J. P. Bernard

The value of middle cerebral artery peak systolic velocity in the diagnosis of fetal anemia after intrauterine death of one monochorionic twin

OBJECTIVEnThe purpose of this study was to assess the value of the fetal middle cerebral artery peak systolic velocity in the prediction of anemia within 24 hours of the death of one monochorionic twin in twin-to-twin-transfusion syndrome and to establish the correlation between middle cerebral artery peak systolic velocity and hemoglobin concentration in fetuses who are at risk for acute anemia.nnnSTUDY DESIGNnDoppler examination of the middle cerebral artery peak systolic velocity was performed in 20 monochorionic survivors of pregnancies that were complicated by twin-to-twin-transfusion syndrome that occurred between 20 and 34 weeks of gestation. Doppler examination was performed before cordocentesis and after intrauterine transfusion when appropriate. Both hemoglobin concentration and middle cerebral artery peak systolic velocity were expressed in multiples of the median. Severe anemia was defined as hemoglobin concentration of <0.55 multiples of the median, and we used the cutoff point of 1.50 times the median values at any gestational age to calculate the sensitivity and specificity of middle cerebral artery peak systolic velocity in detecting moderate or severe anemia.nnnRESULTSnFetal anemia was confirmed in 10 of 20 fetuses. We performed seven intrauterine transfusions. The sensitivity and specificity of middle cerebral artery peak systolic velocity in the prediction of severe fetal anemia were of 90%, with a false-negative rate of 10%. The correlation between peak systolic velocity and hemoglobin concentration both before and after transfusion was evaluated by regression analysis and was strongly significant.nnnCONCLUSIONnIn fetuses who are at risk of acute anemia, the measurement of middle cerebral artery peak systolic velocity was found to be a reliable noninvasive diagnostic tool and may be helpful in counseling and planning invasive assessment.

Chemotherapy–radiotherapy association in Hodgkin's Disease, clinical stages IA, II2A: Results of a prospective clinical trial with 166 patients

One hundred sixty‐six patients with clinical stages IA, II2A Hodgkins disease were treated between April 1972 and December 1976 with three courses of multiagent chemotherapy (methylchlorethamine, vincristine, procarbazine, prednisone) followed by mantle irradiation—excluding mediastinum for those with initial upper cervical presentation and absence of mediastinal involvement—or inverted Y radiotherapy. None had staging laparotomy. With a follow‐up of 12–84 months, median 40 months, the overall survival is 93.5% and the overall relapse‐free survival 89.9%. Eight patients died, three of them with evident disease. Ten patients relapsed; four are now free of disease after retreatment. With chemotherapy‐radiotherapy sequence, staging laparotomy is not indicated. Results and side effects of this treatment strategy are compared with those of other treatment policies.

Prenatal laser treatment of a placental chorioangioma.

Large placental chorioangiomas are rare complications in pregnancy. We present a case of a placental chorioangioma, complicated by polyhydramnios, in which obliteration of its blood supply using diode laser coagulation at 25 weeks of gestation was followed by an uneventful pregnancy and delivery of a healthy baby with a normal follow‐up at the age of 9 months. Laser coagulation of the feeding vessels seems to be an effective treatment for chorioangiomas when the blood supply is superficial and the feeding vessels are small in diameter. Copyright

Pseudoamniotic band syndrome: a rare complication of monochorionic twins with fetofetal transfusion syndrome treated by laser coagulation

OBJECTIVEnThe purpose of this study was to assess the incidence and risk factors of limb constriction defects that are related to pseudoamniotic band syndrome (PABS) after selective fetoscopic laser surgery (FLS) in fetofetal transfusion syndrome (FFTS).nnnSTUDY DESIGNnAll consecutive cases of FFTS that were treated by selective FLS between 1999 and 2006 were examined prospectively for PABS at the time of delivery. Incidence and characteristics of PABS were reported. Univariate analysis was conducted to look for potential risk factors of developing PABS.nnnRESULTSnThe 438 consecutive FFTS cases were treated at 15-26 weeks of gestation; PABS developed in 8 cases (1.8 %). The affected twin was always the former recipient. The diagnosis was made prenatally in 2 of 8 cases (25%). All cases survived the perinatal period. PABS affected fetal leg, arm, and foot in 3, 4, and 1 cases, respectively. In 5 (62.5%) and 7 (87.5%) cases, PABS occurred after premature rupture of membranes and intrauterine death of the donor, respectively. In 4 cases (50%), there was both premature rupture of membranes (PROM) and intrauterine fetal death; in 3 cases (37.5%), there was intrauterine fetal death alone, and in 1 case (12.5%), there was PROM alone. In the remaining 430 cases, PROM occurred in 62 cases (14.4%) and 66 cases (15.3%) within and after 3 weeks after surgery, respectively. PROM was significantly more frequent within the group that was complicated with PABS than within the rest of the cohort (P = .05). No maternal, fetal, or perioperative risk factor could be identified.nnnCONCLUSIONnAwareness and targeted serial ultrasound evaluation in this high-risk group may improve prenatal diagnosis, counseling, and management of PABS after FLS.

A score‐based method for quality control of fetal images at routine second‐trimester ultrasound examination

Our aim was to develop and evaluate the feasibility and reproducibility of score‐based quality control for routine standardized fetal ultrasound images obtained in the second trimester of pregnancy.

Intertwin discordance in umbilical venous volume flow: a reflection of blood volume imbalance in twin-to-twin transfusion syndrome

To compare umbilical venous volume flow (UVVF) between donor and recipient twins in twin‐to‐twin transfusion syndrome (TTTS) using an index that is independent of gestational age and to correlate changes in this index with outcome following endoscopic laser surgery.

Small biparietal diameter in the first trimester and pregnancy outcome

The biparietal diameter (BPD) should be measured as part of the routine first-trimester ultrasound examination1. Several recent reports have suggested that identification of a small BPD at 11–14 weeks’ gestation, adjusted for crown–rump length, may pick up 60–70% of fetuses with spina bifida, with a 5–10% false-positive rate2–4. However, introducing a policy of BPD measurement at an early gestational age, when termination of pregnancy may be considered, may result in unnecessary anxiety in women and health practitioners if a small BPD is noted. The association between small BPD in the first trimester and adverse pregnancy outcome is controversial; the finding has been variously associated with chromosomal anomalies5 and small-for-gestational-age (SGA) newborns. This prompted us to analyze the outcomes of fetuses with small BPD measurements on the first-trimester scan. We performed a retrospective study of women who had undergone routine first-trimester ultrasound examination at Necker Hospital, Paris, between 1 January 2009 and 1 January 2012. Of 6584 patients, 437 (6.6%) were lost to follow-up. Of the remaining 6147 patients with known pregnancy outcomes, 799 (13.0%), 432 (7.0%) and 246 (4.0%) had a fetus with a BPD below the 10th, 5th and 2.5th percentile, respectively. In the subgroup lost to follow-up, 66 fetuses (15.1%) had a BPD below the 10th percentile (P = 0.27). We found a strong association between BPD ≤ 10th percentile and risk of spina bifida (n = 5/9; odds ratio (OR) 8.41 (95% confidence interval (CI) 1.97–37.2), P = 0.0029), using a significance level of P < 0.05. This measurement was not associated with other adverse outcomes, including early miscarriage (n = 1/29; OR, 0.24 (95% CI, 0.01–1.63), P = 0.16), intrauterine fetal death (n = 7/45; OR, 1.57 (95% CI, 0.63–3.75), P = 0.32), fetal and newborn malformations (n = 30/201; OR, 1.18 (95% CI, 0.79–1.75), P = 0.31), abnormal karyotype (n = 8/53; OR, 1.19 (95% CI, 0.52–2.64), P = 0.64), termination of pregnancy (n = 20/124; OR 1.29 (95% CI, 0.77–2.15), P = 0.29), SGA (n = 125/868; OR, 1.15 (95% CI, 0.93–1.42), P = 0.18) or preterm delivery (n = 88/597; OR, 1.18 (95% CI, 0.92–1.50), P = 0.18). There was a similar lack of association between first-trimester BPD and adverse outcomes for measurements below the 5th and 2.5th percentiles (Table S1). Given the low incidence of adverse pregnancy outcomes after 11 weeks, detecting a 50% increase in the composite adverse outcome risk (from 2 to 3%, for example) would require more than 3500 fetuses with BPD measurements under the 10th percentile. However, our study does not support any strong association between a small BPD in the first trimester and adverse pregnancy outcomes, other than for spina bifida. A small BPD at 11–14 weeks’ gestation should prompt a careful examination of the fetal spine. In the absence of a neural tube defect, a small first-trimester BPD does not seem to be associated with other adverse outcomes, and patients can be immediately reassured, even if the value is below the 5th or 2.5th percentile.

OC164: Mild fetal lateral cerebral ventriculomegaly. Causes and perinatal outcome

(best of at least 3 attempts) relative to the inferoposterior symphyseal margin. Measurements were correlated with patient age. Patient age and all parameters of pelvic organ descent were normally distributed. Results: Overall, there was a weak negative correlation between bladder neck descent on Valsalva and age (r = −0.153, p < 0.001), as well as proximal urethral rotation (r = −0.1, p < 0.001) and age, but not for cystocele descent. These correlations remained negative and significant on controlling for parity. A cubic regression fitted line plot showed a positive slope to the age of 40, then a plateau to 50, and a negative slope from about 50 years of age onwards and closely resembled the generally accepted distribution of stress incontinence prevalence over time. Conclusions: This study demonstrates a weak but significant negative correlation between bladder neck/urethral descent and age in a group of women presenting for urodynamic evaluation. This finding challenges the longheld assumption that anterior vaginal wall prolapse is likely to worsen with age.

OP13.14: Modelling french birth biometrics

flow (ml/min) reduced with UtA PI growth, even not significantly. UtA flow per EFW did show a significant inverse correlation to gestational age, dropping from 780.6 ml/min/kg at 15 weeks to 138.1 at 35 weeks (5.6 fold) (p < 0.001). Conclusions: 1) UtA flow (ml/min) and mean velocity significantly increased across gestation in normal pregnancies, while UtA diameter showed a slight not significant increment; 2) UtA flow volume (ml/min) did not show a significant reduction in relation to UA PI increase; UtA flow per EFW significantly reduced along gestation.

P13.10: Impact of the modelling method on reference charts and equations for biometry

24–30 day cycle. The influence of fetal gender, maternal smoking and maternal height on gestational age (GA) at the time of CRL measurement was assessed using chi-square test. 4,595 deliveries were spontaneous and 1,299 induced (missing information in 31 cases). The relative risk (RR) of preterm delivery (≤ 258 days) using LMP and CRL was estimated for girls compared with boys in women with a spontaneous delivery. Results: The table shows the distribution of the difference between GA by LMP and GA by CRL on fetal gender, maternal smoking and maternal height. In non-smoking women the RR of preterm delivery was unchanged in girls compared with boys when comparing CRL (RR 0.81) to LMP (RR 0.79). In smoking women, however, the RR of preterm delivery increased from 0.50 by LMP to 0.80 by CRL. In tall women the RR increased from 0.38 using LMP to 0.54 using CRL, while the RR was unchanged in women < 173 cm. Conclusions: Fetal gender, maternal smoking and maternal height significantly influence gestational dating by CRL. Using CRL will overestimate GA in tall non-smoking women with a male fetus and underestimate GA in short, smoking women with a female fetus. The effect of the three parameters is additive. P13.08 Comparison of reference charts for estimated fetal weight and for actual birth weight