675: Placental pathology associated with term and preterm intrauterine growth restriction

SMFM Abstracts

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PLACENTAL PATHOLOGY ASSOCIATED WITH TERM AND PRETERM INTRAUTERINE GROWTH RESTRICTION LIAT SARID1, AMALIA LEVY2, GERSHON HOLCBERG3, EYAL SHEINER3, 1Soroka University Medical Center, Pathology, Beer-Sheva, Israel, 2Ben Gurion University of the Negev, Epidemiology, Beer-Sheva, Israel, 3Soroka University Medical Center, Department of Obstetrics and Gynecology, Beer Sheva, Israel OBJECTIVE: To compare term vs. preterm placental histopathology lesions associated with intrauterine growth restriction (IUGR). STUDY DESIGN: A retrospective cohort study was performed, including all singleton deliveries of IUGR. Comparison of placental pathology findings was performed between neonates who were born at term vs. preterm. The presence and severity of placental lesions was scored by a pathologist. When one or more of the following findings were noted in examination of placental tissue, the term placental insufficiency was defined: placental infarction, fibrosis of chorionic villi, thickening of blood vessels and poor vascularity of the chorionic villi. RESULTS: Macroscopic placental finding were available for 1104 singleton IUGR neonates, of these, 395 placentas had microscopic examinations. Of these 72.4% (n⫽ 286) delivered before 37 weeks gestation and 31.9% (n⫽126) delivered before 34 weeks gestation. A significant greater proportion of preterm IUGR cases (⬍37 weeks gestation) had pathology findings associated with placental insufficiency as compared to term IUGR (29.4% vs. 36.7%, OR⫽1.4 95% CI ⫽1.1-1.9; p⫽0.019). The same pattern was seen while comparing placentas of IUGR neonates who were born before and after 34 weeks (32.4% vs.39.4%, OR⫽1.4 95% CI 1.1-1.8; p⫽0.028). Syncycial knots were significantly more common in placentas from neonates who were delivered before 34 weeks gestation (15.2% vs. 6.3%, OR⫽ 2.6 95% CI 1.3-5.6; p⫽0.005). This trend was not statistically significant while comparing IUGR before and after 37 weeks gestation (10.9% vs. 4.6%, OR⫽ 2.4 95% CI 0.9-7.7; p⫽0.053). CONCLUSION: Placentas of preterm IUGR neonates (either ⬍37 weeks or ⬍34 weeks gestation) reveal numerous pathologies reflecting placental insufficiency and abnormal blood supply. There is a strong association between the severity of IUGR (according to prematurity) and the presence of placental insufficiency. The presence of increased syncycial knots in preterm IUGR neonates is probably due to exposure to hypoxia and reactive oxygen agents.

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0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.705

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PREDICTION OF ADVERSE PREGNANCY OUTCOME USING THE RESULTS OF THE SECOND TRIMESTER QUADRUPLE MATERNAL SERUM SCREENING TEST YU MING VICTOR FANG1, JAMES EGAN1, MELINDA SANDERS2, IRINA MAGIDINA1, JAY BOLNICK1, DHANYA MACKEEN1, PETER BENN3, 1University of Connecticut School of Medicine, OB/GYN, Farmington, Connecticut, 2University of Connecticut School of Medicine, Pathology, Farmington, CT, 3University of Connecticut School of Medicine, Genetics and Developmental Biology, Farmington, Connecticut OBJECTIVE: To determine the utility of the second trimester quadruple maternal serum screening results to predict adverse pregnancy outcomes. STUDY DESIGN: A retrospective case control study examining whether the four markers measured in second trimester Down syndrome screening- maternal serum alpha fetal protein (MSAFP), hCG, inhibin-A (INH-A), and unconjugated estriol (UE3) can be used to predict an intrauterine fetal demise (IUFD), intrauterine growth restriction (IUGR), preeclampsia, or spontaneous preterm delivery at ⬍37 weeks. All markers for the quad screen were expressed as multiples of the median (MoM). Pregnancy outcomes were identified using a placental pathology database that was matched to second trimester quad screen results. Median values of quad screen markers from pregnancies resulting in an adverse pregnancy outcome were compared to uncomplicated deliveries at ⬎37 weeks (Normal) using the one way Anova test. RESULTS: 1146 pregnancies with known outcomes and quad screens were available for analysis. Median quad screen marker values and pregnancy outcomes are listed in the table.

CONCLUSION: In our dataset of patients referred for placental pathology, the second trimester screening markers have the potential utility to predict IUGR, IUFD and preeclampsia, but not preterm delivery. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.706

FETAL CHEEK TO CHEEK DIAMETER MEASUREMENT AND FETAL WEIGHT ESTIMATION. BARAK ARICHA-TAMIR1, JACQUES S ABRAMOWICZ2, ADI Y WEINTRAUB1, HEATHER KERRICK2, FERNANDA PRESS1, ARNON WIZNITZER1, EYAL SHEINER1, 1Soroka University Medical Center, Ben-Gurion University of the Negev, Ob/Gyn, beersheva, Israel, Israel, 2RUSH, Ob/Gyn, Chicago, Illinois OBJECTIVE: To assess whether a correlation exists between fetal cheek-to-cheek diameter (CCD), abdomen circumference (AC) and estimated fetal weight (EFW). STUDY DESIGN: A prospective study was designed and 155 women were enrolled. The CCD was obtained during routine obstetric ultrasound examinations performed at 24-40 weeks’ gestation. Correlations were assessed using the Pearson coefficient of correlation. RESULTS: A significant linear association was found between the fetal CCD and the AC (Pearson coefficient of correlation 0.573; P⬍ 0.001). Correlations between CCD and gestational age and the EFW, as well as correlations between the AC and these parameters are presented in the Table 1. CONCLUSION: The CCD is significantly correlated to the EFW. It is also correlated to the AC and the gestational age. In cases with difficulties in the assessment of the AC (such as in congenital malformations), the CCD might be a useful tool for fetal weight estimation. Correlations between CCD as well as AC with gestational age and estimated fetal weight.

Gestational age Estimated fetal weight

Pearson correlation CCD

P value

Pearson correlation AC

P value

0.532 0.555

⬍0.001 ⬍0.001

0.764 0.952

⬍0.001 ⬍0.001

0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.707

VALIDATION OF MIDDLE CEREBRAL ARTERY PEAK SYSTOLIC VELOCITY (MCA-PSV) MEDIANS TAMULA PATTERSON1, AMY ALEXANDER1, JEFF SZYCHOWSKI1, JOHN OWEN1, 1University of Alabama at Birmingham, Birmingham, Alabama OBJECTIVE: To validate center-specific published medians and estimate the effects of sonologist and Manual v. Auto-trace measurement technique on MCAPSV values. STUDY DESIGN: 154 gravidas with singletons underwent MCA-PSV measurement at 18-35 weeks= gestation by one of 3 experienced sonologists. Pregnancies complicated by a known anomaly, isoimmunization, or aneuploidy were excluded. MCA-PSV was measured using both Manual and Auto-trace techniques. The Manual technique required the sonologist to raise an electronic caliper to the peak of the MCA-PSV pulse-wave Doppler waveform. The Auto-trace technique yielded an analogous time-averaged value. Regression models of log-transformed PSV values and gestational age were developed. RESULTS: While Auto-trace medians were significantly lower than those obtained with manual calipers (p⬍0.0001), they more closely approximated published medians used in clinical practice (Figure). Minimal inter-sonologist differences (maximum mean difference ⬍3cm/s) were statistically significant (p⬍0.01). False-positives ⬎1.5 MOM were uncommon, but were observed more frequently when published medians, as compared to our center-specific medians were utilized (1.3% v. 0.0%).

CONCLUSION: Compared to Manual-trace, Auto-trace measurement yields significantly lower medians. However, center-specific medians obtained by our sonologists using Auto-trace more closely approximated published standards and yielded fewer false positives. Estimated interobserver variability suggested that different sonologists can utilize the same medians. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.708

Supplement to DECEMBER 2008 American Journal of Obstetrics & Gynecology

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