Jessica Swartout

Management of mild fetal pyelectasis : A comparative analysis

The purpose of this study was to compare 2 protocols for the antenatal management of isolated mild fetal pyelectasis and perform a cost analysis.

The Effect of Abdominal Wall Depth on Transabdominal Compared With Transvaginal Cervical Length Measurement

INTRODUCTION: The objective of this study was to determine the effect of the anterior abdominal wall depth on the correlation between transabdominal cervical length and transvaginal cervical length measurements. METHODS: A cross-sectional study included patients with singleton pregnancies between 18 and 24 weeks of gestation. Postvoid transabdominal cervical length and transvaginal cervical length measurements were obtained on each participants. Anterior abdominal wall depth was defined as the distance between the lower abdominal skin and the fascia in the midsagittal plane. Obstetric history and body mass index (BMI) were obtained. All transabdominal cervical length images were graded for quality using standardized grading criteria defined as visualization of the internal and external os, cervicovaginal junction, and cervical corpus. RESULTS: Ninety-five participants (mean gestational age 20+3 weeks) were included in the analysis. Mean BMI was 28.8 kg/m2 and the mean anterior abdominal wall depth was 18.5 mm (range 7.7–43.0 mm). No difference between the transabdominal cervical length and transvaginal cervical length was detected despite a large variation in anterior abdominal wall depth and BMI (Lin correlation 0.9761; Pearson correlation coefficient r=0.48, P<.001). Mean variation between transabdominal cervical length and transvaginal cervical length was −0.05 mm. Fifty-nine of the participants had at least three landmarks visualized on transabdominal imaging. Using general linear models, as the anterior abdominal wall depth increased, the number of visualized cervical landmarks on transabdominal imaging significantly decreased (P=.002). CONCLUSION: Anterior abdominal wall depth does not affect the correlation between transabdominal cervical length and transvaginal cervical length assessment. Irrespective of the anterior abdominal wall depth or BMI, there was moderate correlation between the two imaging modalities. With increasing anterior abdominal wall depth, the quality of transabdominal cervical length imaging decreased significantly. However, despite not visualizing all cervical landmarks, there is still a clinically significant correlation between transabdominal cervical length and transvaginal cervical length measurements.

P28.18: Elusive diagnosis of pregnancy in non‐communicating rudimentary horn

karyogram: 47XX+16. Amniocentesis showed a 46XX karyogram with normal chromosomes 16. Analysis for uniparental disomy (UPD) proved negative. 2D and 3D US examinations revealed no structural anomalies and normal foetal Dopplers. Growth however remained below the p2.3. The mother developed pregnancy-induced hypertension. At 37 weeks a female infant was born, birth weigth of 2010 grams (< P2.5). After birth, growth climbed to the p50 in the first 2 months and remained there. No congenital abnormalities were found. Discussion: In embryos surviving the 1st trimester trisomy 16 is in almost all cases mosaic. Increased frequency of trisomic cells in the placenta is believed to result in impaired placentation and subsequent intra-uterine-growth-restriction (IUGR). In this patient serum PAPP-A levels were extremely low. This has been associated with a number of adverse pregnancy outcomes, such as increased risk of pre-eclampsia, gestational hypertension and IUGR. To our knowledge, this is the first report describing low serum PAPP-A level in association with placental confined trisomy 16. Interestingly, IUGR was already observed in the embryonic period in the I-Space VR System.

Controlled-release dinoprostone vaginal insert for cervical ripening and labor induction

Labor is induced in approximately 20% of pregnancies in Europe and North America. Labor induction in patients with an unfavorable cervix is associated with a higher incidence of prolonged labor and higher rates of operative and cesarean delivery. Prostaglandins used for cervical ripening lead to shorter labor, less use of oxytocin and a greater likelihood of vaginal delivery within 24 h. Dinoprostone (prostaglandin E2) has been used since the 1970’s and is recognized as an agent that not only results in cervical ripening but also activates myometrial contractility. A proprietary sustained- and controlled-release dinoprostone vaginal insert releases a continuous dose of dinoprostone for 12 h and has been shown to decrease the time to vaginal delivery compared with placebo. This controlled-release insert has been compared with various prostaglandin agents and provides safe and efficacious cervical ripening in women with an unfavorable cervix.