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173 Clinical Significance of Uterine Leiomyomata in Pregnancy
spa Abstracts
Volume 166 N umber I, Part 2
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174
CLINICAL SIGNIFICANCE OF UTERINE LEIOMYOMATA IN PREGNANCY. A Ghidin?, P. Vergan?, N. Strobelt X , N. RoncagliaX, A. Spell}" A. Locatelli x . MI. Sinai School of Medicine, New York, NY, SI. Gerardo Hospital, Monza, Italy. The clinical significance of uterine myomas in pregnancy has only been examined in small retrospective studies. leading to conflicting results. From Jan. 1983 to Jan. 1988 we followed prospectively 209 pregnant patients with sonographically identified myomas and 7523 pregnant women. without myomas. Site. number and location of myomas were documented. Among patients with fibroids, 12 had elective abortions performed, one had an ectopic pregnancy and 16 delivered elsewhere. leaving 180 cases for analysis. Spontaneous abortions (SAb's) were not more common in cases compared with controls (7.8% \IS 8.3%, p=NS). SAb's were not related to myoma size. or location; however SAb's were more common with solitary compared with multiple myomas (5.5% vs 17%, p=O.02). Preterm deliveries were not more frequent in cases than in controls (9.6% vs. 9.7%). Cesarean sections were more common in cases than in controls (23% vs 14%. p 5cm (35% vs 16%, p<0.01). There were no increased occurrences of placental abruptio (1.2% vs 0.4%). fetal growth retardation < 5th percentile (3.6% vs 4.5%). preterm membrane rupture (2.4% vs 4.0%). post-partum hemorrhage> 500 cc (16.5% vs 17.6%), or post-partum endometritis (0.8% vs 0.9%). in cases compared with controls. However there was an inereased prevalence ofplacenla previa in cases compared with controls (3.6% vs 0.6%. p<0.01). SUMMARY; Uterine myomas were found to be associated with an increased occurrence of cesarean sections and placenta previa, but not of SAb or preterm delivery.
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WHAT IS THE PREDICTIVE VALUE OF A FOURCHAMBER VIEW OF THE FETAL HEART IN TilE PRENATAL DIAGNOSIS OF CONGENITAL HEART DEFECTS? A. Ghidini x, P. Verganix. S. Mariani" R. Schiavinax • l. Ciarlax, A. Spelta X , N. Strobeltx. MI. Sinai School of Medicine. New York. NY and SI. Gerardo Hospital. Mo07.a. Italy, In January 1987 we introduced the four-chamber fetal heart view to scw.en for eonge... ital heart defects (CHDs) during all prenatal ultrasound examinations. We now eompare the detection rate for CHD during the subsequent threc years (1987 -89) to that during the two preceding years (1985-86). Routine ultrasound examinations were performed 011 9016 women during the period 1985-89. All patients were followed through delivery or termination of the pregnancy. and neonatal clinical or autopsy confirmation of prenatal findings were available on all cases. The four-chamber view was considered abnormal if any of the following findings were detected: ventricular disproportion. myocardial hypertrophy, dilation or hypoplasia of any cardiac chamber. septal defect. or atrio-ventricular valve deformity. The overall prevalence of CHDs was 0.53% (48/9016). A four-chamber view of the fetal heart was obtained in 95% of cases. During the years 1985-86. 16 neonates with CHDs were identified. 7 of which were prenatally diagnosed (sensitivity 43%). During the period 1987-89.32 cases of CHDs occurred. 26 of which were diagnosed antenatally (sensitivity = 81%. p = 0.01). No false positive diagnoses were made in either time-period. therefore the specificity was 100%. The four-chamber of the fetal heart is easily oblained. docs not significantly inerea'C the duration of a routine ultrasound examination and has an excellent sensitivity for the identification of CHDs.
176 TRANSVERSE CEREBELlAR DIAMETER (TCD) IN 'IWIN GESTATIONS. T Shimizu'; S GaUdette'; C N:inrr>od, Division of Perinatology, Dept. of Ob/Gyn, Ottawa General Hospital, Ottawa, Canada. Fetal biometric measurements are accepted to be useful for assessing intrauterine fetal growth in twin pairs. Although TCD is reported to be \.Ulaffected by IUGR in singleton pregnancy, there has not been any study on TCD in twin pregnancy. The present study canpared TCD measurements in singletons with those in twins and also the effect of the chorionicity and discordancy on TCD growth. TCD was measured in both 94 fetuses of 47 normal concordant twin pairs and normal 329 singleton fetuses between 15 and 36 weeks. There was no significant difference in TCD measurements between normal singleton and twin gestations. TCD is \.Ulaffected by the chorionicity in normal concovdant twin pairs. Mean % intrapair differences in BPD, TCD, HC, AC, FL, and estimated fetal weight were canpared between concordant (n =-13) and discordant (n-;;ll) twin pairs. Only TCD and HC did not show significant differences (P~ 0.80ll; p: 0.095). This study suggests that TCD is not impaired in discordant twin pairs and singleton normograms may be useful in all types of twin growth assessment.
USE OF THE TRANSVERSE CEREBELLAR/ABDOMINAL CIRCUMFERENCE RATIO TO IDENTIFY GROWTH RETARDED FETUSES. W.A. Campbell A.M. Vintzileos, J.F. Rodis, G.W. Turner, J.FX. Egan. D.Nardi.X University of COlmecticut Health Center. Farmington, CT SPO 1990-Abstract #519 reported that the transverse cerebellar/abdominal circumference ratio (TCD/AC) is gestalional age independent and might be useful to diagnose intrauterine growth retardation (IUGR). We undertook this study to evaluate this. Methods:Patients were prospectively enrolled if. they had sure dates (l st 'trimester prenatal care and/or ultrasound :5 20 weeks), and their pregnancy WjlS at risk for IUGR (eg. hypertension, drug abuse). At each
ultrasound examination a transverse cerebellar diameter was obtained
along with standard growth measurements. The TCD/AC was calculated for each examination. IUGR was defined as a birth weight (BW) :5 the 10th %ile for gestational age. A TCD/AC was abnormal when> 15.9%.
The examination t9 delivery interval waS $' 14 days for alJ cases.
Results: Eighty-seven (87) patients were analyzed. Based on BW. 48/87 (55%) neonates had IUGR. Comparing IUGR and non-IUGR groups~ th~re
was no significant difference in the mean gestational age
at delivery, or examination to delivery interval (4 days). Growth measurements were significantly smaller in the IUGR cases (p< .05).
The exception was the TeD measurement, which was not significanlly
different between the groups (p=.2). The mean TCD/AC ratio was 16.6% for the IUGR cases; significantly large.r tllan nOIl-IUGR cases (14.8%- p <.05). There were 14/48 (29%) IUGR cases missed by the TCD/AC; 57% of these cases had a BW < 3rd %ile. The TCD/At had a sensitivity of 71 %, specificity 77%. positive predictive value 79%,
negative predictive v.lue 68%. Summary: The TCD/AC ratio can be a useful adjunct for evaluation of fetuses at risk for IUGR. If BW is < 3rd %ile this ratio may be normal.
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Volume 166 N umber I, Part 2
173
174
CLINICAL SIGNIFICANCE OF UTERINE LEIOMYOMATA IN PREGNANCY. A Ghidin?, P. Vergan?, N. Strobelt X , N. RoncagliaX, A. Spell}" A. Locatelli x . MI. Sinai School of Medicine, New York, NY, SI. Gerardo Hospital, Monza, Italy. The clinical significance of uterine myomas in pregnancy has only been examined in small retrospective studies. leading to conflicting results. From Jan. 1983 to Jan. 1988 we followed prospectively 209 pregnant patients with sonographically identified myomas and 7523 pregnant women. without myomas. Site. number and location of myomas were documented. Among patients with fibroids, 12 had elective abortions performed, one had an ectopic pregnancy and 16 delivered elsewhere. leaving 180 cases for analysis. Spontaneous abortions (SAb's) were not more common in cases compared with controls (7.8% \IS 8.3%, p=NS). SAb's were not related to myoma size. or location; however SAb's were more common with solitary compared with multiple myomas (5.5% vs 17%, p=O.02). Preterm deliveries were not more frequent in cases than in controls (9.6% vs. 9.7%). Cesarean sections were more common in cases than in controls (23% vs 14%. p
175
WHAT IS THE PREDICTIVE VALUE OF A FOURCHAMBER VIEW OF THE FETAL HEART IN TilE PRENATAL DIAGNOSIS OF CONGENITAL HEART DEFECTS? A. Ghidini x, P. Verganix. S. Mariani" R. Schiavinax • l. Ciarlax, A. Spelta X , N. Strobeltx. MI. Sinai School of Medicine. New York. NY and SI. Gerardo Hospital. Mo07.a. Italy, In January 1987 we introduced the four-chamber fetal heart view to scw.en for eonge... ital heart defects (CHDs) during all prenatal ultrasound examinations. We now eompare the detection rate for CHD during the subsequent threc years (1987 -89) to that during the two preceding years (1985-86). Routine ultrasound examinations were performed 011 9016 women during the period 1985-89. All patients were followed through delivery or termination of the pregnancy. and neonatal clinical or autopsy confirmation of prenatal findings were available on all cases. The four-chamber view was considered abnormal if any of the following findings were detected: ventricular disproportion. myocardial hypertrophy, dilation or hypoplasia of any cardiac chamber. septal defect. or atrio-ventricular valve deformity. The overall prevalence of CHDs was 0.53% (48/9016). A four-chamber view of the fetal heart was obtained in 95% of cases. During the years 1985-86. 16 neonates with CHDs were identified. 7 of which were prenatally diagnosed (sensitivity 43%). During the period 1987-89.32 cases of CHDs occurred. 26 of which were diagnosed antenatally (sensitivity = 81%. p = 0.01). No false positive diagnoses were made in either time-period. therefore the specificity was 100%. The four-chamber of the fetal heart is easily oblained. docs not significantly inerea'C the duration of a routine ultrasound examination and has an excellent sensitivity for the identification of CHDs.
176 TRANSVERSE CEREBELlAR DIAMETER (TCD) IN 'IWIN GESTATIONS. T Shimizu'; S GaUdette'; C N:inrr>od, Division of Perinatology, Dept. of Ob/Gyn, Ottawa General Hospital, Ottawa, Canada. Fetal biometric measurements are accepted to be useful for assessing intrauterine fetal growth in twin pairs. Although TCD is reported to be \.Ulaffected by IUGR in singleton pregnancy, there has not been any study on TCD in twin pregnancy. The present study canpared TCD measurements in singletons with those in twins and also the effect of the chorionicity and discordancy on TCD growth. TCD was measured in both 94 fetuses of 47 normal concordant twin pairs and normal 329 singleton fetuses between 15 and 36 weeks. There was no significant difference in TCD measurements between normal singleton and twin gestations. TCD is \.Ulaffected by the chorionicity in normal concovdant twin pairs. Mean % intrapair differences in BPD, TCD, HC, AC, FL, and estimated fetal weight were canpared between concordant (n =-13) and discordant (n-;;ll) twin pairs. Only TCD and HC did not show significant differences (P~ 0.80ll; p: 0.095). This study suggests that TCD is not impaired in discordant twin pairs and singleton normograms may be useful in all types of twin growth assessment.
USE OF THE TRANSVERSE CEREBELLAR/ABDOMINAL CIRCUMFERENCE RATIO TO IDENTIFY GROWTH RETARDED FETUSES. W.A. Campbell A.M. Vintzileos, J.F. Rodis, G.W. Turner, J.FX. Egan. D.Nardi.X University of COlmecticut Health Center. Farmington, CT SPO 1990-Abstract #519 reported that the transverse cerebellar/abdominal circumference ratio (TCD/AC) is gestalional age independent and might be useful to diagnose intrauterine growth retardation (IUGR). We undertook this study to evaluate this. Methods:Patients were prospectively enrolled if. they had sure dates (l st 'trimester prenatal care and/or ultrasound :5 20 weeks), and their pregnancy WjlS at risk for IUGR (eg. hypertension, drug abuse). At each
ultrasound examination a transverse cerebellar diameter was obtained
along with standard growth measurements. The TCD/AC was calculated for each examination. IUGR was defined as a birth weight (BW) :5 the 10th %ile for gestational age. A TCD/AC was abnormal when> 15.9%.
The examination t9 delivery interval waS $' 14 days for alJ cases.
Results: Eighty-seven (87) patients were analyzed. Based on BW. 48/87 (55%) neonates had IUGR. Comparing IUGR and non-IUGR groups~ th~re
was no significant difference in the mean gestational age
at delivery, or examination to delivery interval (4 days). Growth measurements were significantly smaller in the IUGR cases (p< .05).
The exception was the TeD measurement, which was not significanlly
different between the groups (p=.2). The mean TCD/AC ratio was 16.6% for the IUGR cases; significantly large.r tllan nOIl-IUGR cases (14.8%- p <.05). There were 14/48 (29%) IUGR cases missed by the TCD/AC; 57% of these cases had a BW < 3rd %ile. The TCD/At had a sensitivity of 71 %, specificity 77%. positive predictive value 79%,
negative predictive v.lue 68%. Summary: The TCD/AC ratio can be a useful adjunct for evaluation of fetuses at risk for IUGR. If BW is < 3rd %ile this ratio may be normal.
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