B. Chayen

Tailored management of twin reversed arterial perfusion (TRAP) sequence

To describe our management of pregnancies complicated by twin reversed arterial perfusion (TRAP) sequence.

Management of Kell isoimmunization — evaluation of a Doppler‐guided approach

To assess the role of peak systolic velocity in the middle cerebral artery (MCA‐PSV) in the management of pregnancies complicated by Kell isoimmunization.

Safety of labor induction with prostaglandin E2 in grandmultiparous women

Objective: The aim of this study was to assess the safety of labor induction with vaginal prostaglandin E2 (PGE2) in grandmultiparous women. Methods: We conducted a retrospective cohort study of 1376 grandmultiparous women who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, postpartum hemorrhage and five minutes Apgar score. Results: One case was diagnosed with uterine rupture (0.07%). Vaginal delivery was achieved in 1329 (96.6%) patients, whereas 47 (3.4%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in three cases (0.2%). There was no correlation between parity and cesarean delivery rate or low Apgar score. There were no significant differences between the grandmultiparous and great-grandmultiparous patients regarding cesarean delivery rate (3.1 vs. 5%, P = 0.12), operative vaginal delivery rate (2 vs. 2.3%, P = 0.74) or postpartum hemorrhage rate (0.8 vs. 1.1%, P = 0.6). Conclusions: Low dose PGE2 is a safe and efficient method for induction of labor in grandmultiparous and great-grandmultiparous women.

Safety of low-dose prostaglandin E2 induction in grandmultiparous women with previous cesarean delivery

Abstract Objective: To determine the safety and efficacy of labor induction with low-dose vaginal prostaglandin E2 (PGE2) in grandmultiparous women with a previous cesarean delivery. Methods: We conducted a retrospective cohort study of 219 grandmultiparous women with a previous cesarean delivery (study group) who underwent induction of labor with low dose PGE2. These patients were compared to 1376 grandmultiparous women without a previous cesarean section (control group) who underwent induction of labor with low dose PGE2. The primary outcome was uterine rupture and secondary outcomes included mode of delivery, post-partum hemorrhage (PPH) and a low 5-min Apgar score (≤7). Results: One patient in the study group as well as one patient in the control group were diagnosed with uterine rupture (0.4% versus 0.07%). In the study group, vaginal delivery was achieved in 204 (93.16%) patients, whereas 15 (6.84%) patients had emergent cesarean delivery. Five minutes Apgar score ≤7 was recorded in two cases (0.9%) in the study group. Patients in the study group had a significantly higher rate of cesarean delivery (6.84%, versus 3.4%, respectively, p < 0.001) as well as operative vaginal delivery (4.56% versus 2% respectively, p < 0.05) compared to the control group. There were no significant differences between the groups regarding the rate of PPH (0.91% versus 0.90%, p = 0.2) or 5-min Apgar score ≤7 (0.91% versus 0.22%, p = 0.28). Conclusions: Low dose PGE2 is a relative safe method for induction of labor in grandmultiparous women with a previous cesarean section.

OP15.05: Perinatal outcome of monochorionic twins with sIUGR according to the umbilical artery Doppler flow pattern: a prospective cohort study: Short oral presentation abstracts

Results: Of 12 cases diagnosed from 2008, two were lost of follow-up and two had laser coagulation of placental anastomosis by standard fetoscopy surgery. Only eight pregnancies were included in this report. In these eight pregnancies, SIUGR3 was diagnosed at 22.5 weeks of GA (18 to 30), with only three diagnosed after 24 weeks (26,28 and 30). Mean discordance was 33% (25-49%). Only one had double fetal demise at 26 weeks, without ductus venosus abnormalities. In the rest, delivery was indicated because of the diagnosis, early in third trimester in all. This occurred at a mean of 30 weeks (28 to 32). There were two neonatal demises, which left 12 live children at discharge from the neonatal care unit (75% survival). Mean follow-up is 4.5 years, with only three children with less than two years. There are no cases with cerebral palsy, but some minor language or neurologic disabilities. All are at normal schools attending their age level or one behind (one child). Conclusions: In these few cases with conservative management, long term follow-up seems better than described. Greater series and strict follow-up is needed to confirm these findings.

Amniotic fluid discordance in monochorionic diamniotic twin pregnancies is associated with increased risk for twin anemia-polycythemia sequence.

To estimate the risk for twin anemia–polycythemia sequence (TAPS) and adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancies with amniotic fluid discordance (AFD).

OC11.01: The value of prenatal US and MRI in the assessment of pregnancies with proven vertical transmission of CMV

delivered of a second child between the first and second postnatal assessments. Results: Out of 715 participants seen at an average gestation of 36+5, 529 returned for their first postnatal assessment at a median follow-up time of 4.2 (2.3–22.1) months postpartum. Of those, 227 were again seen for a second postnatal appointment, and 94 of them seen at an average of 2.7 (1.43–4.21) years after their first delivery reported a second birth. 65 (69%) had a vaginal delivery (NVD 58 [62%], vacuum 4, [4%]; forceps 3 [3%]), and 29 (31%) a Caesarean section. There were 9 VBAC attempts, of which 6 were successful (2 NVD, 3 Vacuum, 1 FD). On imaging there was a trend towards increased bladder neck descent, with no significant change observed for cystocele descent and hiatal area on valsalva. Delivery mode of the second birth seemed to have little effect on changes observed between follow ups. On reviewing patients who were diagnosed with avulsion at their 2–3 year visit and comparing them with findings at the first follow up, we found identical normal findings in 87. In 5 there was an unchanged avulsion. In one case findings had improved from complete to partial avulsion – after a second NVD. There was one new avulsion in a patient who had delivered her first baby by emergency C/S, and her second by vacuum. Conclusions: A second pregnancy and delivery do not seem to have a major effect on pelvic organ support and/ or levator functionunless the pregnancy results in that patient’s first vaginal birth.

OC25.04: Should fetuses with congenital cystic lung lesions complicated by hydrops be treated by thoraco‐amniotic shunting?

Objectives: To determine the perinatal outcome of fetuses with congenital cystic lung lesions complicated by hydrops, who underwent thoracoamniotic shunting. Methods: A retrospective study of 7 hydropic fetuses with prenatally diagnosed congenital cystic lung malformation (4) or bronchopulmonary sequestration (3), who underwent thoracoamniotic shunting at a single tertiary center. Results: The median gestational age at diagnosis was 23 weeks (15–29) and the median gestational age at shunt insertion was 25 weeks (19–31). In 6 cases, the hydrops resolved following shunt insertion, whereas in one fetus, who underwent shunting at 19 weeks, the hydrops persisted despite the shunting and the patient elected to terminate the pregnancy. All 6 fetuses whose hydrops resolved following shunting were born alive at a median gestational age of 36.5 weeks (33–38) resulting in perinatal survival of 86%. None of the patients delivered prior to 32 weeks of gestation. Conclusions: Hydropic fetuses with congenital cystic lung lesions can benefit from thoraco-amniotic shunting resulting in perinatal survival of 86%. Therefore, hydropic fetuses with macrocystic CCAM or BPS should be offered thoraco-amniotic shunting as the treatment of choice.

OP15.08: Selective reduction in complicated monochorionic pregnancies beyond viability: is it feasible?

Objectives: The most severe complication in monochorionic (MC) pregnancies is TTTS. Fetoscopic selective laser coagulation (FSLC) is the first choice of treatment but is associated with risk of severe neurodevelopmental morbidity. Studies on outcome after umbilical cord occlusion (UCO) have indicated smaller risk of neurological adverse outcome. Selected TTTS cases have been offered UCO since 2006, as an alternative treatment to FCSL. This study documents indications and short term pregnancy outcome of UCO for TTTS. Methods: A cohort of all 56 MC pregnancies with TTTS, who consecutively underwent UCO between 2004 and 2010 at Rigshospitalet Copenhagen, was included. No exclusion criteria were used. Outcome was evaluated as overall survival per fetus. Survival until four weeks after birth was used. Results: Indications: 52 cases (49 twins, three triplets) underwent UCO as primary treatment, while four were treated secondary to FSLC. Eight cases (14%) had additional structural fetal discrepancies. 45 (80%) of the cases were Quintero stage 3 and 4. Outcome: of the 59 intended survivors there were eight (14%) intrauterine fetal deaths (IUFD) i.e. three within 24 hours after surgery, four within one to four weeks and one 13 weeks after surgery. Median gestational age (GA) at delivery was 34.6 weeks. 70% of patients delivered after 32 weeks. Preterm rupture of the membranes before 25 weeks was associated with three perinatal deaths (5%). Survival rate was 80%. One case was lost to follow up for outcome. Conclusions: Quintero stage 3 was by far the most common Q stage treated with UCO. Nevertheless, our survival rate of 80% is very similar to reports from other investigators reporting on UCO in MC multiples with or/out TTTS. We are aware, that the number of cases in this cohort is limited, but outcome by means of survival and GA at birth is in agreement with the literature and, furthermore, indicates that pregnancy outcome after UCO on TTTS is similar to outcome after UCO without the presence of TTTS. Long term outcome is ongoing in the presented group.

OP01.10: Isolated intrauterine growth restriction in the presence of fetal cytomegalovirus infection: does it predict poor neurodevelopmental outcome?

Objectives: Infants with intrauterine growth restriction (IUGR) feature higher rates of mortality and postnatal morbidity. This study aimed to evaluate the perinatal and long-term neurodevelopmental outcome of IUGR fetuses compared to constitutionally small fetuses (small-for-gestational-age, SGA). Methods: Data of patients with IUGR and SGA who were examined at the Department of Obstetrics and Gynecology at the Medical University of Graz, Austria between 2003 and 2009 was analyzed retrospectively. Group assignment was based on birth weight, Doppler ultrasound, biophysical profile and placental morphology. Primary outcome parameters were neurodevelopmental as well as nutritional status at the age of two-years. Secondary outcomes were perinatal complications (periventricular leukomalacia, intraventricular hemorrhage, asphyxia and meconium obstruction). Results: 565 patients with IUGR and SGA were detected, from which 47 (8.3%) were excluded from further analysis due to major congenital malformations, twin pregnancies or incomplete data, resulting in a collective of 219 IUGR and 299 SGA fetuses. 157 patients did not follow the two-year neurodevelopmental evaluation leaving 146 IUGR and 215 SGA infants for that analysis. Fetuses with IUGR were delivered significantly earlier (35 vs. 38 weeks’ gestation, P < 0.0001) and had more perinatal complications (24.4% vs. 1.0%, OR 31.6, 95% CI 9.7–103.0). IUGR infants further had higher rates of mortality (8% vs. 1%; OR 8.3, 95% CI, 2.4–28.7), long-term neurodevelopmental impairment (24.7% vs. 5.6%; OR 5.5, 95% CI, 2.8–11.1) and dystrophy (21.2% vs. 7.4%, OR 3.4, 95% CI, 1.8–6.4). Conclusions: The study confirms a significantly increased risk for adverse outcome in IUGR infants in contrast to SGA babies, emphasizing the importance of prenatal identification of affected fetuses to allow adopted management.