Opportunity for Life: The Link | Martha W. F. Rac, M.D.

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Martha W.F. Rac, M.D.

Martha W. F. Rac, M.D.

		Assistant Professor Medical Director of Obstetric Ultrasound Ben Taub Hospital Director of Maternal-Fetal Medicine and Ultrasound Services The Centers for Children and Women, Texas Children's Health Plan Maternal-Fetal Medicine Baylor College of Medicine Houston, Texas

INSTITUTION AND LOCATION	DEGREE		COMPLETION DATE		FIELD OF STUDY

The University of Texas at Austin Austin, Texas	BA		05/2004		Chemistry

The University of Texas Health Sciences Center at Houston Houston, Texas	MD		05/2008		Medicine

The University of Texas Southwestern Medical Center Dallas, Texas			06/2012		Obstetrics and Gynecology

The University of Texas Southwestern Medical Center Dallas, Texas			06/2015		Maternal-Fetal Medicine

A. Personal Statement
I have chosen a career in academic medicine to be on the front lines of discovery. With determination, motivation, organization, training and a healthy degree of skepticism, I am posed to translate clinical innovations into better bedside manner. My prior training at one of the country’s largest county hospitals exposed me to the need for continual progress as well as provided me with mentors who have had great success in the field of academic medicine. I have experience being PI for many internally-funded projects. In doing so, I have experience constructing and maintaining large research databases from which peer-reviewed publications were developed. My background is in both obstetrical infectious disease and the diagnosis and management of morbidly adherent placenta. Publications from both fields have garnered international exposure. Specifically, my experience in obstetrical infectious disease positions me to carry out this project with success. My research in maternal and fetal syphilis has helped close the gap on the pathophysiology of syphilis after maternal treatment as well as laid the groundwork for future studies. I am Co-Director of our High Risk Obstetrics Infectious Disease clinic at Ben Taub Hospital, one of two county hospitals within Harris county, which was formed in an effort to improve access and focus care of these women. Additionally, I am one of four Maternal-Fetal Medicine specialists who staffed a Congenital Zika Clinic at Texas Children’s Hospital during the Zika virus epidemic. Both of these responsibilities require collaboration internally, as well as between community providers and our local health department. In addition to providing highly specialized care, both clinics also provide opportunities for longitudinal research and long-term follow-up. My clinical responsibilities and research experiences provide me with the tools for success and the passion for continual education through research.

B. Positions and Honors

Positions and Employment
2012-2015		Fellow, Division of Maternal-Fetal Medicine, University of Texas Southwestern, Dallas, TX
2015-present		Assistant Professor, Co-Director High Risk Obstetrics Infectious Disease Clinic, Division of Maternal-Fetal Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, TX
2017-present		Assistant Professor, Director of Obstetric Ultrasound, Division of Maternal-Fetal Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, TX

Other Experience and Professional Memberships
2008-present		Fellow, American College of Obstetricians and Gynecologists
2012-present		Associate Member, Society for Maternal-Fetal Medicine
2015-present		Fellow (General Ob/Gyn), American Board of Obstetrics and Gynecology
2018-present		Fellow (Maternal-Fetal Medicine), American Board of Obstetrics and Gynecology

Honors
2012		Highest CREOG score
2014		Best presentation in the category “Role of Ultrasound in Patient Safety”, International Society of Ultrasound in Obstetrics and Gynecology 24th World Congress on Ultrasound in Obstetrics and Gynecology, Barcelona, Spain
2015		Expert for National Public Radio, “More Babies In The U.S. Are Dying Because Of Congenital Syphilis”, published online Nov 13, 2015

C. Contribution to Science

	1.	Despite the availability of penicillin for almost a century, syphilis remains a threat to the well-being of the mother and her fetus. I was the PI of two studies that improved our understanding of the pathophysiology of syphilis during pregnancy and define non-treponemal titer decline after maternal treatment. Previously reported sonographic signs of fetal syphilis, from early to late findings, include placentomegaly, hepatomegaly, elevated peak systolic velocities of the middle cerebral artery indicative of fetal anemia, ascites, polyhydramnios and worsening degrees of fetal hydrops. My team of researchers and I were able to show that late findings of fetal syphilis resolve first after maternal treatment followed by the early findings of placentomegaly and hepatomegaly, the latter persisting the longest. Understanding this sequence of events lays the groundwork for further studies. We also defined a timeline of maternal nontreponemal titer decline after treatment, an area previously extrapolated from studies that specifically excluded pregnancy. We found that pregnancy is most likely an inadequate time frame to assess adequate titer decline, defined as 4-fold or more, but that time from treatment to delivery was more indicative of congenital infection. Our findings emphasize the importance of timely prenatal care, screening, adequate treatment and follow-up of syphilis during pregnancy. We also identified contemporaneous demographics and risk factors that can help target deficiencies in care of this vulnerable population. Although most of my work has been in the field of syphilis, my interests expand to other areas of infectious disease and pregnancy as evidence by the review articles and case reports I have authored.

	a.	Rac MWF, Bryant SN, McIntire DD, Cantey JB, Twickler DT, Wendel GD, Sheffield JS. Progression of Ultrasound Findings of Fetal Syphilis Following Maternal Treatment. Am J Obstet Gynecol 2014;211:426.e1-6.
	b.	Rac MWF, Bryant SN, McIntire DD, Cantey JB, Wendel GD, Sheffield JS. Maternal Titers After Adequate Syphilotherapy During Pregnancy. Clinical Infectious Diseases 2015;60(5):686–90.
	c.	Rac MWF, Sheffield JS. Prevention and Management of Viral Hepatitis in Pregnancy. Obstet Gynecol Clin North Am. 2014 Dec;41(4):573-92.
	d.	Rac MWF, Revell P, Eppes CS. Syphilis During Pregnancy: A Preventable Threat to Maternal-Fetal Health. Am J Obstet Gynecol. 2016. Accepted. Publication date TBD.
	e.	Eppes CE, Rac MWF, Dunn J, Versalovic J, Murray KO, Suter MA, Sanz Cortes M, Espinoza J, Seferovic MD, Lee W, Hotez P, Mastrobattista J, Clark SL, Belfort MA, Aagaard KM. Testing for Zika virus infection in pregnancy: key concepts to deal with an emerging epidemic. Am J Obstet Gynecol. 2017 Mar;216(3):209-225. both are first authors
	2.	Morbidly adherent placenta is estimated to occur in 1 of every 500 deliveries and is the source of considerable maternal morbidity. I was PI of a team of researchers who published a standardized approach to diagnosis using a scoring system we termed “The Placenta Accreta Index”, derived from multiparametric analysis and receiver operating characteristics. The Placenta Accreta Index gives an individualized score, or risk of morbidly adherent placenta, based on clinical and sonographic factors specific to each patient. I was also PI, along with the same team of co-investigators, of a project that looked at the incidence of vaginal bleeding requiring delivery according to gestational age in women with proven morbidly adherent placenta. This project was particularly timely and important because current delivery recommendations of a late preterm delivery at 34-36 weeks are based on level III evidence or extrapolated from studies in women with placenta previa but not necessarily morbidly adherent placenta. We showed that overall, 1 in 5 women with morbidly adherent placenta had vaginal bleeding severe enough to require emergent delivery, in contrast to 1 in 4 women with non-adherent placenta previa. Further, as gestational age at delivery increased, the likelihood of vaginal bleeding necessitating urgent delivery decreased in women with placenta accreta such that nearly 90% delivering at 36 weeks of gestation or greater did not experience bleeding. We concluded that timing of delivery in women with suspected morbidly adherent placenta can be individualized and in those who remain stable, a preterm delivery with its associated morbidities, may be averted.

	a.	Rac MWF, Dashe JD, Wells CE, Moschos E, McIntire DD, Twickler DT. Ultrasound Predictors of Placenta Accreta: The Accreta Index. Am J Obstet Gynecol, 2015 Mar;212(3):343.e1-7.
	b.	Rac MWF, Wells CE, Twickler DM, Moschos E, McIntire DD, Dashe JS. Placenta Accreta: Vaginal Bleeding According to Gestational Age at Delivery. Obstet and Gynecol, 2015 Apr;125(4):808-13.
	c.	Rac MWF, McIntire DD, Wells CE, Moschos E, Twickler DD. Cervical Length in Women at Risk for Placental Invasion. J Ultrasound Med. Publication date TBD.
	3.	In addition to the contributions stated above, my team of co-investigators and I have helped define the sonographic appearance of morbidly adherent placenta in the first trimester. We have found that the thickness of the myometrium directly behind the developing placenta during first trimester ultrasound is significantly smaller in women who develop morbidly adherent placenta. Using receiver-operating characteristics, we showed the addition of this parameter to clinical characteristics significantly improved prenatal detection. I am also the PI on a prospective, observational study of pregnancies implanted onto the lower uterine segment, otherwise known as “low-implantations”. Having a “low-implantation” during first trimester ultrasound in women with prior cesarean deliveries is a known risk factor for morbidly adherent placenta. Preliminary results of our study show that the majority of pregnancies implanted into the lower uterine segment during first trimester ultrasound do not persist and become a placenta previa. However, those that do persist are implanted significantly lower during first trimester ultrasound. This information was presented at the Society for Maternal-Fetal Medicine Annual Conference in Atlanta, GA February 1-6, 2016. We hope that our findings will improve the understanding of the early sonographic appearance of pregnancies at risk for morbidly adherent placenta and prompt more research into this area of women’s imaging.

	a.	Rac MWF, Moscos E, Wells CE, McIntire DD, Dashe JS, Twickler DM. Ultrasound Findings of Placenta Accreta in the First Trimester. J Ultrasound Med. 2015 Dec 11. pii: 15.03020.
	b.	Rac MWF, Moscos, E, Wells CE, McIntire DD, Twickler DM. Low-Implantation on First Trimester Ultrasound and Subsequent Placenta Previa and Accreta. Mentor: Twickler, Diane. Poster presentation, SMFM 36th Annual Meeting, Atlanta, GA. Feb 1-6, 2016.

Complete List of Published Work in My Bibliography:
https://www.ncbi.nlm.nih.gov/sites/myncbi/16WanNU4TiBk2/bibliography/56366093/public/?sort=date&direction=ascending

D. Research Support

Rac (Consultant)	01/01/2017-01/01/2018
Texas Medical Center Funding Program in Collaborative Health Policy Research Developing a Multi-institutional Policy for Zika, $170,000

Events with Dr. Rac


	10 January 2024 7:30 PM BTT/BST		Rac, Martha W. F. M.D.		Urinary Tract Infections in Pregnancy International Lecture Series		Archive

	02 November 2022 7:00 PM BTT/BST		Rac, Martha W. F. M.D.		Syphilis International Lecture Series		Archive

	26 February 2021 9:00 PM BTT/BST		Rac, Martha W. F. M.D.		Syphilis in Pregnancy International Lecture Series		Archive Slides