Erkan Kalafat

Cardiovascular origins of preeclampsia

Purpose of review To review the current data on maternal cardiovascular adaptation in normal pregnancy and preeclampsia. Recent findings Defective placentation causes early-onset preeclampsia, a disease entity that is considered more or less distinct from late-onset preeclampsia. The latter has been attributed as ‘maternal’ preeclampsia. There are inconsistencies with the placental origins hypothesis, especially when considering the lack of a causative association with abnormal placental histology or impaired fetal growth. An alternative explanation is that placental dysfunction is secondary to maternal cardiovascular maladaptation in pregnancy. The concept that placental dysfunction is secondary to a maternal disorder is not new when one considers the clinical similarities between preeclampsia and gestational diabetes – both pregnancy-specific conditions that are cured by birth. It is accepted that gestational diabetes develops when the maternal pancreas is unable to manage the increasing glucose load of pregnancy. It is now apparent that pregnancy presents a substantial cardiovascular load on the maternal heart, and that cardiovascular dysfunction precedes the disorder, predominates in the clinical syndrome and persists for several decades postpartum. It is time to consider the evidence that failure of the maternal cardiovascular system to adapt to pregnancy may well be the primary mechanism leading to secondary placental dysfunction in preeclampsia. Summary Many of the existing paradoxes of preeclampsia challenge the placental origin hypothesis and are explained if one considered preeclampsia to be a cardiovascular syndrome.

Comparison of effects of digital vaginal examination with transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial

To evaluate whether routine vaginal examination during labor is associated with increased levels of anxiety and pain compared with transperineal ultrasound assessment.

Comparison of digital vaginal examination versus transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial.

To evaluate whether routine vaginal examination during labor is associated with increased levels of anxiety and pain compared with transperineal ultrasound assessment.

Ophthalmic artery Doppler for prediction of pre‐eclampsia: systematic review and meta‐analysis

To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre‐eclampsia (PE).

Predictive accuracy of the Southwest Thames Obstetric Research Collaborative (STORK) chorionicity‐specific twin growth charts for stillbirth: a validation study

Twin pregnancy is associated with a 2–3‐fold increased risk of stillbirth compared with singleton pregnancy. Despite the fact that the growth pattern in twins has been shown to be different from that in singletons, it is controversial whether twin‐specific growth charts should be used routinely. A major goal of prenatal ultrasound is to identify fetuses with growth restriction at risk of stillbirth. The main aim of this study was to compare the performance of chorionicity‐specific twin charts with singleton charts, both customized and non‐customized, in the antenatal prediction of small‐for‐gestational‐age (SGA) stillborn and liveborn fetuses.

Is home blood‐pressure monitoring in hypertensive disorders of pregnancy consistent with clinic recordings?

To assess the agreement between home blood‐pressure monitoring (HBPM) and blood‐pressure measurements in a clinic setting, in a cohort of pregnant women with hypertensive disorders of pregnancy (HDP).

Metformin for the prevention of hypertensive disorders of pregnancy in women with gestational diabetes and obesity: a systematic review and meta‐analysis

Metformin has been reported to reduce the risk of pre‐eclampsia. It is also known to influence soluble fms‐like tyrosine kinase‐1 level, which correlates significantly with the gestational age at onset and severity of pre‐eclampsia. The main aim of this systematic review and meta‐analysis of randomized trials was to determine whether metformin use is associated with the incidence of hypertensive disorders of pregnancy (HDP).

Risk of neonatal care unit admission in small for gestational age fetuses at term: a prediction model and internal validation

Abstract Objective: Small for gestational age (SGA) fetuses are at increased risk of admission to the neonatal unit, even at term. We aimed to develop and validate a predictive model for the risk of prolonged neonatal unit admission in suspected SGA fetuses at term. Methods: A single-center cohort study of singleton pregnancies with SGA fetus, defined as estimated fetal weight (EFW) less than the 10th centile, at term. The variables included known risk factors for neonatal unit admissions: maternal characteristics, EFW, abdominal circumference (AC), fetal Dopplers, gestational age (GA) at delivery, and intrapartum risk factors (meconium, pyrexia). Logistic regression analysis was used for model building and the prediction models were validated internally using bootstrapping. Results: Seven hundred and one SGA pregnancies at term were included; 5.9% had prolonged neonatal unit admission (>48 h). The multivariable model (AUC 0.71; 95% CI: 0.63–0.79) included GA at delivery <39 weeks (OR 2.76; 95% CI 1.23–6.04, p = .011), cerebroplacental ratio (CPR) multiples of median (MoM) (OR 0.21; 95% CI 0.05–0.79, p = .023), and EFW below the third centile (OR 2.43; 95% CI 1.26–4.68, p < .007). The combined model showed a sensitivity 30.9% (95% CI: 16.6–45.2%) for a fixed 10% false positive rate. Conclusion: The prediction model shows good accuracy and good calibration for assessing the risk of neonatal unit admission in suspected SGA fetuses. It has the potential to be used for patient counseling, determining the timing of delivery and the individual risk. Brief rationale Objective: The objective of this study is to determine the factors associated with prolonged neonatal unit admissions in small for gestational age fetuses at term. What is already known: Fetal weight and Doppler parameters are associated with adverse outcome in small for gestational age fetuses. However, most studies use composite outcome criteria by combining neonatal unit admission with adverse delivery outcomes. A comprehensive model combining antenatal and intrapartum variables is also lacking. What this study adds: Our model describes the association of antenatal and intrapartum variables with prolonged neonatal unit admission without using a composite adverse outcome measure. Estimated fetal weight, gestational age at delivery, and the cerebroplacental ratio can be used to estimate the risk of prolonged neonatal unit admission. The risk estimation can be useful for patient counseling and to determine the time of delivery.

P15.10: Embryo reduction in trichorionic triplets: effect on time to delivery and birthweight discordance

ablation for TRAP sequence, fetal cord blood sampling, fetal blood transfusion, fetal ascites aspiration, thoraco-centesis for severe fetal pleural effusion, amnioinfusion and fetal intramuscular injection for anesthesia. We descriptively analysed the feasibility and efficacy of real-time two-dimensional B-mode bi-plane image using eM6C probe. Results: In all cases, we found the safety because of the real-time two-dimensional images would provide other organ positions such as liver, lung, and heart that we could not see in using 1 dimensional image. In centesis into small cavity such as umbilical cord or thoracic cavity, 3D information supported us the successful centesis by leading tip position. The technical limit is that the well-trained assistant must chase the needle tip by tracking ball just online the guided needle after operator. We needed ‘‘momentary stop ’’ just before final insertion from the edge of the organ surface. Conclusions: A biplane mode of real-time 4D imaging may be a promising tool for applying fetal interventions.

P20.11: Small-for-gestational-age (SGA) fetuses are at higher risk of neonatal unit (NNU) admission: we aimed to develop and validate a predictive model for the risk of NNU admission in SGA fetuses at term

Results: Data from 19,482 ultrasound scans (n = 4,225 women in the FGLS cohort) were available for analysis. The demographics of participants, number of scans per woman, and the probability of cephalic presentation at each GA from 16+0 to 40+6 weeks’ gestation were charted. The probability of cephalic presentation increased from 0.41 (95% CI 0.38 to 0.45) at 16 weeks’ gestation to 0.97 (0.95 to 0.98) at 36 weeks’ gestation and 0.98 (0.96 to 0.99) at 39 weeks’ gestation. Conclusions: It is well recognised that the probability of cephalic presentation increases with GA. Here, we present probabilities at each GA, derived from a longitudinal study of 4,225 individual fetuses, which should help clinicians to counsel women.