1Obstetrics and Gynecology, Stanford University, Stanford,. CA, USA; 2Radiology, University of California, San. Francisco, San Francisco, CA, USA; 3Pediatrics, ...
21st World Congress on Ultrasound in Obstetrics and Gynecology
extrophy and one case of multiple anomaly with holoprosencephaly, cleft lip and palate and hypotelorism. There were 6 cases with minor abnormal US findings including increased nuchal fold thickness (NFT), choroid plexus cyst (CPC), single umbilical artery, wide iliac angle, brachycephaly, intrauterine growth restriction, pericardial effusion, sandal gap deformity, and flattened nose. In 9 cases, there were no fetal anomalies found on the US. Among 15 cases of de novo balanced chromosomal translocations, there were 2 cases of major anomalies; one was cardiomyopathy and the other was ventricular septal defect with unusual mitral regurgitation and reversed aortic arch flow. There were 4 cases of minor congenital anomalies; CPC and increased NFT. In 9 cases, there were no fetal anomalies found on the US. Conclusions: Correlations between fetal US and de novo chromosomal aberrations were higher in unbalanced chromosomal aberration cases. We found several cases with abnormal US findings in de novo balanced translocation, although normal US findings were expected. Consequently, detailed fetal US evaluation is very important in prediction of the prognosis of de novo balanced translocation cases.
OP04.08 The prognostic significance of a single umbilical artery (SUA) in fetuses with prenatally detected congenital diaphragmatic hernia (CDH) K. Bianco4 , V. Feldstein2 , M. Norton1 , J. A. Farrell5 , R. Keller3 1 Obstetrics and Gynecology, Stanford University, Stanford, CA, USA; 2 Radiology, University of California, San Francisco, San Francisco, CA, USA; 3 Pediatrics, University of California, San Francisco, San Francisco, CA, USA; 4 Obsterics and Gynecology, University of California, San Francisco, San Francisco, CA, USA; 5 Surgery, University of California, San Francisco, San Francisco, CA, USA
Objectives: To determine whether the presence of a SUA predicts a poorer survival rate in infants with prenatally diagnosed CDH. Methods: All infants referred to UCSF with CDH from 1997 until the present were identified using the UCSF Fetal Treatment Program database. The outcomes of those found by in utero ultrasound to have SUA were determined and compared with the overall outcomes of CDH cases. Fisher’s exact test was used to compare outcomes between groups. Results: A total of 293 fetuses with CDH were evaluated and had outcomes available over the time period of the study. Of these, 20 with left-sided CDH were noted to have a SUA. Six fetuses with SUA were found to have other prenatally detected structural anomalies (cystic hygroma, facial cleft, or renal abnormality) and 14 appeared to be otherwise isolated. Six fetuses were terminated at the parents’ request, and one remains undelivered. Of the remaining 13 cases, only 3 survived, for a survival rate of 23%. This compares to the overall survival rate of 56% amongst all infants seen through the UCSF program, including those with additional anomalies (P = 0.02). Of 8 cases with left-sided CDH, SUA and no other anomaly seen in utero, there were only 2 survivors. Conclusions: SUA in a fetus with CDH predicts a poorer prognosis, often because of co-existing anomalies or genetic syndromes that may be undetected by prenatal imaging and other diagnostic testing. Such patients should be counseled accordingly.
OP04.09 Single umbilical artery (SUA) in a high risk obstetrical population T. Newman, P. Mattingly, L. Devoe, A. W. Helfgott Obstetrics and Gynecology, Georgia Health Science University, Augusta, GA, USA Objectives: Fetuses with a single umbilical artery (SUA) are found in about 1% of all pregnancies. The prognosis conferred by this condition can vary according to the presence or absence of
68
Oral poster abstracts
other abnormalities. Georgia Health Science University’s Regional Perinatal Center is a tertiary care referral center for high risk obstetrical patients. The purpose of this project was to review the GHSU experience with ultrasound diagnosis of SUA, to determine incidence of SUA in our obstetrical population, and to identify common associated anomalies in this patient population with SUA. Methods: A digital ultrasound database was queried for all cases with an ultrasound diagnosis of SUA. A retrospective review of fetuses with SUA to determine the presence of coexisting fetal anomalies and pregnancy outcomes was conducted. Data were analyzed using the SPSS statistical package. This study was approved by the institutional Human Assurance Committee. Results: The study population was 7044 patients receiving obstetrical ultrasounds between January 1, 2006- December 31, 2010. 76 cases of SUA were identified (1.1%), with one ultimately ruled out on subsequent examination. Complete information was available for 76 infants with the following ultrasound diagnoses: 8 (19.5%) had renal abnormalities (RA); 8 (19.5%) had congenital heart disease (CHD); 19 (46.3%) had other anomalies (OA). At submission neonatal data was available for 43 of 76 infants. 42 were confirmed SUA at delivery. Of these, 5 had RA, 5 had CHD, and 16 had OA. Six infants were small for gestational age. There were 3 neonatal deaths. Data collection continues for the remaining infants. Conclusions: In the GHSU population, ultrasound diagnosis of SUA was associated with renal, cardiac and other anomalies. While isolated SUA usually confers a good prognosis, it is incumbent to screen these fetuses for other anomalies, particularly renal and cardiac. Further, as SUA increases the risk of an SGA infant, these fetuses should have serial ultrasounds for fetal growth.
O P 0 5: P R E D I C T I N G C O M P L I C A T I O N S IN TWIN PREGNANCY OP05.01 Does multi-fetal pregnancy reduction influence perinatal results in twin pregnancies? 1 ¨ , F. F. Yanik1 , E. Tarim2 , C. Iskender2 , G. Onalan H. B. Zeyneloglu1 1 Department of Obstetrics and Gynecology, Baskent University, Ankara, Turkey; 2 Department of Obstetrics and Gynecology, Baskent University, Adana, Turkey
Objectives: Our aim in this study was to compare the perinatal results in multi-fetal pregnancies reduced to twins with the results in non-reduced twin pregnancies. Methods: Perinatal results in 85 sets of twins after transabdominal multi-fetal pregnancy reduction (MFPR) of triple and higher-order multiple gestations performed at two different centers of Baskent University were evaluated and compared with the perinatal results in a control group consisting of 173 sets of non-reduced twin pregnancies. The main outcome measures were gestational age at birth, weight of the newborns and weight discordance between the twin pairs. Results: Gestational age at birth appeared to be similar in both groups (presented as mean ± SD, 34.10 ± 3.34 and 34.47 ± 3.24 weeks in the MFPR and control groups respectively, P = 0.456). Weight of the newborns was significantly lower in the MFPR group (presented as mean ± SD, 2111 ± 577 and 2266 ± 632 grams in the MFPR and control groups respectively, P = 0.018). However, weight discordance between the twin pairs didn’t show any significant difference between the two groups (presented as mean ± SE, 226 ± 30 and 225 ± 15 grams in the MFPR and control groups respectively, P = 0.360). Conclusions: Our series indicated that, although the gestational age at birth appeared to be similar in twin pregnancies obtained with MPPR and in non-reduced twin pregnancies, those undergoing MFPR reduction were associated with lower birthweight. On the other hand, weight discordance between the twin pairs appeared to be similar in both groups.
Ultrasound in Obstetrics & Gynecology 2011; 38 (Suppl. 1): 56–167
