Neil S. Silverman

Hepatitis C virus in pregnancy: Seroprevalence and risk factors for infection

OBJECTIVES Our purpose was to define the prevalence of antibodies to hepatitis C virus among inner-city prenatal patients. We also sought to examine both the reliability of traditional hepatitis risk factors to predict evidence of infection among these women and the incidence of coinfection in this population with other blood-borne and sexually transmissible agents. STUDY DESIGN An anonymous serosurvey was performed to define and compare anti-hepatitis C virus prevalences among women registering for prenatal care at both an inner-city, university hospital-based clinic and an academic private practice based at the same institution. RESULTS Anti-hepatitis C virus antibodies were detected in 4.3% of 599 pregnant women screened. In comparison, 0.8% had positive antibody tests for human T-lymphotropic virus and 0.5% were positive for antibodies to human immunodeficiency virus. Evidence of chronic hepatitis B infection was seen in 0.8%. The relative risk of other coexisting infections was significantly higher among women with anti-hepatitis C virus antibodies than among those who were antibody negative. Substance abuse was the most commonly identified risk factor for anti-hepatitis C virus-positive status, although risk factor-targeted screening would have failed to detect half of the anti-hepatitis C virus-positive women in this study. CONCLUSIONS Hepatitis C virus infection among inner-city pregnant women, with its potential for maternal-fetal transmission, represents a public health issue of sufficient magnitude to warrant more extensive study. More information is needed, given this documented reservoir of maternal seropositivity, regarding the vertical transmissibility of the virus and the effects of coinfections on neonatal disease.

The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic

The Zika pandemic provides biomedical scientists, clinicians, public health advocates, and governments a unique opportunity to advance reproductive justice by addressing the paradoxes outlined in this essay. The circumstances in which pregnancies occur are morally relevant to women’s reproductive life decisions, to the provision of reproductive health care, and to the development of reproductive health policy. Whether the Zika pandemic might foster context-driven reproductive pandemic planning and response is yet to be determined. Maintaining the status quo will surely increase a range of global health disparities and further stratify reproduction, producing predictable and preventable outcomes in which some people receive the necessary care and resources to achieve family building while others are neglected. Women and men should be able to count on biomedical researchers to answer the questions that need answering without undue influence from political agendas. Women should be able to continue pregnancies and count on public health assistance and help for children with Zika-related disabilities, or prevent or end a Zika-affected pregnancy. Pandemic responses that don’t further these ends are morally unacceptable.

Routine measurement of amniotic fluid alpha-fetoprotein and acetylcholinesterase: the need for a reevaluation

OBJECTIVE The objective of the study was to evaluate whether the current screening regimen of measuring amniotic fluid alpha-fetoprotein (AF-AFP) at the time of amniocentesis and reflex acetylcholinesterase testing vs ultrasound alone to detect neural tube and ventral wall defects offers improved diagnostic accuracy and cost benefit. STUDY DESIGN A retrospective chart review on all patients who had amniocentesis performed at 1 center over the past 11 years was performed. Those with an elevated AF-AFP were compared with those whose AF-AFP was within normal limits. Ultrasound findings and outcomes were reviewed in all cases to assess whether neural tube defects (NTDs) or ventral wall defects (VWDs) were missed by AF-AFP or ultrasound screening. A cost-benefit analysis was then performed. RESULTS Of 6232 women who underwent amniocentesis between January 2002 and December 2012, 81 had an elevated AF-AFP with or without a positive acetylcholinesterase (AChE). Of these 81 women, 13 had NTDs and 5 had VWDs. The sensitivity of the detailed ultrasound was 100% in detecting NTDs and VWDs, whereas that of the AF-AFP ranged from 22% to 77%, with the inclusion of AChE. The total expenditure for AF-AFP in our sample set (n = 6232 amniocentesis at

The value of the first trimester ultrasound in the era of cell free DNA screening

76.00 per AF-AFP) was

Clinical accuracy of abnormal cell‐free fetal DNA results for the sex chromosomes

473,632, and all NTDs and VWDs were detected by ultrasound. Translated to a national laboratory (>42,447 samples/year), the cost savings in 2011 alone would be

Management of hereditary antithrombin deficiency in pregnancy

3,225,972. CONCLUSION Given the accuracy of high-resolution ultrasound in the detection of both NTDs and VWDs, measuring AF-AFP and AChE as a reflex-screening test is not a cost-effective approach.

P19.06: Increased intertwin discrepancy in cerebroplacental ratio (CPR-Δ) is predictive of earlier age at delivery in monochorionic-diamniotic (MCDA) twins: Poster discussion hub abstracts

To describe the clinically relevant findings detected by the first trimester ultrasound (FTU) and to determine the additional value of the FTU compared to cell free DNA (cfDNA) alone.

Detection of Y chromosome material in a 46,XX male with SRY translocation: novel application of cell-free fetal DNA testing

To investigate factors associated with abnormal cell‐free DNA (cfDNA) results for sex chromosomes (SCs).

OC25.01: Assisted reproductive technologies and fetal anomalies in singleton gestations

Antithrombin (AT) deficiency is a high-risk thrombophilia and a rare condition. Despite full anticoagulation during pregnancy and the postpartum period, women with AT deficiency may still be vulnerable to developing venous thromboembolism (VTE), including fatal events. There is limited guidance on the management of AT deficiency in pregnancy, including the role of AT concentrates. Following a comprehensive review of the state of the art with respect to recommendations and guidelines, our expert panel in maternal-fetal medicine, hematology and basic science reached consensus on key issues in the recognition and management of AT deficiency in pregnancy. This paper summarizes the state of the art and summarizes what we believe are best practices with special emphasis on a multidisciplinary approach involving obstetrics and hematology in the care of women with AT deficiency.

OP11.03: Intra- and inter-observer variability of crown–rump length and other fetal biometry at the nuchal translucency scan

Objectives: To investigate the role of CPRfor the prediction of gestational age (GA) of delivery in MCDA pregnancies. Methods: This was a retrospective cohort study of all MCDA pregnancies at a maternal fetal medicine referral centre between 1/2007-2/2017. Exclusion criteria were structural or chromosomal anomalies, intrauterine fetal demise (IUFD) < 16 weeks, or referral after development of Twin–twin transfusion syndrome (TTTS) or twin anemia polycythemia sequence (TAPS). Ultrasounds were performed biweekly from 16-37 weeks to survey umbilical artery (UA) and middle cerebral artery (MCA) Dopplers. CPR was calculated as MCA-PI:UA-PI. CPRwas defined as the absolute difference between the twins and calculated at each visit. The maximum CPRin both the second and third trimester were assessed as predictors of adverse birth outcomes by logistic regression analysis. Pearson’s correlation coefficients were calculated to assess the relationship between CPRand birth outcomes. Results: 143 MCDA twin pregnancies (16 were lost to follow up) and 249 newborns met inclusion criteria: 16 pregnancies (11.2%) were complicated by TTTS, 7 (4.9%) were complicated by TAPS, 41 (28.7%) were complicated by sIUGR, and 8 (5.6%) developed an IUFD of one twin. Mean GA at delivery was 34.9 weeks, of which 73.4% were via Caesarean. Mean birth weight was 2157 g (range: 540 g-3980 g), and 76 (58.7%) pregnancies had NICU admission of at least one twin. There was a significant correlation between maximum CPRin the second trimester to GA at delivery (r = -0.2955, p = 0.0017) and average birth weight (r = -0.3778, p < 0.0001). Logistic regression analysis showed a significant association between maximum CPRin the second trimester and NICU admissions (OR 3.94, 95% CI 1.31-11.85; p = 0.0146). Conclusions: In MCDA twin pregnancies, increasing intertwin CPRis correlated with earlier GA at delivery, lower average birth weight, and NICU admissions. CPR evaluation may be of clinical utility in the surveillance of MCDA twin pregnancies.