Danielle Tate

A Novel Translational Model of Percutaneous Fetoscopic Endoluminal Tracheal Occlusion - Baboons (Papio spp.)

Introduction: Percutaneous fetoscopic endoluminal reversible tracheal occlusion (FETO) was developed to prevent the pulmonary complications of fetal congenital diaphragmatic herniation. There is an urgent need to establish the closest to human translational model of FETO in order to improve fetal outcomes and to determine new clinical approaches and applications. Material and Methods: Seven non-human primates underwent two subsequent surgeries: the first, the FETO in the experimental group (n = 3) or sham operation in the control animals (S-FETO, n = 4) at 132-142 days of gestation (dGA); the second, the reversal of occlusion or sham operation at 162 ± 5 dGA. Maternal stress axis, complete blood count, and biochemical parameters were evaluated and newborn tracheal radiography was performed. Results: The average pregnancy duration and neonatal weights in the FETO group did not differ from the animals in the S-FETO group. There was no bleeding or premature fetal membrane rupture during the procedures in any of the baboons. The maximal tracheal width was 7.02 ± 0.6 mm in the FETO versus 5.46 ± 0.6 mm in S-FETO group. Discussion: This is the very first report of a successful FETO model in non-human primates. Similarities to human tracheomegaly were for the first time documented in any model studied.

The Effect of Prenatal Alcohol Exposure on Fetal Growth and Cardiovascular Parameters in a Baboon Model of Pregnancy

Prenatal alcohol exposure often results in an array of fetal developmental abnormalities termed fetal alcohol spectrum disorders (FASDs). Despite the high prevalence of FASDs, the pathophysiology of fetal damage by alcohol remains poorly understood. One of the major obstacles in studying fetal development in response to alcohol exposure is the inability to standardize the amount, pattern of alcohol consumption, and peak blood alcohol levels in pregnant mothers. In the present study, we used Doppler ultrasonography to assess fetal growth and cardiovascular parameters in response to alcohol exposure in pregnant baboons. Baboons were subjected to gastric alcohol infusion 3 times during the second trimester equivalent to human pregnancy, with maternal blood alcohol levels reaching 80 mg/dL within 30 to 60 minutes following alcohol infusion. The control group received a drink that was isocaloric to the alcohol-containing one. Doppler ultrasonography was used for longitudinal assessment of fetal biometric parameters and fetal cardiovascular indices. Fetal abdominal and head circumferences, but not femur length, were significantly decreased in alcohol-exposed fetuses near term. Peak systolic velocity of anterior and middle cerebral arteries decreased during episodes of alcohol intoxication, but there was no difference in Doppler indices between groups near term. Acute alcohol intoxication affected fetal cerebral blood flow independent of changes in the fetal cardiac output. Unlike fetal growth parameters, changes in vascular indices did not persist over gestation. In summary, alcohol effects on fetal growth and on fetal vascular function have different time courses.

17 alpha-hydroxy-progesterone Caproate Does Not Impair Glucose Control in Women With Pregestational Diabetes Mellitus [271]

INTRODUCTION: We sought to investigate the effects of &agr;-hydroxy-progesterone caproate on glucose control in women with pregestational diabetes mellitus (DM). METHODS: Retrospective cohort study of &agr;-hydroxy-progesterone caproate users in women with DM from January 2009 to December 2013 with a history of prior spontaneous preterm delivery. RESULTS: We identified 15 of 373 women with DM among our cohort of &agr;-hydroxy-progesterone caproate users (2.9%). When compared with women in a control group (women with DM not using &agr;-hydroxy-progesterone caproate) during the study period (n=180), the prevalence of elevated HbA1C in the third trimester before delivery (greater than 6.5%) was greater among &agr;-hydroxy-progesterone caproate users (5/15 [30%]) than in women in the control group (39/180 [21.6%]; P=.03). There were no significant differences in the rate of macrosomia (neonatal weight greater than 4,000 g [8% compared with 12%, respectively]) or in the rate of indicated preterm delivery at less than 37 weeks of gestation among groups (5% compared with 7%). When adjusted for number of prenatal visits, compliance to insulin regimen, ethnicity, and body mass index, we did not identify significant difference in the prevalence of elevated HbA1C in the third trimester among both groups. CONCLUSION: The use of &agr;-hydroxy-progesterone caproate does not impair glucose control or the rate of macrosomia in users with pregestational DM.

Adjuvant administration of 17-α-hydroxy-progesterone caproate in women with three or more second trimester pregnancy losses undergoing cervical cerclage is no more effective than cerclage alone

Abstract Objective: To investigate the role of adjuvant 17-α-hydroxy-progesterone caproate (17OHP-C) in reducing the risk of preterm delivery <34 weeks and adverse perinatal outcomes in women with ≥3 second trimester pregnancy losses attributed to cervical insufficiency undergoing prophylactic cerclage. Material and methods: Retrospective cohort study of women with prophylactic cerclage placed between 2006 and 2014 divided into a cohort of (i) those receiving adjuvant 17OHP-C (n=43), and (ii) controls with cerclage alone (n=59). Results: Demographic characteristics were comparable in both groups. There was no significant difference in gestational age at delivery between the cerclage-17OHP-C group (33.4±5.6 weeks) and the cerclage-alone group (34.4±4.6 weeks); P=0.33. We noted a non-significant increase for deliveries <34 weeks in the cerclage-17OHP-C group (44.2%) compared to controls (28.8%) which remained non-significant after adjusting for confounders; P=0.46. There was no statistically significant difference in the rate of delivery <37, 32, 28 and 24 weeks. Adverse neonatal outcomes were comparable in both groups (cerclage-17OHP-C 48.8% vs. cerclage-alone 39%); P=0.43. Conclusion: Intramuscular 17OHP-C in combination with prophylactic cerclage in women with cervical insufficiency and ≥3 second trimester pregnancy losses had no synergistic effect in reducing the rate of recurrent preterm birth or improving perinatal outcomes.

Pregnancy with uncorrected tetralogy of Fallot (TOF), pulmonary atresia and major aorto-pulmonary collateral arteries (MAPCA)

Abstract Pregnancy with uncorrected tetralogy of Fallot (TOF) is a rare event, and increases the risk for fetal growth restriction and adverse outcomes related to worsening right-to-left shunt, cyanosis, pulmonary hypertension and arrhythmia. Obstetric management is made on a case-by-case basis. Patients who remain stable can achieve term pregnancies and the mode of delivery can be based on obstetric indications. We present the case of a 21-year-old primigravida with baseline cyanosis, oxygen saturation 90% at rest (74% with activities), hematocrit 50%, and echocardiogram showing pulmonary atresia, ventricular septal defect (VSD), and major aorto-pulmonary collateral arteries (MAPCA). We managed her with aspirin, metoprolol and oxygen supplementation. She delivered at 38 weeks (fetal growth restriction) via cesarean; she received epidural and endocarditis prophylaxis. Three years later, she presented pregnant and had a repeat cesarean at term. Both newborns had normal structural hearts. Knowledge of the cardiovascular physiology during pregnancy and baseline assessment, and a multidisciplinary management are key aspects in the management of these cases during pregnancy.

Does Sickle Cell Trait Affect Adverse Pregnancy Outcomes? [20A]

INTRODUCTION: While data and pregnancy outcomes are well established, previous data published on sickle cell trait and pregnancy outcomes have been controversial with some reports showing a significant association with preeclampsia. Our study aims to evaluate the risk of adverse pregnancy outcomes in pregnant patients with sickle cell trait who underwent prenatal care at our tertiary-care institution. METHODS: Database obtained from LabCorp of all patients from the Regional One Health Outpatient Clinic who underwent hemoglobin electrophoresis obtained from July 2012 to April 2013. Chart review was performed to collect medical history, laboratory data, delivery information and pregnancy outcomes. Data were analyzed with SPSS Version 22 software. ANOVA, chi-square test and Bonferroni correction test were used where applicable. RESULTS: Of 350 patients, 102 were excluded for lack of delivery information, multiple gestation, and delivery less than 20 weeks. A comparison of 223 patients with normal hemoglobin and 16 patients with HbAS showed no statistically significant difference in pregnancy outcomes including Preeclampsia or HELLP Syndrome, gestational hypertension, fetal growth restriction, preterm delivery, gestational diabetes, premature rupture of membranes or cesarean delivery. Furthermore, in our cohort, there was no increased risk of bacteriuria diagnosed in the outpatient setting. A subanalysis of patients with HbAS who tested positive for bacteriuria failed to show increased risk for fetal growth restriction. CONCLUSION: In our cohort, carriers of HbAS are not at increased risk for adverse pregnancy outcomes or bacteriuria. Fetal growth restriction was not more prevalent in our cohort even in women with bacteriuria when compared to controls.

Does 17-α-hydroxyprogesterone Caproate Affect Fetal Birth Weight and Biometry in Singleton Pregnancies? [29R]

INTRODUCTION: We sought to investigate the effects of 17-alpha-hydroxyprogesterone caproate (17P) on fetal weight and biometry in singleton pregnancies. METHODS: Retrospective cohort study, single institution, from 2010–2014. Cohort was composed by women with singletons and history of spontaneous preterm birth requiring 17P from week 16–22 until week 36 or delivery. Controls (4 per 1 cohort) were matched by gestational age at delivery and included women not on 17P and no history of prematurity. Birthweight (BW), head and abdominal circumference (HC, AC) and femur length (FL) were compared. T tests and regression analyses were performed. RESULTS: 18,351 women delivered in our institution during the study period. We had data available for 257 women using 17P and 1,028 randomly selected controls. Median gestational age at delivery was 37.2 (17P) and 38.5 weeks (controls); P<.001. Median BW was lower for 17P users (2,790 gms) than controls (3,030 gms); P<.001. After adjusting for various confounders, the difference in BW persisted lower for 17P users (P=.02). Fetal biometry was not different among groups. There was no difference in NICU length of stay. CONCLUSION: The use of 17P may be associated with lower BW at birth but appears of no clinical significance.

Hemoglobin A1C Values Are Not Affected by Hemoglobin Level in Diabetic and Nondiabetic Pregnant Women [327]

INTRODUCTION: Previous studies suggest that hemoglobin A1C (HbA1C) values are affected by hemoglobin (Hb) levels in nonpregnant women. We sought to investigate the effects of anemia in HbA1C values in pregnant women affected by diabetes. METHODS: We conducted a cross-sectional study in pregnant women who had HbA1C values from June 2012 to June 2014 in a single tertiary care institution. We categorized HbA1C values according to the presence of anemia (Hb less than 10.5 g/dL). RESULTS: During the study period, we analyzed third-trimester HbA1C values in 50 women with gestational diabetes (GDM), 150 women with pregestational diabetes mellitus (DM), and 47 women without diabetes (controls). At a given fasting glucose level, values of HbA1C did not differ significantly according to Hb levels above or below 10.5 g/dL among women with GDM, DM, or those in the control group (P=nonsignificant). CONCLUSION: In our cohort, HbA1C values were not affected by Hb levels and are reliable in pregnant women affected by anemia.