Ramesh Ganapathy

Neonatal outcome of antenatally diagnosed congenital cystic adenomatoid malformations

To investigate the natural history and outcome of antenatally diagnosed congenital cystic adenomatoid malformation (CCAM) of the lung.

P08.01: Relationship of uterine artery Doppler and trophoblast invasion in the first trimester of pregnancy

decrease the concentration of prostaglandins. (PG) Whether PG have similar effect in human is not known. To evaluate the effect of indomethacin on human FBM, we studied 21 pregnant women who presented with preterm labor (gestational age: < 36 weeks). They were divided into a control group (n = 10) and a group treated with indomethacin (n = 11). For both groups, FBM were measured sonographically and recorded on videotape during a 1 hour baseline period. Then, the treated group received indomethacin in a dose of 2–3 mg/kg.. FBM measurements were repeated 24 h later for both groups. To quantify FBM, we reviewed the videotapes and recorded FBM with an event marker on a polygraph. In treated group, there were significant increases in incidence of FBM (x +/− s.e.: 23 +/− 5 vs. 37 +/− 8% of the time, p < 0.05, Wilcoxon Signed Rank Test) and duration of the longest episode of FBM (84 +/− 13 vs. 196 +/− 25 sec, p < 0.05); the increase in average duration of episodes approached significance (21 +/− 3 vs. 37 +/− 8 sec, p = 0.09). The number of episodes of FBM did not change. In the control group there were no significant changes in any of the measured variables. We conclude that indomethacin given to pregnant women increases incidence and duration of FBM, possibly due to a decrease in fetal concentrations of PG.

Echocardiographic Structure and Function in Hypertensive Disorders of PregnancyCLINICAL PERSPECTIVE

Background—Echocardiography is commonly used to direct the management of hypertensive disorders in medical patients, but its application in pregnancy is unclear. Our objective was to define the use of echocardiography in pregnancies complicated by gestational hypertension (GH) and preeclampsia. Methods and Results—We performed a systematic review of articles using an electronic search of databases from inception to March 2015, prospectively registered with PROSPERO (CRD42015015700). Eligible studies included pregnant women with GH or preeclampsia, evaluating left ventricular structure and function using echocardiography. The search strategy identified 36 studies, including 745 women with GH and 815 women with preeclampsia. The populations were heterogeneous with respect to clinical characteristics, parity, and risk of bias. Increased vascular resistance and left ventricular mass were the most consistent findings in GH and preeclampsia. Differentiating features from normal pregnancy were left ventricular wall thickness of ≥1.0 cm, exaggerated reduction in E/A, and lateral e′ of <14 cm/s. There was disagreement between studies with regard to cardiac output because of the timing of echocardiography, although reduced stroke volume was an indicator of adverse prognosis. Diastolic dysfunction and left ventricular remodeling are most marked in severe and early-onset preeclampsia, but are also markers of preeclampsia before clinical manifestation, and are associated with adverse outcomes. Conclusions—Echocardiography is a valuable tool to stratify risk and can guide management and counseling in the preclinical and clinical phases of GH and preeclampsia. Changes in cardiac function and morphology are recognizable at an asymptomatic early stage and correlate with disease severity and adverse outcomes.

Echocardiographic Structure and Function in Hypertensive Disorders of PregnancyCLINICAL PERSPECTIVE: A Systematic Review

Background—Echocardiography is commonly used to direct the management of hypertensive disorders in medical patients, but its application in pregnancy is unclear. Our objective was to define the use of echocardiography in pregnancies complicated by gestational hypertension (GH) and preeclampsia. Methods and Results—We performed a systematic review of articles using an electronic search of databases from inception to March 2015, prospectively registered with PROSPERO (CRD42015015700). Eligible studies included pregnant women with GH or preeclampsia, evaluating left ventricular structure and function using echocardiography. The search strategy identified 36 studies, including 745 women with GH and 815 women with preeclampsia. The populations were heterogeneous with respect to clinical characteristics, parity, and risk of bias. Increased vascular resistance and left ventricular mass were the most consistent findings in GH and preeclampsia. Differentiating features from normal pregnancy were left ventricular wall thickness of ≥1.0 cm, exaggerated reduction in E/A, and lateral e′ of <14 cm/s. There was disagreement between studies with regard to cardiac output because of the timing of echocardiography, although reduced stroke volume was an indicator of adverse prognosis. Diastolic dysfunction and left ventricular remodeling are most marked in severe and early-onset preeclampsia, but are also markers of preeclampsia before clinical manifestation, and are associated with adverse outcomes. Conclusions—Echocardiography is a valuable tool to stratify risk and can guide management and counseling in the preclinical and clinical phases of GH and preeclampsia. Changes in cardiac function and morphology are recognizable at an asymptomatic early stage and correlate with disease severity and adverse outcomes.

P03.17: Post‐term pregnancies: what are the predictors of intrapartum distress?

Objective: to determine whether a single threshold of the sonographic cervical length or different cut-offs for each period of pregnancy are more sensitive in predicting preterm delivery. Methods: We observed 108 patients between the 10th and 34th week of gestational age admitted for threatened preterm labour. The cervical length was determined using ultrasound on admission. Exclusion criteria included multiple pregnancies, singleton pregnancies lacking sonographic determination of the gestational age prior to 22 weeks, ruptured membranes, cervical dilatation 33 cm at digital exploration, vaginal bleeding, placenta previa and prior cervical cerclage. Two cut-offs (15 and 25 mm) and two centiles (2.5◦ and 10◦) of our reference curves were used for predicting delivery within 7 days and before 34 weeks. Results: 76.8% of the patients delivered after 34 weeks, 23.1% before 34 weeks while in 17.5% of the cases delivery occurred within 7 days. The median cervical length at admission was 35 mm, 25 mm, and 21 mm respectively. Univariate analysis of the different cut-offs showed a higher odds ratio for 25 and 15 mm compared to the 2.5 and 10◦P both in predicting delivery within 7 days and before 34 weeks. The diagnostic accuracy was statistically higher for the 15 and 25 mm thresholds both in predicting PTL within 7 days respectively 83 and 76% and before 34 weeks, 77 and 76% respectively. Conclusion: sonographic measurement of the cervical length proved to be a feasible and effective method in identifying the population with an increased risk for PTL both within 7 days and before 34 weeks following the exam. The negative predictive value resulted particularly high90% for the 25 mm cut-off and for the 2.5◦ and 10◦P, giving a likelihood ratio of 93% and 91% respectively that delivery will probably not occur within 7 days. These elements obviously need to be integrated with clinical aspects of each case, for the optimal management of patients with suspected PTL.