M. V. Senat

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.

Intra- and interoperator variability in fetal nasal bone assessment at 11–14 weeks of gestation

Examination of the fetal nasal bones by ultrasound between 11 and 14 weeks of gestation has been proposed as an additional tool in the detection of trisomy 21 in a high‐risk population. However the variability in the identification of fetal nasal bones by ultrasound has not yet been investigated. The aim of this study was to assess the intraobserver and interobserver reproducibility of fetal nasal bone identification by ultrasound between 11 and 14 weeks of gestation.

Technique de cerclage cervico-isthmique par voie vaginale avec bandelette de polypropylène: technique de Fernandez: Description et résultats

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 5 - p. 465-471OBJECTIVEnTo assess the efficacy of performing transvaginal cervico-isthmic cerclage using synthetic tape in prevention of preterm labor in high-risk women.nnnPATIENTS AND METHODSnA retrospective analysis of 24 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of pregnancy losses in the second trimester, prior failure of Mac Donalds cerclage and/or absent portio vaginalis of the cervix. Cerclage was performed between 12 and 16 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route.nnnRESULTSnThe median age of the patients in this series was 32.1 years (range 22-39 years). No intra-operative complication occurred. The median operating time was 34.9 minutes (+/-5.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Mean gestational age and birth weight at delivery were respectively 37.1 weeks (+/-1.8) and 2850 g (+/-745). Preterm birth rate was 19% (4/21). Birth at less than 32 weeks occurred in only one patient (4%). In one case, the tape has been removed later because symptomatic vaginal erosion was noted. One neonatal death occurred following amniotic fluid infection at 34 weeks. At the present time, 3 women are at 22, 26 and 26 weeks of gestation with no preterm labor.nnnCONCLUSIONnTransvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.

Determining chorionicity in twin gestations: three-dimensional (3D) multiplanar sonographic measurement of intra-amniotic membrane thickness

Measuring the thickness of the membranes to determine chorionicity in twins using two‐dimensional (2D) ultrasound may provide uncertain results, given the possibility of measuring in an oblique view. We aimed to determine whether chorionicity can be assessed during the second and third trimesters by measuring the thickness of the membranes with three‐dimensional (3D) multiplanar ultrasound, which ensures the measurement is perpendicular to the membranes, and to evaluate the reproducibility of the technique.

Prenatal diagnosis of a possible new middle interhemispheric variant of holoprosencephaly using sonographic and magnetic resonance imaging.

A peculiar subtype of holoprosencephaly, middle interhemispheric variant (MIH), which is characterized by a partial posterior interhemispheric fusion of the brain, has been described in children. We describe the features of a case of a possible new MIH at 26 weeks of gestation, diagnosed using prenatal sonography and magnetic resonance imaging and confirmed by postmortem examination. This malformation of the brain was associated with an unusual appearance of the corpus callosum and rare chromosomal abnormality: a 45X/46,XX/47,XX,+ 18 mosaicism. Copyright

Evaluation of the third trimester amniocentesis for fetal karyotyping in women with fear of pregnancy loss

OBJECTIVESnThe aim of this study is to determine the complications of third trimester amniocentesis for fetal karyotyping among women unwilling to accept the fetal loss risks of second trimester amniocentesis.nnnMATERIALS AND METHODSnA retrospective study was carried out from January 1998 to December 2006 of 182 singleton pregnancies that underwent a late amniocentesis (after 32 weeks) for fetal karyotyping. The indications were integrated risk (maternal age, first trimester nuchal translucency, second trimester maternal serum markers) over 1/250 (n=68), isolated maternal age over 38 years (n=51), isolated abnormal second trimester biochemical markers (n=34), history of personal or familial a chromosomal abnormality (n=21) or maternal choice (n=8). Presence of fetal abnormalities at ultrasound or context of viral or parasitologic seroconversion as well as multiple pregnancies were considered as non-inclusion criteria.nnnRESULTSnMedian maternal age and gestational age at sampling were 39 years (range 23-48) and 32.4 weeks (29.5-37.6). Median interval between amniocentesis and definitive results of amniocentesis on the one hand, and delivery on the on the hand were 15 days (7-42) and 47 days (8-69), respectively. There were no chromosomal abnormality and non-termination of pregnancy. Nine patients out of 182(5%) had a spontaneous labour followed by premature delivery before 37 weeks and six women (3.3%) among those nine displayed preterm premature rupture of membranes (PPROM). Four patients out of 182 (2%) gave birth before definitive karyotyping result but all of them had a direct fluorescence in situ hybridisation analysis with a normal karyotyping result known well before delivery.nnnCONCLUSIONSnThe risk of preterm premature rupture of membrane is 3.3%, with a 5% risk of premature delivery before 37 weeks. This late procedure provides a safe reassurance to women who are unwilling to accept the risks of earlier amniocentesis. However, it should only be used in particular situation and in countries were legislation allows late termination of pregnancy.

OP09.15: Prenatal features of a fetal frontal hemangioma assessed by 3D ultrasound and color Doppler imaging

Methods: A total of 124 women attending the prenatal diagnostic clinic of a teaching hospital were randomized into the intervention (2DUS followed by 3D/4DUS) or control (2DUS alone) group. One operator performed all the ultrasound examinations. The primary outcome was maternal anxiety levels which were assessed by the Spielberger State-Trait Anxiety Inventory. The secondary outcome was breastfeeding rate. We measured the anxiety levels in all women at the first visit, around 18 weeks’ (immediately after ultrasound examinations) and finally at 28 weeks’ gestation. Results: A short-term reduction of stateanxiety score (by around two) from the first visit to after ultrasound examinations was similarly observed in both the intervention group and control group. Repeated measures ANOVA showed that there was no significant interaction effect between groups and time of assessment on the stateanxiety scores (F value = 1.072 and P value = 0.344). There was also no significant difference in the breastfeeding rate on discharge from the hospital after delivery between the control group (33.3%) and the intervention group (43.6%). About 80% of women reported a better understanding that their baby was normal after viewing 3D than 2D images. Conclusion: This randomized study indicates that the addition of 3D/4DUS does not cause a significant reduction on maternal anxiety or increase in breastfeeding rate in pregnancies at risk of fetal abnormalities compared with conventional 2DUS alone.

Preterm premature rupture of membranes: is home care acceptable?

Abstract Background: Preterm prelabor rupture of membranes is a frequent obstetric condition associated with increased risks of maternal and neonatal morbidity and mortality. Conventional management is in hospital. Outpatient management is an alternative in selected cases; however, the safety of home management has not been established. Objective: To study the obstetric and neonatal outcomes of women with preterm premature rupture of membranes between 24 and 34 weeks who were managed as outpatient (outpatient care group), compared with those managed in hospital (hospital care group). Study design: A retrospective cohort study between 1 January 2009 and 31 December 2013 in three French tertiary care centers. Results: Ninety women were included in the outpatient care group and 324 in the hospital care group. In the outpatient care group, the gestational age at membrane rupture was lower, compared to the hospital care group (28.8 (26.6–30.5) vs. 30.3 (27.6–32.1) weeks; pu2009<u2009.01) and the cervical length at admission was higher (31.7u2009±u200910.4 vs. 24.3u2009±u200911.8u2009mm; pu2009<u2009.01). In the outpatient care group, no delivery or major obstetric complication occurred at home. Conclusion: We observed no major complication related to home care after a period of observation. A randomized study would be necessary to confirm its safety.

OP10.06: Predictive score for early preterm birth in decisions about emergency cervical cerclage

Objectives: Amniotic fluid ‘sludge’ (AFS) has been linked to intraamniotic infection, increased rates of spontaneous preterm delivery, PPROM and short interval from ultrasound diagnosis to delivery. This observational pilot study aims to determine if management with broad-spectrum antibiotics and progesterone initiated at diagnosis could delay delivery in patients incidentally found to have extremely premature cervical shortening and the presence of AFS. Methods: From 2008 to 2010, 42 patients were diagnosed with extremely premature cervical shortening (≤ 15 mm) at routine ultrasound between 18–24 weeks’ gestation. Ten patients were excluded because of multiple pregnancy or fetal anomaly. The presence of AFS was identified in 17 of the 32 patients and these women were managed uniformly with bed rest, broad-spectrum antibiotics and progesterone initiated at diagnosis and followed prospectively until delivery. Patients without AFS did not receive antibiotics. Results: Mean gestational (GA) at diagnosis was 21.4 ± 1.9 weeks. The mean GA at delivery was 31.9 ± 6.0 (range 23.0–40.6) for patients without AFS and 35.1 ± 6.9 (range 21.9–41.4) weeks for patients with AFS (P = 0.16). The median delay from ultrasound diagnosis to delivery was 9.8 ± 6.2 (range 1.14–19.0) for patients without AFS and 14.3 ± 6.6 weeks (range 1.9–17.7) for patients with AFS. Conclusions: Though limited by small sample size, it appears that the outcome for women with very premature cervical changes and AFS treated with antibiotics and progesterone does not differ from those women with premature cervical changes without ‘sludge’. Antibiotic and progesterone therapy may improve outcome in these women who have been shown to have a very poor prognosis when treated expectantly or with cerclage. Future studies involving multiple centers are needed to better answer this question.

OP10.09: Normal reference values of postpartum intra abdominal pressure

Methods: The amount of gastric volume was estimated in 20 preterm infants with the use of three-dimensional ultrasound (3DUS) volumetry method (VOCAL). The procedure of gastric emptying was determined by three volume measurements of the gastric volume after routine feeding (0-, 30and 60minute-volumes). In the control group 0-, 30and 60minute gastric volumes were measured in the same infants with the same volumetric method one day before the ophthalmologic examination. The preterms were born at the 30.50 ± 2.67 gestational week with an average of 1454.50 ± 400.23 g birth weight. Tropicamide and phenylephrin hydrochlorid were used in a dose of 0.25 mg and 0.15 mg three times before the eye examination. Results: Contrary to earlier reports the authors did not find significantly delayed gastric emptying with the doses of mydriatics. At the time of the second and third measurement the authors found 64.98% and 40.02% of gastric volume in the control group and a 68.51% and 44.27% of gastric volume after instillation of mydriatics, respectively. Conclusions: Current dose of mydriatics does not seem to delay gastric emptying significantly, the doses administered in routine clinical practice can be used safely on the day of screening examinations for ROP. The gastric volume measurement in preterm infants using 3D-US volumetry is rapid, painless, reproducible, and non-invasive.