F. Perrotin

Omphalocele in the first trimester: prediction of perinatal outcome

This study aims to evaluate the perinatal outcomes of fetuses with isolated omphalocele diagnosed before 14 weeks of gestation (WG) and determine whether visceral–abdominal disproportion (ratio between mean omphalocele diameter and transverse abdominal diameter) and omphalocele contents can predict neonatal morbidity.

Biparietal/transverse abdominal diameter ratio ≤ 1: potential marker for open spina bifida at 11–13‐week scan

In the first trimester of pregnancy, a biparietal diameter (BPD) below the 5th percentile is a simple marker that enables the prenatal detection of half of all cases of open spina bifida. We hypothesized that relating the BPD measurement to the transverse abdominal diameter (TAD) might be another simple and effective screening method. In this study we assessed the performance of using the BPD/TAD ratio during the first trimester of pregnancy in screening for open spina bifida.

Decrease of uteroplacental blood flow after feticide during second-trimester pregnancy termination with complete placenta previa: Quantitative analysis using contrast-enhanced ultrasound imaging

Contrast enhanced ultrasound (CEUS) was used to quantify the dynamic changes in uteroplacental blood flow before and after the interruption of fetal villus circulation resulting from feticide during a second trimester pregnancy termination in a patient with complete placenta previa. Quantitative analysis was performed on time-intensity curves acquired 24 h before and 48 h and 120 h after feticide and demonstrated the persistence of utero-placental blood flow with a progressive and two-step reduction in intervillous space and uteroplacental blood flow. Our results suggest that placental blood flow reduction after interruption of fetal circulation is a progressive and delayed mechanism.

Individual and organisational determinants associated with maintenance tocolysis in the management of preterm labour: a multilevel analysis.

Background Clinical guidelines do not recommend maintenance tocolysis for the management of preterm labour. The French national survey EVAPRIMA revealed it was administered to more than 50% of women hospitalised for preterm labour. Our aim was to identify the individual and organisational determinants associated with maintenance tocolysis. Methods The study was a secondary analysis of the prospective population-based EVAPRIMA study database. Population study included every women hospitalised for preterm labour and at risk of receiving maintenance tocolysis, over a one month period, in 99 randomly selected French maternity units. Main outcome was the prescription of maintenance tocolysis. The association between maintenance tocolysis and individual (maternal or obstetrical) and organisational determinants were evaluated with multilevel analysis. Results Of the 531 women included, 68.9% (95% CI 0.65–0.73) received maintenance tocolysis. The only individual factor associated with maintenance tocolysis was gestational age at admission; the rate of maintenance tocolysis was higher among women hospitalised before 32 weeks of gestation. The significantly different rates between maternity units demonstrated the existence of a maternity unit effect. Maintenance tocolysis was also associated with organisational determinants and was more frequent in level 1 (ORa = 6.54[2.21–19.40]) and level 2 maternity units (ORa = 3.68[1.28–10.59]), in units with less than 1500 deliveries/year (ORa = 5.27[4.43–19.44]), and in specific areas of France. Conclusion A maternity unit effect, explained partly by the organisational characteristics of the units, plays a major role in the practice of maintenance tocolysis. Widespread dissemination of these results might improve adherence to clinical guidelines.

OP06.20: In utero Doppler ultrasound-guided embolization for the treatment of a large, vascular sacrococcygeal teratoma causing fetal hydrops

26.3 weeks of gestation. Other 4 women were referred to our University hospital because of maternal trauma. Mean gestational age was 28.6. In all the fetuses the MCA-PSV was > 1.5 MoM according to the reference range of Mari et al, and showed sinusoidal pattern during cardiotocography. Mean time of delivery has been of 47 hours because of abruptio placenta. In the other 4 women the MCA-PSV was normal as well as the cardiotocography pattern and delivered in a mean time of 8 hours because of acute abruptio placenta. Conclusion: MCA-PSV has a great sensibility in the prediction of fetal anemia, in case of maternal-fetal hemorrhage the fetuses may be anemic in case of chronic bleeding from the placenta, while in case the bleeding is acute MCA-PSV is usually normal. Thus the assessment of the MCA-PSV may be helpful to look for sign of fetal anemia in case of maternal-fetal hemorrhage.

First trimester uterine artery Doppler, sFlt-1 and PlGF to predict preeclampsia in a high-risk population.

Abstract Objective: The study aims to evaluate the accuracy of combining uterine artery Doppler (UAD), PlGF and sFlt-1 in the first trimester for preeclampsia screening. Methods: Prospectively enrolled women at high risk of preeclampsia were included. Transabdominal UAD measurements and serum biomarkers were collected between 11 and 13 weeks of gestation in three university hospitals and in one general hospital. The main outcome was preeclampsia. UAD parameters and biomarker levels among women with preeclampsia were compared with those of women in the unaffected group in univariate and multivariate analyses. Results: Out of 226 women included from May 2007 to January 2011, 27 (11.9%) women developed preeclampsia. Among women affected by preeclampsia, the lowest pulsatility index was higher (p = 0.02), bilateral notching was more frequent (p = 0.01), and PlGF was lower (p < 0.001). No significant differences were observed for other indicators. The multivariate model, adjusted for laboratory and sonographic indicators, had an area under the curve (AUC) estimated at 0.76, which was not significantly different from the AUC of the univariate model adjusted only for PlGF (p = 0.7). Conclusion: In a high-risk population, PlGF in the first trimester is useful for predicting preeclampsia, but neither sFlt-1 nor any UAD indices improved the prediction of preeclampsia.

Ultrasound in labor monitoring: how to define the plane of ischial spines?

. Furthermore,we would like to add another argument in favor ofultrasound, particularly in the evaluation of descent of thefetal head.The subjective and poorly reproducible nature ofclinical examination is often highlighted in the literatureand we believe that the clinical method to assess fetal headdescent is less standardized than are ultrasound methods.Engagement of the fetal head is assessed clinically byfetal head station according to the American College ofObstetrician and Gynecologists (ACOG)

P27.14: Arterial embolization in arterial venous shunt: about our experience in the management of placental chorioangiomas with fetal hydrops

Objectives: Oligohydramnios occurring early during the second trimester has to be considered a severe sign of poor prognosis. Amnioinfusion has been reported improving the prognosis in case of reduction of amniotic fluid volume due to premature rupture of membranes (PROM). We present our experience with amnioinfusion for oligohydramnios with or without preterm PROM. Methods: We prospectively enrolled pregnant women presenting oligohydramnios from January 2009 to December 2009. Second level scan was performed after each amnioinfusion. Further analysis such as magnetic resonance or genetic tests were performed after counselling. Results: Twenty-six cases were included in our study. Ten cases presented PROM and eight out of ten performed more than one amnioinfusion. One case of PROM revealed sonographic sign of fetal aneuploidy confirmed at karyotype. Sixteen cases were enrolled without any anamnestic or clinical sign of PROM. Ten cases presented sign of renal dysplasia before amnioinfusion confirmed after the procedure, and in two cases the second level scan revealed further anomalies. The five remaining fetuses did not presented either PROM of renal anomalies. One case out of six demonstrate intrauterine growth retardation (IUGR) and congenital heart disease, two cases presented IUGR associated to altered uterine artery Doppler. The three remaining cases remained unexplained. Conclusions: Amnioinfusion might provide benefits such as confirmation of rupture of membranes and detailed sonography examination. This procedure has to be considered in cases with oligohydramnios due to further counselling during pregnancy.

CRISPR: A Useful Genetic Feature to Follow Vaginal Carriage of Group B Streptococcus

Clustered regularly interspaced short palindromic repeats (CRISPR) and Cas (CRISPR-associated proteins) play a critical role in adaptive immunity against mobile genetic elements, especially phages, through their ability to acquire novel spacer sequences. Polarized spacer acquisition results in spacer polymorphism and temporal organization of CRISPR loci, making them attractive epidemiological markers. Group B Streptococcus (GBS), a genital commensal for 10 to 30% of healthy women and a major neonatal pathogen, possesses a ubiquitous and functional CRISPR1 locus. Our aim was to assess the CRISPR1 locus as an epidemiological marker to follow vaginal carriage of GBS in women. This study also allowed us to observe the evolution of the CRISPR1 locus in response to probable phage infection occurring in vivo. We followed carriage of GBS among 100 women over an 11-year period, with a median duration of approximately 2 years. The CRISPR1 locus was highly conserved over time. The isolates that show the same CRISPR1 genotype were collected from 83% of women. There was an agreement between CRISPR genotyping and other typing methods [MLVA (multilocus variable number of tandem repeat Analysis) and MLST (multilocus sequence typing)] for 94% of the cases. The CRISPR1 locus of the isolates from 18 women showed modifications, four of which acquired polarized spacer, highlighting the in vivo functionality of the system. The novel spacer of one isolate had sequence similarity with phage, suggesting that phage infection occurred during carriage. These findings improve our understanding of CRISPR-Cas evolution in GBS and provide a glimpse of host-phage dynamics in vivo.

Computed tomographic study of anatomical relationship between pubic symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound

To analyze the anatomical relationship between the pubic symphysis and the ischial spines to determine reliable landmarks for the assessment of fetal head descent by intrapartum translabial ultrasound (ITU).