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685: Is cervical length associated with maternal characteristics?
Poster Session IV
Academic Issues, Antepartum Fetal, Clinical Ob, Fetus, Genetics, Hypertension, Med-Surg-Diseases, Operative Ob, U/S
www.AJOG.org
able analysis. Separate analysis for BMI did not change these results. Ethnicity was associated with CL (mean CL in Caucasian women 45.2mm, Mediterranean 43.5mm, Asian 43.1mm, and African 42.1mm, p-value 0.003) as was parity (mean CL multiparous 45.2mm, nulliparous 43.5mm, p-value ⬍0.0001) in both the univariable as the multivariable analysis. CONCLUSION: Midtrimester cervical length is associated with maternal ethnicity and parity but not with maternal height or weight.
686 What is the utility of nuchal translucency ultrasound in the era of cell free DNA testing? Shilpa Chetty1, Mary Norton1 1 Stanford University/Lucile Packard Children’s Hospital, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Stanford, CA
685 Is cervical length associated with maternal characteristics? Jeanine van der Ven1, Brenda Kazemier1, Melanie van Os5, Emily Kleinrouweler1, Petra Kuiper4, Jan Derks3, Ben Willem Mol1, Monique Haak2, Eva Pajkrt1 1 AMC, Obstetrics and gynaecology, Amsterdam, Netherlands, 2LUMC, Obstetrics and gynaecology, Leiden, Netherlands, 3UMCU, Obstetrics and gynaecology, Utrecht, Netherlands, 4FARA, Ultrasound centre, Ede, Netherlands, 5VUmc, Obstetrics and gynaecology, Amsterdam, Netherlands
OBJECTIVE: Several studies have demonstrated the relationship between short cervical length (CL) and the risk of preterm delivery. Thus, measurement of the cervical length, has potential as a screening tool to identify women at risk for preterm birth. We assessed whether maternal characteristics such as height, weight, ethnicity and parity had an impact on cervical length. STUDY DESIGN: In the Netherlands a nationwide screening study is performed in which CL is measured during the standard anomaly scan (18⫹0 and 22⫹6 weeks gestational age) among low risk women with a singleton pregnancy. In the present study, data were used from three different participating centers (one hospital, two ultrasound centers) from January 2010 to June 2012. We collected data on height, prepregnancy weight, ethnicity, parity and gestational age (GA) at the time of the CL measurement. Univariable and a subsequent multivariable linear regression analysis were performed to assess the relationship between CL and the maternal characteristics RESULTS: We included 3586 women in this study. The mean cervical length was 44.2mm. No association was found between CL and maternal height or gestational age of the measurement. Weight was associated with CL in the univariable analysis but not in the multivari-
S288
OBJECTIVE: The increasing availability and use of cell free fetal DNA has potential to change the current prenatal aneuploidy screening paradigm, raising questions about the utility and role of nuchal translucency ultrasound. We investigated the frequency with which clinically pertinent findings were identified at the time of first trimester ultrasound performed for nuchal translucency screening. STUDY DESIGN: A query of the ultrasound database was performed to identify all patients who underwent first trimester ultrasound from November 2011 to July 2012, following implementation of a standardized first trimester protocol that included a fetal anatomy examination. Ultrasound reports were reviewed for presence or absence of significant maternal or fetal pathology, including myomas ⬎5 cm, adnexal masses, uterine anomalies, previously undetected multiple gestations, incorrect dating, fetal structural anomalies, NT⬎3.5 mm, fetal demise, or large subchorionic hematomas. RESULTS: We identified 3565 ultrasounds performed for the purpose of NT aneuploidy screening. In 21% (n⫽734), clinically significant findings were identified. These included incorrect dating in 9% (n⫽305), fetal pathology or clinically significant findings in 2% (n⫽74), including structural anomalies (n⫽24), cystic hygroma or enlarged NT (n⫽21), missed abortion (n⫽28), and undiagnosed multiple gestation (n⫽1). Clinically significant maternal issues were diagnosed in 10% (n⫽344), including large myomas (n⫽34), adnexal masses (n⫽135), synechiae (n⫽8), subchorionic hemorrhage (n⫽36), and uterine anomalies (n⫽13). CONCLUSION: Ultrasound examination at 11-14 weeks gestation allowed identification and diagnosis of clinically important findings in one out of every five cases. Despite the potential changes to current prenatal screening in the era of cell free fetal DNA, the first trimester ultrasound provides valuable clinical information for pregnancy management.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013
Academic Issues, Antepartum Fetal, Clinical Ob, Fetus, Genetics, Hypertension, Med-Surg-Diseases, Operative Ob, U/S
www.AJOG.org
able analysis. Separate analysis for BMI did not change these results. Ethnicity was associated with CL (mean CL in Caucasian women 45.2mm, Mediterranean 43.5mm, Asian 43.1mm, and African 42.1mm, p-value 0.003) as was parity (mean CL multiparous 45.2mm, nulliparous 43.5mm, p-value ⬍0.0001) in both the univariable as the multivariable analysis. CONCLUSION: Midtrimester cervical length is associated with maternal ethnicity and parity but not with maternal height or weight.
686 What is the utility of nuchal translucency ultrasound in the era of cell free DNA testing? Shilpa Chetty1, Mary Norton1 1 Stanford University/Lucile Packard Children’s Hospital, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Stanford, CA
685 Is cervical length associated with maternal characteristics? Jeanine van der Ven1, Brenda Kazemier1, Melanie van Os5, Emily Kleinrouweler1, Petra Kuiper4, Jan Derks3, Ben Willem Mol1, Monique Haak2, Eva Pajkrt1 1 AMC, Obstetrics and gynaecology, Amsterdam, Netherlands, 2LUMC, Obstetrics and gynaecology, Leiden, Netherlands, 3UMCU, Obstetrics and gynaecology, Utrecht, Netherlands, 4FARA, Ultrasound centre, Ede, Netherlands, 5VUmc, Obstetrics and gynaecology, Amsterdam, Netherlands
OBJECTIVE: Several studies have demonstrated the relationship between short cervical length (CL) and the risk of preterm delivery. Thus, measurement of the cervical length, has potential as a screening tool to identify women at risk for preterm birth. We assessed whether maternal characteristics such as height, weight, ethnicity and parity had an impact on cervical length. STUDY DESIGN: In the Netherlands a nationwide screening study is performed in which CL is measured during the standard anomaly scan (18⫹0 and 22⫹6 weeks gestational age) among low risk women with a singleton pregnancy. In the present study, data were used from three different participating centers (one hospital, two ultrasound centers) from January 2010 to June 2012. We collected data on height, prepregnancy weight, ethnicity, parity and gestational age (GA) at the time of the CL measurement. Univariable and a subsequent multivariable linear regression analysis were performed to assess the relationship between CL and the maternal characteristics RESULTS: We included 3586 women in this study. The mean cervical length was 44.2mm. No association was found between CL and maternal height or gestational age of the measurement. Weight was associated with CL in the univariable analysis but not in the multivari-
S288
OBJECTIVE: The increasing availability and use of cell free fetal DNA has potential to change the current prenatal aneuploidy screening paradigm, raising questions about the utility and role of nuchal translucency ultrasound. We investigated the frequency with which clinically pertinent findings were identified at the time of first trimester ultrasound performed for nuchal translucency screening. STUDY DESIGN: A query of the ultrasound database was performed to identify all patients who underwent first trimester ultrasound from November 2011 to July 2012, following implementation of a standardized first trimester protocol that included a fetal anatomy examination. Ultrasound reports were reviewed for presence or absence of significant maternal or fetal pathology, including myomas ⬎5 cm, adnexal masses, uterine anomalies, previously undetected multiple gestations, incorrect dating, fetal structural anomalies, NT⬎3.5 mm, fetal demise, or large subchorionic hematomas. RESULTS: We identified 3565 ultrasounds performed for the purpose of NT aneuploidy screening. In 21% (n⫽734), clinically significant findings were identified. These included incorrect dating in 9% (n⫽305), fetal pathology or clinically significant findings in 2% (n⫽74), including structural anomalies (n⫽24), cystic hygroma or enlarged NT (n⫽21), missed abortion (n⫽28), and undiagnosed multiple gestation (n⫽1). Clinically significant maternal issues were diagnosed in 10% (n⫽344), including large myomas (n⫽34), adnexal masses (n⫽135), synechiae (n⫽8), subchorionic hemorrhage (n⫽36), and uterine anomalies (n⫽13). CONCLUSION: Ultrasound examination at 11-14 weeks gestation allowed identification and diagnosis of clinically important findings in one out of every five cases. Despite the potential changes to current prenatal screening in the era of cell free fetal DNA, the first trimester ultrasound provides valuable clinical information for pregnancy management.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013