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Trends in termination of pregnancy rates and live birth rates for major congenital anomalies
S130
Ultrasound in Medicine and Biology
surgery and/or methotrexate treatment. Although cornual pregnancy can also be treated with surgery or methotrexate, according to our study, cornual pregnancy can be safely treated with curettage in the early stage, and subcornual pregnancy does not require treatment. Subcornual pregnancy, therefore, should be differentiated from cornual pregnancy. It is impossible to differentiate subcornual from cornual pregnancies by old ultrasonographic criteria. 31064 High-resolution ultrasonographic evaluation of the finger: Cadaveric findings and clinical experiences Kovacs P,* Gruber H, Peer S, Jaschke WR, Bodner G, Radiodiagnostics I, University Hospital, Innsbruck, Tyrol, Austria Objective: 1) To evaluate the ultrasonographic (US) anatomy of the finger in cadaveric specimens. 2) To present patients suffering from injuries and inflammations of the finger. Methods: The extensor and flexor tendon apparatus of three embalmed cadaveric hands, as well as the ligaments, the distributing nerves, and the bed of the nail were investigated using a 5–12 MHz broad band linear transducer (HDI 5000, ATL) in longitudinal and transverse section planes. US findings were compared with corresponding cryosections, which were sliced using a fine needle band saw. We present the most impressive findings of patients with cuts or ruptures of the flexor tendons (n⫽21) and extensor tendons including the dorsal extensions (n⫽13), suffering from tenosynovitis (n⫽29) and post-traumatic neuromas of the digital nerves (n⫽12) investigated at our department since 2000. Results: The flexor tendons and all anular (A1–A5) and cruciform (C1–C3) pulleys, the ceck rein ligaments, dorsal extensions of the extensor tendons, the digital nerve branches, and the bed of the nail were depicted using US. In the patients, US helped to diagnose partial and total cuts and ruptures of the finger tendons surrounded by fluid or embedded in scars. Other patients presented with hypervascularisation and ballooning of the tendon sheath between the anular and cruciform pulleys because of tenosynovitis. The last group of patients showed hypoechoic globular swellings of the digital nerve stumps after traumatic amputation of the finger. Conclusions: High-resolution US allows detection of even very small structures of the finger and, therefore, can be a helpful tool to diagnose several injuries and inflammations of the finger. 31066 High-resolution ultrasonography of peripheral nerve branches at the upper and lower extremities Kovacs P,* Gruber H, Peer S, Jaschke WR, Bodner G, Radiodiagnostics I, University Hospital, Innsbruck, Tyrol, Austria Objective: The aim of this study was to demonstrate feasibility of depicting peripheral nerve branches on both the upper and the lower extremity of cadavers using high-resolution ultrasonography (US). Methods: On both upper and lower extremities of a 90-year-old cadaveric specimen, branches of the major motor and sensory nerves were detected by means of a 5–12 MHz broad band linear transducer in transverse planes. After assessing each peripheral nerve, the limbs were cryosected (3 mm, fine needle band saw) corresponding to ultrasonographic planes to compare US and cryosectional findings side by side. Results: At the upper limbs, the musculocutaneous, median, ulnar, and radial nerve, including superficial and deep branches, and at the lower limbs, the femoral, sciatic, tibial, and common fibular nerve with their superficial and deep branches were detected by means of US at several levels. Conclusions: Knowing the topography of the peripheral nerve branches of the upper and lower extremities, high-resolution US allows to detect all major nerves with their superficial and deep branches.
Volume 29, Number 5S, 2003 31074 Trends in termination of pregnancy rates and live birth rates for major congenital anomalies Maharaj S,*1,2 Edwardes MD,3 Morin L,1,2 1. Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, QC, Canada, 2. Maternal Fetal Medicine, McGill University, Montreal, QC, Canada, and 3. Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, QC, Canada Objective: The aim of this study was to determine the trends in termination of pregnancy rates and live birth rates for major congenital anomalies. Methods: We conducted a retrospective study examining all pregnancies delivered between 1978 and 1997 and all terminations of pregnancy between 1988 and 2000 at the Royal Victoria Hospital, Montreal, Canada. Live birth rates of all infants with congenital anomalies and termination of pregnancy rates for all major prenatally diagnosable anomalies were analyzed on an annual basis using Poisson regression. Results: There was a statistically significant increase in live birth rates of all infants with congenital abnormalities (P⬍0.0001). There were significantly increased live birth rates for anomalies of: cardiovascular (P⬍0.0001), genitourinary (P⬍0.001), central nervous system (P⬍0.01), and isolated (minor) limb anomalies (P⫽0.05). Live birth rates for gastrointestinal and syndromic anomalies increased, but this was not statistically significant. There was a significant reduction in the birth rates of skeletal and major limb anomalies (P⫽0.01). There was a reduction in live birth rates for abdominal wall defects, chromosomal, head/neck/facial, lung, and unclassified anomalies, but these were not statistically significant. Terminations, considered all together, showed increased rates that were statistically significant (P⫽0.03). Analyzed individually, only terminations for cardiovascular (P⬍0.01) and unclassified anomalies (P⬍0.0001) showed increased rates that were statistically significant. Conclusions: It has been suggested that the large decrease in infant mortality in Canada has been due to increases in prenatal diagnosis and termination for congenital anomalies. This study has shown there has been a statistically significant increase in both live birth rates of affected infants and termination rates for congenital anomalies and that this varies with the specific system. This may reflect improvement in prenatal diagnosis, changing attitudes towards termination, better selection of cases for termination, and better preparation and neonatal care at delivery. These trends have implications for the future provision of both antenatal and neonatal care facilities. 31079 Successful treatment of cornual pregnancy using ultrasoundguided injection of KCL and intra-muscular injection of methotrexate Koscica KL,* Bebbington M, OBGYN, Albert Einstein College of Medicine, Bronx, NY Description of case(s): A 35-year-old primigravida was diagnosed with a left cornual ectopic pregnancy on a routine first-trimester dating ultrasound. The patient’s history was significant for a fibroid uterus. The patient expressed a desire for future fertility. She underwent an abdominal ultrasound-guided amniocentesis in which a 20-gauge spinal needle was placed into the gestational sac. Clear fluid was aspirated to confirm placement and reduce risk of cornual rupture with subsequent injection. KCL (20 meq/ml) was injected into the gestational sac until no fetal heart rate was noted. A total volume of 4 cc was injected. The patient then received a single dose of methotrexate at 50 mg/m2 (112 mg IM). Serial B-HCG were followed and within 7 days titers had fallen from 37,327 to 13,328. The patient remained asymptomatic and stable. The b-HCG titers were followed and were negative by 3 months. The patient is not pregnant at time of this report.
Ultrasound in Medicine and Biology
surgery and/or methotrexate treatment. Although cornual pregnancy can also be treated with surgery or methotrexate, according to our study, cornual pregnancy can be safely treated with curettage in the early stage, and subcornual pregnancy does not require treatment. Subcornual pregnancy, therefore, should be differentiated from cornual pregnancy. It is impossible to differentiate subcornual from cornual pregnancies by old ultrasonographic criteria. 31064 High-resolution ultrasonographic evaluation of the finger: Cadaveric findings and clinical experiences Kovacs P,* Gruber H, Peer S, Jaschke WR, Bodner G, Radiodiagnostics I, University Hospital, Innsbruck, Tyrol, Austria Objective: 1) To evaluate the ultrasonographic (US) anatomy of the finger in cadaveric specimens. 2) To present patients suffering from injuries and inflammations of the finger. Methods: The extensor and flexor tendon apparatus of three embalmed cadaveric hands, as well as the ligaments, the distributing nerves, and the bed of the nail were investigated using a 5–12 MHz broad band linear transducer (HDI 5000, ATL) in longitudinal and transverse section planes. US findings were compared with corresponding cryosections, which were sliced using a fine needle band saw. We present the most impressive findings of patients with cuts or ruptures of the flexor tendons (n⫽21) and extensor tendons including the dorsal extensions (n⫽13), suffering from tenosynovitis (n⫽29) and post-traumatic neuromas of the digital nerves (n⫽12) investigated at our department since 2000. Results: The flexor tendons and all anular (A1–A5) and cruciform (C1–C3) pulleys, the ceck rein ligaments, dorsal extensions of the extensor tendons, the digital nerve branches, and the bed of the nail were depicted using US. In the patients, US helped to diagnose partial and total cuts and ruptures of the finger tendons surrounded by fluid or embedded in scars. Other patients presented with hypervascularisation and ballooning of the tendon sheath between the anular and cruciform pulleys because of tenosynovitis. The last group of patients showed hypoechoic globular swellings of the digital nerve stumps after traumatic amputation of the finger. Conclusions: High-resolution US allows detection of even very small structures of the finger and, therefore, can be a helpful tool to diagnose several injuries and inflammations of the finger. 31066 High-resolution ultrasonography of peripheral nerve branches at the upper and lower extremities Kovacs P,* Gruber H, Peer S, Jaschke WR, Bodner G, Radiodiagnostics I, University Hospital, Innsbruck, Tyrol, Austria Objective: The aim of this study was to demonstrate feasibility of depicting peripheral nerve branches on both the upper and the lower extremity of cadavers using high-resolution ultrasonography (US). Methods: On both upper and lower extremities of a 90-year-old cadaveric specimen, branches of the major motor and sensory nerves were detected by means of a 5–12 MHz broad band linear transducer in transverse planes. After assessing each peripheral nerve, the limbs were cryosected (3 mm, fine needle band saw) corresponding to ultrasonographic planes to compare US and cryosectional findings side by side. Results: At the upper limbs, the musculocutaneous, median, ulnar, and radial nerve, including superficial and deep branches, and at the lower limbs, the femoral, sciatic, tibial, and common fibular nerve with their superficial and deep branches were detected by means of US at several levels. Conclusions: Knowing the topography of the peripheral nerve branches of the upper and lower extremities, high-resolution US allows to detect all major nerves with their superficial and deep branches.
Volume 29, Number 5S, 2003 31074 Trends in termination of pregnancy rates and live birth rates for major congenital anomalies Maharaj S,*1,2 Edwardes MD,3 Morin L,1,2 1. Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, QC, Canada, 2. Maternal Fetal Medicine, McGill University, Montreal, QC, Canada, and 3. Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, QC, Canada Objective: The aim of this study was to determine the trends in termination of pregnancy rates and live birth rates for major congenital anomalies. Methods: We conducted a retrospective study examining all pregnancies delivered between 1978 and 1997 and all terminations of pregnancy between 1988 and 2000 at the Royal Victoria Hospital, Montreal, Canada. Live birth rates of all infants with congenital anomalies and termination of pregnancy rates for all major prenatally diagnosable anomalies were analyzed on an annual basis using Poisson regression. Results: There was a statistically significant increase in live birth rates of all infants with congenital abnormalities (P⬍0.0001). There were significantly increased live birth rates for anomalies of: cardiovascular (P⬍0.0001), genitourinary (P⬍0.001), central nervous system (P⬍0.01), and isolated (minor) limb anomalies (P⫽0.05). Live birth rates for gastrointestinal and syndromic anomalies increased, but this was not statistically significant. There was a significant reduction in the birth rates of skeletal and major limb anomalies (P⫽0.01). There was a reduction in live birth rates for abdominal wall defects, chromosomal, head/neck/facial, lung, and unclassified anomalies, but these were not statistically significant. Terminations, considered all together, showed increased rates that were statistically significant (P⫽0.03). Analyzed individually, only terminations for cardiovascular (P⬍0.01) and unclassified anomalies (P⬍0.0001) showed increased rates that were statistically significant. Conclusions: It has been suggested that the large decrease in infant mortality in Canada has been due to increases in prenatal diagnosis and termination for congenital anomalies. This study has shown there has been a statistically significant increase in both live birth rates of affected infants and termination rates for congenital anomalies and that this varies with the specific system. This may reflect improvement in prenatal diagnosis, changing attitudes towards termination, better selection of cases for termination, and better preparation and neonatal care at delivery. These trends have implications for the future provision of both antenatal and neonatal care facilities. 31079 Successful treatment of cornual pregnancy using ultrasoundguided injection of KCL and intra-muscular injection of methotrexate Koscica KL,* Bebbington M, OBGYN, Albert Einstein College of Medicine, Bronx, NY Description of case(s): A 35-year-old primigravida was diagnosed with a left cornual ectopic pregnancy on a routine first-trimester dating ultrasound. The patient’s history was significant for a fibroid uterus. The patient expressed a desire for future fertility. She underwent an abdominal ultrasound-guided amniocentesis in which a 20-gauge spinal needle was placed into the gestational sac. Clear fluid was aspirated to confirm placement and reduce risk of cornual rupture with subsequent injection. KCL (20 meq/ml) was injected into the gestational sac until no fetal heart rate was noted. A total volume of 4 cc was injected. The patient then received a single dose of methotrexate at 50 mg/m2 (112 mg IM). Serial B-HCG were followed and within 7 days titers had fallen from 37,327 to 13,328. The patient remained asymptomatic and stable. The b-HCG titers were followed and were negative by 3 months. The patient is not pregnant at time of this report.