Jerome Kopelman

Placental growth factor in the first trimester: relationship with maternal factors and placental Doppler studies

Placental growth factor (PlGF) is a potent angiogenic factor that impacts on early placental vascular development. It was our aim to clarify relationships between PlGF and first‐trimester maternal/placental factors that are related to placental development.

Serum pentraxin-3 levels at 11 to 14 weeks' gestation: association with maternal and placental characteristics

OBJECTIVE Pentraxin (PTX)-3 is an inflammatory molecule that may be increased in the first trimester in pregnancies with subsequent preeclampsia. We measured first-trimester serum PTX-3 and correlated levels with maternal/placental factors related to placental development. STUDY DESIGN Prospectively enrolled women had ultrasound, physical examination, and blood draw at 11-14 weeks. PTX-3 determined by enzyme-linked immunosorbent assay was related to maternal age, parity, race, body mass index (BMI), mean arterial blood pressure (MAP), smoking/caffeine, and uterine/umbilical artery Doppler pulsatility index (PI). RESULTS In 111 patients PTX-3 levels ranged from 0.2-13.8 ng/mL. Spearman correlation between PTX-3 and gestational age (rho = 0.096), maternal age (rho = -0.049), BMI (rho = -0.07), MAP (rho = -0.085), mean uterine artery PI (rho = 0.150), and umbilical artery PI (rho = -0.021) was nonsignificant (all P > .05). Similarly, PTX-3 distribution was unaffected by smoking/caffeine use, BMI >30, MAP >100 mm Hg, or uterine artery notching (P > .05 for all). CONCLUSION First-trimester PTX-3 is unrelated to maternal characteristics and placental Doppler.

P29.09: The use of long-term indomethacin stabilises cervical length in twin pregnancies

cord simulating dead fetus was measured in ml/min meanwhile set tonometer attached to the cannulated second umbilical cord simulated the mean arterial preasure of surviving fetus. All placentas were divided on the basis of typical clinical courses of MCDA pregnancies into the following subgroups: Physiological course (PC) N=57, Twin–twin syndrome without (TTTS 1) N=2 and after laser therapy (TTTS 2) N=6, selective fetal growth (sFGR) N=14 subdivided into sFGR 1 N=8 with type I and II flow in umbilical artery (UA) and sFGR 2 N= 6 with type III flow in UA and twin anemia polycytemia sequence subgroup (TAPS) N=2. All damaged and/or fixed placentas or placentas unable to analyse for any reason were excluded. Results: In all 81 MCDA placentas was present at least any type of interfetal anastomosis. The highest risk of F-F TRF had sFGR2 ( 6/6; 100%) followed by sFGR1 ( 6/8; 75%), PC (33/57; 58%), TTTS1 (1/2 in case of the recipient death and 0/2 in donor death simulation), TAPS (0/2; 0%) and TTTS2 (0/6; 0%) respectively. Essential risk factor for F-F TRF was presence superficial low-resistence AA anastomose and close umbilical cord insertions. Conclusions: Proven F-F TRF was significantly different for different clinical subtypes whose clinical courses are influenced by the composition of interfetal anastomoses with highest risk in the presence of AA anastomoses.

OC30.03: Cerebrouterine Doppler ratio: a predictor of third trimester stillbirth

growth restriction with or without preeclampsia, twin-to-twin transfusion syndrome, or oligohydramnios. UA Doppler waveforms were obtained at intra-abdominal cord insertion site in order to distinguish one from the other. Doppler findings of one UA were expressed as present end-diastolic flow (EDF), absent enddiastolic flow (AEDF), or reversed end-diastolic flow (REDF). The findings were recorded at both UAs and into four patterns: EDF/AEDF, AEDF/AEDF, AEDF/REDF, and REDF/REDF. There was no EDF/REDF case. Results: A total of 155 observations were undertaken. Twenty-seven of 50 patients (54%) showed AEDF or REDF in at least one umbilical artery during surveillance period and were included for analysis. Of these 27, 11 patients (40.7%) revealed discrepancy in Doppler waveforms between two umbilical arteries. The proportion of patients according to UA Doppler patterns was 30% in EDF/AEDF (8/27), 37% in AEDF/AEDF (10/27), 11% in AEDF/REDF (3/27), 22% in REDF/REDF (6/27). (Table 1). Conclusions: Doppler waveforms have discrepancy between two umbilical arteries in more than one third of high-risk pregnancies beginning to show AEDF or REDF in at least one UA. When Doppler waveforms of an UA were revealed as AEDF or REDF, clinicians must be cautioned to examine the contralateral UA.

OC30.06: Integrated surveillance predicts deterioration in fetal gastroschisis

fetal growth, amniotic fluid volume gastrointestinal appearance and cardiotocography (CTG). Pregnancy outcome was noted. Results: 105 cases of gastroschisis were identified in a 12 years period. FHM was performed in 97 cases starting at a median gestational age of 30 weeks (range 28–35). In 24 cases an abnormal FHM was registered, 11 were confirmed by in-hospital CTG including 2 cases of fetal demise, 9 emergency Cesarean section were performed at a mean gestational age of 33.1 ± 1.2 weeks, other 4 women had emergency cesarean section within one week for abnormal FHR at inhospital CTG. In 73 cases of normal FHM there were 17 emergency cesarean sections for abnormal FHR at in-hospital CTG at a mean gestational age of 34.6 ± 2.0 weeks. Eight women had no FHM, 3 of them undergone emergency cesarean section for abnormal FHR at in-hospital CTG at a mean gestational age of 35.3 ± 0.57 weeks. USexaminations showed the presence of intra-abdominal bowel dilation in 6/11 patients with abnormal FHM confirmed by in-hospital CTG compared to 24/73 of those without FHM anomalies. Conclusions: FHR abnormalities are frequent in fetuses with gastroschisis. The practice of FHM leaded to 23.2% percent of emergency cesarean sections for FHR abnormality at earlier gestational age, but it failed to prevent 2 intrauterine fetal deaths. The policy of routine FHM should now be evaluated in a randomized control trial.

OC30.01: Perinatal outcome of mildly decreased amniotic fluid index (AFI) in the early third trimester

Objectives: Mesh reinforcement of anterior colporrhaphy (AC) for cystocele repair has become popular in recent years, with some evidence of reduced recurrence rates. In this case control series, we aim to compare the effect of mesh use on anatomical and functional outcomes, including imaging assessment of prolapse recurrence after AC with and without transobturator mesh augmentation. Methods: Outcomes of 183 patients after anterior vaginal prolapse repair between Jan 1998 and Oct 2008 were analysed. 83 patients had AC, 100 patients AC with transobturator mesh. Patients were assessed post-surgically with a standardised interview, ICS POP-Q clinical examination and 4D translabial ultrasound using GE Kretz Voluson 730 expert and Voluson I system. Results: Potential predictors of recurrence such as age, BMI, vaginal parity and recurrence of prolapse as defined as POPQ ≥ Stage 2 were tested. Only length of follow-up and avulsion injury were significant predictors. Consequently, to match both groups for these two parameters, 49 datasets were removed in a blinded fashion, leaving a total of 67 patients in each group for analysis. Recurrent cystocele ≥ Stage 2 was observed in 31% of mesh patients and 55% in the non-mesh group (OR 0.37 [CI 0.18–0.75] P = 0.005). The rate of recurrence was significantly higher amongst patients with levator avulsion, 36% in the mesh group compared to 78% in the non-mesh group (OR 0.16 [CI 0.04–0.59] P = 0.004). Conclusions: At 4 years follow-up, mesh augmentation was associated with less recurrence of cystocele. This effect was mainly due to reduced recurrence in women with levator avulsion.

OC29.08: Extended antenatal fetal‐ECG monitoring in high‐risk patients

a trend of increasing aortic thickness with severity of intrauterine growth restriction, which was not correlated in AGA fetuses. Aortic diameters and blood flow velocity were significantly higher in IUGR fetuses compared to AGA (4.53 ± 0.87 mm vs 3.55 ± 0.69 mm, p<0.0001; 50.8 ± 38.9 cm/s vs 20.3±11.6 cm/s, p<0.0002, respectively). At follow-up there were no significant differences in diameters of abdominal aorta between IUGR newborns and AGA (6.6 ± 2.4 mm vs 7.3 ± 2.1 mm; p = 0.21). Conclusions: Aortic wall thickening course in IUGR fetuses and infants shows differences respect AGA, which may be related to an early vascular damage, hypothesizing a predisposition to hypertension and cardiovascular risk in adulthood.