J. G. Acuna

Methamphetamine use during pregnancy: maternal and neonatal implications.

OBJECTIVE: To report the demographic characteristics and clinical morbidity of methamphetamine-exposed pregnancies compared with control patients in a tertiary care, urban, academic medical center. METHODS: A single-site chart review from 2000 to 2006 was conducted. International Classification of Diseases, 9th Revision code 648.3x was used to identify potential study participants. Specific inclusion criteria required either a positive urine drug screen for methamphetamine use or by patient statement of methamphetamine use during pregnancy. Data from 276 identified patients were then compared with the 34,055 in the general obstetric population during the same period for various demographic factors and perinatal outcomes. RESULTS: Two hundred seventy-six patients responsible for 273 live births were identified between 2000 and 2006. Factors that were significantly associated with methamphetamine use were age younger than 20 years (9% methamphetamine compared with 16% control patients), non-Hispanic white ethnicity (55% compared with 71%), married (12% compared with 46%), preterm delivery (52% compared with 17%), low Apgar scores (6% compared with 1–2%), cesarean delivery (29% compared with 23%), and neonatal mortality (4% compared with 1%). Additionally, the maternal demographic characteristics suggested that these women were more likely to be unemployed, use other abusive substances, and have higher rates of domestic violence and adoption when compared with the control population. CONCLUSION: Methamphetamine use in pregnancy is complicated by more morbid maternal and neonatal outcomes when compared with the general obstetric population. Because the patients in this study were in a variety of ways demographically distinct, attempts to identify these patients early and intervene in an effort to improve pregnancy-related outcomes appears possible and warranted. LEVEL OF EVIDENCE: II

First-trimester visualization of the fourth ventricle in fetuses with and without spina bifida.

The purpose of this study was to examine the efficacy of nonvisualization of the fourth ventricle for first‐trimester detection of spina bifida.

OC12.02: Spina bifida detection at 11–14 weeks: systematic analysis of technical factors associated with false‐positive and false‐negative image interpretation

Objectives: Screening at 11–14 weeks is changing from a simple NT measurement to a comprehensive first trimester anomaly scan. However, the detection of open neural tube defect (NTD) before 14 weeks is still a challenge, since lemon and banana signs, used in second trimester ultrasound, are rarely present. Aim of the study is to seek for simple first trimester signs to alert the examiner for the presence of NTD. Methods: The midsagittal view of the face used for NT and nasal bone measurements was analyzed in normal fetuses and fetuses with NTD. The region between the brain stem and occipital bone, includes the 4th ventricle (intracranial translucency = IT), the choroid plexus of the 4th ventricle and the future cisterna magna. Results: In normal fetuses between 11–14 weeks there is an increase in the anterior posterior diameters of posterior fossa structures. Fetuses with NTD detected prospectively and retrospectively showed however abnormal values due to the downward shifting of the brain stem. Conclusions: In the plane used for NT measurement the evaluation of the posterior part of the brain between the brain stem and the occipital bone appears to be the clue in suspecting NTD at the 11–14 weeks scan. Further prospective studies are needed to find the sensitivity of these observations during routine screening.

OC12.03: Visualization of the fourth ventricle in first trimester fetuses with a normal spine versus spina bifida

Objectives: Screening at 11–14 weeks is changing from a simple NT measurement to a comprehensive first trimester anomaly scan. However, the detection of open neural tube defect (NTD) before 14 weeks is still a challenge, since lemon and banana signs, used in second trimester ultrasound, are rarely present. Aim of the study is to seek for simple first trimester signs to alert the examiner for the presence of NTD. Methods: The midsagittal view of the face used for NT and nasal bone measurements was analyzed in normal fetuses and fetuses with NTD. The region between the brain stem and occipital bone, includes the 4th ventricle (intracranial translucency = IT), the choroid plexus of the 4th ventricle and the future cisterna magna. Results: In normal fetuses between 11–14 weeks there is an increase in the anterior posterior diameters of posterior fossa structures. Fetuses with NTD detected prospectively and retrospectively showed however abnormal values due to the downward shifting of the brain stem. Conclusions: In the plane used for NT measurement the evaluation of the posterior part of the brain between the brain stem and the occipital bone appears to be the clue in suspecting NTD at the 11–14 weeks scan. Further prospective studies are needed to find the sensitivity of these observations during routine screening.

OC12.05: Visualization and measurement of the cisterna magna and maximal posterior fossa translucency for spina bifida screening at 11–13 weeks gestation

Methods: We retrospectively assessed the 2D and/or 3D dates from the pregnancies undergoing routine ultrasound examination at 11–13 weeks’ gestation during 2009–2010, as part of screening for chromosomal abnormalities. Our targets of evaluation consisted in: spine aspect, cranium and intracranial anatomy of choroids plexus, thalamic angle, cerebellum aspect and antero-posterior measurement of the fourth ventricle in the mid-sagital view of the fetal face, recently described (2009) as intracranial translucency (IT). Results: All the 1749 fetuses without NTD presented measurable IT with median values at 11–13+6 weeks between 1.39 and 2.62 mm. From the cases diagnosed with open spina bifida, 2 underwent 11–13+6 scan in our clinic and both cases presented abnormal early neurosonogram: in one case we found abnormalities in cranium shape, choroids plexus, IT and aspect of the cerebellum; in the second case the only detectable sign was IT not detectable/measurable. Both of them resulted in sacral spina bifida and none presented abnormalities in the first trimester spine evaluation. Measurement of the IT is reproducible and in 95% of cases the difference between two consecutive measurements by the same or two sonographers is <5%; and second, the measurements of the FMF angle obtained by 3D and 2D ultrasound are similar. Conclusions: The mid-sagittal view of the face as routinely used in screening for chromosomal defects could offer an important diagnostic marker for the detection of CNS anomalies in the very early pregnancy.

OP02.03: Intracranial morphometry of the first trimester fetus with chromosomal anomalies

centile) 2) Control group (n = 88) included patients whose infants were appropriate for gestational age (birth weight > 10th centile). Poor neurodevelopmental outcome was defined as the presence of hearing impairment or severe developmental delay and was compared between the two groups. Results: Primary CMV infection occurred during the first trimester in 5 (33%) of the IUGR cases and 26 (29%) of the control cases (P = 0.8). The mean birth weight in the study group was 2460 gr compared to 3180 gr among the control patients (P < 0.01). The median age of children at follow-up was 2 years (range 3 months–8 years). The rate of poor neurodevelopmental outcome was similar among the two groups: Two (13%) infants in the study group had hearing impairment whereas 8 (9%) of the infants in the control group were diagnosed with hearing impairment (7) or developmental delay (1) on post-natal follow-up (P = 0.6). Conclusions: The outcome of congenital CMV infection does not seem to be affected by the presence of isolated IUGR. Therefore, the prognostic value of IUGR as a sole finding in fetuses infected by CMV is limited.

OP14.02: Posterior brain in fetuses with open spina bifida at 11 to 13 weeks gestation

area were significant univariate predictors, and remained significant in multivariate models for clinical and sonographic recurrence, with ROC analysis showing an area under the curve of 0.65 and 0.73 respectively. Avulsion was associated with an OR of 2.95 for recurrence; hiatal area on valsalva conveyed an additional 7% per cm2 for likelihood of recurrence. Predicted individual probability of recurrence varied from 12% to 95%. Conclusions: Recurrence risk after AC is largely determined by the state of the patient’s pelvic floor. The likelihood of recurrence may vary enormously between patient with a given degree of cystocele, depending on avulsion and hiatal ballooning. Both should be determined prior to prolapse surgery, especially if mesh use is contemplated.

OP21.06: Umbilical vein (UV) blood flow calculation by pixel-specific digital color hue mapping (PixelFlux) and spatially corrected Doppler insonation angles

Mean CRL was 63.03 ± 8.30 mm. Mean gestational age was 12.55 ± 0.63 weeks. Fetal placental sites and ratios were as following; Anterior location 48.1%, Posterior location 40.9%, Lateral location 5.4% and fundal location 3.6%. Left and right uterine artery PI values according to placental sites are shown in the Table 1. There were no statistical significant differences among placental sites. Unilateral or bilateral uterine artery notch was present in 350 pregnant women (19%). Uterine artery notch laterality ratios according to placental sites are as following; in anterior location (n = 168) 65% bilateral, 24% left sided, 11% right sided; in posterior (n = 122) 68% bilateral, 18% left sided, 13% right sided; in lateral (n = 39) 62% bilateral, 28% left sided, 10% right sided and in fundus (n = 21) 58% bilateral, 28% left sided, 14% right sided. The ratios did not show significant difference. Conclusions: The placental site does not seem to have effect on uterine artery PI values and the laterality of uterine artery notch.

OC16.03: Midbrain curvature for the detection of spina bifida in the first trimester of pregnancy

or severe retardation. Study population was subclassified in two groups according to the age at which BDIST was applied (< 4 years vs. ≥ 4 years) for further comparisons. Results: Routine neuropediatrical evaluation detected neurological disorders in five children (28%) (3 with language impairment, one left hemiparesis and one with intellective retardation). However, BDIST showed some degree of neurodevelopmental delay in higher proportions: 66% in social-personal skills, 56% in gross motor skills, 39% in adaptive behavior and 28% in fine motor skills. Expressive communication and cognitive areas were the least affected (22% and 17%, respectively). A general trend towards worse outcomes was observed in the group of ≥ 4 years, although significant differences were only found for gross motor skills. Conclusions: Subtle neurological delays may appear during the infant period after a prenatal diagnosis of mild isolated VM. This information should prompt early and specific supportive measures in the developing child to minimize the neurological impact of isolated mild VM.

OP03.03: Frontomaxillary facial angle in first trimester spina bifida

V. Frisova1, Z. Bejlkova1, M. Kyncl1, B. Prosova1, R. Vlk2, D. Smetanova3, L. Haakova4, L. Hornofová5, M. Rocek1 1Clinic of Imaging Methods, Faculty Hospital Motol and Charles University, Prague 5, Czech Republic; 2Department of Gynaecology and Obstetrics, Faculty Hospital Motol and Charles University, Prague 5, Czech Republic; 3Fetal Medicine Unit, GENNET, Prague 7, Czech Republic; 4Fetal Medicine Unit, Institute for the Care of Mother and Child, Prague 4, Czech Republic; 5Institute for Pathological Anatomy and Molecular Medicine, Faculty Hospital Motol and Charles University, Prague 5, Czech Republic