- Email: [email protected]
169 Comparison of Different Ultrasound Parameters in the Prediction of Small-For Gestational Age (SGA) Infants
326
169
SPO Abstracts
January 1992 Am J Obstet Gynecol
COMPARISON OF DIFFERENT ULTRASOUND PARAMETERS IN THE PREDICTION OF SMALL-FOR'(;ESTATIONAL AGE (SGA) INFANTS. 'TC Chang.'SC Robson.' lADS Spencer, Dept. of Ob/Gyn, University College Hospital, London ;x R Boys, DepLof Statistics. Newcastle University, England. Many different ultrasonic parameters have been used to predict
birthweight below the 10th percentile (SGA). Results have invariably
been presented as sensitivity and positive predictive value; the latter being highly prevalence dependent. No previous reports have attempted to present summary statistics [or each ultrasound variable for comparison. We have reviewed the literature from the past 15 years (72 studies) regarding the ultra~onic prediction of SGA. Studies were included if; a) the reported population was high risk; h) the outcome measure was a birthwcight < 10th centile (using appropriate population charts); and c) the necessary information to constrllct a :2 x 1 table was reported. Only ultrasound variahles reported in at least 1 different studies were included. For each variahle a pooled· sensitivity and common odds ratio with 95(1k, confidence intervals is reported.
Results U/soulld parameter
RI'D95th FL / AC >23 EFW < 10th AC < 10th Gmde II I Placenta
Sensitivity
6:1.7 47.6 49.1
77.9 84.4 61.7
Common Odds Ratio
5.R3 3.34 2.82 39.07 I R.38 3.06
95lJcconfidcnce intcrval (3.62 -9.37)
(1.55 - 7.99) ( 1.71 - 4.66)
(28.9 - 52.7) (9.83 - 34.33) (1.7 - 5.25)
Conclusion: In a high risk population. AC has thc highest scnsitivity and EFW the highcst ,,-·omlllon odds ratiofor thc prcdidion of SGA. Comparahle data for low risk populations and for thc prcdiction of neonatal p()nderal index will also he presented.
170 r:ALU,l.TIOIi OF OBSTETRICAL ULTRASOCIID AS A LABORATORY TEST AT FIRST ';ISIT, !lro',lle ~, Halller LB, ';roon DIIx, Clark OiSx Departlent of Gynecology /Obstetrics, EIory University School of Medlcine, Atlanta, GA iie cOlpared routine obstetrical ultrasound to other standard laooratory tests perfonted at the first obstetrical visit in an indigent, inner-city patient population. iie exalined "nolltal" and "abnonal" values for blood type, rhesus qroup, antibody screen, rubella serology, syphilis serology, hepatitis serology, HI'; serology, urine culture, GC test, chlalydia test and cenical cytolO
28.6\ 06.0% 04,9% 02.5% 02,2% 00,6% 00.6%
STAIIDARD LABORATORY Rubella 1I0n-iuune Rhesus lIeqative AbnoIllal HelOqlobin Positive Drug Screen Positive A.~tibody Screen HI',' Posi ti ve Hepatitis B Posi ti ve
TEST 13,ll
07,01 ();,ll
04.7% 01.4%
00.6% 00.5%
171 ADVERSE FETAL CARDIAC EFFECTS OF ORAL iUTODRINE TOCOLYSIS. D.M. Fciedman x , J. Blackstone x , I. Hoskins, Div. Pediatcic Car-diologj/r1at-Fetal r'led, New Yor-k Univ. 11ed. Ctr-. NY The beta-sympathomimetic or-al tocolytic, r-itodr-ine (R), can cause mater-nal tachycar-dia and hypotension, and may ccoss the placenta. A new echo-Doppler technique was developed to explor-e fetal and placental R effects in 76 contr-ols and 18 studies on stable oeal R doses, at baseline and 30 min latec. Data collected: mater-nal pulse and Sp, fetal cer-ebr-al and umbilical Doppler wavefoems, and FHR. A new index of fetal [Llyocacdial contcactility, combined ventr-icular- shor-tening fr-action (~), was deeived feom 2D dieected M-mode. RESULTS: Maternal pulse and SP, FHR and fetal heaet size, and all Dopplers were nornal, without doseresponse effects. In normals, CVSF fell l-lith increasing gestational age (CVSF=-.27 EGA + 49, F=5.8, P ~ .OOL SEE=ll). CVSF in R pte. was abnorlllally decreased, at either peak or- trough, in 72% of ca32S. The mean CVSF in normals was 43 ± 5% but in R pts. was 31%. CONCLUSION: Pr-emature labor- and/or oral R is associated with ceduced CVSF. Since thec2 lias no change in placental resistance, cer-ebral hypoxia, 2'flR, oc heart size (preload), then low CVSF may be due to increased fetal systemic vascular resistance (SP) oc decr-eased myocardial conteactility.
172
SIGNIFICANCE OF THE UL TRASONOGRAPHIC DIAGNOSIS OF AMNIOTIC BAND IN RELATION TO FETAL OUTCOME AND MATERNAL COMPLICATIONS. ~x, M.D., A. Karimi x, M.D., E. loannou x, BA, H. Minkolf, M.D. Siale Univers~y Heallh Science Cenler at Brooklyn, New York. ~: In the routine practice of obstetrics, the uitra-sonographic diagnosis of an amniotic band is not rare and presents the physician and the patient with a counseling dilemma. Specifically, reports of limb disruptions and craniofacial anomalies raise major concerns. Materials: In an attempt to assess the prognostic significance of an uitrasonographic diagnosis of amniotic band, a relrospective review of ultrasonographic records at SUNY Health Science Center at Brooklyn and Kings County Hosp~a1 was performed. Between 1986 and 199125 cases of amniotic band were diagnosed. Cases were compared to 25 control patients who had uitrasound evaluations at the same gestational age (GA). Outcomes included anomalies (amniolic band syndrome), obstetrical complications (e.g. prelerm labor, premature rupture of membranes (PROM), birth weight) and maternal faclors that might predispose 10 bands (e.g. previous cesarean section, previous termination of pregnancy). ~: All cases had normal fetal anatomy and unrestricled felal movement on the index sonogram (1 in the first trimester, 13 in the second and 11 in the third). No component of the amniotic band syndrome was found in the newborns, all of whom were liveborn. Sixleen (64%) had ultrasound follow up of which 9 revealed the disappearance of the amniotic band. No significant dilference was found in fetal oulcomes, maternal risk faclors or complications belween the two groups, except for preterm labor which was more common among cases. [Table 11. ~: This study suggests Ihallhe u~rasonographic diagnosis of an amniolic band in conjunclion with sonographic findings of normal felal analomy and unreslricled felal movement may carry minimal risk to the felus and Ihe molher. Preliminary evidence of an association w~h preterm labor needs to be confirmed. Table 1. Obstetrical Outcome Case (n = 25) Control (n=25) P mean (SO) mean (SD) Birth Wt (g) 2813 (680) 3045 (929) .31 GA (wk) 37.4 (2.8) 37.4 (5.9) .95 PRa..1 12% (.33) 16% (.37) .95 Preterm Labor 20% (.41) .02 0.0 (0.0)
169
SPO Abstracts
January 1992 Am J Obstet Gynecol
COMPARISON OF DIFFERENT ULTRASOUND PARAMETERS IN THE PREDICTION OF SMALL-FOR'(;ESTATIONAL AGE (SGA) INFANTS. 'TC Chang.'SC Robson.' lADS Spencer, Dept. of Ob/Gyn, University College Hospital, London ;x R Boys, DepLof Statistics. Newcastle University, England. Many different ultrasonic parameters have been used to predict
birthweight below the 10th percentile (SGA). Results have invariably
been presented as sensitivity and positive predictive value; the latter being highly prevalence dependent. No previous reports have attempted to present summary statistics [or each ultrasound variable for comparison. We have reviewed the literature from the past 15 years (72 studies) regarding the ultra~onic prediction of SGA. Studies were included if; a) the reported population was high risk; h) the outcome measure was a birthwcight < 10th centile (using appropriate population charts); and c) the necessary information to constrllct a :2 x 1 table was reported. Only ultrasound variahles reported in at least 1 different studies were included. For each variahle a pooled· sensitivity and common odds ratio with 95(1k, confidence intervals is reported.
Results U/soulld parameter
RI'D
Sensitivity
6:1.7 47.6 49.1
77.9 84.4 61.7
Common Odds Ratio
5.R3 3.34 2.82 39.07 I R.38 3.06
95lJcconfidcnce intcrval (3.62 -9.37)
(1.55 - 7.99) ( 1.71 - 4.66)
(28.9 - 52.7) (9.83 - 34.33) (1.7 - 5.25)
Conclusion: In a high risk population. AC has thc highest scnsitivity and EFW the highcst ,,-·omlllon odds ratiofor thc prcdidion of SGA. Comparahle data for low risk populations and for thc prcdiction of neonatal p()nderal index will also he presented.
170 r:ALU,l.TIOIi OF OBSTETRICAL ULTRASOCIID AS A LABORATORY TEST AT FIRST ';ISIT, !lro',lle ~, Halller LB, ';roon DIIx, Clark OiSx Departlent of Gynecology /Obstetrics, EIory University School of Medlcine, Atlanta, GA iie cOlpared routine obstetrical ultrasound to other standard laooratory tests perfonted at the first obstetrical visit in an indigent, inner-city patient population. iie exalined "nolltal" and "abnonal" values for blood type, rhesus qroup, antibody screen, rubella serology, syphilis serology, hepatitis serology, HI'; serology, urine culture, GC test, chlalydia test and cenical cytolO
28.6\ 06.0% 04,9% 02.5% 02,2% 00,6% 00.6%
STAIIDARD LABORATORY Rubella 1I0n-iuune Rhesus lIeqative AbnoIllal HelOqlobin Positive Drug Screen Positive A.~tibody Screen HI',' Posi ti ve Hepatitis B Posi ti ve
TEST 13,ll
07,01 ();,ll
04.7% 01.4%
00.6% 00.5%
171 ADVERSE FETAL CARDIAC EFFECTS OF ORAL iUTODRINE TOCOLYSIS. D.M. Fciedman x , J. Blackstone x , I. Hoskins, Div. Pediatcic Car-diologj/r1at-Fetal r'led, New Yor-k Univ. 11ed. Ctr-. NY The beta-sympathomimetic or-al tocolytic, r-itodr-ine (R), can cause mater-nal tachycar-dia and hypotension, and may ccoss the placenta. A new echo-Doppler technique was developed to explor-e fetal and placental R effects in 76 contr-ols and 18 studies on stable oeal R doses, at baseline and 30 min latec. Data collected: mater-nal pulse and Sp, fetal cer-ebr-al and umbilical Doppler wavefoems, and FHR. A new index of fetal [Llyocacdial contcactility, combined ventr-icular- shor-tening fr-action (~), was deeived feom 2D dieected M-mode. RESULTS: Maternal pulse and SP, FHR and fetal heaet size, and all Dopplers were nornal, without doseresponse effects. In normals, CVSF fell l-lith increasing gestational age (CVSF=-.27 EGA + 49, F=5.8, P ~ .OOL SEE=ll). CVSF in R pte. was abnorlllally decreased, at either peak or- trough, in 72% of ca32S. The mean CVSF in normals was 43 ± 5% but in R pts. was 31%. CONCLUSION: Pr-emature labor- and/or oral R is associated with ceduced CVSF. Since thec2 lias no change in placental resistance, cer-ebral hypoxia, 2'flR, oc heart size (preload), then low CVSF may be due to increased fetal systemic vascular resistance (SP) oc decr-eased myocardial conteactility.
172
SIGNIFICANCE OF THE UL TRASONOGRAPHIC DIAGNOSIS OF AMNIOTIC BAND IN RELATION TO FETAL OUTCOME AND MATERNAL COMPLICATIONS. ~x, M.D., A. Karimi x, M.D., E. loannou x, BA, H. Minkolf, M.D. Siale Univers~y Heallh Science Cenler at Brooklyn, New York. ~: In the routine practice of obstetrics, the uitra-sonographic diagnosis of an amniotic band is not rare and presents the physician and the patient with a counseling dilemma. Specifically, reports of limb disruptions and craniofacial anomalies raise major concerns. Materials: In an attempt to assess the prognostic significance of an uitrasonographic diagnosis of amniotic band, a relrospective review of ultrasonographic records at SUNY Health Science Center at Brooklyn and Kings County Hosp~a1 was performed. Between 1986 and 199125 cases of amniotic band were diagnosed. Cases were compared to 25 control patients who had uitrasound evaluations at the same gestational age (GA). Outcomes included anomalies (amniolic band syndrome), obstetrical complications (e.g. prelerm labor, premature rupture of membranes (PROM), birth weight) and maternal faclors that might predispose 10 bands (e.g. previous cesarean section, previous termination of pregnancy). ~: All cases had normal fetal anatomy and unrestricled felal movement on the index sonogram (1 in the first trimester, 13 in the second and 11 in the third). No component of the amniotic band syndrome was found in the newborns, all of whom were liveborn. Sixleen (64%) had ultrasound follow up of which 9 revealed the disappearance of the amniotic band. No significant dilference was found in fetal oulcomes, maternal risk faclors or complications belween the two groups, except for preterm labor which was more common among cases. [Table 11. ~: This study suggests Ihallhe u~rasonographic diagnosis of an amniolic band in conjunclion with sonographic findings of normal felal analomy and unreslricled felal movement may carry minimal risk to the felus and Ihe molher. Preliminary evidence of an association w~h preterm labor needs to be confirmed. Table 1. Obstetrical Outcome Case (n = 25) Control (n=25) P mean (SO) mean (SD) Birth Wt (g) 2813 (680) 3045 (929) .31 GA (wk) 37.4 (2.8) 37.4 (5.9) .95 PRa..1 12% (.33) 16% (.37) .95 Preterm Labor 20% (.41) .02 0.0 (0.0)