John Visintine

Cervical length for prediction of preterm birth in women with multiple prior induced abortions.

To determine whether transvaginal sonographic cervical length predicts preterm birth in women with multiple prior induced abortions.

Indomethacin administration at the time of ultrasound-indicated cerclage: is there an association with a reduction in spontaneous preterm birth?

OBJECTIVE The purpose of this study was to estimate the effect of indomethacin on the prevention of preterm birth (PTB) in women with an ultrasound-indicated cerclage. STUDY DESIGN We performed a retrospective cohort study from 1995-2006. Asymptomatic women with a cerclage for a short cervical length (CL), which was defined as <25 mm, between 14-23 weeks 6 days of gestation were included. Women who received indomethacin therapy at the time of ultrasound-indicated cerclage for a short CL were compared with those women who did not. Our primary outcome was spontaneous PTB at <35 weeks of gestation. RESULTS Fifty-one women received indomethacin, and 50 women did not. There were no differences between groups regarding previous PTB, gestational age, or CL at time of cerclage. The rate of spontaneous PTB at <35 weeks of gestation was similar between those who received indomethacin (20/51 [39%]) and those who did not (17/50 [34%]; relative risk, 1.15 [95% CI 0.69-1.93]). In our post hoc power analysis, 190 patients would have been needed to detect a 50% reduction in the rate of PTB. CONCLUSION Administration of indomethacin around the time of ultrasound-indicated cerclage was not associated with a decrease in spontaneous PTB.

Is Cerclage Height Associated with the Incidence of Preterm Birth in Women with a History-Indicated Cerclage?

This study was performed to determine if cerclage height is associated with spontaneous preterm birth in patients with a history-indicated cerclage. We performed a retrospective cohort study of women with a history-indicated cerclage. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. The cohort was grouped into thirds, based on cerclage height percentile. Our primary outcome was spontaneous preterm birth <35 weeks. There were 21 women in group 1 (cerclage height <10 mm), 53 in group 2 (cerclage height 10 to 19 mm), and 31 in group 3 (cerclage height ≥20 mm). The rates of spontaneous preterm birth <35 weeks were similar between each group: 24, 17, and 10%, respectively ( P = 0.38). Cerclage height is not associated with a reduction in spontaneous preterm birth for women with a history-indicated cerclage. The association between longer cerclage height and decrease in preterm birth was nonsignificant possibly due to the small sample size.

Is cerclage height associated with the incidence of preterm birth in women with an ultrasound-indicated cerclage?

OBJECTIVE Our aim was to determine whether there was a cerclage height threshold associated with spontaneous preterm birth in patients with an ultrasound-indicated cerclage. STUDY DESIGN We performed a retrospective cohort study of women with an ultrasound-indicated cerclage. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. Our cohort was grouped into thirds, based on cerclage height percentile. Our primary outcome was spontaneous preterm birth less than 35 weeks. RESULTS There were 20 women in group 1 (< 18 mm), 25 in group 2 (13-17 mm), and 25 in group 3 (> or = 18 mm). Women with cerclage height 18 mm or greater had a lower incidence of spontaneous preterm birth less than 35 weeks (4%) when compared with those with a cerclage height less than 18 mm (33%) (relative risk, 0.69; 95% confidence interval, 0.55-0.86). CONCLUSION Cerclage height of 18 mm or greater is associated with a reduction in spontaneous preterm birth for women with an ultrasound-indicated cerclage.

Interval to spontaneous delivery after elective removal of cerclage

OBJECTIVE The purpose of this study was to estimate the time interval between elective cerclage removal and spontaneous delivery. METHODS Singleton pregnancies with McDonald cerclage were evaluated for the interval between elective cerclage removal (36-37 weeks) and spontaneous delivery. We also compared spontaneous delivery within 48 hours after cerclage removal between women with ultrasound-indicated vs history-indicated cerclage. RESULTS We identified 141 women with elective cerclage removal. The mean interval between removal and delivery was 14 days. Only 11% of women delivered within 48 hours. Women with ultrasound-indicated cerclage were more likely to deliver within 48 hours, compared with women with history-indicated cerclage (odds ratio, 5.14; 95% confidence interval, 1.10-24.05). CONCLUSION The mean interval between elective cerclage removal and spontaneous delivery is 14 days. Women with cerclage who achieved 36-37 weeks should be counseled that their chance of spontaneous delivery within 48 hours after elective cerclage removal is only 11%.

OP13.05: Stomach dilatation may be associated with fetal demise in fetuses with isolated gastroschisis

Introduction: Various forms of antepartum fetal surveillance are routinely performed to reduce the risk of stillbirth in fetuses with gastroschisis. Preliminary evidence suggests that fetal abdominal findings may play a role in evaluating fetal wellbeing. Objectives: To determine the stomach size in fetuses with gastroschisis who were undergoing multiple fetal surveillance modalities (MFSM) and were delivered for non reassuring fetal status (NRFS). Study Design: This is a retrospective review of pregnancies complicated by fetal gastroschisis and managed with MFSM at our institution from 2001 to 2008. MFSM included fetal growth assessment, biophysical profile (BPP), non stress test (NST), Umbilical artery Dopplers (UAD), and maternal perception of fetal activity. Indications for delivery included gestational age > 38 weeks, or NRFS. NRFS was defined as more than one abnormal testing modality after 28 weeks. Fetal stomach size was documented at each examination. None of the fetuses were delivered because of dilated stomach. Results: 18 cases of gastroschisis were managed by MFSM. There were no fetal demises. Gestational age at delivery was from 34 to 39 weeks. All fetuses prior to delivery had normal UAD and a BPP of 8/8 or 8/10. 10/18 fetuses had a non-reactive NST. A total of 4/18 fetuses were noted to have persistently dilated stomach. 4/18 fetuses were delivered because of NRFS. 3 of these 4 fetuses delivered for NRFS also had persistent stomach dilation and polyhydramnios. The 4th fetus delivered for NRFS had fetal growth restriction and oligohydramnios. Conclusions:

P02.88: Transient hydrops fetalis associated with fetal cystic fibrosis

pregnancies. A 24 year old lady, G1P0, with no known consanguinity, detected multiple congenital malformation at 26 weeks including early onset fetal growth restriction, microcephaly, cerebellar hypoplasia, ventriculomegaly, micrognathia and abnormal limbs posture. She declined amniocentesis and resulted in a intrapartum stillbirth at 39 week, birth weight 955g. Placental karyotype was 46XX and autopsy confirmed all the ultrasound findings but no specific diagnosis could be reached. She was pregnant again 3 months later. She did not come early until 20 weeks and ultrasound showed similar features as last pregnancy. Amniocentesis revealed 46XX and the couple declined the option of pregnancy termination despite grave prognosis explained. Polyhydramnios developed at 35 weeks. A ‘collodion baby’, 1475g, was delivered by Cesarean section at 38 weeks for breech presentation and maternal request. Diagnostic skin biopsy revealed lamellar ichthyosis. A diagnosis of Neu-Laxova syndrome was made. Baby died on day 5 of life. Postmortem showed additional findings including pulmonary hypoplasia, lissencephaly and agenesis of corpus callosum. The diagnosis of Neu-Laxova syndrome was confirmed. Review of previous autopsy also showed features compatible with the syndrome. The differential diagnosis included restrictive dermopathy, bullous congenital ichthyosiform erythroderma, fetal akinesia sequence etc. The recurrence risk of 25% was explained to the couple. Prenatal ultrasound remains the mainstay of diagnosis and the diagnosis may be reached in the first trimester.