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Virginia Winn, MD, PhD

  • Virginia D Winn
  • “I have a great respect for pregnancy and the labor process.”

I feel so connected to pregnant women. I have two children of my own, so I understand what the process of pregnancy is like. I have a great respect for pregnancy and the labor process. While Im a midwife at heart I am also a highly trained Maternal-Fetal Medicine specialist who strives for a healthy pregnancy for both mother and child. When there are complications, I help navigate through the challenges, joys and sorrows.

My other passion is the amazing organ- the placenta. I study how the human placenta develops and sometimes leads to pregnancy complications. My research focuses on the complication called preeclampsia, which affects both the mother and baby. My lab is working on research that will help us develop better treatment or prevention for preeclampsia.

I am proud to support patients in their journey to have a child. Even when women have complicated pregnancies, my goal is to keep the labor process as natural as possible.

Ultimately Im here to contribute meaning and support during the birth experience, and to improve the outcomes of maternal and neonatal health in the future. I study human placental development in order to improve the health of mothers and their children.

Specialties

Maternal & Fetal Medicine

Work and Education

Professional Education

University of Rochester School of Medicine, Rochester, NY, 5/25/1996

Residency

UCSF, San Francisco, CA, 7/1/2000

Fellowship

UCSF, San Francisco, CA, 9/1/2003

Board Certifications

Maternal & Fetal Medicine, American Board of Obstetrics and Gynecology

Obstetrics & Gynecology, American Board of Obstetrics and Gynecology

Services

Obstetrics

All Publications

Mapping the Fetomaternal Peripheral Immune System at Term Pregnancy. Journal of immunology Fragiadakis, G. K., Baca, Q. J., Gherardini, P. F., Ganio, E. A., Gaudilliere, D. K., Tingle, M., Lancero, H. L., McNeil, L. S., Spitzer, M. H., Wong, R. J., Shaw, G. M., Darmstadt, G. L., Sylvester, K. G., Winn, V. D., Carvalho, B., Lewis, D. B., Stevenson, D. K., Nolan, G. P., Aghaeepour, N., Angst, M. S., Gaudilliere, B. L. 2016

Abstract

Preterm labor and infections are the leading causes of neonatal deaths worldwide. During pregnancy, immunological cross talk between the mother and her fetus is critical for the maintenance of pregnancy and the delivery of an immunocompetent neonate. A precise understanding of healthy fetomaternal immunity is the important first step to identifying dysregulated immune mechanisms driving adverse maternal or neonatal outcomes. This study combined single-cell mass cytometry of paired peripheral and umbilical cord blood samples from mothers and their neonates with a graphical approach developed for the visualization of high-dimensional data to provide a high-resolution reference map of the cellular composition and functional organization of the healthy fetal and maternal immune systems at birth. The approach enabled mapping of known phenotypical and functional characteristics of fetal immunity (including the functional hyperresponsiveness of CD4(+) and CD8(+) T cells and the global blunting of innate immune responses). It also allowed discovery of new properties that distinguish the fetal and maternal immune systems. For example, examination of paired samples revealed differences in endogenous signaling tone that are unique to a mother and her offspring, including increased ERK1/2, MAPK-activated protein kinase 2, rpS6, and CREB phosphorylation in fetal Tbet(+)CD4(+) T cells, CD8(+) T cells, B cells, and CD56(lo)CD16(+) NK cells and decreased ERK1/2, MAPK-activated protein kinase 2, and STAT1 phosphorylation in fetal intermediate and nonclassical monocytes. This highly interactive functional map of healthy fetomaternal immunity builds the core reference for a growing data repository that will allow inferring deviations from normal associated with adverse maternal and neonatal outcomes.

View details for PubMedID 27793998

Differential expression of human placental PAPP-A2 over gestation and in preeclampsia. Placenta Kramer, A. W., Lamale-Smith, L. M., Winn, V. D. 2016; 37: 19-25

Abstract

Pregnancy Associated Plasma Protein A2 (PAPP-A2) is a pregnancy related insulin-like growth factor binding protein-5 (IGFBP-5) protease, known to be elevated in preeclampsia. As the insulin-like growth factors are important in human implantation and placentation, we sought to determine the expression pattern of PAPP-A2 over human gestation in normal and preeclamptic pregnancies to evaluate its role in placental development and the pathogenesis of preeclampsia.Placental basal plate and chorionic villi samples, maternal and fetal cord blood sera were obtained from preeclamptic and control pregnancies. Formalin-fixed tissue sections from across gestation were stained for cytokeratin-7, HLA-G, and PAPP-A2. PAPP-A2 immunoblot analysis was also performed on protein lysates and sera.PAPP-A2 expression is predominately expressed by differentiated trophoblasts and fetal endothelium. Chorionic villi show strong expression in the first trimester, followed by a progressive decrease in the second trimester, which returns in the third trimester. PAPP-A2 expression is not impacted by labor. PAPP-A2 is increased in the basal plate, chorionic villi and maternal sera in preeclampsia compared to controls, but is not detectable in cord blood.PAPP-A2 is differentially expressed in different trophoblast populations and shows strong down regulation in the mid second trimester in chorionic villous samples. Both maternal sera and placental tissue from pregnancies complicated by preeclampsia show increased levels of PAPP-A2. PAPP-A2 levels are not altered by labor. Additionally, PAPP-A2 cannot be detected in cord blood demonstrating that the alterations in maternal and placental PAPP-A2 are not recapitulated in the fetal circulation.

View details for DOI 10.1016/j.placenta.2015.11.004

View details for PubMedID 26748159

Characterization of choline transporters in the human placenta over gestation PLACENTA Baumgartner, H. K., Trinder, K. M., Galimanis, C. E., Post, A., Phang, T., Ross, R. G., Winn, V. D. 2015; 36 (12): 1362-1369
Hepatitis C Virus Sensing by Human Trophoblasts Induces Innate Immune Responses and Recruitment of Maternal NK Cells: Potential Implications for Limiting Vertical Transmission. Journal of immunology Giugliano, S., Petroff, M. G., Warren, B. D., Jasti, S., Linscheid, C., Ward, A., Kramer, A., Dobrinskikh, E., Sheiko, M. A., Gale, M., Golden-Mason, L., Winn, V. D., Rosen, H. R. 2015; 195 (8): 3737-3747

Abstract

Hepatitis C virus (HCV) is the world's most common blood-borne viral infection for which there is no vaccine. The rates of vertical transmission range between 3 and 6% with odds 90% higher in the presence of HIV coinfection. Prevention of vertical transmission is not possible because of lack of an approved therapy for use in pregnancy or an effective vaccine. Recently, HCV has been identified as an independent risk factor for preterm delivery, perinatal mortality, and other complications. In this study, we characterized the immune responses that contribute to the control of viral infection at the maternal-fetal interface (MFI) in the early gestational stages. In this study, we show that primary human trophoblast cells and an extravillous trophoblast cell line (HTR8), from first and second trimester of pregnancy, express receptors relevant for HCV binding/entry and are permissive for HCV uptake. We found that HCV-RNA sensing by human trophoblast cells induces robust upregulation of type I/III IFNs and secretion of multiple chemokines that elicit recruitment and activation of decidual NK cells. Furthermore, we observed that HCV-RNA transfection induces a proapoptotic response within HTR8 that could affect the morphology of the placenta. To our knowledge, for the first time, we demonstrate that HCV-RNA sensing by human trophoblast cells elicits a strong antiviral response that alters the recruitment and activation of innate immune cells at the MFI. This work provides a paradigm shift in our understanding of HCV-specific immunity at the MFI as well as novel insights into mechanisms that limit vertical transmission but may paradoxically lead to virus-related pregnancy complications.

View details for DOI 10.4049/jimmunol.1500409

View details for PubMedID 26342030

Baseline placental growth factor levels for the prediction of benefit from early aspirin prophylaxis for preeclampsia prevention PREGNANCY HYPERTENSION-AN INTERNATIONAL JOURNAL OF WOMENS CARDIOVASCULAR HEALTH Moore, G. S., Allshouse, A. A., Winn, V. D., Galan, H. L., Heyborne, K. D. 2015; 5 (4): 280-286

View details for DOI 10.1016/j.preghy.2015.06.001

View details for Web of Science ID 000366078600005

View details for PubMedID 26597741

A Hertzian contact mechanics based formulation to improve ultrasound elastography assessment of uterine cervical tissue stiffness JOURNAL OF BIOMECHANICS Briggs, B. N., Stender, M. E., Muljadi, P. M., Donnelly, M. A., Winn, V. D., Ferguson, V. L. 2015; 48 (9): 1524-1532

Abstract

Clinical practice requires improved techniques to assess human cervical tissue properties, especially at the internal os, or orifice, of the uterine cervix. Ultrasound elastography (UE) holds promise for non-invasively monitoring cervical stiffness throughout pregnancy. However, this technique provides qualitative strain images that cannot be linked to a material property (e.g., Young's modulus) without knowledge of the contact pressure under a rounded transvaginal transducer probe and correction for the resulting non-uniform strain dissipation. One technique to standardize elastogram images incorporates a material of known properties and uses one-dimensional, uniaxial Hooke's law to calculate Young's modulus within the compressed material half-space. However, this method does not account for strain dissipation and the strains that evolve in three-dimensional space. We demonstrate that an analytical approach based on 3D Hertzian contact mechanics provides a reasonable first approximation to correct for UE strain dissipation underneath a round transvaginal transducer probe and thus improves UE-derived estimates of tissue modulus. We validate the proposed analytical solution and evaluate sources of error using a finite element model. As compared to 1D uniaxial Hooke's law, the Hertzian contact-based solution yields significantly improved Young's modulus predictions in three homogeneous gelatin tissue phantoms possessing different moduli. We also demonstrate the feasibility of using this technique to image human cervical tissue, where UE-derived moduli estimations for the uterine cervix anterior lip agreed well with published, experimentally obtained values. Overall, UE with an attached reference standard and a Hertzian contact-based correction holds promise for improving quantitative estimates of cervical tissue modulus.

View details for DOI 10.1016/j.jbiomech.2015.03.032

View details for Web of Science ID 000357147000003

View details for PubMedID 26003483