Yoni Barnhard

The impact of maternal age, body mass index and maternal weight gain on the glucose challenge test in pregnancy

Objective. The aim of this study was to determine whether maternal age, prepregnancy and mid-trimester body mass index (BMI), or excessive mid-pregnancy weight gain predict abnormal glucose challenge test (GCT) results. Methods. A retrospective chart review of 75 consecutive singleton pregnancies was performed. Patients were screened at 24–28 weeks of gestation with a 50-g oral GCT. Prepregnancy BMI and pregnancy weight gain up to the time of GCT testing, as well as other demographic data, were recorded. Statistical analysis included regression analysis and Students t-test, receiver–operator characteristic curve and multivariate logistic regression. Results. Maternal age and prepregnancy and mid-trimester BMI were significantly higher in women with an abnormal GCT (p < 0.05). A direct correlation was found between these parameters and GCT results (R2 = 0.08, R2 = 0.102 and R2 = 0.116, respectively; p < 0.05). Mid-trimester maternal BMI of ≥30 kg/m2 and maternal age ≥32 years are the optimal predictors of abnormal GCT results. Conclusions. Mid-trimester maternal BMI of ≥30 kg/m2 and maternal age ≥32 years are useful predictors of abnormal GCT results. We suggest that these factors should also be considered when selective screening for gestational diabetes mellitus is practiced.

The hazards to practitioners of obstetric and gynecological ultrasound

To investigate the specific complaints of physicians and technicians performing obstetric and gynecological ultrasound.

The association of maternal BMI with fetal echogenic intracardiac foci and echogenic bowel

Objectives. To evaluate the impact of maternal body mass index (BMI) as well as maternal ethnicity on the detection of either echogenic intra-cardiac focus (EIF) or echogenic bowel (EB). Methods. This prospective study identified 74 uncomplicated singleton fetuses in which EIF and/or EB were detected between 18 and 21 weeks of gestation (i.e. study group). Seventy four consecutively scanned fetuses without EIF or EB, at the same gestational age, were selected as controls. The differences in maternal BMI and maternal ethnicity were compared between the two groups using the χ2 test, Fishers exact test, and the Student t-test. A multivariable logistic regression model was constructed to control for confounders. Odds ratios (OR) and their 95% confidence interval (CI) were computed. Results. The mean maternal BMI was significantly lower in the study group as compared to controls (22.9 ± 3.1 vs. 28.0 ± 7.5 kg/m2, respectively; p < 0.0001). Patients with fetal EIF and/or EB were significantly more likely to be Asians (20.3% vs. 5.4%, OR = 4.5; 95% CI 1.3–16.9). Using a multivariable analysis, controlling for ethnicity, the association between maternal BMI and fetal EIF or EB remained significant (OR = 0.83; 95% CI 0.76–0.91). However, based on this model Asian ethnicity was not an independent risk factor for the detection of EIF and/or EB (OR = 2.6; 95% CI 0.8–8.9). Conclusions. Our data suggests an inverse relationship between the maternal BMI and the detection of fetal EIF and/or EB. Moreover, it appears that low maternal BMI, and not Asian ethnicity, is an independent risk factor for the detection of these echogenic fetal findings.

P39.13: An early pregnancy failure followed by a tubal pregnancy and 2 full-term deliveries in different uterine cavities in a patient with uterine didelphys

counselled regarding the outcome for the baby. Amniocentesis was deferred in view of the gestational age and polyhydraminos. Mode of delivery was discussed and vaginal birth planned with consideration for caesarean section for obstetric indications. At 37 weeks gestation she delivered vaginally a female child weighing 2.25 kg. The baby was transferred immediately to the Paediatric cardiology unit and despite all measures died after two weeks of birth. Later debriefing and counselling was performed regarding future recurrence risk and prenatal diagnosis. In this case an important maternal and fetal diagnosis of chromosomal abnormality was made due to attendance in a dedicated specialist clinic and specific ultrasound features.

P10.35: Is notching in the umbilical artery Doppler waveform a benign finding? A case report

Objective: The optimal timing of delivery in pregnancy complicated by intrauterine growth restriction is not resolved. The risks balance between prematurity or fetal hypoxemia and acidemia which can lead to fetal death. We reported five cases of preterm restricted fetuses which outcome was intrauterine death in relation to qualitative venous Doppler waveform and computerized cardiotocogram analysis. Methods: This study was part of a prospective observational study on singleton pregnancies with small-for-gestational-age fetuses. All growth-restricted fetuses were free from structural and chromosomal abnormalities. Patients were recruited between 24 and 32 weeks onwards from February 2002. These women underwent serial monitoring sessions including especially short-term variation (STV) analysis and umbilical artery (UA), ductus venosus (DV), umbilical vein (UV) Doppler assessment. Values of STV, absence or reverse end-diastolic velocity in UA (UA-AREDV), absence or reverse of atrial systolic blood flow velocity in DV (DV-RAV) and pulsatile flow in the UV (UV-P) were recorded. Results: There were five intrauterine deaths. Gestational age at delivery ranged from 26.2 to 29.6 weeks and birthweight from 420 to 560 grams. UA-AREDV was present in all the 5 cases. Within 24 hours before intrauterine death, DV-RAV and UV-P were demonstrated for all fetuses; however STV was higher than 5.4 ms for 3 fetuses, equal to 2.1 ms for one and uninterpretable for another. Serial monitoring sessions were performed for two patients; in the first case two days before intrauterne death, there were neither DVRAV, nor UV-P and in the second case four days before fetal demise, UV-P was noted but not DV-RAV. Conclusions: These results would suggest in preterm restricted fetuses that the presence of DV-RAV and/or UV-P was associated with impeding fetal demise and that STV analysis must be considered cautiously.