Samadh Ravangard

Fetal Hydronephrosis as a Predictor of Neonatal Urologic Outcomes

The ability to predict surgically relevant fetal renal hydronephrosis is limited. We sought to determine the most efficacious second‐ and third‐trimester fetal renal pelvis anteroposterior diameter cutoffs to predict the need for postnatal surgery.

Perinatal outcomes based on the institute of medicine guidelines for weight gain in twin pregnancies

Abstract Objective: To estimate the impact of the Institute of Medicine’s (IOM) weight gain recommendations on perinatal outcomes in twin pregnancies. Methods: In this multicenter cohort study, using the 2009 IOM guidelines, we examined pregnancy outcomes in 570 uncomplicated diamniotic twin pregnancies. Subjects were grouped according to pre-pregnancy body mass index. Perinatal outcomes were assessed based on whether maternal weekly weight gain was less than, at, or in excess of the recommended IOM guidelines. Results: In women with a normal pre-pregnancy BMI, patients whose weight gain met the IOM recommendations had a significantly higher mean gestational age at delivery; less prematurity and larger birth weight infants compared to women whose weekly weight gain was less or excess than the recommended IOM guidelines. Similarly, when compared with their low weight gain counterparts, overweight women with appropriate weight gain had improved outcomes including higher mean gestational age at delivery, higher birth weight infants and less prematurity. In obese women, the amount of pregnancy weight gain did not impact perinatal outcomes. Conclusion: Our results confirm that weekly maternal weight gain according to the IOM guidelines results in improved outcomes in twin pregnancies. Importantly, women with a normal or overweight pre-pregnancy BMI whose weekly weight gain was less than recommended, had increased risks of prematurity and lower birth weight infants. Similarly, women with a normal pre-pregnancy BMI whose weekly weight gain was excess than recommended had increased risks of prematurity and lower birth weight infants.

First-Trimester Sonographic Prediction of Obstetric and Neonatal Outcomes in Monochorionic Diamniotic Twin Pregnancies

The purpose of this study was to investigate whether discordant nuchal translucency and crown‐rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes.

Efficacy of the Genetic Sonogram in a Stepwise Sequential Protocol for Down Syndrome Screening

The purpose of this study was to evaluate the efficacy of the genetic sonogram in Down syndrome screening for women who have received the stepwise sequential test.

Nuchal translucency and cardiac abnormalities in euploid singleton pregnancies.

Abstract Objective: To investigate different cut-off levels of nuchal translucency (NT) to predict abnormal cardiac findings (ACF) in second trimester ultrasound examination and confirmed postnatal congenital heart defects (CHD) in euploid pregnancies. Methods: A retrospective analysis was performed on singleton pregnancies examined in our ultrasound units from 2006 to 2011. Fetuses with an abnormal karyotype were excluded. Different cut-off levels of NT thickness were analyzed to evaluate its performance to detect the ACF on second trimester ultrasound (2nd US) examination and also the CHD detected in neonatal follow-up evaluation of ACF cases. Results: Of the 12 840 cases, a total number of 8541 euploid pregnancies were included in the study. Thirty-three had ACFs detected by 2nd US (3.86/1000). The mean NT thickness was found to be higher in fetuses with ACFs (p < 0.0001). Of 33 ACFs, 17 (52%, 1.99/1000) had major CHDs in neonatal follow-up. The area under the ROC curves for NT thickness to predict ACFs and CHDs were 0.67 and 0.65, respectively. Conclusions: Higher NT thickness is associated with higher risk of ACF. NT is a weak predictor of ACF and major CHD; however, fetuses with an unexplained increase in NT measurement should be referred for further cardiac investigations.

Short-term neonatal outcomes in diamniotic twin pregnancies delivered after 32 weeks and indications of late preterm deliveries.

OBJECTIVE We sought to compare neonatal outcomes in twin pregnancies following moderately preterm birth (MPTB), late preterm birth (LPTB), and term birth and determine the indications of LPTB. STUDY DESIGN We performed a retrospective cohort study. MPTB was defined as delivery between 32(0/7) and 33(6/7) weeks and LPTB between 34(0/7) and 36(6/7) weeks. The composite neonatal adverse respiratory outcome was defined as respiratory distress syndrome and/or bronchopulmonary dysplasia. The composite neonatal adverse nonrespiratory outcome included early onset culture-proven sepsis, necrotizing enterocolitis, retinopathy of prematurity, intraventricular hemorrhage, or periventricular leukomalacia. LPTB cases were categorized as spontaneous (noniatrogenic), evidence-based iatrogenic, and non-evidence-based (NEB) iatrogenic. RESULTS Of the 747 twin deliveries during the study period, 453 sets met the inclusion criteria with 22.7% (n = 145) MPTB, 32.1% (n = 206) LPTB, and 15.9% (n = 102) term births. Compared with term neonates, the composite neonatal adverse respiratory outcome was increased following MPTB (relative risk [RR] 24; 95% confidence interval [CI] 3.0 to 193.6) and LPTB (RR 13.7; 95% CI 1.8 to 101.8). Compared with term neonates, the composite neonatal adverse nonrespiratory outcome was increased following MPTB (RR 22.3; 95% CI 3.9 to 127.8) and LPTB (RR 5.5; 95% CI 1.1 to 27.6). Spontaneous delivery of LPTB was 63.6% (n = 131/206) and the rate of iatrogenic delivery was 36.4% (n = 75/206). The majority, 66.6% (n = 50/75), of these iatrogenic deliveries were deemed NEB, giving a total of 24.2% (50/206) NEB deliveries in LPTB group. CONCLUSION Our data demonstrate a high rate of late preterm birth among twin pregnancies, with over half of nonspontaneous early deliveries due to NEB indications. Although our morbidity data will be helpful to providers in counseling patients, our finding of high NEB indications underscores the need for systematic evaluation of indications for delivery in LPTB twin deliveries. Furthermore, this may lead to more effective LPTB rate reduction efforts.

Does Early Second-Trimester Sonography Predict Adverse Perinatal Outcomes in Monochorionic Diamniotic Twin Pregnancies?

To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second‐trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.

Subsequent pregnancy after two uterine artery embolizations

Uterine artery embolization (UAE) was first described in 1995 as an effective alternative in the treatment of symptomatic uterine leiomyomas [1]. This procedure has remained a popular option for women wishing to avoid surgery (myomectomy or hysterectomy) and preserve the uterus [2]. For women wishing to maintain fertility, the safety of this procedure remains controversial. There have been a limited number of reports describing the surveillance and outcome of pregnancy after embolization. Complications such as fetal malpresentation, small for gestational age, premature delivery, cesarean delivery, and postpartum hemorrhage have been previously reported in pregnancies occurring after a single UAE [3]. Here, we describe the first reported case of pregnancy after undergoing two prior uterine artery embolizations. A 34-year-old G2P0010 was referred to our practice for a perinatal consultation at 16 weeks due to a history of two prior uterine artery embolizations. The patient experienced menometrorrhagia with severe anemia secondary to extensive uterine leiomyomas 2 years prior to conception. Treatment options were offered including a myomectomy to preserve fertility. She ultimately chose UAE to avoid a laparotomy. 1 year after her initial uterine artery embolization procedure, she continued to experience menometrorrhagia with anemia and was found to have persistent leiomyomas. After extensive counseling, she chose a second uterine artery embolization procedure. An MRI obtained 3 months following the second procedure revealed significantly smaller, devascularized leiomyomas. 6 months later, she underwent a hysteroscopic resection of a submucosal fibroid. She spontaneously conceived an intrauterine pregnancy about 1 year after the second UAE procedure. The patient was extensively counseled regarding the potential risks including small for gestational age, premature delivery, cesarean delivery, and postpartum hemorrhage, which have been previously described with pregnancy following a single uterine artery embolization procedure. She elected to continue her pregnancy. She underwent close follow-up with monthly serial growth ultrasounds, and twice weekly fetal testing beginning at 32 weeks. Biometry and growth were appropriate for gestational age throughout the pregnancy and her antepartum course remained uncomplicated. At 40 weeks and 6 days, the patient presented for a scheduled induction of labor. She subsequently underwent a primary low transverse cesarean section for arrest of dilatation and delivered a healthy male infant, weighing 3,288 g. Her postpartum course was uncomplicated. Uterine artery embolization is a treatment option that is increasingly used for women who experience symptoms of menorrhagia and/or pelvic pressure due to uterine leiomyoma [4, 5]. The effectiveness of this minimally invasive and uterine preserving procedure makes UAE an attractive option. Currently, myomectomy is the only recommended surgical option for women with leiomyomas who desire future fertility [4]. However, one study found that 30% of patients who underwent UAE desired future fertility [6]. Embolization has also been employed in the management of postpartum hemorrhage and uterine arteriovenous S. F. Ravangard (&) Department of Obstetrics and Gynecology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA e-mail: Sravangard@resident.uchc.edu

OP01.10: First-trimester nuchal translucency cutoffs to detect second trimester cardiac abnormalities in euploid fetuses

regurgitation at 12+6 wg evolved into ventricles disproportion and tricuspid insufficiency at 15 wg. 1 case of anomalous outflow tract with larger aorta and small pulmonary artery at 12 wg was identified as TOF at 15 wg. Conclusions: 1st trimester right ventricle prevalence showed evolution into HLV below 17 wg in 75% of cases. 1st trimester right A-V flow reduction led to 2nd trimester HRV. In presence of anomalous or doubtful 1st trimester cardiac scans, longitudinal evaluation up to 20 wg is mandatory.

OC25.02: The impact of fetal renal pelvic diameter on postnatal outcome

during treatment (T1, T2). We characterized change patterns that differentiate between responsive and non-responsive groups. Results: The overall response rate for 45 patients was 67%. Before chemotherapy, FI was significantly higher in responders than non-responders (P < 0.05). Receiver-operating characteristics curve analysis suggested that a sensitivity of 80% and a specificity of 73% can be achieved with an optimum FI threshold of 35.8. During treatment, we observed a dramatic change (increment or decrement) of VI at T1 stage in the responsive group, but not the non-responsive group. When the VI change was more than 42%, we could predict the final response to chemotherapy with a sensitivity of 84% and a specificity of 79%. Patients with VI change more than 42% had a response rate of 96% (26/27), in contrast, the remaining patients has a response rate of 22% (4/18) only (P < 0.001). Conclusions: By using 3D power Doppler, the initial FI and the VI change can be used as early predictors of patient response to neoadjuvant chemotherapy.