During my fellowship I focused on hemodynamic changes that occur in normal pregnancy and in pregnancy complicated by cardiovascular diseases. With this background, I developed an interest in twin pregnancy and fetal growth discordancy. I was instrumental in setting up a clinical data bank that has been in operation since 1994. In 2000, I participated in the first consensus statement on twins in Canada. I was the main coordinator of the subgroup on fetal growth in multiples. In 2005, Dr Klam (a fellow under my supervision) published a paper on the usefulness of abdominal circumference ratios in twins < 24 weeks to predict significant birth weight discordance. We reported that an AC ratio < 0.93 had the best sensitivity and positive predictive value to predict birth weight discordance in twins with one co-twin with fetal growth restriction < 10th percentile. This tool is useful in pregnancies of less than 24 weeks’ gestation when no fetal growth curve is available.
During my fellowship, I gained experience in maternal cardiac diseases and their management during pregnancy (in the intensive care unit and through invasive monitoring with Swan-Ganz catheter, etc.). Upon my return to Montreal, I set up a Maternal (acquired and congenital) Cardiac Disease and Pregnancy Clinic. The clinic requires a multidisciplinary approach involving an anesthesiologist, an internist, a (pediatric and adult) cardiologist and an ob-gyn (myself). All clinical data are included in a databank. The Montreal Heart Institute participates in patient care and follow-up. This clinic is unique in Canada and we have one of the most extensive patient lists in the data bank (%7e 350 cases) from the same tertiary center. We have a clinical discussion about our patients once every two months and the chief-resident or a fellow in fetomaternal medicine is involved in patient care and follow-up.
We recently submitted a paper (see below) from our data bank. With this expertise, I focus my research interest toward the fetal programming of vascular dysfunction in IUGR studied in a twin model. In 2006, I obtained a grant from the Canadian Institutes of Health Research for this study.