it is so

powerful, the impact of modern medicine goes far beyond the physiological.

It touches on a host of very sensitive social, ethical and religious issues.”

“dr. Al-Khan was the one bright spot in those months of dreadfulness.

A beacon of hope, strength and positive thoughts,” says Jenny.

dr. Al-Khan is an expert in the diagnosis and surgical management

of placenta accreta, with a proven record of all positive

outcomes and no mortalities. “I chose women’s health

because it is all about the next generation,” dr. Al-Khan says.

“It is only by providing good healthcare for mothers

that we can hope for a better future.”


The Center for Abnormal Placentation (CAP) has been established under the leadership of

dr. Abdulla Al-Khan, section chief of the division of Maternal Fetal Medicine and Surgery.

the cAP teAm

Maternal Fetal Medicine & Surgery Abdulla Al-Khan, M.D. Director, Center for Abnormal Placentation Section Chief Maternal Fetal Medicine & Surgery

Manuel Alvarez, M.D. Chairman, Dept. of Obstetrics, Gynecology and Reproductive Science

Research Scientists Stacy Zamudio, Ph.D. Senior Scientist

Nicholas P. Illsley, Ph.D. Senior Scientist

Maternal Fetal MRI Adam Bogomol, M.D. Department of Radiology

Senior Sonographer Leigh Pappas, RDMS

High Risk Nurse Manager Kathleen Cocozzo, RNC

Nurse Coordinator Magdalena Pawlik, APN

Main Operating Room Coordinator Mary Ann Villanella, RNC

Labor & Delivery Coordinators Anne Patrick, RNC Laurie Hansen, RNC

Anesthesiology Mark D. Schlesinger, M.D. Chairman, Dept. of Anesthesiology

Urologic Surgery Gregory Lovallo, M.D.

Vascular Surgery Gregory Simonian, M.D. Director, Endovascular Surgery

Plastic & Reconstructive Surgery Hakan Usal, M.D.

Trauma-Critical Care Sanjeev Kaul, M.D. Assistant Director, Trauma/Critical Care & Injury Prevention Section

Neonatology Michael Giuliano, M.D. Director, Neonatal Intensive Care Unit

Pathology Ciaran Mannion, M.D. Chairman, Dept. of Pathology

Bioethics Linda Farber Post, JD, MA, BSN

Program Administrator Kate Raines, MSN, APN-C

Clinical Social Worker Marisa Hamilton, LCSW


OUR RECENT PUBLICATIONS

Aboujaoude r, Alvarez Jr, Alvarez M, Al-Khan A. “Management of missed abortion in a patient with congenital uterine

anomalies.” Archives of Gynecology & Obstetrics. 2007 Feb;275(2):137-9.

Aboujaoude r, Alvarez J, Alvarez M, Al Khan A. “Acute myelogenous leukemia mimicking a hemolysis, elevated liver

enzymes, and low platelets syndrome during pregnancy: case report and review of the literature.” American

Journal of Perinatology. 2007 Jan;24(1):1-4.

Aboujaoude r, Alvarez Jr, Alvarez M, Al-Khan A. “Follicular dendritic cell sarcoma in pregnancy: case report and

review of the literature” American Journal of Perinatology. 2006 nov;23(8):459-61.

Aboujaoude r, Maloof P,Alvarez M, Al Khan A. “A novel method for laparoscopic abdominal cerclage utilizing

minimally invasive hydrodissection: a case report.” Journal of Reproductive Medicine. 2007 May;52(5):428-30.

Aboujaoude r, Alvarez J, Alvarez M, Al-Khan A. “Pregnancy-induced bone marrow aplasia mimicking idiopathic

thrombocytopenia: a case report.” Journal of Reproductive Medicine. 2007 Jun;52(6):526-8.

Al-Khan A. et al. “IFPA Meeting 2010 Workshops report II: Placental pathology.” Placenta, 32 Suppl 2:S90-9 (2011)

Al-Khan A, Jones r, Fricchione d, Apuzzio J. “Intravenous methotrexate for treatment of interstitial pregnancy: a case

report.” Journal of Reproductive Medicine.2004 Feb;49(2):121-2.

Al-Khan A, Caligiuri A, Apuzzio J. “Parvovirus b-19 infection during pregnancy.” Infectious Diseases in Obstetrics &

Gynecology” 2003;11(3):175-9.

Al-Khan A, Colon J, Palta V, bardeguez A. “Assisted reproductive technology for men and women infected with

human immunodeficiency virus type 1.” Clinical Infectious Diseases. 2003 Jan 15;36(2):195-200.

Al-Khan, A, Gupta V, Illsley NP, Mannion C, Koenig C, Bogomol A, Alvarez M and Zamudio S. “Outcomes after

institution of team-managed care of placenta accreta.” Obstetrics and Gynecology (under review).

Al-Khan A, Shah M, Altabban M, Kaul S, Dyer KY, Alvarez M, Saber S. “ Measurement of intraabdominal pressure in

pregnant women at term.” Journal of Reproductive Medicine. 2011 Jan-Feb;56(1-2):53-7.

Alvarez Jr, Al-Khan A, Apuzzio JJ. “Malaria in pregnancy.” Infectious Diseases in Obstetrics & Gynecology. 2005

dec;13(4):229-36.

Alvarez JA, Al-Khan A, Ganesh V, Apuzzio JJ. “Salmonella as a causative organism of acute pyelonephritis during

pregnancy.” American Journal of Obstetrics & Gynecology. 2004 May;190(5):1482-3.

Apuzzio J, Ganesh V, Iffy l, Al-Khan A. “Varicella vaccination during early pregnancy: a cause of in utero miliary fetal

tissue calcifications and hydrops?” Infectious Diseases in Obstetrics & Gynecology.2002;10(3):159-60.

Apuzzio J, Chan y, Al-Khan A, Illsley NP, Kim Pl and Vonhaggen S. “Second-trimester amniotic fluid interleukin-10

concentration predicts preterm delivery.” Journal of Maternal-Fetal and Neonatal Medicine. 15:313-7 (2004).

baumann Mu, Zamudio S and Illsley NP. “hypoxic upregulation of glucose transporters in beWo choriocarcinoma cells

is mediated by hypoxia-inducible factor-1.” American Journal of Physiology - Cell Physiology, 293:C477-485 (2007).


baumann Mu, Schneider h, Malek A, Palta V, Surbek dV, Sager r, Zamudio S and Illsley NP “regulation of

trophoblast GluT1 glucose transporter by insulin-like growth factor I (IGF-I).” Journal of Clinical

Endocrinology & Metabolism (under review).

brimacombe M, heller d and Zamudio S. “A comparison of fetal demise case series drawn from

socioeconomically distinct counties in new Jersey.” Fetal and Pediatric Pathology, 26:213-22 (2007).

brown K, heller d, Zamudio S and Illsley NP. “Glucose transporter 3 (GluT3) protein expression in human

placenta across gestation.” Placenta, 32:1041-1049 (2011).

dyer Ky, Alvarez Jr, Salamon CG, Apuzzio JJ, Alvarez M, Al-Khan A. “The influence of race on the incidence of

respiratory distress syndrome after antenatal betamethasone or dexamethasone.” Journal of Reproductive

Medicine. 2010 Mar-Apr;55(3-4):124-8

Illsley NP, Caniggia I and Zamudio S. “Placental metabolic reprogramming: do changes in the mix of energy-

generating substrates modulate fetal growth?” International Journal of Developmental Biology, 54:409-419

(2010).

Illsley NP. “Placental metabolism.” In The Placenta: From Development to Disease (Kay hh, nelson dM, Wang y,

eds.), Wiley-blackwell, pp 50-56 (2011).

Illsley NP and Zamudio S. “hypoxia-inducible factor-1 (hIF-1)-directed diversion of carbon flux in murine

trophoblast cells.” Placenta 33:A92 (2012).

Mandell MS, Zamudio S, Seem d, McGaw lJ, Wood G, liehr P, ethier A and d’Alessandro AM. “national

evaluation of healthcare provider attitudes toward organ donation after cardiac death.” Critical Care

Medicine, 34:2952-2958 (2006).

Nasseri S, Zamudio S, Bogomol A, Alvarez M, Sbarra M, Nyirenda T and Al-Khan A. “A scoring system for

severity of placenta accreta.” Presented at the 2012 Meeting of the International Federation of Placenta

Associations, hiroshima, Japan (2012).

nevo O, Many A, Xu J, Kingdom J, Piccoli e, Zamudio S, Post M, bocking A, Todros T and Caniggia I. “Placental

expression of soluble fms-like tyrosine kinase 1 is increased in singletons and twin pregnancies with

intrauterine growth restriction.” Journal of Clinical Endocrinology & Metabolism, 93:285-292 (2008).

Postigo l, heredia G, Illsley NP, Torricos T, dolan C, echalar l, Tellez W, Maldonado I, brimacombe M, balanza e,

Vargas e and Zamudio S. “Where the O2goes to: preservation of human fetal oxygen delivery and

consumption at high altitude.” Journal of Physiology, 587:693-708 (2009).

Soleymanlou n, Jurisica I, nevo O, Ietta F, Zhang X, Zamudio S, Post M and Caniggia I. “Molecular evidence of

placental hypoxia in preeclampsia.” Journal of Clincal Endocrinology & Metabolism, 90:4299-4308 (2005).

Williams S, Fik e, Zamudio S and Illsley NP. “Global protein synthesis in human trophoblast is resistant to

inhibition by hypoxia.” Placenta, 33:31-38 (2012).


yurteri-Kaplan l, Saber S, Zamudio S, Srinivasan d, nyirenda T, Alvarez M and Al-Khan A. “brain natriuretic

peptide in term pregnancy.” Reproductive Sciences, 19:520-525 (2012).

Zamudio S. “high altitude and preeclampsia.” In Preeclampsia: aetiology and clinical practice, (lyall F, belfort M,

eds.) Cambridge university Press, pp195-208 (2006).

Zamudio S, baumann Mu and Illsley NP. “effects of chronic hypoxia in vivo on the expression of human

placental glucose transporters.” Placenta, 27:49-55 (2006).

Zamudio S. “high-altitude hypoxia and preeclampsia.” Frontiers in Bioscience, 12:2967-2977 (2007).

Zamudio S, Kovalenko O, Vanderlelie J, Illsley NP, heller d, belliappa S and Perkins AV. “Chronic hypoxia in vivo

reduces placental oxidative stress.” Placenta, 28:846-853 (2007).

Zamudio S, Postigo l, Illsley NP, rodriguez C, heredia G, brimacombe M, echalar l, Torricos T, Tellez W,

Maldonado I, balanza e, Alvarez T, Ameller J and Vargas e. “Maternal oxygen delivery is not related to

altitude- and ancestry-associated differences in human fetal growth.” Journal of Physiology, 582:883-895

(2007).

Zamudio S, Wu y, Ietta F, rolfo A, Cross A, Wheeler T, Post M, Illsley NP and Caniggia I. “human placental

hypoxia-inducible factor-1alpha expression correlates with clinical outcomes in chronic hypoxia in vivo.”

American Journal of Pathology, 170:2171-2179 (2007).

Zamudio, S. “When oxygen is not enough: why is fetal growth decreased at high altitude?” Physiology News,

76:7-8 (2009).

Zamudio S, Torricos T, Fik e, Oyala M, echalar l, Pullockaran J, Tutino e, Martin b, belliappa S, balanza e and

Illsley NP. “hypoglycemia and the origin of hypoxia-induced reduction in human fetal growth.” PLoS One,

5:e8551 (2010).

Zamudio S, Al-Khan A, Alvarez M and Illsley NP “Fetal blood flow, oxygen delivery and consumption in sub-

categories of preeclampsia.” Placenta 33:A84 (2012).

Zamudio S, WilliamsSF, Kovalenko O, borgesMh, echalarl, TorricosT, PaivaP and IllsleyNP. “Maternal and

fetoplacental hypoxia do not alter circulating angiogenic growth factors.” Journal of Clinical Endocrinology &

Metabolism (under review).


ABDULLA M. AL-KHAN, M.D.

dr. Al-Khan is the director of the division of Maternal-Fetal Medicine & Surgery at

hackensack university Medical Center. he is the director of The Center for

Abnormal Placentation and also the Co-director of the Fetal Care Center at

hackensackuMC. he is a double board certified physician and an Associate

Professor of Obstetrics and Gynecology at the university of Medicine and dentistry

of new Jersey-new Jersey Medical School, and a Professor at Seton hall university

School of Graduate Medical education.

upon completion of his internship at Mount Sinai School of Medicine and his

residency in obstetrics and gynecology at Seton hall university, he was in academic

faculty practice for two years and then proceeded to a three-year fellowship in

Maternal Fetal Medicine at the university of Medicine and dentistry-new Jersey

Medical School.

dr. Al-Khan has lectured extensively in all areas of perinatal medicine, including

general obstetrics and gynecology, both nationally and internationally. he was

named Outstanding Teaching Attending at Seton hall university School of graduate

medical education in 2001 and received a national Faculty Award for excellence in

teaching from the Counsel of resident education in Obstetrics and Gynecology in

2002. In 2004, he received a faculty achievement award from the Association of

Professors of Gynecology and Obstetrics.

dr. Al-Khan is recognized as an expert in high risk pregnancy, caring for patients

with the most complex medical and surgical conditions. he was the first physician

in the world to perform a robotic transabdominal cerclage. he received national

and International recognition for delivering the oldest pregnant patient in the

united States. dr. Al-Khan has also been featured on multiple media channels

including Cnn, FOX news, MSnbC, Good Morning America, nbC, The Today Show

and many others, discussing a variety of topics.

he established The Center for Abnormal Placentation at hackensack university

Medical Center, in new Jersey. This multidisciplinary center is the first in the united

States and the world to coordinate the care of patients who present with placenta

accreta, a major cause of obstetric hemorrhage and maternal mortality.

Translational research complements the care which the program delivers.

dr. Al-Khan is a fellow of the American College of Obstetrics and Gynecology, a

fellow of the American College of Surgeons, and a fellow of the American

Association of Gynecologic laparoscopists.

Profile


Patient Transfer Center

The Patient Transfer Center increases community access to tertiary care services by

streamlining the patient transfer process through a single customer service agent.

hackensackuMC Patient Transfer Center services are available 24 hours a day, seven

days a week, directing emergent patients into appropriate hackensackuMC tertiary

care with just one phone call.

To contact the Patient Transfer Center, please call 855-FOr-huMC (855-376-4862).

AirMed One

AirMed One provides emergent air medical lifesaving transportation of the critical

and injured in our community. In addition to providing rapid scene response for trauma,

stroke and cardiac events, AirMed One specializes in inter-facility transports between

hospitals and expands the footprint of hackensackuMC’s capabilities and access.

equipped with a full range of technology and advanced medical equipment, AirMed

One is configured to mirror that of the most sophisticated intensive care units. When

minutes count for patient survival, AirMed One can make each moment count.

Specialty Care Transport Unit

hackensackuMC’s Specialty Care Transport unit (SCTu) provides the highest level

of acute care interfacility transport, 24 hours a day, seven days a week, including

neonatal Intensive Care transfers. Our experienced, three-member team consists

of a licensed and credentialed critical care nurse, a mobile intensive care

paramedic, and a certified emergency medical technician (eMT).

At your Service


hackensackuMC, a non-profit teaching and research hospital located in bergen County, new Jersey,

is the largest provider of inpatient and outpatient services in the state, and home to the only level II

Trauma Center in the county. This 775-bed facility has gone beyond traditional thinking by creating

an entire campus of care, including: the heart & Vascular hospital, the John Theurer Cancer Center,

the Joseph M. Sanzari Children’s hospital and the donna A. Sanzari Women’s hospital. As a result

of using science and creativity to push medicine further, hackensackuMC was listed as the number

one hospital in new Jersey and one of the top four new york metro area hospitals by the U.S. News

& World Report, and has received nine national rankings in: Cancer; Cardiology & heart Surgery; ear,

nose & Throat; Gastroenterology; Geriatrics; neurology & neurosurgery; Orthopedics; urology; and

the Joseph M. Sanzari Children’s hospital ranked as one of the Top 25 best Children’s hospitals for

neurology and neurosurgery in the 2012-13 best Children’s hospitals list.

The medical center has also been named one of the Truven health Analytics 100 Top hospitals® and

one of America’s 50 best hospitals by healthGrades®. It is listed among the leapfrog Top hospitals

list, received 18 Gold Seals of Approval™ by the Joint Commission, and is listed as one of the 50 best

hospitals in America by Becker’s Hospital Review. It was the first hospital in new Jersey and second

in the nation to become a Magnet® recognized hospital for nursing excellence. The medical center is

the hometown hospital of the new york Giants and the new york red bulls, and remains committed

to its community through fundraising and community events.

About HACKENSACK UNIVERSITY MEDICAL CENTER


To schedule an appointment or for further information regarding patient transport or consultations, please call: 551-996-2453 or 551-996-4447 (24 hours a day, 7 days a week).


For more information: Center for Abnormal Placentation551-996-2453 www.HackensackUMC.org/CAP

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Center for Abnormal Placentation

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