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2086408 The Adjuvant, Hemostatic Use of a Foley Balloon Catheter in the Treatment of Cesarean Scar and Cervical Pregnancies
Abstracts
Cx appears safe and is associated with excellent pregnancy outcomes. 2086408 The Adjuvant, Hemostatic Use of a Foley Balloon Catheter in the Treatment of Cesarean Scar and Cervical Pregnancies Ilan E. Timor-Tritsch,1 Giuseppe Cali,2 Ana Monteagudo,1 Robert Berg,1 Francesco Forlani2 1 Ob/Gyn, NYU School of Medicine, New York, NY, United States; 2Arnas Civico Hospital, Palermo, Italy Objectives: We evaluated the hemostatic effect of a Foley balloon catheter after treatment or in bleeding cesarean scar pregnancy (CSP) and cervical pregnancy (CxP). Methods: We present 16 patients from 2 centers, in which Foley balloon catheters were used as an adjuvant treatment to prevent/manage bleeding from the CSP/CxP. Fifteen patients had CSP and 2 were CxPs with GA ranging 5wks/6dys-12wks. Initial hCG levels before/after treatment and length of the catheters will be detailed in a table at the presentation. Silicon catheters with inflatable balloon volume capacity between 5 & 30 ml placed under real time US guidance to achieve desired size/effect. Catheters were kept in place for a mean of 3.6 days. Treatment: 14 patients with local intragestational sac and systemic injection of methotrexate; 2 by Foley catheter; 7 included additional suction aspiration of the sac on day 5 hCG returned below 25 IU/mL between 27-32 days. Second series of 8 patients hCG returned to below 5 IU/ mL was 34-82 days. Results: Foley balloon tamponade effectively reduced/prevented vaginal bleeding in all but 1 patient with heterotopic intrauterine and CxP. Overall catheter placement was tolerated well by patients. Conclusions: Foley balloon tamponade, used as an ‘‘up-front’’ preventive/adjuvant treatment method to control bleeding from CSP/CxP, is simple, effective, easy to use and can alleviate complications/prevent risky surgical interventions. 2091721 Cervical Length at 16 And 18 Weeks Gestational Age in Extremely and Very Preterm Twin Births Katherine Hrebinko,2,3 Stephanie Hope Factor,1,3 Maria Teresa Mella,3 Meredith Miller,3 3 3 1 Angela Bianco, Joanne Stone Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Obstetrics, Gynecology and Reproductive Science/Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States Objectives: Research has shown an association between cervical length (CL) obtained within the interval of 18 and 24 weeks gestational age (GA) and early delivery in dichorionic-diamniotic (di-di) twins; CL routinely collected at 16 and 18 weeks has not yet been examined. Two case-control studies determined if CL measured at 16 and 18 weeks GA from 1/08 through 6/13 was predictive of delivery of di-di twins # 28 weeks and # 32 weeks Methods: For the first case-control study, case-patients were di-di twin pregnancies with GA at delivery # 28 weeks and control subjects were di-di twin pregnancies with
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GA at delivery $ 36 weeks. For the second case-control study, case-patients were di-di twin pregnancies with GA # 32 weeks and control subjects were di-di twin pregnancies with GA $ 36 weeks. A chart review identified patient characteristics and cervical lengths measured by ultrasound at 16 and 18 weeks GA. Exclusion criteria included cerclage placement, major fetal anomalies, monochorionicity, and multiple fetal pregnancy reduction. A T-test compared CL. Results: There were no differences in age, race, mode of conception and BMI in the 16 di-di twin pregnancies with GA # 28 weeks compared to the 251 di-di twin pregnancies with GA $ 36 weeks. The CL at 16 weeks was not different in those with GA # 28 weeks compared to those with GA $ 36 weeks [4.3 cm (6 0.8) vs. 4.8 cm (6 0.7), P5.10]. The CL at 18 weeks was shorter in those with GA # 28 weeks compared to those with GA $ 36 [3.7 cm (6 0.5 cm) vs. 4.8 cm (6 0.8 cm), P5.009]. There were no differences in age, race, mode of conception and BMI in the 49 di-di twin pregnancies with GA # 32 weeks compared to the 251 twin pregnancies with GA $ 36 weeks. The CL at 16 weeks was not different in those with GA # 32 weeks compared to those with GA $ 36 weeks [4.6 cm (6 1.0) vs. 4.8 cm (6 0.7), P5.26]. The CL at 18 weeks was shorter in those with GA # 32 weeks compared to those with GA $ 36 weeks [4.3 cm (6 0.6) vs. 4.8 cm (6 0.8), P5.03]. Conclusions: This data suggest that the biological mechanism associated with deliveries # 28 and # 32 weeks are observable in CL measurements at 18 weeks. More research is needed to determine the usefulness of CL measurements at 16 weeks. 2080099 Does the Presence of Intra-Amniotic ‘‘Sludge’’ Affect Pregnancy Outcome in Patients Undergoing Cerclage for a Short Cervix? Fereshteh Boozarjomehri,1 Margaret Dziadosz,4 Morgan R. Peltier,3 Fatima Sarah Boozarjomehri,2 Anthony Mark Vintzileos,1 Ilan E. Timor-Tritsch,4 Frederick Naftolin4 1OBGYN, Winthrop University Hospital, Mineola, NY, United States; 2Swarthmore College, Swarthmore, PA, United States; 3OBGYN, Winthrop University Hospital, Mineola, NY, United States; 4OBGYN, New York University School of Medicine, New York, NY, United States Objectives: Previous studies have shown that intraamniotic ‘‘sludge’’ (IAS), a sonographic finding of hyperechoic matter in the amniotic fluid close to the internal os, is associated with high risk for preterm birth due to intaamniotic infection. The aim of this study was to determine if IAS affects pregnancy outcome in asymptomatic patients (pts) undergoing a sonographically indicated cerclage for a short cervix. Methods: A case records of 46 consecutive pts, who underwent MacDonald cerclage between 16-24 6/7 weeks for a sonographically short Cx (,25 mm), were reviewed for transvaginal ultrasound images of IAS. Baseline morphalogical characteristics and pregnancy outcomes were compared between those with and without IAS. Results: Of the 46 pts, 33 had IAS present and 13 did not. Comparison of the two groups is shown in the Table. Pts with IAS had significantly shorter Cx lengths at the time of the procedure 8.9 6 7.1 vs.17.2 6 6.3 mm; P 5 0.007) and more frequently had Cx funneling (P 5 0.005). Other baseline characteristics were largely similar. Adjustment for differences
Cx appears safe and is associated with excellent pregnancy outcomes. 2086408 The Adjuvant, Hemostatic Use of a Foley Balloon Catheter in the Treatment of Cesarean Scar and Cervical Pregnancies Ilan E. Timor-Tritsch,1 Giuseppe Cali,2 Ana Monteagudo,1 Robert Berg,1 Francesco Forlani2 1 Ob/Gyn, NYU School of Medicine, New York, NY, United States; 2Arnas Civico Hospital, Palermo, Italy Objectives: We evaluated the hemostatic effect of a Foley balloon catheter after treatment or in bleeding cesarean scar pregnancy (CSP) and cervical pregnancy (CxP). Methods: We present 16 patients from 2 centers, in which Foley balloon catheters were used as an adjuvant treatment to prevent/manage bleeding from the CSP/CxP. Fifteen patients had CSP and 2 were CxPs with GA ranging 5wks/6dys-12wks. Initial hCG levels before/after treatment and length of the catheters will be detailed in a table at the presentation. Silicon catheters with inflatable balloon volume capacity between 5 & 30 ml placed under real time US guidance to achieve desired size/effect. Catheters were kept in place for a mean of 3.6 days. Treatment: 14 patients with local intragestational sac and systemic injection of methotrexate; 2 by Foley catheter; 7 included additional suction aspiration of the sac on day 5 hCG returned below 25 IU/mL between 27-32 days. Second series of 8 patients hCG returned to below 5 IU/ mL was 34-82 days. Results: Foley balloon tamponade effectively reduced/prevented vaginal bleeding in all but 1 patient with heterotopic intrauterine and CxP. Overall catheter placement was tolerated well by patients. Conclusions: Foley balloon tamponade, used as an ‘‘up-front’’ preventive/adjuvant treatment method to control bleeding from CSP/CxP, is simple, effective, easy to use and can alleviate complications/prevent risky surgical interventions. 2091721 Cervical Length at 16 And 18 Weeks Gestational Age in Extremely and Very Preterm Twin Births Katherine Hrebinko,2,3 Stephanie Hope Factor,1,3 Maria Teresa Mella,3 Meredith Miller,3 3 3 1 Angela Bianco, Joanne Stone Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Obstetrics, Gynecology and Reproductive Science/Maternal Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States Objectives: Research has shown an association between cervical length (CL) obtained within the interval of 18 and 24 weeks gestational age (GA) and early delivery in dichorionic-diamniotic (di-di) twins; CL routinely collected at 16 and 18 weeks has not yet been examined. Two case-control studies determined if CL measured at 16 and 18 weeks GA from 1/08 through 6/13 was predictive of delivery of di-di twins # 28 weeks and # 32 weeks Methods: For the first case-control study, case-patients were di-di twin pregnancies with GA at delivery # 28 weeks and control subjects were di-di twin pregnancies with
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GA at delivery $ 36 weeks. For the second case-control study, case-patients were di-di twin pregnancies with GA # 32 weeks and control subjects were di-di twin pregnancies with GA $ 36 weeks. A chart review identified patient characteristics and cervical lengths measured by ultrasound at 16 and 18 weeks GA. Exclusion criteria included cerclage placement, major fetal anomalies, monochorionicity, and multiple fetal pregnancy reduction. A T-test compared CL. Results: There were no differences in age, race, mode of conception and BMI in the 16 di-di twin pregnancies with GA # 28 weeks compared to the 251 di-di twin pregnancies with GA $ 36 weeks. The CL at 16 weeks was not different in those with GA # 28 weeks compared to those with GA $ 36 weeks [4.3 cm (6 0.8) vs. 4.8 cm (6 0.7), P5.10]. The CL at 18 weeks was shorter in those with GA # 28 weeks compared to those with GA $ 36 [3.7 cm (6 0.5 cm) vs. 4.8 cm (6 0.8 cm), P5.009]. There were no differences in age, race, mode of conception and BMI in the 49 di-di twin pregnancies with GA # 32 weeks compared to the 251 twin pregnancies with GA $ 36 weeks. The CL at 16 weeks was not different in those with GA # 32 weeks compared to those with GA $ 36 weeks [4.6 cm (6 1.0) vs. 4.8 cm (6 0.7), P5.26]. The CL at 18 weeks was shorter in those with GA # 32 weeks compared to those with GA $ 36 weeks [4.3 cm (6 0.6) vs. 4.8 cm (6 0.8), P5.03]. Conclusions: This data suggest that the biological mechanism associated with deliveries # 28 and # 32 weeks are observable in CL measurements at 18 weeks. More research is needed to determine the usefulness of CL measurements at 16 weeks. 2080099 Does the Presence of Intra-Amniotic ‘‘Sludge’’ Affect Pregnancy Outcome in Patients Undergoing Cerclage for a Short Cervix? Fereshteh Boozarjomehri,1 Margaret Dziadosz,4 Morgan R. Peltier,3 Fatima Sarah Boozarjomehri,2 Anthony Mark Vintzileos,1 Ilan E. Timor-Tritsch,4 Frederick Naftolin4 1OBGYN, Winthrop University Hospital, Mineola, NY, United States; 2Swarthmore College, Swarthmore, PA, United States; 3OBGYN, Winthrop University Hospital, Mineola, NY, United States; 4OBGYN, New York University School of Medicine, New York, NY, United States Objectives: Previous studies have shown that intraamniotic ‘‘sludge’’ (IAS), a sonographic finding of hyperechoic matter in the amniotic fluid close to the internal os, is associated with high risk for preterm birth due to intaamniotic infection. The aim of this study was to determine if IAS affects pregnancy outcome in asymptomatic patients (pts) undergoing a sonographically indicated cerclage for a short cervix. Methods: A case records of 46 consecutive pts, who underwent MacDonald cerclage between 16-24 6/7 weeks for a sonographically short Cx (,25 mm), were reviewed for transvaginal ultrasound images of IAS. Baseline morphalogical characteristics and pregnancy outcomes were compared between those with and without IAS. Results: Of the 46 pts, 33 had IAS present and 13 did not. Comparison of the two groups is shown in the Table. Pts with IAS had significantly shorter Cx lengths at the time of the procedure 8.9 6 7.1 vs.17.2 6 6.3 mm; P 5 0.007) and more frequently had Cx funneling (P 5 0.005). Other baseline characteristics were largely similar. Adjustment for differences