Amen Ness

Gestational age at cervical length measurement and incidence of preterm birth.

OBJECTIVE: To estimate the risk of spontaneous preterm birth based on transvaginal ultrasound cervical length and gestational age at which cervical length was measured. METHODS: Women at high risk for spontaneous preterm birth and with transvaginal ultrasound cervical length measurements between weeks 12 and 32 were identified at one institution between July 1995 and June 2005. Inclusion criteria for women at high risk for spontaneous preterm birth were prior spontaneous preterm birth at 14 to 35 weeks, cone biopsy, müllerian anomaly, or two or more dilation and evacuations. Women with multiple gestations, cerclage, indicated preterm birth, or fetal anomalies were excluded. Logistic regression was used to estimate the spontaneous preterm birth risk before 35, 32, and 28 weeks. RESULTS: Seven hundred five women received 2,601 transvaginal ultrasound measurements for cervical length. The incidences of spontaneous preterm birth before 35, 32, and 28 weeks were 17.7, 10.6, and 6.7%, respectively. The risk of spontaneous preterm birth before 35 weeks decreased by approximately 6% for each additional millimeter of cervical length (odds ratio 0.94, 95% confidence interval, 0.92–0.95, P=.001) and by approximately 5% for each additional week of pregnancy at which the cervical length was measured (odds ratio 0.95, 95% confidence interval 0.92–0.98, P=.004). Similar results were obtained for spontaneous preterm birth before 32 and 28 weeks. CONCLUSION: Gestational age at which transvaginal ultrasound cervical length is measured significantly affects the calculation of risk of spontaneous preterm birth. The spontaneous preterm birth risk increases as the length of the cervix declines and as the gestational age decreases. These spontaneous preterm birth risks are important for counseling and management for women with various degrees of short cervical length at different gestational ages. LEVEL OF EVIDENCE: II

Prevention of Preterm Birth Based on Short Cervix: Symptomatic Women With Preterm Labor or Premature Prelabor Rupture of Membranes

The diagnosis of preterm labor (PTL) is challenging, especially in women whose cervical dilatation is <2 cm and who are <80% effaced. In symptomatic women, with threatened PTL in both singletons and twins, transvaginal ultrasound cervical length (CL) identifies a high-risk group that is more likely to be in true PTL, more likely to deliver sooner, and more likely to deliver preterm. The addition of fetal fibronectin improves the predictive accuracy in women whose CL is <30 mm but >15 mm. Transvaginal ultrasound CL can also be performed in the presence of ruptured membranes and predicts latency. Although additional data are needed, the evidence so far suggests that the use of transvaginal ultrasound CL and fetal fibronectin can be used to better identify and manage women with PTL likely to have an imminent preterm delivery, and to avoid interventions in women who would not.

Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta‐analysis of randomized controlled trials using individual patient‐level data

Cervical length screening by transvaginal sonography (TVS) has been shown to be a good predictive test for spontaneous preterm birth (PTB) in symptomatic singleton pregnancy with threatened preterm labor (PTL). The aim of this review and meta‐analysis of individual participant data was to evaluate the effect of knowledge of the TVS cervical length (CL) in preventing PTB in singleton pregnancies presenting with threatened PTL.

Massive Fetal Ileal Duplication Requiring Antenatal Intervention

Enteric duplication is a rare congenital anomaly that is typically diagnosed during infancy or childhood and is seen in approximately 1 per 10,000 live births. 1 Although a number of case reports of prenatal identification of abdominal cystic masses have been confirmed to be enteric duplications after delivery, 2-14 no prenatal interventions or complications related to the mass have been reported. We present a case of large cystic ileal duplication that underwent transabdominal decompression with eventual fetal cardiovascular impairment that required emergency preterm delivery.

Maternal‐fetal medicine fellowship obstetrical ultrasound experience: results from a fellowship survey

To assess maternal‐fetal medicine (MFM) fellowship obstetrical ultrasound training, scope of practice and research.

Fetofetal Transfusion Syndrome in Monochorionic-Triamniotic Triplets Treated with Fetoscopic Laser Ablation: Report of Two Cases and A Systematic Review

Objective This study aims to determine the clinical outcomes of monochorionic-triamniotic (MT) pregnancies complicated by severe fetofetal transfusion undergoing laser photocoagulation. Study Design We report two cases of MT triplets complicated by fetofetal transfusion syndrome (FFTS) and a systematic review classifying cases into different subtypes: MT with two donors and one recipient, MT with one donor and two recipients, MT with one donor, one recipient, and one unaffected triplet. The number of neonatal survivors was analyzed based on this classification as well as Quintero staging. Results A total of 26 cases of MT triples complicated by FFTS were analyzed. In 56% of the cases, the FFTS involved all three triplets, 50% of whom had an additional donor and 50% an additional recipient. Among the 24 cases that survived beyond 1 week after the procedure, the average gestational age of delivery was 29.6 weeks, and the average interval from procedure to delivery was 10.1 weeks. The overall neonatal survival rate was 71.7%, with demises occurring equally between donor and recipient triplets. Overall neonatal survival including survival of at least two fetuses occurred with equal frequency between the different groups. Conclusion Significant neonatal survival can be achieved in most cases of MT triplets with FFTS.

Clostridium botulinum Toxin A Inhibits Contractility in Pregnant Human Myometrium In Vitro

Studies were undertaken to evaluate the effect of Botulinum neurotoxin type-A (BoNTA) preparation on oxytocin-induced contractions of pregnant human myometrium in vitro. Human myometrial tissue was exposed to increasing concentrations (1-50 000 U/mL) of BoNT/A. Isometric contractions were measured using a force displacement transducer. The cumulative effect of BoNT/A on myometrial activity (time to half relaxation [TTR50], frequency, and amplitude) was evaluated. The frequency of myometrial contractions was depressed by 40% from baseline (P < .05) and relaxation time was increased by 30% (P < .05) from baseline within a narrow range of concentrations. There was no significant difference in amplitude. The observed effects were rapidly reversed after complete wash out of the tissue. BoNT/A or its analogues with more specific tissue affinity may be of value as future agents for prevention of unwanted uterine contractile activity associated with preterm labor and fetal surgery.

Outcome and Treatment of Antenatally Diagnosed Nonimmune Hydrops Fetalis

Introduction: The objectives of this study were to evaluate the outcome of nonimmune hydrops fetalis in an attempt to identify independent predictors of perinatal mortality. Material and Methods: A retrospective cohort study was conducted including all cases of nonimmune hydrops from two tertiary care centers. Perinatal outcome was evaluated after classifying nonimmune hydrops into ten etiological groups. We examined the effect of etiology, site of fluid accumulation, and gestational age at delivery on postnatal survival. Neonatal mortality and hospital discharge survival were compared between the expectant management and fetal intervention groups among those with idiopathic etiology. Results: A total of 142 subjects were available for analysis. Generally, nonimmune hydrops carried 37% risk of neonatal mortality and 50% chance of survival to discharge, which varies markedly based on the underlying etiology. Ascites was an independent predictor of perinatal mortality (p value = 0.003). There was nonsignificant difference in neonatal mortality and hospital discharge survival among idiopathic cases that were managed expectantly versus those in whom fetal intervention was carried out. Discussion: The outcome of nonimmune hydrops varies largely according to the underlying etiology and the presence of ascites is an independent risk factor for perinatal mortality. In our series, fetal intervention did not offer survival advantage among fetuses with idiopathic nonimmune hydrops.

Maternal-Fetal Medicine Fellowship 3- and 4-Dimensional Ultrasound Experience Room for Improvement

The purpose of this study was to assess maternal‐fetal medicine (MFM) fellowship 3‐ and 4‐dimensional (3D/4D) ultrasound experience and training.

OC16.04: The “3‐line sign:” A useful observation in the detection of fetal agenesis of the corpus callosum (ACC)

or severe retardation. Study population was subclassified in two groups according to the age at which BDIST was applied (< 4 years vs. ≥ 4 years) for further comparisons. Results: Routine neuropediatrical evaluation detected neurological disorders in five children (28%) (3 with language impairment, one left hemiparesis and one with intellective retardation). However, BDIST showed some degree of neurodevelopmental delay in higher proportions: 66% in social-personal skills, 56% in gross motor skills, 39% in adaptive behavior and 28% in fine motor skills. Expressive communication and cognitive areas were the least affected (22% and 17%, respectively). A general trend towards worse outcomes was observed in the group of ≥ 4 years, although significant differences were only found for gross motor skills. Conclusions: Subtle neurological delays may appear during the infant period after a prenatal diagnosis of mild isolated VM. This information should prompt early and specific supportive measures in the developing child to minimize the neurological impact of isolated mild VM.