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158: The association of maternal BMI with fetal echogenic bowel and echogenic intracardiac foci
SMFM Abstracts 157
SINGLE UMBILICAL ARTERY: DOES SIDE MATTER? MARK SANTILLAN1, DONNA SANTILLAN1, DIEDRE FLEENER1, STEPHEN HUNTER1, JEROME YANKOWITZ1, 1University of Iowa, Iowa City, Iowa OBJECTIVE: A single umbilical artery (SUA) occurs in up to 2.0% of fetuses. Increased rates of other congenital malformations, chromosomal abnormalities, perinatal mortality, growth restriction and preterm labor have been associated with SUA. An absent left umbilical artery (UA) has been associated with an increased rate of malformations. Other studies refute this. In this study, the largest to date, we investigate whether the laterality of the missing UA has an association with the rate of congenital malformations, chromosomal abnormalities, or Doppler abnormalities. STUDY DESIGN: Fetuses with a SUA were retrospectively identified from the University of Iowa obstetric ultrasound database (1989-2002). The ultrasound reports and medical records of these patients were evaluated for laterality of the absent UA, congenital malformations, chromosomal abnormalities and UA Doppler abnormalities. To control for confounding variables, demographic, maternal, and other obstetric variables were also obtained. Binary logistic regression and 2 tail Fisher exact test were performed with ␣⫽ 0.05. RESULTS: Prenatal diagnosis of SUA was made in 230 fetuses. An absent left and right UA were identified in 86 (37%) and 63 (28%) patients respectively. Laterality was not specified in 81 (35%) patients. Overall, congenital malformations were found in up to 21% of the fetuses. The rates of UA Doppler abnormality and birth defects documented postpartum were 8.3% and 47% respectively. With regard to biometry, placental appearance, amniotic fluid index, and congenital malformations, there were no statistically significant differences between those with a left or right UA missing. Chromosomal abnormalities, UA Dopplers, and documented postpartum birth defects were not statistically different between those with absence of the left or right UA. CONCLUSION: Our data support other studies which conclude that the laterality of the absent UA has no effect on the rate of congenital malformations and chromosomal abnormalities. Furthermore, our study concludes that laterality has no effect on UA doppler values. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.169
158
THE ASSOCIATION OF MATERNAL BMI WITH FETAL ECHOGENIC BOWEL AND ECHOGENIC INTRACARDIAC FOCI RINAT HACKMON1, EYAL SHEINER2, ERAN BORNSTEIN3, YONI BARNHARD4, KERRIE MCKEANNA4, DAVID BINDER4, MICHAEL DIVON4, 1 Fred Hutchison Cancer Research Institute, Seattle, Washington, 2Ben-Gurion University, Beer-Sheva, Israel, 3New York University, New York, New York, 4Lenox Hill Hospital, Ob/Gyn Department, New York, New York OBJECTIVE: Adipose tissue has been shown to attenuate ultrasonic signals and to affect image quality. Thus, we sought to evaluate the impact of maternal body mass index (BMI) on the detection of fetal echogenic bowel (EB) and/or echogenic intracardiac focus (EIF). STUDY DESIGN: In this prospective study the case group included 72 mother carrying fetuses diagnosed with EB, and/or EIF while undergoing an anatomical survey. Seventy two mothers carrying fetuses with normal anatomical survey served as controls. Data regarding maternal BMI (Kg/m2), age, ethnicity, gravity, parity and gestational age were obtained. A multiple logistic regression model was performed to control for confounders. P value ⱕ 0.05 indicated statistical significant. RESULTS: Thirty-one fetuses were diagnosed with EB, 51 with EIF and 10 were diagnosed with both EB and EIF. The mean maternal BMI was significantly lower among women carrying fetuses diagnosed with EB and//or EIF as compared to controls (22.8⫾2.9 vs. 28.1⫾7.6 Kg/m2, respectively; p⬍0.0001). No significant differences were noted between mean maternal BMI in fetuses with EB and EIF (22.1⫾7.2 and 23.4⫾3.2 Kg/m2, respectively p⫽0.08). A significant association was documented between Asian ethnicity and either EB or EIF (OR⫽4.8; 95% CI 1.515.2; p⫽0.04). No significant differences were found in maternal age, gravity or parity between groups. Using a multivariable analysis, controlling for ethnicity and maternal age, the association between BMI and fetal echogenic bowel or intracardiac foci remained significant (OR⫽0.8; 95% CI 0.8-0.9; p⬍0.001). Asian ethnicity was not found as an independent risk factor for either EIF or EB in the multiple logistic regression model (OR⫽2.6; 95% CI 0.8-8.9; p⫽0.115). CONCLUSION: Our results show that an independent inverse association exists between maternal BMI and the occurrence of fetal echogenic bowel and/or intracardiac foci. These findings suggest that EB and/or EIF might be a reflection of maternal body habitus. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.170
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www.AJOG.org 159
ISOLATED MILD FETAL PYELECTASIS AND TRISOMY 21 PEER DAR1, VICTOR MORALES1, 1Montefiore Medical Center, Bronx, New York OBJECTIVE: To evaluate the association between isolated mild pyelectasis diagnosed during second trimester detailed anatomy scan and trisomy 21 STUDY DESIGN: A retrospective analysis of all infants diagnosed antenatally with isolated mild fetal pyelectasis and all fetuses and newborns diagnosed with trisomy 21 for the period between January and December 2006. RESULTS: Of 4123 fetuses that had detailed second trimester anatomy scan, 132 (3.25%) were diagnosed with fetal pyelectasis. Isolated mild pyelectasis was seen in 97 cases (73.4%). None of the newborns were pre or postnatally diagnosed with trisomy 21. Of 5215 pregnancies seen in our department during the study period, five fetuses and two newborns were diagnosed with trisomy 21. All patients diagnosed prenatally with trisomy 21 elected pregnancy termination. In the two pregnancies that ended in a live birth, amniocentesis was offered for sonographic abnormality and was declined by the mother. Of the four fetuses that had detailed second trimester ultrasound scan, only one (25%) had pyelectasis which was mild but not isolated. CONCLUSION: Isolated mild pyelectasis should not be recommended as a single indication for amniocentesis for ruling out trisomy 21 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.171
160
ULTRASOUND FINDINGS IN COMPLETE TRISOMY 22 WADE SCHWENDEMANN1, STEPHEN CONTAG2, RICHARD C. MILLER3, PATRICK KOTY2, PATRICIA DEVERS4, WILLIAM WATSON1, 1Mayo Clinic College of Medicine, Maternal Fetal Medicine, Rochester, Minnesota, 2Wake Forest Medical Center, Winston-Salem, North Carolina, 3Saint Barnabas Medical Center, Division of Maternal-Fetal Medicine, Livingston, New Jersey, 4The University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina OBJECTIVE: Trisomy 22 is a rare chromosomal abnormality complicating approximately one in 30,000 to 50,000 live births. The objective of this study was to identify the characteristic ultrasonographic findings of fetal complete trisomy 22. STUDY DESIGN: Nine cases of fetal trisomy 22 were retrospectively identified at the four participating institutions over a 10-15 year interval. Fetal karyotype was documented via chorionic villus sampling, amniocentesis, or karyotype of products of conception or live births. All cases of chromosomal mosaicism were excluded. Indications for referral, gestational age, and sonographically detected fetal anomalies were recorded. RESULTS: The majority of patients were referred for advanced maternal age or abnormal screening ultrasound findings. Increased nuchal thickness and fetal growth restriction were the most common sonographic abnormalities present, being found in 44% of affected fetuses. Oligohydramnios and cardiac malformations (33%) were slightly less frequent (Table 1). Incidence of ultrasound findings Anomaly Identified
# of Cases (% of cases)
Thickened Nuchal Fold IUGR Cardiac Oligohydramnios Anomalous IVC Genitourinary Clubbed Feet Pleural Effusion
4 (44%) 4 (44%) 3 (33%) 3 (33%) 1 (11%) 1 (11%) 1 (11%) 1 (11%)
CONCLUSION: This series represents the largest case series of fetal trisomy 22 that we could identify in the literature to date. Fetal growth restriction and increased nuchal thickening were the most frequent sonographic anomalies detected on prenatal screening. While these findings are often characteristic of more common autosomal trisomies, clinicians should exercise caution when counseling patients on the basis of a normal prenatal aneuploid FISH screening result until a complete karyotype result is available. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.172
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2007
SINGLE UMBILICAL ARTERY: DOES SIDE MATTER? MARK SANTILLAN1, DONNA SANTILLAN1, DIEDRE FLEENER1, STEPHEN HUNTER1, JEROME YANKOWITZ1, 1University of Iowa, Iowa City, Iowa OBJECTIVE: A single umbilical artery (SUA) occurs in up to 2.0% of fetuses. Increased rates of other congenital malformations, chromosomal abnormalities, perinatal mortality, growth restriction and preterm labor have been associated with SUA. An absent left umbilical artery (UA) has been associated with an increased rate of malformations. Other studies refute this. In this study, the largest to date, we investigate whether the laterality of the missing UA has an association with the rate of congenital malformations, chromosomal abnormalities, or Doppler abnormalities. STUDY DESIGN: Fetuses with a SUA were retrospectively identified from the University of Iowa obstetric ultrasound database (1989-2002). The ultrasound reports and medical records of these patients were evaluated for laterality of the absent UA, congenital malformations, chromosomal abnormalities and UA Doppler abnormalities. To control for confounding variables, demographic, maternal, and other obstetric variables were also obtained. Binary logistic regression and 2 tail Fisher exact test were performed with ␣⫽ 0.05. RESULTS: Prenatal diagnosis of SUA was made in 230 fetuses. An absent left and right UA were identified in 86 (37%) and 63 (28%) patients respectively. Laterality was not specified in 81 (35%) patients. Overall, congenital malformations were found in up to 21% of the fetuses. The rates of UA Doppler abnormality and birth defects documented postpartum were 8.3% and 47% respectively. With regard to biometry, placental appearance, amniotic fluid index, and congenital malformations, there were no statistically significant differences between those with a left or right UA missing. Chromosomal abnormalities, UA Dopplers, and documented postpartum birth defects were not statistically different between those with absence of the left or right UA. CONCLUSION: Our data support other studies which conclude that the laterality of the absent UA has no effect on the rate of congenital malformations and chromosomal abnormalities. Furthermore, our study concludes that laterality has no effect on UA doppler values. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.169
158
THE ASSOCIATION OF MATERNAL BMI WITH FETAL ECHOGENIC BOWEL AND ECHOGENIC INTRACARDIAC FOCI RINAT HACKMON1, EYAL SHEINER2, ERAN BORNSTEIN3, YONI BARNHARD4, KERRIE MCKEANNA4, DAVID BINDER4, MICHAEL DIVON4, 1 Fred Hutchison Cancer Research Institute, Seattle, Washington, 2Ben-Gurion University, Beer-Sheva, Israel, 3New York University, New York, New York, 4Lenox Hill Hospital, Ob/Gyn Department, New York, New York OBJECTIVE: Adipose tissue has been shown to attenuate ultrasonic signals and to affect image quality. Thus, we sought to evaluate the impact of maternal body mass index (BMI) on the detection of fetal echogenic bowel (EB) and/or echogenic intracardiac focus (EIF). STUDY DESIGN: In this prospective study the case group included 72 mother carrying fetuses diagnosed with EB, and/or EIF while undergoing an anatomical survey. Seventy two mothers carrying fetuses with normal anatomical survey served as controls. Data regarding maternal BMI (Kg/m2), age, ethnicity, gravity, parity and gestational age were obtained. A multiple logistic regression model was performed to control for confounders. P value ⱕ 0.05 indicated statistical significant. RESULTS: Thirty-one fetuses were diagnosed with EB, 51 with EIF and 10 were diagnosed with both EB and EIF. The mean maternal BMI was significantly lower among women carrying fetuses diagnosed with EB and//or EIF as compared to controls (22.8⫾2.9 vs. 28.1⫾7.6 Kg/m2, respectively; p⬍0.0001). No significant differences were noted between mean maternal BMI in fetuses with EB and EIF (22.1⫾7.2 and 23.4⫾3.2 Kg/m2, respectively p⫽0.08). A significant association was documented between Asian ethnicity and either EB or EIF (OR⫽4.8; 95% CI 1.515.2; p⫽0.04). No significant differences were found in maternal age, gravity or parity between groups. Using a multivariable analysis, controlling for ethnicity and maternal age, the association between BMI and fetal echogenic bowel or intracardiac foci remained significant (OR⫽0.8; 95% CI 0.8-0.9; p⬍0.001). Asian ethnicity was not found as an independent risk factor for either EIF or EB in the multiple logistic regression model (OR⫽2.6; 95% CI 0.8-8.9; p⫽0.115). CONCLUSION: Our results show that an independent inverse association exists between maternal BMI and the occurrence of fetal echogenic bowel and/or intracardiac foci. These findings suggest that EB and/or EIF might be a reflection of maternal body habitus. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.170
S56
www.AJOG.org 159
ISOLATED MILD FETAL PYELECTASIS AND TRISOMY 21 PEER DAR1, VICTOR MORALES1, 1Montefiore Medical Center, Bronx, New York OBJECTIVE: To evaluate the association between isolated mild pyelectasis diagnosed during second trimester detailed anatomy scan and trisomy 21 STUDY DESIGN: A retrospective analysis of all infants diagnosed antenatally with isolated mild fetal pyelectasis and all fetuses and newborns diagnosed with trisomy 21 for the period between January and December 2006. RESULTS: Of 4123 fetuses that had detailed second trimester anatomy scan, 132 (3.25%) were diagnosed with fetal pyelectasis. Isolated mild pyelectasis was seen in 97 cases (73.4%). None of the newborns were pre or postnatally diagnosed with trisomy 21. Of 5215 pregnancies seen in our department during the study period, five fetuses and two newborns were diagnosed with trisomy 21. All patients diagnosed prenatally with trisomy 21 elected pregnancy termination. In the two pregnancies that ended in a live birth, amniocentesis was offered for sonographic abnormality and was declined by the mother. Of the four fetuses that had detailed second trimester ultrasound scan, only one (25%) had pyelectasis which was mild but not isolated. CONCLUSION: Isolated mild pyelectasis should not be recommended as a single indication for amniocentesis for ruling out trisomy 21 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.171
160
ULTRASOUND FINDINGS IN COMPLETE TRISOMY 22 WADE SCHWENDEMANN1, STEPHEN CONTAG2, RICHARD C. MILLER3, PATRICK KOTY2, PATRICIA DEVERS4, WILLIAM WATSON1, 1Mayo Clinic College of Medicine, Maternal Fetal Medicine, Rochester, Minnesota, 2Wake Forest Medical Center, Winston-Salem, North Carolina, 3Saint Barnabas Medical Center, Division of Maternal-Fetal Medicine, Livingston, New Jersey, 4The University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina OBJECTIVE: Trisomy 22 is a rare chromosomal abnormality complicating approximately one in 30,000 to 50,000 live births. The objective of this study was to identify the characteristic ultrasonographic findings of fetal complete trisomy 22. STUDY DESIGN: Nine cases of fetal trisomy 22 were retrospectively identified at the four participating institutions over a 10-15 year interval. Fetal karyotype was documented via chorionic villus sampling, amniocentesis, or karyotype of products of conception or live births. All cases of chromosomal mosaicism were excluded. Indications for referral, gestational age, and sonographically detected fetal anomalies were recorded. RESULTS: The majority of patients were referred for advanced maternal age or abnormal screening ultrasound findings. Increased nuchal thickness and fetal growth restriction were the most common sonographic abnormalities present, being found in 44% of affected fetuses. Oligohydramnios and cardiac malformations (33%) were slightly less frequent (Table 1). Incidence of ultrasound findings Anomaly Identified
# of Cases (% of cases)
Thickened Nuchal Fold IUGR Cardiac Oligohydramnios Anomalous IVC Genitourinary Clubbed Feet Pleural Effusion
4 (44%) 4 (44%) 3 (33%) 3 (33%) 1 (11%) 1 (11%) 1 (11%) 1 (11%)
CONCLUSION: This series represents the largest case series of fetal trisomy 22 that we could identify in the literature to date. Fetal growth restriction and increased nuchal thickening were the most frequent sonographic anomalies detected on prenatal screening. While these findings are often characteristic of more common autosomal trisomies, clinicians should exercise caution when counseling patients on the basis of a normal prenatal aneuploid FISH screening result until a complete karyotype result is available. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2007.10.172
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2007