Jeong-In Yang

Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section

To investigate the value of transvaginal sonographic findings of intraplacental lacunae for predicting adherent placenta and clinical outcome in patients with placenta previa totalis and a history of Cesarean section.

Diagnosis in the first trimester of placenta accreta with previous Cesarean section

The prenatal diagnosis of adherent placenta is clinically very important, as this condition can seriously affect perinatal mortality and morbidity. The outcome is generally worse in cases with a history of Cesarean section. Here we report a case of placenta increta associated with previous Cesarean delivery, diagnosed by sonography during the first trimester, enabling earlier counseling of the parents and planning of appropriate treatment. Copyright

Clinical outcomes of pregnancy with one elevated glucose tolerance test value.

Objective: To evaluate clinical outcomes of pregnancies with one elevated glucose tolerance test. Methods: We performed a 50 g glucose challenge test (GCT) in 5019 pregnant women at 24–28 weeks of gestation. In 1170 women with plasma glucose levels over 130 mg/dl, a 100 g oral glucose tolerance test (OGTT) was performed at 28–32 weeks of gestation. During follow‐up, 282 patients were lost and in the 888 cases that were followed‐up, 189 were excluded because of GDM. Therefore 699 study patients were divided into four groups: No Elevated group (NE, N=577) with all four normal 100 g OGTT values, and Groups 1 (N=16), 2 (N=35), and 3 (N=71) with one elevated 100 g OGTT value after 1, 2 and 3 h, respectively. Results: Poor maternal outcomes (NE group, Group 1, Group 2, Group 3: 17.5%, 37.6%, 22.9%, 25.3%) with pre‐eclampsia, cesarean delivery for cephalopelvic disproportion, failure to progress, or fetal distress, was highest in Group 1 (odds ratio 2.94; 95% confidence interval 1.02–8.42). Poor perinatal outcomes (15.8%, 43.1%, 14.3%, 21.1%) with any one of the following; fetal distress, Apgar score of <7 at 5 min, hypoglycemia, respiratory distress syndrome, small for gestational age and perinatal death, was also highest in Group 1 (odds ratio 4.24; 95% confidence interval 1.02–17.52). Conclusion: Pregnancies with one elevated glucose tolerance test value after 1 h exhibited increased adverse maternal and perinatal outcomes compared with the group with all normal OGTT values or the groups with an elevated glucose tolerance test value after 2 or 3 h.

P46.07: Perinatal outcome according to umbilical artery blood flow velocity waveform of term pregnancies with small for gestational age pregnancies

outcome were significantly increased in infants with abnormal S/D ratio (P < 0.001). When logistic regression analysis was performed after adjusting for gestational age, the odds ratio for poor perinatal outcome was 3.7 in the group showing abnormal S/D ratio (95% confidence interval 1.42–9.54, P = 0.007). Conclusion: Umbilical artery Doppler velocimetry is shown as a significantly efficient method in predicting perinatal outcome in preterm neonates with small-for-gestational age, and it may be useful in managing preterm patients with small-for-gestational age fetuses.

P46.05: Umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm pregnancies with small for gestational age

Objectives: Fetal kidney produces amniotic fluid and it is crucial for the fetal and development maturation. To evaluate fetal renal function by analyzing the hemodynamics of fetal renal artery and the renal volume, we have measured them in normal fetuses after 20 weeks of gestation using the color Doppler and 3D sonography. Methods: After obtaining informed consent from 66 pregnant women with healthy fetuses, the following investigations were performed every 4 weeks after 20 weeks of gestation.: (1) Hemodynamic analysis: maximum systolic velocity (Vmax), mean velocity (Vmean), minimal velocity (Vmin), arterial cross sectional area (Area), resistance index (RI) and pulsatility index (PI) of the fetal renal artery (2) Fetal renal volume. Results: All hemodynamic indexes except RI and PI increased significantly with the course of pregnancy. Vmax, Vmean and area of the renal artery increased significantly from 21.80 ± 0.40 cm/s, 9.56 ± 0.17 cm/s and 6.78 ± 0.25 mm2 at 20–24 weeks to 41.59 ± 0.46, 20.15 ± 0.22 and 10.12 ± 0.19 at 37–40 weeks, respectively (P < 0.05). Renal Volume of the fetal kidney also increased significantly between the 20–24 weeks and the 37–40 weeks (1.375 ± 1.41 mm2 vs. 11.21 ± 1.63 mm2, P < 0.003). Conclusions: We have clarified the changes of fetal renal hemodynamic indexes and the fetal renal volume during the normal course of pregnancy. These indices might be used for the evaluation of fetal renal function in the near future.

OC014: Clinical significance of sonographic findings in placenta previa with prior Cesarean section

Objective: To evaluate the efficacy of intraplacental lacunae by transvaginal sonography in diagnosing the placenta accreta and increta and the prediction of clinical outcome. Methods: Forty-seven patients delivered in our hospital with history of cesarean section, diagnosis of placenta previa totalis by transvaginal sonography, and postpartum placental pathology were included in the study. Intraplacental lacunae were classified into 4 different grades from 0 to 3 by the degree (HJ Finberg, 1992). Placental pathology was done to all the patients delivered, and in case of hysterectomy, pathologic examination of removed uterus was also performed.Then they were compared with antepartum sonographic findings. Results: The lacunae was found in 8 cases with grade 1, 11 cases with grade 2, 5 cases with grade 3, and they were not showed in 23 cases. Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing placenta accreta above grade 1 lacunae were 79.2%, 87.0%, 86.4%, and 80%, respectively. When the pathologic diagnosis of placenta and removed uterus were placenta increta or percreta, all sonographic findings were above grade 2 lacunae. Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing placenta increta with lacunae above grade 2 were 93.8%, 100%, 100%, and 96.9%. Hysterectomy was performed to 17 cases, among them, 1 case showed grade 1 lacuna, 11 cases showed grade 2 lacunae, and 5 cases showed grade 3 lacunae. Without lacunae, no hysterectomy was done. Comparing the absence of lacunae or grade 1 lacunae, the relative risks of cesarean hysterectomy was 17 folds in the above grade 2 lacunae. Conclusions: Lacunar findings of transvaginal ultrasonography in patients with placenta previa totalis and history of cesarean section are very usefulness for diagnosis of placenta accreta and increta. These might be used as a valuable clinical prognostic marker.