Ran Neiger

Pregnancy outcome in isolated single umbilical artery.

Our objective was to determine whether the rate of small for gestational age (SGA) infants and adverse perinatal outcome are increased in pregnancies diagnosed with an isolated single umbilical artery (SUA). We compared 297 pregnancies with a SUA diagnosed on routine obstetrical ultrasound with 297 pregnancies with a three-vessel cord control. Pregnancies complicated by major fetal anomalies were excluded. The rate of SGA, fetal death, and neonatal outcomes were compared between the two groups. Data analysis were performed using the T-test and chi-square test. The sample size had 80% power to detect a 50% difference between groups assuming a SGA rate of 20% in the SUA group and 10% in the control, alpha = 0.05. Among the SUA group, in 21 neonates (7.1%) the presence of a SUA could not be confirmed by postnatal examination, and 21 (7.1%) had major congenital anomalies, leaving 255 for final analysis. In the control group, 8 of the 297 (2.7%) had major congenital anomalies, leaving 289 for final analysis. The incidence of SGA neonates was 35 of 255 (13.7%) in the isolated SUA group compared with 38 of 289 (13.1%) in the control group ( P = 0.93). The composite perinatal outcomes (fetal death and/or SGA) were also similar between the groups (16.1% versus 14.5%; P = 0.72). We concluded that pregnancies with isolated SUA have a similar rate of SGA to those with 3VC. When a SUA is identified antenatally, a targeted ultrasound is warranted to rule out associated anomalies. Serial antepartum ultrasound for fetal growth is not necessary in managing pregnancies complicated by isolated SUA.

Gender-related differences in fetal heart rate during first trimester

Objective: Many expecting parents wish to ascertain fetal gender early in pregnancy. Our goal was to determine whether fetal heart rate (FHR) of males and females during the first trimester is significantly different. Materials and Methods: From November 1997 to February 2003 we enrolled pregnant women with singleton gestations who underwent obstetric sonography at less than 14 weeks of gestational age. Indications for the sonographic study included first-trimester bleeding, uncertain gestational dating, poor obstetrical history, and aneuploidy screening by nuchal translucency. The sonographic studies were performed by a single sonographer and reviewed by the first author. The FHR was determined by m-mode. All subjects underwent second-trimester sonography at 18.0–24.0 weeks’ gestation by the same team, and fetal gender was recorded. Multiple gestations, miscarriages and pregnancies with uncertain fetal gender were excluded. Sonographically assigned fetal gender was confirmed at delivery. Results: Of the 966 first-trimester studies performed, 477 met the inclusion criteria. Of these, 244 (51%) were female and 233 (49%) were males. There were no statistical differences in mean maternal age, gravidity, parity, and mean gestational age at the time of the first study (9.0 ± 2.3 weeks for female fetuses and 9.0 ± 2.3 weeks for males, p = 0.7). The average female FHR was 151.7 ± 22.7 bpm and male FHR was154.9 ± 22.8 bpm (p = 0.13). Discussion: Contrary to beliefs commonly held by many pregnant women and their families, there are no significant differences between male and female FHR during the first trimester.

OP10.12: Intrauterine growth rate in pregnancies complicated by isolated two-vessel cord

patients who had normal placental parenchyma. The groups were matched for maternal age, gestational age, parity, race, and smoking. Transverse and sagittal scans in real time were used to evaluate the degree and severity of thrombosis. The mean of the two largest lesion diameters was used for severity classification. Results: Mean gestational age at delivery was 39.1 wks (± 1.8) for the control group, 37.9 wks (± 2.8) for mild thrombosis and 35.2 wks (± 5.8) for severe thrombosis, (p < 0.0001). Mean birth weight was 3348 g (± 492) for the control, 3134 g (± 657) for the mild thrombosis and 2524 g (± 1339) for the severe thrombosis group, (p = 0.0005). The presence of IUGR was more frequent in patients with thrombotic lesions: 9.6% in mild thrombosis and 38.4% in severe thrombosis, in comparison to 3.1% in the control group (p = 0.0003; OR = 5.7; p = 0.0151). Pre-eclampsia was also more frequent in patients with thrombosis: control group, 0.0%; the mild group, 7.7%; and severe group, 15.4% (p < 0.0214; OR = 14.3, p = 0.0139). Conclusions: There is a strong association between placental thrombosis and adverse perinatal outcomes. Increased size and/or number of thrombotic lesions is associated with more adverse perinatal outcomes. Ultrasound may be useful in identifying patients with pro-thrombotic abnormalities associated with placental thrombosis.

OP01.09: Nasal bone evaluation in prenatal screening for trisomy 21: a review

Objective: To evaluate the interobserver variability on the subjective assessment of the hypoplastic NB and thickened Nbr used to screen for DS after 18 weeks in women at increased risk for this aneuploidy. Methods: Images of facial profiles for true DS cases were compared to controls without DS. From Oct/03 all cases with images of facial profiles were matched to randomly selected controls having a similar initial risk for DS. The subjective assessment was for a severely hypoplastic/absent NB and if the Nbr was thickened as defined by Nbr tissue that entirely buried the underlying NB. Coded images were independently evaluated by three MFM specialists. Each image was assessed for adequacy of the profile and then for the NB and Nbr. Responses were evaluated using Cohen’s kappa. Results: 118 images were assessed, of which 31 were eliminated due to inadequate image profiles. All examiners agreed on inadequate profiles. Among the 87 cases studied, 22 had DS and 65 were normal controls.