Richard Broth

Abdominal wall defects and congenital heart disease

To determine the incidence of cardiac disease associated with abdominal wall defects of fetuses and associated parameters including maternal age, sex, gestational age at delivery, outcome, karyotypes, Apgar scores and associated congenital anomalies.

P04.33: Sonographic assessment of weight in fetuses with gastroschisis

Objective: To determine the accuracy of ultrasound (US) estimation of fetal weight (EFW) in gastroschisis. Methods: The reliability of US EFW in gastroschisis has been questioned, mainly due to the presumed decrease in abdominal circumference resulting from bowel evisceration. In order to answer this question, we performed a retrospective review of all infants delivered at Thomas Jefferson University Hospital between 1991–2003 with gastroschisis. EFW was determined from the most recent US prior to delivery combined with a correction for normal anticipated interval growth (Williams RL, Obstet Gynecol 1982). Adjusted EFW was then compared with actual birth weight (BW). The primary outcome was the difference between adjusted EFW and BW. Mann-Whitney test was used for comparison of nonevenly distributed continuous variables. Type 1 error was set at 0.05 (two-sided). Results: Overall, US accurately predicted weight in 26 cases of gastroschisis with a mean difference of 2% ± 15% SD. However, there was a trend for US < 36 w GA to overestimate BW, compared to US ≥ 36 w GA: 45% vs. 0%, p 0.09. Similarly, when anticipated normal growth was factored in, US performed ≥ 2 w from delivery was more likely to overestimate BW than US < 2 w from delivery: 90% vs. 0%, p < 0.001. Infants born < 36 w (N = 10) had a mean BW at the 52% for GA compared to 37% for infants born ≥ 36 w (N = 16), p 0.14. No infants born < 36 w were < 10% for GA, compared to 12.5% born ≥ 36 w, p 0.51. Conclusions: Overall, US is an accurate predictor of fetal weight in gastroschisis. When compared to the expected growth rate of normal fetuses, the rate of fetal growth appears to be slower in fetuses with gastroschisis, particularly after 36 w GA.

OC14.04: Outcomes after the functional evaluation of fetal pulmonary vascular reactivity by the maternal hyperoxygenation test in diaphragmatic hernia

Objective: In utero diagnosed congenital diaphragmatic hernia (CDH) is associated to high antenatal and neonatal loss rates. Accurate prediction of outcome is crucial in counselling parents about management options. We evaluated lung-to-head ratio (LHR) and liver position in prediction of outcome of isolated left CDH in the previable period. Methods: Retrospective review of consecutive patients diagnosed with isolated LCDH prior to 28 weeks, evaluated at 6 tertiary units from 1995 onwards. Only patients with LHR measurements, obtained by experienced sonographers and with determined liver position by ultrasound or MRI, both ≤ 28 wks, were included. In all participating centers, LHR measurement was performed as previously described (Metkus et al. JPS 1996; 31 : 148–52) by experienced operators. Outcome measure was survival at discharge from NICU. Results: 134 cases were available for review; LHR was obtained at a mean of 24.4 ± 2.8 wks. Eleven patients (8%) opted for termination after being evaluated, all having LHR < 1.4. There were no postnatal diagnoses of chromosomal anomalies. Overall survival rate was 43% (58/134), after substraction of antenatal losses (11 TOP) it was 47% (58/123). LHR correlated to survival irrespective of liver position. In case of liver herniation survival was 35%. Combination of both variables predicted neonatal outcome better: liver up & LHR < 1 predicted a survival of 9%. When LHR < 0.8 & liver up, there were no survivors, but with liver down (37% of cases) survival was 40%. When LHR < 0.6 there were no survivors irrespective of liver position. Conclusions: Combination of liver up & LHR < 1 at ≤ 28 wks predicts a < 10% chance of survival, dropping to 0% if LHR < 0.8 and liver up, or 0% if LHR < 0.6, irrespective of the liver. 8% of patients opted for termination, all with LHR < 1.4, but only in half this coincided with LHR < 1.0 and liver up.