Andrea Desai

First‐trimester fetal cardiac examination using spatiotemporal image correlation, tomographic ultrasound and color Doppler imaging for the diagnosis of complex congenital heart disease in high‐risk patients

A four‐dimensional (4D) fetal echocardiographic technique utilizing spatiotemporal image correlation, tomographic ultrasound imaging display (STIC‐TUI echo) and color Doppler has previously been shown to be effective in displaying the examination planes constituting the extended cardiac examination. The aim of this study was to evaluate the performance of this first‐trimester STIC‐TUI echo technique in identifying complex congenital heart disease (CHD) in high‐risk pregnancies.

Marijuana use and pregnancy: prevalence, associated behaviors, and birth outcomes.

INTRODUCTION: This study examines the prevalence, behaviors, and birth outcomes associated with marijuana use in pregnancy. METHODS: This was a retrospective cohort study of patients presenting for prenatal care in a university-based setting from July 1, 2009, to June 30, 2010. The primary exposure was marijuana use, defined by self-report or first-trimester urine toxicology. Continued use was evaluated by urine toxicology each trimester and at the time of delivery. Demographic and outcome data were determined by chart review and analyzed by &khgr;2, Fishers exact, analysis of variance, and logistic regression. RESULTS: Three hundred ninety-six patients initiated prenatal care during this timeframe, 79 (20%) of whom tested positive for marijuana. Patients who smoked marijuana were less likely to have graduated high school (P=.016) or be employed (P=.015) but were more likely to use tobacco (P<.001) or alcohol (P=.032) and report a history of abuse (P=.01) or depressed mood (P=.023). When analyzed by logistic regression, only tobacco use remained associated with marijuana use (adjusted odds ratio 3.3, 95% confidence interval 1.9–5.9). Birth outcomes were available for 170 (43%) patients. Only three (1.9%) had positive toxicology screens at the time of delivery. Marijuana use was not related to late initiation of prenatal care (25.2% compared with 34.7%, P=.065), preterm deliveries (17.7% compared with 12.0%, P=.325), birth weight (3,025.6 g compared with 3,088.8 g, P=.555), or neonatal intensive care unit admissions (25.5% compared with 15.8%, P=.139). CONCLUSIONS: Cigarette smoking has the highest correlation to marijuana use in pregnancy. No differences were found in birth outcomes in this cohort.

OC26.02: Maternal hyperglycemia affects first trimester fetal cardiac function in normal hearts

Objectives: Non invasive measurement of fetal vascular flow remains an elusive matter, accuracy of current tools is very limited and relies mainly in operator skills. The aim of our study was to develop a tool for indirect flow measurement, accurate and repeatable, by using power Doppler signal, Real time three dimensional ultrasound (4DPD) and mathematical image data simulation and adjustment tools based on artificial neural networks (ANN). Methods: Six pregnant sheep with adequately controlled gestational age of 125 days (near term) were surgically instrumented to access fetal ascending aorta by transventricular catheterization. Cardiac output was measured by Fick thermodilution, as well as by pulsed Doppler. Several sets of 4DPD volumes were taken during the procedure. Measurements were stored in an electronic datasheet. Pearson’s correlation coefficient and simple linear regression were obtained. Linear equation matrix were generated and obtained data was evaluated through an error adjustment process by employing an artificial neural network software (ANN). Results: A total of 30 sets of measurements in controlled conditions were collected during the study period. A mean of six measurements by cardiac cycle were digitally obtained from the velocity curve. A six by six matrix of data was designed for every measurement. Mean velocity at every time was calculated and compared to actual data, intraclass correlation coefficient (95% CI) was 0.9 (0.73–0.99). ANN predicted calculated measurements in 99% of cases. Conclusions: 4DPD might be a reliable, accurate, non invasive tool for fetal vascular flow measurement.

Connect the Dots-August 2016.

This past week, in our Maternal-Fetal Medicine clinic at the North Carolina Women’s Hospital, a resident and I discussed the relative merits of recommending the use of intramuscular progesterone prophylaxis for women whose only prior delivery had occurred at 36 weeks of gestation. In this issue of Obstetrics & Gynecology, Yang et al (see page 364) analyze recurrence risks for preterm birth and early term birth using California vital statistics data, which would have helped to provide some evidence for consultation with this patient. Their Table 3 has one answer to our clinical question. Among the 4,246 women who delivered their first child at 36 weeks, 488 (11.5%) delivered their second child at less than 37 weeks. The adjusted odds ratio for delivery before 32 weeks in this group was 4.4. Compare this with the 2.7% rate of delivery before 37 weeks for those women who delivered at 39 weeks. The potential utility of reports such as this one in our daily care of patients is high. Even so, we need to understand the limitations of population-based research when we apply results to the patient in front of us. Does she fit the population studied? Are there data missing that would bias results? Do we know how patients in the study were treated? One way to be more certain is to make sure that the hazard ratios are within what Grimes and Schulz refer to as the zones of potential interest, which diminish the risks of introduced bias in the analysis. This article can be used to inform evidence-based, patient-centered counseling about one of the major public health problems we face in the United States—premature birth. It is worth a deep dive when you read it.