Molly Carpenter

Childhood cardiac function after prenatal diagnosis of intracardiac echogenic foci.

Objective. To determine whether prenatally diagnosed intracardiac echogenic foci are associated with childhood cardiac dysfunction and persistence. Methods. Children in whom intracardiac echogenic foci were shown on prenatal sonography at 1 perinatal center underwent echocardiography at ages 2 to 7 years. A single pediatric cardiologist, blinded to the prenatal sonographic intracardiac echogenic focus locations, assessed cardiac function by measuring the left ventricular shortening fraction and myocardial performance index. The presence of tricuspid and mitral valve regurgitation was also sought. The secondary outcome was intracardiac echogenic focus persistence. Results. Twenty‐five children, 14 (56%) male and 11 (44%) female, were examined at a mean age ± SD of 3.0 ± 1.0 years. Prenatally, 18 children (72%) had left ventricular intracardiac echogenic foci, and 7 (28%) had right ventricular intracardiac echogenic foci. The left ventricular shortening fraction was normal in all children. The overall mean left ventricular myocardial performance index (reference value, 0.36 ± 0.06), was normal for both children with left ventricular intracardiac echogenic foci (0.36 ± 0.06) and those with right ventricular intracardiac echogenic foci (0.36 ± 0.04). Two children with left ventricular intracardiac echogenic foci had an isolated left ventricular myocardial performance index of greater than 2.5 SD above the mean. Trace tricuspid valve regurgitation and mitral valve regurgitation were noted in 13 (52%) and 2 (8%) of the children, respectively, similar to the general population. Left ventricular intracardiac echogenic foci persisted in 16 children (89%), whereas right ventricular intracardiac echogenic foci persisted in 2 (29%) (P = .007). Conclusions. Prenatally diagnosed intracardiac echogenic foci are often persistent but not associated with childhood myocardial dysfunction.

Reducing pain with genetic amniocentesis—A randomized trial of subfreezing versus room temperature needles

Objective. To determine whether pain associated with second trimester genetic amniocentesis is decreased by using subfreezing rather than room temperature needles. Methods. Subjects were randomized to a −14°C or room temperature (20–22°C) 22-gauge spinal needle. Patients, blinded to allocation, recorded anticipated and actual pain before and after the procedure, respectively, using a 0–10 visual analog scale with 0 = no pain and 10 = excruciating pain. Results. Thirty-three subjects were randomized to room temperature and 29 subjects to subfreezing needles. Anticipated pain was similar in room temperature, 5.1 ± 1.7, and subfreezing groups, 4.9 ± 2.0, respectively (p = 0.6). Actual pain was also similar in the room temperature, 3.6 ± 2.0, and subfreezing groups, 2.8 ± 2.0, respectively (p = 0.14). Similar numbers of subjects in the room temperature and subfreezing groups reported less actual pain (20 vs. 18), greater actual pain (4 vs. 4) or no difference in pain (9 vs. 5) than anticipated (p = 0.6). Conclusion. A subfreezing 22-gauge spinal needle does not decrease perceived pain associated with second trimester genetic amniocentesis.

Pain associated with chorionic villus sampling: transabdominal vs transcervical approach

OBJECTIVE The purpose of this study was to compare anticipated and perceived pain that is associated with transabdominal and transcervical chorionic villus sampling (CVS). STUDY DESIGN Women with singleton pregnancies who were undergoing CVS completed a preprocedure 0-10 visual analog scale (VAS; 0 = no pain, 10 = excruciating pain) for anticipated transabdominal and transcervical CVS-related pain. After the procedure, patients completed a VAS for perceived pain. RESULTS One hundred twenty-one women underwent transabdominal (n = 98) or transcervical (n = 23) CVS. Anticipated pain was 4.5 +/- 2.0, which was similar in patients who ultimately underwent transabdominal (score, 4.6 +/- 3.8) or transcervical (score, 4.1 +/- 2.2) CVS. Postprocedure perceived pain was similar for transabdominal CVS in women with an abdominal wall thickness of <4 cm (score, 2.3 +/- 0.8) and transcervical CVS (score, 2.6 +/- 2.2) but was significantly greater for transabdominal CVS among women with an abdominal wall thickness of > or =4 cm (score, 5.6 +/- 1.2; P < .0001) and nulliparous women who had transcervical CVS (score, 4.3 +/- 2.1; P = .01). CONCLUSION Transabdominal CVS is more painful in heavier women, and transcervical CVS is more painful in nulliparous women.

Prenatal Sonographic Diagnosis of a Perineal Lipoma

Received March 8, 2010, from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (J.R.W., M.G.P., M.C., A.C.), Division of Pediatric Surgery, Department of Surgery (B.M.), and Department of Radiology (S.W.), Maine Medical Center, Portland, Maine USA. Manuscript accepted for publication March 9, 2010. Address correspondence to Joseph R. Wax, MD, Maine Medical Partners Women’s Health, 887 Congress St, Suite 200, Portland, ME 04102 USA. E-mail: waxj@mmc.org primagravid patient underwent an obstetric ultrasound examination at a gestational age of 31 weeks 5 days for a fundal height less than expected. The pregnancy was dated by a 15week sonogram, and the fetus had a known 46,XX karyotype following amniocentesis performed because of an increased risk for trisomy 21 by maternal serum screening. The fetal anatomy was sonographically normal at 18 weeks’ gestation. Sonography revealed a normally grown fetus (1746 g, 43rd percentile) surrounded by a normal amniotic fluid volume. A 2.3 ×1.4-cm lobulated right labial and perineal mass was observed (Figures 1 and 2). A review of the 18-week study confirmed a normal perineum at that time. Color and power Doppler interrogation showed no flow within the lesion. The likely diagnosis was a lipoma, for which the patient was counseled and referred for pediatric surgical consultation. The pregnancy was followed weekly, with the mass showing stable dimensions and appearance. A healthy neonate weighing 3150 g with 1and 5minute Apgar scores of 8 and 9, respectively, was delivered vaginally at 39 weeks’ gestation. The neonate had normal bowel and bladder function with physical examination notable only for the 5 ×4 ×3-cm bilobed mass arising from the right perineum extending to the right labium minora and introitus (Figure 3). Magnetic resonance imaging performed on the second day of life showed a signal intensity consistent with fat, no enhancement with gadolinium contrast, and a 1.7-cm vascular pedicle extending cephalad to the right lateral vagina, lower rectum, and anus (Figure 4). At 1 month of age, the mass was locally excised without complications (Figure 5). Histologic examination of the specimen showed mature adipose tissue interspersed with collagenous bands, leading to the diagnosis of a fibrolipoma.

Pain associated with transabdominal chorionic villus sampling—Anticipated versus actual

Objective. To assess anticipated and perceived pain associated with transabdominal chorionic villus sampling (TA CVS). Methods. Sixteen consecutive patients completed 0 (no pain) to 10 (excruciating pain) visual analog scales before and after TA CVS. Results. Anticipated pain (5.1 ± 2.9) and perceived pain (5.5 ± 3.2) were similar (p = 0.42) and moderate. Actual pain was less in five (31%), the same in six (38%), and greater in five (31%) compared to anticipated pain. Conclusions. These baseline data are useful for patient counseling and designing interventional trials to decrease procedural pain. TA CVS is associated with moderate perceived pain.

P09.05: A randomized single blinded trial of subfreezing versus room temperature needles to reduce pain with amniocentesis

Results: Excellent visualization of the external fetal anatomy was obtained in 83% of cases (5/6) with the duration of procedures ranging 15 to 40 minutes. A diagnosis of Meckel-Gruber syndrome was made at 13 + 1 weeks of gestation by visualizing postaxial polydactyly and an occipital encephalocele. Subsequently the pregnancy was terminated. Three full-term infants were delivered with no gross limb or facial abnormalities. Amniotic fluid leakage after the procedure occurred in 2 cases resulting in termination of pregnancy. Conclusion: Our experiences confirm the efficacy of embryofetoscopy for early diagnosis in the first trimester of pregnancy. Procedure-related risks are to be established by multicenter studies.

Stepwise sequential aneuploidy screening in clinical practice.

To evaluate stepwise sequential screening (SSS) efficiency in clinical practice.

First trimester transabdominal chorionic villus sampling—does the needle matter?

To compare first‐trimester transabdominal chorionic villus samples (TA‐CVS) when obtained by 20‐gauge amniocentesis versus lancet needles.

P09.24: Pain associated with transabdominal chorionic villus sampling—anticipated versus actual

OBJECTIVE To assess anticipated and perceived pain associated with transabdominal chorionic villus sampling (TA CVS). METHODS Sixteen consecutive patients completed 0 (no pain) to 10 (excruciating pain) visual analog scales before and after TA CVS. RESULTS Anticipated pain (5.1 +/- 2.9) and perceived pain (5.5 +/- 3.2) were similar (p = 0.42) and moderate. Actual pain was less in five (31%), the same in six (38%), and greater in five (31%) compared to anticipated pain. CONCLUSIONS These baseline data are useful for patient counseling and designing interventional trials to decrease procedural pain. TA CVS is associated with moderate perceived pain.

Childhood cardiac function after prenatal diagnosis of intracardiac echogenic foci

OBJECTIVE To determine whether prenatally diagnosed intracardiac echogenic foci are associated with childhood cardiac dysfunction and persistence. METHODS Children in whom intracardiac echogenic foci were shown on prenatal sonography at 1 perinatal center underwent echocardiography at ages 2 to 7 years. A single pediatric cardiologist, blinded to the prenatal sonographic intracardiac echogenic focus locations, assessed cardiac function by measuring the left ventricular shortening fraction and myocardial performance index. The presence of tricuspid and mitral valve regurgitation was also sought. The secondary outcome was intracardiac echogenic focus persistence. RESULTS Twenty-five children, 14 (56%) male and 11 (44%) female, were examined at a mean age +/- SD of 3.0 +/- 1.0 years. Prenatally, 18 children (72%) had left ventricular intracardiac echogenic foci, and 7 (28%) had right ventricular intracardiac echogenic foci. The left ventricular shortening fraction was normal in all children. The overall mean left ventricular myocardial performance index (reference value, 0.36 +/- 0.06), was normal for both children with left ventricular intracardiac echogenic foci (0.36 +/- 0.06) and those with right ventricular intracardiac echogenic foci (0.36 +/- 0.04). Two children with left ventricular intracardiac echogenic foci had an isolated left ventricular myocardial performance index of greater than 2.5 SD above the mean. Trace tricuspid valve regurgitation and mitral valve regurgitation were noted in 13 (52%) and 2 (8%) of the children, respectively, similar to the general population. Left ventricular intracardiac echogenic foci persisted in 16 children (89%), whereas right ventricular intracardiac echogenic foci persisted in 2 (29%) (P = .007). CONCLUSIONS Prenatally diagnosed intracardiac echogenic foci are often persistent but not associated with childhood myocardial dysfunction.