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699: Perinatal outcome in pregnancies complicated by isolated oligohydramnios prior to 37 weeks of gestation
www.AJOG.org
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
Average accuracy results Amplitude Difference (bpm) Paper
Correct Category (%) Ruler
Paper
Ruler
..........................................................................................................................................................................................
Experts -1.1 ⫾ 2.8* .3 ⫾ 4.4 76 ⫾ 12 71 ⫾ 9 .......................................................................................................................................................................................... Non-experts .7 ⫾ 4.1 1.1 ⫾ 5.1 73 ⫾ 10 75 ⫾ 10 ..........................................................................................................................................................................................
698 Fetal demise and prior non-stress testing in pregnancies affected by diabetes vs. other indications for testing Lisa Gray1, Temitope Oshodi2, Eva K. Pressman1, Loralei L. Thornburg1 1 University of Rochester, Rochester, NY, 2University of Rochester School of Medicine and Dentistry, Rochester, NY
OBJECTIVE: To evaluate the use of antenatal surveillance by non-stress testing (NST) among patients with diabetes compared to other indications and subsequent intrauterine fetal demise (IUFD). STUDY DESIGN: Retrospective cohort review of all non-anomalous IUFD beyond 32 weeks gestation delivered from 1998 and 2009 at a single institution. All non-diabetic patients with indications for NST were compared to those with known diabetes. Adequate fetal surveillance was defined as a reactive NST or a non-reactive NST with a BPP ⬎ 8/10 within 7 days. RESULTS: Of 26 patients with IUFD and indicated testing, only 11 patients (42%) had adequate surveillance within 7 days. Primary indication for NST among 13 non-diabetics included chronic hypertension (4), hypertensive disorders of pregnancy (2), growth restriction (2), prior IUFD (1), post dates (1), abruption (1) and other (2). There was no difference in rates of adequate fetal surveillance in diabetic (7/13, 53%) versus non-diabetic patients (4/13, 30%), p⫽0.4, however, 100% of diabetic patients had a least one NST prior to IUFD, compared to 46% (6/13) of non-diabetic patients (p⫽0.01). Among those patients undergoing at least one NST, 67% (4/6) of non-diabetic and 53% (7/13) of diabetic patients had adequate surveillance (p⫽0.99). Median time from NST to diagnosis was 6 days among diabetic and 9 days among non-diabetic patients. Power was limited, with an 80% power to detect differences in adequate surveillance of more than 50% between groups at the current sample size. CONCLUSIONS: Adequate fetal surveillance was not predictive of demise in 53% of diabetic patients and 30% of non-diabetic patients. Despite the presence of indications, most patients with IUFD underwent inadequate fetal surveillance, regardless of diabetic status. More diabetics received at least some fetal surveillance than those patients with other indications, which may indicate a need for provider education. Identifying and resolving barriers to antenatal testing in high risk populations is clearly needed.
699 Perinatal outcome in pregnancies complicated by isolated oligohydramnios prior to 37 weeks of gestation Nir Melamed1, Eran Hadar1, Avi Ben-Haroush2, Joseph Pardo1, Rony Chen1, Moshe Hod1, Yariv Yogev1 1
Helen Schneider Hospital for Women, Petach Tikva, Helen Schneider Hospital for Women, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 2
OBJECTIVE: Optimal management in cases of isolated oligohydramnios is a matter of controversy, moreover, data is limited regarding isolated oligohydramnios⬍ 37 weeks of gestation. Thus, we aimed to compare pregnancy outcome in cases of isolated oligohydramnios at preterm with that of low-risk pregnancies with normal amount of amniotic fluid. STUDY DESIGN: A retrospective cohort study. The study group included all singleton pregnancies with isolated oligohydramnios (AFI ⬍ 5 cm) prior to 37⫹0 weeks of gestation (n⫽108). Control group: low-risk pregnancies with normal amount of amniotic fluid matched by gestational age and parity in a 3:1 ratio (n⫽324).
Poster Session V
RESULTS: 1) The mean gestational age at diagnosis was 34.9⫾2.0 weeks. 2) When compared to controls, pregnancies in the study group were characterized by a higher overall rate of preterm delivery (26.9% vs. 12.3, p⬍0.001), most of which was iatrogenic (82.8%), a higher rate of labor induction (50.0% vs. 9.6%, p⬍0.001), and a higher rate of CS (47.2% vs.16.9%, p⬍0.001). 3) Neonates in the study group were characterized by a lower birthweight (2762⫾371 vs. 3056⫾539, p⬍0.001), higher rate of transient tachypnea of the newborn (8.3% vs. 2.2%, p⫽0.003), and were admitted more often to NICU (11.1% vs. 4.9%, p⫽0.02). Importantly, these differences were eliminated when analysis was limited to the subgroup of pregnancies with isolated oligohydramnios that were managed conservatively and delivered spontaneously at term. 4) There was no difference between study and control groups in the rate of new onset of preeclampsia (1.9% vs. 2.2%, p⫽0.8) and new onset of fetal growth restriction (7.4% vs. 6.2%, p⫽0.7). 5) In 9 of the women in the isolated oligohydramnios (8.3%) the level of amniotic fluid was found to be normalized on subsequent examinations. CONCLUSIONS: A significant proportion of adverse maternal and neonatal outcome in cases of isolated oligohydramnios prior to 37 weeks of gestation appears to be related to iatrogenic prematurity, despite lack of evidence that conservative management increases the risk of adverse pregnancy outcome.
700 The accuracy of sonographic fetal weight estimation in cases of breech presentation-how accurate we are? Nir Melamed1, Yariv Yogev1, Avi Ben-Haroush2, Reuven Mashiach1, Israel Meizner1, Joseph Pardo1 1
Helen Schneider Hospital for Women, Petach Tikva, Helen Schneider Hospital for Women, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 2
OBJECTIVE: To determine the accuracy of sonographic estimated fetal weight (EFW) for fetuses in breech presentation and to compare it to that of fetuses in the vertex presentation STUDY DESIGN: A total of 3,174 sonographic EFW performed within 3 days prior to delivery. Fetal weight was estimated by 8 different sonographic models based on different combinations of the following: abdominal circumference (AC), femur length (FL), biparietal diameter (BPD) and head circumference (HC). The EFW was than compared with the actual birthweight. RESULTS: 1) Overall 3,174 fetuses were included, of them, 165 (5.2%) were in breech presentation. 2) The systematic error for fetuses in breech presentation was not significantly different from zero for all models tested (-1.0-1.5%), and was significantly lower than the systematic error for fetuses in vertex presentation (-0.3-3.3%, p⬍0.05). 3) These presentation-related differences in the systematic error were eliminated when models that incorporated HC rather than BPD were employed. 3) The random error for fetuses in breech presentation was significantly higher vs. vertex presentation (9.4-13.6% vs. 7.5-8.6%, p⬍0.05) and was lower for models that incorporated 3-4 biometric indices (9.4-9.5%) vs.models that incorporated only 1-2 biometric indices (9.8-13.6%, p⬍0.05). 4) The fraction of weight estimation within 10% of birthweight was significantly lower for fetuses in breech vs. vertex presentation when models that are based on only 1-2 biometric indices were used (51.9-72.1% vs. 61.179.2%), although no such differences were observed when models that incorporate 3-4 indices were used (77.0-77.6% vs. 78.3-81.2%, p⫽0.3). 5). These presentation-related differences in the systematic and random error were independent of birthweight, gestational age at delivery, and fetal head shape. CONCLUSIONS: EFW appears to be less accurate for fetuses in breech than in vertex presentation, mainly due to higher random error, which overrides the decreased systematic error observed in these cases. Differences may be minimized by using sonographic models which incorporate 3-4 biometric indices.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S277
Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging
Average accuracy results Amplitude Difference (bpm) Paper
Correct Category (%) Ruler
Paper
Ruler
..........................................................................................................................................................................................
Experts -1.1 ⫾ 2.8* .3 ⫾ 4.4 76 ⫾ 12 71 ⫾ 9 .......................................................................................................................................................................................... Non-experts .7 ⫾ 4.1 1.1 ⫾ 5.1 73 ⫾ 10 75 ⫾ 10 ..........................................................................................................................................................................................
698 Fetal demise and prior non-stress testing in pregnancies affected by diabetes vs. other indications for testing Lisa Gray1, Temitope Oshodi2, Eva K. Pressman1, Loralei L. Thornburg1 1 University of Rochester, Rochester, NY, 2University of Rochester School of Medicine and Dentistry, Rochester, NY
OBJECTIVE: To evaluate the use of antenatal surveillance by non-stress testing (NST) among patients with diabetes compared to other indications and subsequent intrauterine fetal demise (IUFD). STUDY DESIGN: Retrospective cohort review of all non-anomalous IUFD beyond 32 weeks gestation delivered from 1998 and 2009 at a single institution. All non-diabetic patients with indications for NST were compared to those with known diabetes. Adequate fetal surveillance was defined as a reactive NST or a non-reactive NST with a BPP ⬎ 8/10 within 7 days. RESULTS: Of 26 patients with IUFD and indicated testing, only 11 patients (42%) had adequate surveillance within 7 days. Primary indication for NST among 13 non-diabetics included chronic hypertension (4), hypertensive disorders of pregnancy (2), growth restriction (2), prior IUFD (1), post dates (1), abruption (1) and other (2). There was no difference in rates of adequate fetal surveillance in diabetic (7/13, 53%) versus non-diabetic patients (4/13, 30%), p⫽0.4, however, 100% of diabetic patients had a least one NST prior to IUFD, compared to 46% (6/13) of non-diabetic patients (p⫽0.01). Among those patients undergoing at least one NST, 67% (4/6) of non-diabetic and 53% (7/13) of diabetic patients had adequate surveillance (p⫽0.99). Median time from NST to diagnosis was 6 days among diabetic and 9 days among non-diabetic patients. Power was limited, with an 80% power to detect differences in adequate surveillance of more than 50% between groups at the current sample size. CONCLUSIONS: Adequate fetal surveillance was not predictive of demise in 53% of diabetic patients and 30% of non-diabetic patients. Despite the presence of indications, most patients with IUFD underwent inadequate fetal surveillance, regardless of diabetic status. More diabetics received at least some fetal surveillance than those patients with other indications, which may indicate a need for provider education. Identifying and resolving barriers to antenatal testing in high risk populations is clearly needed.
699 Perinatal outcome in pregnancies complicated by isolated oligohydramnios prior to 37 weeks of gestation Nir Melamed1, Eran Hadar1, Avi Ben-Haroush2, Joseph Pardo1, Rony Chen1, Moshe Hod1, Yariv Yogev1 1
Helen Schneider Hospital for Women, Petach Tikva, Helen Schneider Hospital for Women, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 2
OBJECTIVE: Optimal management in cases of isolated oligohydramnios is a matter of controversy, moreover, data is limited regarding isolated oligohydramnios⬍ 37 weeks of gestation. Thus, we aimed to compare pregnancy outcome in cases of isolated oligohydramnios at preterm with that of low-risk pregnancies with normal amount of amniotic fluid. STUDY DESIGN: A retrospective cohort study. The study group included all singleton pregnancies with isolated oligohydramnios (AFI ⬍ 5 cm) prior to 37⫹0 weeks of gestation (n⫽108). Control group: low-risk pregnancies with normal amount of amniotic fluid matched by gestational age and parity in a 3:1 ratio (n⫽324).
Poster Session V
RESULTS: 1) The mean gestational age at diagnosis was 34.9⫾2.0 weeks. 2) When compared to controls, pregnancies in the study group were characterized by a higher overall rate of preterm delivery (26.9% vs. 12.3, p⬍0.001), most of which was iatrogenic (82.8%), a higher rate of labor induction (50.0% vs. 9.6%, p⬍0.001), and a higher rate of CS (47.2% vs.16.9%, p⬍0.001). 3) Neonates in the study group were characterized by a lower birthweight (2762⫾371 vs. 3056⫾539, p⬍0.001), higher rate of transient tachypnea of the newborn (8.3% vs. 2.2%, p⫽0.003), and were admitted more often to NICU (11.1% vs. 4.9%, p⫽0.02). Importantly, these differences were eliminated when analysis was limited to the subgroup of pregnancies with isolated oligohydramnios that were managed conservatively and delivered spontaneously at term. 4) There was no difference between study and control groups in the rate of new onset of preeclampsia (1.9% vs. 2.2%, p⫽0.8) and new onset of fetal growth restriction (7.4% vs. 6.2%, p⫽0.7). 5) In 9 of the women in the isolated oligohydramnios (8.3%) the level of amniotic fluid was found to be normalized on subsequent examinations. CONCLUSIONS: A significant proportion of adverse maternal and neonatal outcome in cases of isolated oligohydramnios prior to 37 weeks of gestation appears to be related to iatrogenic prematurity, despite lack of evidence that conservative management increases the risk of adverse pregnancy outcome.
700 The accuracy of sonographic fetal weight estimation in cases of breech presentation-how accurate we are? Nir Melamed1, Yariv Yogev1, Avi Ben-Haroush2, Reuven Mashiach1, Israel Meizner1, Joseph Pardo1 1
Helen Schneider Hospital for Women, Petach Tikva, Helen Schneider Hospital for Women, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 2
OBJECTIVE: To determine the accuracy of sonographic estimated fetal weight (EFW) for fetuses in breech presentation and to compare it to that of fetuses in the vertex presentation STUDY DESIGN: A total of 3,174 sonographic EFW performed within 3 days prior to delivery. Fetal weight was estimated by 8 different sonographic models based on different combinations of the following: abdominal circumference (AC), femur length (FL), biparietal diameter (BPD) and head circumference (HC). The EFW was than compared with the actual birthweight. RESULTS: 1) Overall 3,174 fetuses were included, of them, 165 (5.2%) were in breech presentation. 2) The systematic error for fetuses in breech presentation was not significantly different from zero for all models tested (-1.0-1.5%), and was significantly lower than the systematic error for fetuses in vertex presentation (-0.3-3.3%, p⬍0.05). 3) These presentation-related differences in the systematic error were eliminated when models that incorporated HC rather than BPD were employed. 3) The random error for fetuses in breech presentation was significantly higher vs. vertex presentation (9.4-13.6% vs. 7.5-8.6%, p⬍0.05) and was lower for models that incorporated 3-4 biometric indices (9.4-9.5%) vs.models that incorporated only 1-2 biometric indices (9.8-13.6%, p⬍0.05). 4) The fraction of weight estimation within 10% of birthweight was significantly lower for fetuses in breech vs. vertex presentation when models that are based on only 1-2 biometric indices were used (51.9-72.1% vs. 61.179.2%), although no such differences were observed when models that incorporate 3-4 indices were used (77.0-77.6% vs. 78.3-81.2%, p⫽0.3). 5). These presentation-related differences in the systematic and random error were independent of birthweight, gestational age at delivery, and fetal head shape. CONCLUSIONS: EFW appears to be less accurate for fetuses in breech than in vertex presentation, mainly due to higher random error, which overrides the decreased systematic error observed in these cases. Differences may be minimized by using sonographic models which incorporate 3-4 biometric indices.
Supplement to JANUARY 2011 American Journal of Obstetrics & Gynecology
S277