Marianna Andreani

Large uterine leiomyomata and risk of cesarean delivery

OBJECTIVE: To study the causes of the observed association between presence of leiomyomata in pregnancy and increase in risk of cesarean delivery. METHODS: We accessed the obstetric database of women who underwent second-trimester ultrasound screening between January 1996 and December 2004 and who delivered at more than 22 weeks of gestation. Ultrasonographic characteristics of the leiomyomata, including number, maximum diameter, change in size during pregnancy, and location were recorded. Pregnancy outcome was compared between the cohort with large uterine leiomyomata (5 cm or more) (n=251) and those without leiomyomata (n=24,546) using &khgr;2, Fisher exact test, Student t test, and linear and logistic regression analysis, with an odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity considered significant. RESULTS: Women with large leiomyomata had higher rates of cesarean delivery before onset of labor (OR 3.1, 95% CI 2.2–4.2) but not during labor (OR 1.0, 95% CI 0.6–1.6). The association between leiomyomata and cesarean delivery before labor remained significant after controlling for maternal age, nulliparity, fetal malpresentation, and placenta previa (OR 2.1, 95% CI 1.4–3.1). The only ultrasonographic leiomyoma characteristic independently associated with cesarean delivery before labor after controlling for confounders was maximum diameter of the largest leiomyoma (OR 1.3, 95% CI 1.1–1.4, P=.001). CONCLUSION: Uterine leiomyomata 5 cm or larger are independently associated with cesarean delivery performed before labor, and the risk increases with the size of the leiomyoma. LEVEL OF EVIDENCE: II

Two‐ or three‐dimensional ultrasonography: which is the best predictor of pulmonary hypoplasia?

The aim of our study is to compare the three‐dimensional (3D) ultrasound fetal lung volume measurements with two‐dimensional (2D) ultrasound biometric parameters in predicting pulmonary hypoplasia (PH).

Comparative analysis of cesarean delivery rates over a 10-year period in a single Institution using 10-class classification.

Objective: To evaluate the variables associated with changes in cesarean delivery (CD) rates in a University Hospital with standardized and unchanged protocols of care. Methods: Retrospective analysis of consecutive deliveries between two triennia 10 years apart. The Robson classification of CD was used, and the analysis focused on factors affecting Robson’s classes 1 and 2 combined (term singleton cephalic nulliparae) and class 5 (previous CD). Results: A total of 8237 deliveries occurred in the 1st period, and 8420 in the 2nd. CD increased from 12.5 to 18% (p < 0.001). Robson’s classes 1 and 2 combined contributed more than other classes to CD rates (32 vs 36%; p < 0.001). At multivariate analysis, BMI (Odds ratio [OR]: 1.08; 95% CI: 1.06–1.1) and maternal age (OR: 1.06; 95% CI: 1.05–1.08) were independently related to CD. In Robson class 5, the rate of CD increased from 34 to 46%, p < 0.001, mostly due to an increase in elective CD (39 vs 67.5%; p < 0.001). At multivariate analysis, BMI (OR: 1.06 95% CI: 1.02–1.1) and more than one previous CD (OR: 18.7; 95% CI: 9.6–36.4) were independently related to CD. Conclusions: BMI and maternal age are independent factors associated to the increasing rate of CD in nulliparae with spontaneous or induced labor at term. In women with previous CD, BMI and more than one previous CD are factors associated with the increasing rate of CD.

Which factors affect the occurrence of severe cerebral lesions in preterm neonates who are born with intrauterine infection

OBJECTIVE The purpose of this study was to evaluate which factors affect the occurrence of neonatal ultrasonographic evidence of severe cerebral lesions in the presence of intrauterine infection. STUDY DESIGN From a cohort of 567 singleton neonates who were born between 24.0 and 31.6 weeks of gestation, we identified the 180 infants with histologic and/or clinical evidence of intrauterine infection. We excluded stillbirths and congenital anomalies. Obstetric and neonatal variables were related to evidence of severe neonatal ultrasonographic cerebral lesions with the use of logistic regression analysis. RESULTS Severe cerebral lesions were identified in 10% of infants (18/180). After we controlled for variables that were clinically relevant, logistic regression analysis demonstrated that ultrasound evidence of severe neonatal cerebral lesions was associated independently with antenatal administration of corticosteroids (adjusted odds ratio, 0.3; 95% CI, 0.11-0.88; P = .03) and occurrence of placental abruption (adjusted odds ratio, 5.4; 95% CI, 1.4-20.7; P = .02). CONCLUSION Antenatal administration of corticosteroids in the presence of intrauterine infection has a protective effect on the risk of ultrasonographic evidence of severe neonatal cerebral lesions.

Are ultrasonographic myoma characteristics associated with blood loss at delivery

The presence of myomas in pregnancy is associated with greater blood loss at delivery. The aim of this study was to evaluate whether the sonographic characteristics of myomas can predict blood loss at delivery in women with large myomas.

Gestational age at glucocorticoids administration after premature rupture of membranes and cerebral white matter damage

Objective. We investigated whether gestational age at glucocorticoids administration in very preterm premature rupture of membranes (PROM) affects the occurrence of neonatal cerebral white matter damage (WMD). Methods. In a cohort of singleton neonates born at 24.0–33.6 weeks after PROM who underwent at least one full course of glucocorticoids (n = 130), we compared the gestational age at first and last course of glucocorticoids between those who developed WMD (n = 8) and those who did not (n = 122) after adjusting for gestational age at PROM using logistic regression with P < 0.05 considered significant. Results. Gestational age at first course of glucocorticoids (P = 0.2), at last course of glucocorticoids (P = 0.2) and at delivery (P = 0.2), were not significantly different between those who developed WMD and those who did not. Although latency between PROM and first course of glucocorticoids was protective against WMD (P = 0.02), the significance was lost after controlling for gestational age at PROM, which was significantly lower in cases that developed WMD (P < 0.01). Conclusions. In very preterm PROM, the beneficial effect of glucocorticoids on occurrence of WMD is not related to gestational age at steroid administration.

P28.08: 2‐ or 3‐dimensional ultrasonography: What is the best predictor of pulmonary hypoplasia in complicated pregnancies?

Objectives: The purpose of this study is defining the reference range of fetal renal volume by three-dimensional ultrasound (3D-US) using the VOCAL (Virtual Organ Computer-aided Analysis) technique. Methods: A prospective longitudinal study was performed in 54 singleton pregnancies between 24 to 34 weeks gestation. The volume of both kidneys was obtained separately using the VOCAL method with a 30◦ rotation using Sonoace 8000 Live (Medison, Seoul, Korea). The mean, maximal and minimal volumes were determined for each kidney. Polynomial regression models were used to determine the correlation between gestational age and fetal renal volume, and adjusts were done with the coefficient of determination (R2). The Wilcoxon test verified the differences between the volume of right and left kidneys. Results: The right kidney mean volume grew from 4.48 cm3 (2.23–6.74 cm3) at 24a weeks to 12.07 cm3 (9.15–14.99 cm3) at 34a weeks. The left kidney mean volume grew from 4.66 cm3 (3.03–6.28 cm3) at 24a weeks to 10.61 cm3 (7.93–13.31 cm3) at 34a weeks. A strong correlation was found between the gestational age and kidney volume (R2 = 0.98 for right kidney and R2 = 0.96 for left kidney) In addition, there were no differences between the volumes of bilateral kidneys (P > 0.08). Conclusion: The reference range of fetal renal volume by threedimensional ultrasound using the VOCAL method was determined