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343: Cardiac function monitoring before, during and after labor: impedance cardiography versus echocardiography
Poster Session II
Diabetes, Labor, Ultrasound-Imaging
www.AJOG.org
varying gestational ages at the time of diagnosis, as well as interval between diagnosis and CVS.
Mean CRL at initial NT (mm)
Resolved NT
Persistent NT
47 (n ⫽30)
54 (n ⫽196)
p 0.001
..........................................................................................................................................................................................
Interval between NT and 5.9 (n ⫽29) 1.6 (n ⫽177) ⬍0.0001 CVS (days) .......................................................................................................................................................................................... Twins 4% (n ⫽ 9) 13% (n ⫽31) 0.058 .......................................................................................................................................................................................... Aneuploidy 4 /26 (15%) 59/142 (41%) 0.011 .......................................................................................................................................................................................... Abnormal anatomy 3/20 (15%) 24 /86 (28%) 0.232 .......................................................................................................................................................................................... Live birth 18 /22 (82%) 51/113 (45%) 0.0016 ..........................................................................................................................................................................................
343 Cardiac function monitoring before, during and after labor: impedance cardiography versus echocardiography Janet Burlingame1, Patrick Ohana2, Michael Aaronoff 3, Todd Seto4
Jason D Retzke1, Christine M Kovac1, David S McKenna2, Catherine M Downing3, Jiri D Sonek3 1
1
John A Burns University of Hawaii School of Medicine, Honolulu, HI, 2The Research Corporation of the University of Hawaii, Honolulu, HI, 3The University of Hawaii, Honolulu, HI, 4The Queen’s Medical Center, Honolulu, HI
OBJECTIVE: To determine if selected measurements shared by impedance cardiography (ICG) and echocardiography (ECG) are comparable before, during and after labor. STUDY DESIGN: A pilot study involving 64 paired measurements of 28 healthy parturients (Mean age ⫽ 30.8 years, SD ⫽ 5.2 years) was carried out (26 measurements before labor, 18 during labor, and 20 after labor) using the CardioDynamics BioZ Dx (ICG) and the GE Vivid e (ECG) in the left lateral recumbent supine position. Inclusion criteria included uncomplicated pregnancy, gestational age ⬎ 31 weeks, and 18-45 years of age. Exclusion criteria included pre-existing heart disease, diagnosed hypertensive disorder, and clinical diagnosis of pulmonary edema.Pearson correlations and Bland-Altman plots of difference by average were generated for stroke volume (SV), stroke index (SI), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI). RESULTS: Pearson correlations were significant for SV, SVR and SVRI before labor, and SV, CO, CI, SVR and SVRI during labor, while Bland-Altman plots, a statistical evaluation of agreement between the two methods of measuring hemodynamic data, showed acceptable agreement for all six parameters before, during and after labor (see examples in Table 1 and Figure 1). CONCLUSIONS: ICG, a non-invasive method like ECG, does not require the skill level of performing ECG, is subject to very little user error, and is significantly cheaper. An acceptable correlation/ agreement was found between our ICG and ECG data. However, more data is required to narrow the confidence intervals of the Bland-Altman analysis and show a more acceptable clinical use of ICG. Table 1. Pearson r and Bland-Altman mean differences and confidence intervals between the ICG and ECG devices Before Labor During Labor Measurement Nⴝ26 Nⴝ18
After Labor Nⴝ20
SV
NS
.443*
344 The intracranial translucency as a means of first trimester screening for neural tube defects
.770**
Wright State University, Dayton, OH, 2Perinatal Partners, Dayton, OH, Wright State University, Fetal Medicine Foundation USA, Dayton, OH
3
OBJECTIVE: Evaluation of intracranial translucency (IT) may be of value in first trimester screening for meningomyeloceles. We evaluated the feasibility of obtaining an IT and its thickness in relation to gestational age. The thickness of the brain stem (BS) was also measured and the ratio of IT to BS established. STUDY DESIGN: Routine first trimester screening (11⫹0 to 13⫹6 weeks) includes a magnified mid-sagittal view of the fetal profile. The IT may be visualized in this view. Electronically stored images were reviewed from 100 consecutive patients in whom first trimester screening was performed in our unit between 5/27/10 and 7/21/10. Anatomical landmarks to confirm midline view were checked. The IT and the BS were measured and a ratio of the two measurements was calculated (IT/BS). Gestational age, crown-rump length (CRL), and maternal weight were recorded. RESULTS: The mean CRL was 63.9 ⫹/⫺ 7.8 mm (12⫹5 weeks [range: 11⫹2 – 13⫹6 wks]). The IT was identified in 97% of patients (maternal weight of 79.4 ⫹/- 23.9 kg). The mean maternal weight with nonvisualized IT was 124.9 kg. The IT measurement increased linearly with gestation (r2⫽0.28, P⬍0.0001; Figure 1), and the ratio of IT/BS remained unchanged (r2⫽0.003, P⫽0.6; Figure 1). CONCLUSIONS: We found that the IT thickness increases with gestational age while the IT/BS ratio remains unchanged. The IT is an easily identifiable structure visible at the time of first trimester screening. As such, it may be obtained with a minimum of additional time and training. In a previously published report, obliteration of the IT was 100% sensitive and specific for the detection of meningomyeloceles. However, the number of affected fetuses thus identified was quite small. Therefore, future research looking into the efficacy of posterior fossa evaluation as a screening method for meningomyeloceles should not only include the evaluation for absence of the IT but also whether deviations in the size of the IT contribute to its screening efficacy.
..........................................................................................................................................................................................
10.2 (⫺36.3, 56.8)
2.9 (⫺28.0, 33.7)
⫺9.2 (⫺60.1, 41.7)
..........................................................................................................................................................................................
CO
NS
.706**
NS
..........................................................................................................................................................................................
0.5 (⫺3.6, 4.7)
0.3 (⫺1.9, 2.4)
⫺0.6 (⫺4.1, 2.8)
..........................................................................................................................................................................................
SVR
.561**
.663**
NS
..........................................................................................................................................................................................
⫺72.9 (⫺738, 592)
⫺23.0 (⫺448, 442)
245 (⫺630, 1119)
..........................................................................................................................................................................................
S140
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
Diabetes, Labor, Ultrasound-Imaging
www.AJOG.org
varying gestational ages at the time of diagnosis, as well as interval between diagnosis and CVS.
Mean CRL at initial NT (mm)
Resolved NT
Persistent NT
47 (n ⫽30)
54 (n ⫽196)
p 0.001
..........................................................................................................................................................................................
Interval between NT and 5.9 (n ⫽29) 1.6 (n ⫽177) ⬍0.0001 CVS (days) .......................................................................................................................................................................................... Twins 4% (n ⫽ 9) 13% (n ⫽31) 0.058 .......................................................................................................................................................................................... Aneuploidy 4 /26 (15%) 59/142 (41%) 0.011 .......................................................................................................................................................................................... Abnormal anatomy 3/20 (15%) 24 /86 (28%) 0.232 .......................................................................................................................................................................................... Live birth 18 /22 (82%) 51/113 (45%) 0.0016 ..........................................................................................................................................................................................
343 Cardiac function monitoring before, during and after labor: impedance cardiography versus echocardiography Janet Burlingame1, Patrick Ohana2, Michael Aaronoff 3, Todd Seto4
Jason D Retzke1, Christine M Kovac1, David S McKenna2, Catherine M Downing3, Jiri D Sonek3 1
1
John A Burns University of Hawaii School of Medicine, Honolulu, HI, 2The Research Corporation of the University of Hawaii, Honolulu, HI, 3The University of Hawaii, Honolulu, HI, 4The Queen’s Medical Center, Honolulu, HI
OBJECTIVE: To determine if selected measurements shared by impedance cardiography (ICG) and echocardiography (ECG) are comparable before, during and after labor. STUDY DESIGN: A pilot study involving 64 paired measurements of 28 healthy parturients (Mean age ⫽ 30.8 years, SD ⫽ 5.2 years) was carried out (26 measurements before labor, 18 during labor, and 20 after labor) using the CardioDynamics BioZ Dx (ICG) and the GE Vivid e (ECG) in the left lateral recumbent supine position. Inclusion criteria included uncomplicated pregnancy, gestational age ⬎ 31 weeks, and 18-45 years of age. Exclusion criteria included pre-existing heart disease, diagnosed hypertensive disorder, and clinical diagnosis of pulmonary edema.Pearson correlations and Bland-Altman plots of difference by average were generated for stroke volume (SV), stroke index (SI), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI). RESULTS: Pearson correlations were significant for SV, SVR and SVRI before labor, and SV, CO, CI, SVR and SVRI during labor, while Bland-Altman plots, a statistical evaluation of agreement between the two methods of measuring hemodynamic data, showed acceptable agreement for all six parameters before, during and after labor (see examples in Table 1 and Figure 1). CONCLUSIONS: ICG, a non-invasive method like ECG, does not require the skill level of performing ECG, is subject to very little user error, and is significantly cheaper. An acceptable correlation/ agreement was found between our ICG and ECG data. However, more data is required to narrow the confidence intervals of the Bland-Altman analysis and show a more acceptable clinical use of ICG. Table 1. Pearson r and Bland-Altman mean differences and confidence intervals between the ICG and ECG devices Before Labor During Labor Measurement Nⴝ26 Nⴝ18
After Labor Nⴝ20
SV
NS
.443*
344 The intracranial translucency as a means of first trimester screening for neural tube defects
.770**
Wright State University, Dayton, OH, 2Perinatal Partners, Dayton, OH, Wright State University, Fetal Medicine Foundation USA, Dayton, OH
3
OBJECTIVE: Evaluation of intracranial translucency (IT) may be of value in first trimester screening for meningomyeloceles. We evaluated the feasibility of obtaining an IT and its thickness in relation to gestational age. The thickness of the brain stem (BS) was also measured and the ratio of IT to BS established. STUDY DESIGN: Routine first trimester screening (11⫹0 to 13⫹6 weeks) includes a magnified mid-sagittal view of the fetal profile. The IT may be visualized in this view. Electronically stored images were reviewed from 100 consecutive patients in whom first trimester screening was performed in our unit between 5/27/10 and 7/21/10. Anatomical landmarks to confirm midline view were checked. The IT and the BS were measured and a ratio of the two measurements was calculated (IT/BS). Gestational age, crown-rump length (CRL), and maternal weight were recorded. RESULTS: The mean CRL was 63.9 ⫹/⫺ 7.8 mm (12⫹5 weeks [range: 11⫹2 – 13⫹6 wks]). The IT was identified in 97% of patients (maternal weight of 79.4 ⫹/- 23.9 kg). The mean maternal weight with nonvisualized IT was 124.9 kg. The IT measurement increased linearly with gestation (r2⫽0.28, P⬍0.0001; Figure 1), and the ratio of IT/BS remained unchanged (r2⫽0.003, P⫽0.6; Figure 1). CONCLUSIONS: We found that the IT thickness increases with gestational age while the IT/BS ratio remains unchanged. The IT is an easily identifiable structure visible at the time of first trimester screening. As such, it may be obtained with a minimum of additional time and training. In a previously published report, obliteration of the IT was 100% sensitive and specific for the detection of meningomyeloceles. However, the number of affected fetuses thus identified was quite small. Therefore, future research looking into the efficacy of posterior fossa evaluation as a screening method for meningomyeloceles should not only include the evaluation for absence of the IT but also whether deviations in the size of the IT contribute to its screening efficacy.
..........................................................................................................................................................................................
10.2 (⫺36.3, 56.8)
2.9 (⫺28.0, 33.7)
⫺9.2 (⫺60.1, 41.7)
..........................................................................................................................................................................................
CO
NS
.706**
NS
..........................................................................................................................................................................................
0.5 (⫺3.6, 4.7)
0.3 (⫺1.9, 2.4)
⫺0.6 (⫺4.1, 2.8)
..........................................................................................................................................................................................
SVR
.561**
.663**
NS
..........................................................................................................................................................................................
⫺72.9 (⫺738, 592)
⫺23.0 (⫺448, 442)
245 (⫺630, 1119)
..........................................................................................................................................................................................
S140
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011