G. A. Hackett

Obstetric and neonatal outcomes in apparently isolated mild fetal ventriculomegaly

Abstract Aims and methods: To determine obstetrical and neonatal outcomes in referrals of apparently isolated mild ventriculomegaly following routine ultrasound scan, over the period 2001–2003. Specialist ultrasound and other investigations were performed. Neonatal examination and postnatal ultrasound findings were collected and local neurodevelopmental follow-up was obtained. Results: 30 cases of suspected isolated mild ventriculomegaly (posterior horn of lateral ventricle 10–15 mm at diagnosis) were identified. There were two abnormal karyotypes, no abnormal TORCH screens, and only one false-positive alloimmune thrombocytopenia screen. In 21 cases, isolated ventriculomegaly was confirmed following specialist investigation. In 11 of 21 cases, ventriculomegaly resolved during antenatal follow-up, and in one case it progressed. Six of 21 had ventriculomegaly confirmed on postnatal ultrasound and lissencephaly was diagnosed in one following postnatal MRI. Of the 11 infants with antenatal resolution of ventriculomegaly, 2 have delayed development. The infant with progressive ventriculomegaly has severe developmental problems.

Perinatal Postmortems: What Is Important to Parents and How Do They Decide?

BACKGROUND Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth. METHODS A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem. RESULTS Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the babys body. CONCLUSIONS Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby.

Obstetric pelvimetry in the UK: an appraisal of current practice

The practice of radiological pelvimetry in pregnancy should be subjected to close scrutiny. The Royal College of Radiologists and National Radiological Protection Board (1990) have drawn our attention to the large proportion of X-ray investigations carried out unnecessarily in the United Kingdom. More recently, the Royal College of Radiologists (1993) has recommended that there should be a valid clinical indication for all X-ray examinations and has stated that a useful investigation is one where the result-positive or negative-will alter patient management. Radiological pelvimetry has been used for more than 50 years now and is a technique that was introduced without prospective clinical trials. Recent studies, both prospective (Parsons & Spellacy 1985; Thubisi et al. 1993), and retrospective (Krishnamurthy et a/. 1991) have led to an increasing scepticism as to its value. On the other hand developments in newer imaging technologies (Wade 1992; Powell 1993) have created renewed enthusiasm for pelvic measurements. We wished to document the characteristics of current practice in the United Kingdom as a prerequisite to establishing the necessary guidelines for future use of this investigation.

The NTplus method of screening for Down syndrome: achieving the 2010 targets?

The performance of pregnancy‐associated plasma protein‐A (PAPP‐A) as a first trimester trisomy 21 marker is hypothesized to improve below 11 weeks, whereas β‐human chorionic gonadotrophin (hCG) is better after 14 weeks. We audited a model combining early PAPP‐A (9–10 weeks) with NT (11–13 weeks and 6 days) and early triple test (>14 weeks).

Tissue collagenase: serum levels during pregnancy and parturition.

Serum levels of tissue collagenase, matrix metalloproteinase-1, were measured in both longitudinal and cross-sectional studies, in 332 pregnant women and 27 non-pregnant volunteers. The enzyme-linked immunosorbent assay (ELISA) used is the first described to measure collagenase in serum directly, is specific, and is rapid and reproducible. Levels were determined throughout pregnancy, during term and preterm labour, and in the post-partum period. Serum tissue collagenase levels were elevated in pregnancy (P < 0.001). There was no difference between levels of serum collagenase prior to labour at term and those observed during labour. Similarly, there was no significant difference in levels obtained during preterm labour and those at a similar gestation in women who subsequently delivered at term. No significant decrease in levels had occurred by the 4th post-partum day. In view of these findings of unaltered matrix metalloproteinase-1 levels in association with labour, previous reports of raised serum collagenase activity in association with the onset of spontaneous labour, at term and preterm gestation periods, may be due to increased neutrophil collagenase activity.

OC10.01: Early pregnancy changes in maternal haemodynamics using pulse wave analysis

Objectives: The objective of our study was to determine the incidence of stillbirth in monochorionic twin pregnancies after 24 0/7 weeks gestational age in a large, unselected cohort of monochorionic (MC) twins. In addition, we sought to explore the added risk factor of twin-to-twin transfusion syndrome (TTTS) in this cohort. Methods: We completed a retrospective cohort study of all MC twin pregnancies in the Kaiser Northern California (KPNC) population delivered between 1996 and 2003. All twin placentas were submitted to pathology during this time frame, and chorionicity was confirmed by placental pathology. Pregnancies were excluded if delivery or termination occurred prior to 24 0/7 weeks’ gestation, birth data was unavailable or chorionicity could not be confirmed. The incidence of stillbirth, TTTS and outcomes for liveborn twins were assessed by database search and chart review. Results: From 1996–2003, 646 monochorionic twin sets were cared for and delivered by KPNC and 594 of these pregnancies met criteria for inclusion. Thirteen pregnancies resulted in the demise of both twins and 26 pregnancies resulted in the demise of a single twin, thus 4.4% of all infants delivered after 24 0/7 weeks’ gestation were stillborn (52/1188). 9.1% of MC pregnancies were affected by TTTS (54/594) and 25.9% of the TTTS pregnancies resulted in intrauterine fetal demise (IUFD) of at least one twin (14/54) compared to 4.6% of non-TTTS pregnancies (25/540). The RR for fetal demise after 24 weeks’ gestation in MC twins affected by TTTS is 4.86 (CI 2.86–8.59). Conclusions: In our study population, one in every fifteen MC twin pregnancies resulted in a post-viability IUFD of at least one twin. This incidence of IUFD appears higher than that of the general population, affirming the results of previous studies. Families should be counseled about these pregnancy prognoses and further prospective studies should be done to assess the optimal gestational age for delivery to potentially prevent these outcomes.

OP02.05: Ovulation‐implantation interval in relation to early pregnancy outcome

Objectives: To determine the variables associated with different outcomes for pregnancies of unknown location (PUL). Methods: Prospective observational study. Women in the 1st trimester of pregnancy presenting to the early pregnancy unit (EPU), between 2009 and March 2011, underwent a transvaginal scan (TVS). A PUL was classified on TVS if there was no intraor extra-uterine pregnancy. Data was collected from women with a PUL at the first TVS. More than 10 historical, clinical and 3-D ultrasonographic end points were collected for analysis. Women were followed up until the outcome was established: failed PUL, intrauterine pregnancy (IUP) and ectopic pregnancy (EP). Off-line 3-D processing of the uterine and ovarian volumes was performed using VOCAL in order to calculate endometrial volume (EV), mean gray index, vascular index (VI), flow index (FI) and vascular flow index (VFI). Univariate analysis was performed in order to establish the significant variables for the different PUL outcomes (ANOVA F-test and Fisher’s exact test). Results: 154 women were initially classified as a PUL. 143 women were included in the final analysis (11 cases lost to follow up). 69.2% (99/143) failed PULs, 23.1% (33/143) IUPs and 7.7% (11/143) EPs. The variables that were significantly associated with PUL outcomes were: gray index (P = 0.01), flow index (P = 0.01), hCG at 48hrs (P = 3.13E-07), log hCG at 48hrs (P = 1.89E-09), and hCG ratio (P = 4.34E-16). Conclusions: 3-D volumetric indices of the uterus and ovary may be useful in the prediction of PUL outcome. These results could result in the development of new mathematical models in management of PULs.

P20. 05: Placental weight, cord insertion, shape and cord coiling in hypertensive disorders of pregnancy

postnatal or postmortem examination. The frequency of agreement between the ultrasound modalities was estimated and compared using the McNemar-Bower test. Results: Regarding to the ultrasonographic signs, the local and the remote examiners had high correct rates for 2D US and 3D US (80.0%, 84.0% and 76.0% e 86.0%, respectively). Similarly, the diagnosis for congenital anomalies had a better percentage for 3D US compared for 2D US for the remote examiner (92.3 vs. 84.6%) and equal for the local one (96.2% vs. 96.2%), respectively. Regarding to the ultrasonographic signs and the diagnosis of congenital anomalies, comparing the 2D US vs. 3D US performed by the same examiner the local and remote ones did not find any statistically significant difference. Conclusions: In spite of the slightly increased percentage in the ultrasonographic signs of the 3D US compared to 2D US for congenital anomalies from both examiners and in its diagnosis for the remote examiner, it did not reach any statistically significant difference.

P10. 02: Placental weight, cord insertion, shape and cord coiling in pregnancies with gestational diabetes mellitus (GDM)

S. Pathak1, N. J. Sebire4, L. Hook2, F. Jessop2, E. Murdoch3, G. A. Hackett1, C. Lees1 1Fetal Medicine, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; 2Department of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; 3Department of Paediatrics and Neonatology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; 4Department of Histopathology, Great Ormond Street Hospital, London, United Kingdom

OP29.02: Placental weight, cord insertion, shape and cord coiling in pregnancies with birth weight less than the 10th percentile

Methods: This 4 2 year retrospective study is based on 71 fetuses where termination of pregnancy (TOP) was performed because of a fetal malformation and/or chromosomal anomaly. Only fetuses who had undergone both fetal anatomy scanning and autopsy were included. Sensitivity and specificity of ultrasound findings with regard to autopsy findings were calculated. In addition, the fetuses were grouped into four categories depending on the degree of concordance between ultrasound and autopsy. Results: The sensitivity of ultrasound was highest for malformations in the cerebro-spinal and internal organ systems (100% and 91%), while many of the malformations in the cardiovascular and skeletal organ systems were detected only at autopsy (sensitivity of ultrasound 63% and 71%, respectively). The specificity of ultrasound was lowest for the internal and cerebro-spinal organ systems (87% and 89%). There was complete agreement between ultrasound and autopsy findings in 44% of the fetuses and a ‘near match’ in 46%. In 10% of the fetuses, the ultrasound findings were only partially confirmed or not confirmed at all by autopsy. The false positive ultrasound diagnoses were not crucial for the parents decision to terminate the pregnancy. Conclusions: Despite overall good agreement between ultrasound and autopsy findings, the ultrasound examinations were suboptimal for some organ systems. The detection rate was lowest for cardiovascular anomalies. Autopsy often provided important additional information unobserved at ultrasound examination.