Cara Pessel

Novel 3-Dimensional Placental Measurements in Early Pregnancy as Predictors of Adverse Pregnancy Outcomes

Objective. We sought to determine whether novel approaches to volumetric assessment of the early placenta can yield significant predictors of adverse outcome. Methods. We measured placental volume (PV) at 11 to 14 weeks using virtual organ computer‐aided analysis and normalized the PV to the crown‐rump length (CRL) to yield the placental quotient (PQ = PV/CRL). We also calculated the mean placental diameter (MPD) from 4 measurements taken at 45° intervals to serve as a surrogate for the fetal‐maternal surface area. On the fetal side, the distance from the cord insertion (CI) to the placental margin was measured every 45°. Mean cord distance (MCD) is proposed as a novel descriptor of the chorionic plate and CI. Sonographic variables were analyzed as predictors of a composite adverse pregnancy outcome (COMP = small for gestational age [SGA], preeclampsia, spontaneous preterm birth, or neonatal intensive care unit admission). Results. A total of 135 patients were included, and 40 (29.6%) had an adverse outcome. The mean PQ (P = .02) and MCD (P = .02) were significantly lower in patients with COMP, although MPD was not significantly different (P = .26). A PQ of less than 1.00 (relative risk [RR], 2.3 [95% confidence interval, 1.4–2.7]) and an MCD of less than 4.00 cm (RR, 1.8 [1.1–2.9]) conferred an increased risk for COMP. Prediction models adjusting for parity and race yielded favorable characteristics [PV: area under the curve [AUC], 0.796; P = .04; PQ: AUC, 0.802; P = .03; MCD: AUC, 0.800; P = .04; and MPD: AUC, 0.782; P = .07). Secondary models targeting SGA as the sole outcome also showed excellent prediction (PV: AUC, 0.820; PQ: AUC, 0.810; MCD: AUC, 0.827; and MPD: AUC, 0.795). Conclusions. In addition to volume, 3‐dimensional sonography allows for novel techniques to measure other aspects of gross placental morphologic characteristics and CI, which can yield promising biologically plausible early predictors of fetal growth and adverse perinatal outcome.

Placental Morphologic Features and Chorionic Surface Vasculature at Term Are Highly Correlated With 3-Dimensional Sonographic Measurements at 11 to 14 Weeks

The purpose of this study was to examine the potential for 3‐dimensional sonographic measurement of the early placenta in predicting ultimate placental morphologic features at delivery.

Vaginal fetal fibronectin as a predictor of spontaneous preterm delivery in triplet gestations

Objective: To assess the diagnostic accuracy of vaginal fetal fibronectin (fFN) sampling for predicting preterm birth in asymptomatic women carrying triplet gestations. Methods: An historical cohort of patients carrying triplet gestations between 1998 and 2010 was identified from a single practice by chart review. All patients were screened with fFN testing at 2–3 week intervals from 22 weeks to 32 weeks of gestation. Outcomes evaluated were spontaneous preterm birth prior to 28, 30, and 32 weeks’ gestation and delivery within 2 and 3 weeks of testing. Results: There were 56 pregnancies that met criteria for inclusion. For delivery prior to 30 weeks’ gestation, the test had a sensitivity of 75%, a specificity of 85.4%, a positive predictive value of 46.2%, a negative predictive value of 95.3%, positive likelihood ratio of 5.13, and a negative likelihood ratio of 0.29 (p < 0.0001). For delivery within 3 weeks of a single fFN assessment, the test had a sensitivity of 53.3%, a specificity of 95.8%, a positive predictive value of 53.3%, a negative predictive value of 95.8%, positive likelihood ratio of 12.7 and negative likelihood ratio of 0.48 (p < 0.0001). Conclusion: Fetal fibronectin testing provides moderate to high prediction of spontaneous preterm birth in triplet gestations.

Do Doppler studies enhance surveillance of uncomplicated monochorionic diamniotic twins

To determine whether isolated abnormal Doppler indices before 28 weeks predict adverse pregnancy outcomes in uncomplicated monochorionic diamniotic (MCDA) twins.

Early Biometric Lag in the Prediction of Small for Gestational Age Neonates and Preeclampsia

An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes.

The effect of cervical cerclage on the rate of cervical shortening

Although cerclage has been shown to reduce the risk of recurrent preterm birth in a high‐risk patient population, the mechanism by which this occurs is not well understood. Our objective was to evaluate whether cerclage affects the rate of cervical shortening taking into account exposure to 17‐hydroxyprogesterone and vaginal progesterone.

Does the rate of cervical shortening after cerclage predict preterm birth

Abstract Objective: The objective of this study is to evaluate whether the rate of cervical shortening after cerclage can predict spontaneous preterm birth (SPTB). Methods: Women who had cervical length (CL) assessments after cerclage placement were identified. The rate of cervical shortening and its relationship with SPTB was established using a generalized linear regression model. Secondary outcomes included relationship between cervical shortening and risk of SPTB in those with a post-cerclage CL <25 mm versus ≥25 mm at 18–20 weeks; and the rate of cervical shortening in women who delivered preterm compared with those who delivered at term. Results: One hundred thirty-four patients were included and 30 (22.4%) delivered at <36 weeks. A rate of cervical shortening of 1 mm/week conferred a risk of SPTB of 22%. Among women with cerclage who had a CL <25 mm at 18–20 weeks, 1 mm/week of cervical shortening was associated with a 59% risk of SPTB. Patients with cerclage who delivered at term had a slower rate of cervical shortening compared to those who delivered preterm (0.62 mm versus 1.40 mm per week, p = 0.008). Conclusions: The rate of cervical shortening after cerclage placement is associated with the risk of SPTB. Sonographic surveillance of the rate of cervical shortening may be useful in assessing risk for SPTB in patients with cerclage.