Svena Julien

Second-Trimester Ductus Venosus Measurement and Adverse Perinatal Outcome in Fetuses With Congenital Heart Disease

Objective. The purpose of this study was to determine whether Doppler velocimetry of the ductus venosus (DV) predicts adverse perinatal outcome in congenital heart disease (CHD). Methods. We conducted a retrospective cohort study of all pregnant women undergoing fetal echocardiography for CHD in a single perinatal center during a 2‐year period. We compared outcomes for fetuses having a diagnosis of CHD in the second trimester and abnormal DV Doppler velocimetric findings with those having CHD and normal DV Doppler findings. Karyotype, gestational age at delivery, fetal loss rate, and rate of termination were assessed. The referral value for an abnormal DV pulsatility index was above the 95th percentile for gestational age. Statistical analysis included the t test, Fisher exact test, and χ2 test. Results. The incidence of CHD in our population was 7%. There were 98 patients with CHD; of those, 31 had DV measurement. A total of 9 patients had an abnormal DV. Three of this group (33%) had intrauterine fetal death or perinatal death. In patients with CHD and normal DV measurements, 83% had living children versus 33% in the group with an abnormal DV (P < .05). There was no statistically significant difference in the rate of aneuploidy between the normal DV (15%) and abnormal DV (20%) groups (P = .65). The mean gestational age at delivery was similar between the normal (37.63 weeks) and abnormal (38.33 weeks) DV groups (P = .71). There was no difference in the rate of pregnancy termination. Conclusions. Abnormal second‐trimester DV measurements are predictive of adverse perinatal outcome in patients with CHD, independent of karyotype or gestational age at delivery. This information may have a role in the counseling of parents with CHD.

Outcomes of expectant management after betamethasone for hypertensive disorders of pregnancy

Objective: Review the latency period after betamethasone (BMZ) for pregnancies complicated by hypertensive disorders of pregnancy (HDP). Study design: A retrospective chart review of patients that received BMZ for the reduction of preterm morbidity for HDP. Patients were grouped by gestational age of administration of BMZ and type of hypertensive disorder of pregnancy for analysis. The primary outcome was the interval between the gestational age of the patient at BMZ administration and delivery. Results: One-hundred and forty-seven subjects received BMZ for HDP during the study period delivering 168 infants. The median interval between administration of BMZ and delivery was 5 days [interquartile range (IQR) 2–20 days]. The median neonatal intensive care unit length of stay (NICU LOS) was 20 days (IQR 6–33 days). Fifty-seven percent of subjects delivered within 7 days of diagnosis and 32% had a latency period >14 days. Seventy-five percent of subjects were ultimately delivered for worsening hypertension. Conclusions: The median latency period between diagnosis and delivery in the setting of HDP is <7 days. Further studies are warranted to address the use of antihypertensive pharmacotherapy to prolong the latency period for fetal benefit.

OP02.12: Visualization of the fetal three vessel view, aortic arch, and ductal arch views: A comparison of 2‐D and 3‐D rapid acquisition at 18–22 weeks gestation

−3.47 for those without coarctation. Difference between means in the two groups was −0.18 (95%CI = −1.56 to 1.2). In sagittal views, mean Z-scores were −2.97 and −3.45 for those with and without coarctation, respectively. Difference between the means was 0.49 (95%CI = −0.95 to 1.93). Conclusions: In this small case series of prenatally suspected coarctation of the aorta, the use of aortic isthmus Z-scores did not allow prompt identification of affected fetuses.

OP02.06: Satisfactory visualization rates of standard cardiac views at 18–22 weeks gestation: A comparison of static 2‐D and spatial temporal image correlation (STIC 4‐D)

reflecting a good fetal clinical status. In apnea, the pressure of intrathoracic organs on the fetal heart, mainly the non-expanded lungs, limits ventricular distensibility. Impedance to pulmonary venous flow to the left atrium is represented by the pulsatility index. To test the hypothesis that fetal pulmonary venous flow pulsatility index is lower during fetal respiratory movements than in apnea were our purpose. Methods: Twenty-two normal fetuses of mothers without systemic disease were examined in apnea (controls) and in the presence of fetal respiratory movements (cases). Fetuses were examined by prenatal Doppler echocardiography with color flow mapping. The pulsatility index of the pulmonary vein was obtained placing the pulsed Doppler sample volume over the right upper or left lower pulmonary vein, and applying the formula [maximum velocity (systolic or diastolic)pre-systolic velocity]/mean velocity. Results: Mean gestational age was 28.9 ± 2.9 weeks. During fetal apnea, mean systolic, diastolic and pre-systolic velocities were, respectively, 0.35 ± 0.08 m/s, 0.26 ± 0.07 m/s and 0.09 ± 0.03 m/s. In the presence of fetal respiratory movements, mean systolic, diastolic and pre-systolic velocities were, respectively, 0.33 ± 0.1 m/s, 0.28 ± 0.08 m/s and 0.11 ± 0.04 m/s. Pulsatility index pulmonary vein in apnea was 1.25 ± 0.23 (1.69 to 0.82), and during fetal respiratory movements it was 0.97 ± 0.2 (1.53 to 0.61). Conclusions: We showed a significant reduction in impedance of pulmonary venous flow, represented by pulmonary vein pulsatility index, during fetal respiratory movements, reflecting modifications of the left atrial dynamics and enhancement of left ventricular compliance.