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185: Uterine scar imaging in women with previous caesarean delivery
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Ultrasound, Fetus, Genetics
result in an outcome of SGA (51.1% vs. 11.4%; p<0.01) as was BW<5th% (23.4% vs. 4.4%; p<0.01). When patients were complicated by both EFW 10-20th% and preeclampsia, 70.9% (vs. 50.6% without preeclampsia) resulted in an SGA outcome (p<0.05). CONCLUSION: Fetuses with an EFW in the 10-20th% on US, considered by most to be in the normal range, were 10 times more likely to result in neonates with SGA. Even after excluding those gestations that had subsequent IUGR on US, an EFW 10-20th% carried an 8-fold risk for SGA. An EFW 10-20th% complicated by preeclampsia were almost twice as likely to result in an SGA neonate. Pregnancies with fetal growth between the 10-20th percentile may warrant increased antenatal surveillance.
Outcomes in birth weight for neonates with an estimated fetal weight between the 10th to 20th percentile
184 Effect of maternal retroplacental leiomyomata on fetal growth Jordan Knight1, John Elliott1, Odul Amburgey1 1
Riverside Methodist Hospital, Maternal Fetal Medicine, Columbus, OH
OBJECTIVE: To evaluate the effect of retroplacental uterine leiomyo-
mata identified on routine second trimester ultrasound on fetal growth. STUDY DESIGN: A retrospective cohort study of women with singleton pregnancies undergoing routine second trimester fetal anatomic ultrasound at our institution between 2007 and 2012 was completed. The presence or absence of one or more retroplacental leiomyomata was noted. Obstetric and delivery outcomes were obtained through OhioHeath Medical Records. Birth weights of infants of women with at least one retroplacental leiomyoma were compared to a matched cohort of women without leiomyomata. The primary outcomes were fetal birth weight and incidence of SGA infants, defined as birth weight less than 10th percentile for gestational age. Confounders such as maternal medical conditions were accounted for. Secondary analysis evaluated the potential effect of number and size (as measured by greatest diameter) of leiomyomata. RESULTS: 14,156 women underwent routine second trimester anatomic survey. The incidence of leiomyomata was 4.0% (n¼ 453). Of women with documented leiomyomata, 38% (n¼ 172) had at least one retroplacental leiomyoma. Complete obstetric outcome data was available for 141 of these women. Birth weight at delivery was 177g less in women with retroplacental leiomyomata compared to women without leiomyomata [p¼ 0.003, 95% CI: -295g - -95g]. There was a trend in the incidence of SGA infants born to women with retroplacental leiomyomata vs. women without leiomyomata [OR ¼ 2.58 (95%CI: 0.97-6.84), p ¼ 0.057]. Women with a leiomyoma greater than 5 cm in size were more likely to have an SGA infant compared to controls [OR ¼ 2.84 (95%CI: 1.01-8.01), p ¼ 0.048]. There was no effect of multiple retroplacental leiomyomata vs. single leiomyoma. CONCLUSION: Infants born to women with one or more retroplacental leiomyomata have lower birth weight compared to infants born to women with no leiomyomata. Additionally, retroplacental leiomyomata greater than 5 cm conferred significant risk of SGA.
Poster Session I
185 Uterine scar imaging in women with previous caesarean delivery Elisabetta Petrella1, Federica Fiocchi2, Luca Nocetti3, Serena Curra`2, Tiziana Costi3, Pietro Torricelli2, Fabio Facchinetti1 1 University of Modena and Reggio Emilia, Mother-Infant Department, Modena, Italy, 2University of Modena and Reggio Emilia, Department of Radiology, Modena, Italy, 3University of Modena and Reggio Emilia, Medical Physics Department, Modena, Italy
OBJECTIVE: To investigate the value of Magnetic Resonance with Diffusion Tensor Imaging (3T-MRDTI) in assessing uterine scar morphology and myometrial fibers organization in women with prior caesarean delivery (pCD). STUDY DESIGN: Transvaginal ultrasonography (TVU) and 3T-MRDTI were performed after 12,18,24,36 months since pCD. Scars were subjectively classified as “linear” or “retracting”. Myometrial thickness over the scar was measured. To identify the degree of disarray of fibers running through a region of interest (ROI), different ROIs were placed at isthmus, both in posterior (Fig a, b) and anterior wall (Fig c, d) and fiber-tracking was then performed. The percent difference of anterior vs posterior fibers was calculated, according to uterine position, time since pCD, number/type (emergent/elective) of pCD and layers of closure at hysterorraphy. RESULTS: Fourty-four subjects had 1 pCD, 17 had 2 pCD and 12 had just a prior vaginal delivery (Controls). TVU and 3T-MRDTI scar description was discrepant in 39.3%. In linear scars myometrium thickness was higher at 3T-MR (7.31.6mm) compared to TVU (5.71.8mm, p¼0.004). The opposite occurred in retracting scars (3T-MR:4.41.6mm, TVU:5.72.5mm, p¼0.023). A significant reduction of fibers running through the anterior vs posterior wall was evident in subjects with pCD at 3T-MRDTI. Quantitatively, anterior fibers reduction was higher in pCD (Median -50%; IQ:-70%, -30%) respect with Controls (-2%; -27%, 22%, p<0.0001). The reduction is more pronounced in retracting scars (-59%; -82%, -38%) vs linear ones (-37%; -64%, -18%; p¼0.005). Reduction was unaffected by uterine position, layers of closure and type/number of pCD. Since 12th month after pCD, a trend (p¼0.041) toward a slower upturn to a higher percentage of fibers was found. Women with VBAC showed a fiber reduction (-55%; -72%, -48%) similar to those with pCD. CONCLUSION: Quantitative data obtained through 3T-MRDTI seem helpful in assessing myometrial healing according to scar morphology and time since surgery.
Degree of disarray of myometrial fibers running through selected ROIs
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S103
Ultrasound, Fetus, Genetics
result in an outcome of SGA (51.1% vs. 11.4%; p<0.01) as was BW<5th% (23.4% vs. 4.4%; p<0.01). When patients were complicated by both EFW 10-20th% and preeclampsia, 70.9% (vs. 50.6% without preeclampsia) resulted in an SGA outcome (p<0.05). CONCLUSION: Fetuses with an EFW in the 10-20th% on US, considered by most to be in the normal range, were 10 times more likely to result in neonates with SGA. Even after excluding those gestations that had subsequent IUGR on US, an EFW 10-20th% carried an 8-fold risk for SGA. An EFW 10-20th% complicated by preeclampsia were almost twice as likely to result in an SGA neonate. Pregnancies with fetal growth between the 10-20th percentile may warrant increased antenatal surveillance.
Outcomes in birth weight for neonates with an estimated fetal weight between the 10th to 20th percentile
184 Effect of maternal retroplacental leiomyomata on fetal growth Jordan Knight1, John Elliott1, Odul Amburgey1 1
Riverside Methodist Hospital, Maternal Fetal Medicine, Columbus, OH
OBJECTIVE: To evaluate the effect of retroplacental uterine leiomyo-
mata identified on routine second trimester ultrasound on fetal growth. STUDY DESIGN: A retrospective cohort study of women with singleton pregnancies undergoing routine second trimester fetal anatomic ultrasound at our institution between 2007 and 2012 was completed. The presence or absence of one or more retroplacental leiomyomata was noted. Obstetric and delivery outcomes were obtained through OhioHeath Medical Records. Birth weights of infants of women with at least one retroplacental leiomyoma were compared to a matched cohort of women without leiomyomata. The primary outcomes were fetal birth weight and incidence of SGA infants, defined as birth weight less than 10th percentile for gestational age. Confounders such as maternal medical conditions were accounted for. Secondary analysis evaluated the potential effect of number and size (as measured by greatest diameter) of leiomyomata. RESULTS: 14,156 women underwent routine second trimester anatomic survey. The incidence of leiomyomata was 4.0% (n¼ 453). Of women with documented leiomyomata, 38% (n¼ 172) had at least one retroplacental leiomyoma. Complete obstetric outcome data was available for 141 of these women. Birth weight at delivery was 177g less in women with retroplacental leiomyomata compared to women without leiomyomata [p¼ 0.003, 95% CI: -295g - -95g]. There was a trend in the incidence of SGA infants born to women with retroplacental leiomyomata vs. women without leiomyomata [OR ¼ 2.58 (95%CI: 0.97-6.84), p ¼ 0.057]. Women with a leiomyoma greater than 5 cm in size were more likely to have an SGA infant compared to controls [OR ¼ 2.84 (95%CI: 1.01-8.01), p ¼ 0.048]. There was no effect of multiple retroplacental leiomyomata vs. single leiomyoma. CONCLUSION: Infants born to women with one or more retroplacental leiomyomata have lower birth weight compared to infants born to women with no leiomyomata. Additionally, retroplacental leiomyomata greater than 5 cm conferred significant risk of SGA.
Poster Session I
185 Uterine scar imaging in women with previous caesarean delivery Elisabetta Petrella1, Federica Fiocchi2, Luca Nocetti3, Serena Curra`2, Tiziana Costi3, Pietro Torricelli2, Fabio Facchinetti1 1 University of Modena and Reggio Emilia, Mother-Infant Department, Modena, Italy, 2University of Modena and Reggio Emilia, Department of Radiology, Modena, Italy, 3University of Modena and Reggio Emilia, Medical Physics Department, Modena, Italy
OBJECTIVE: To investigate the value of Magnetic Resonance with Diffusion Tensor Imaging (3T-MRDTI) in assessing uterine scar morphology and myometrial fibers organization in women with prior caesarean delivery (pCD). STUDY DESIGN: Transvaginal ultrasonography (TVU) and 3T-MRDTI were performed after 12,18,24,36 months since pCD. Scars were subjectively classified as “linear” or “retracting”. Myometrial thickness over the scar was measured. To identify the degree of disarray of fibers running through a region of interest (ROI), different ROIs were placed at isthmus, both in posterior (Fig a, b) and anterior wall (Fig c, d) and fiber-tracking was then performed. The percent difference of anterior vs posterior fibers was calculated, according to uterine position, time since pCD, number/type (emergent/elective) of pCD and layers of closure at hysterorraphy. RESULTS: Fourty-four subjects had 1 pCD, 17 had 2 pCD and 12 had just a prior vaginal delivery (Controls). TVU and 3T-MRDTI scar description was discrepant in 39.3%. In linear scars myometrium thickness was higher at 3T-MR (7.31.6mm) compared to TVU (5.71.8mm, p¼0.004). The opposite occurred in retracting scars (3T-MR:4.41.6mm, TVU:5.72.5mm, p¼0.023). A significant reduction of fibers running through the anterior vs posterior wall was evident in subjects with pCD at 3T-MRDTI. Quantitatively, anterior fibers reduction was higher in pCD (Median -50%; IQ:-70%, -30%) respect with Controls (-2%; -27%, 22%, p<0.0001). The reduction is more pronounced in retracting scars (-59%; -82%, -38%) vs linear ones (-37%; -64%, -18%; p¼0.005). Reduction was unaffected by uterine position, layers of closure and type/number of pCD. Since 12th month after pCD, a trend (p¼0.041) toward a slower upturn to a higher percentage of fibers was found. Women with VBAC showed a fiber reduction (-55%; -72%, -48%) similar to those with pCD. CONCLUSION: Quantitative data obtained through 3T-MRDTI seem helpful in assessing myometrial healing according to scar morphology and time since surgery.
Degree of disarray of myometrial fibers running through selected ROIs
Supplement to JANUARY 2014 American Journal of Obstetrics & Gynecology
S103