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360: Does first-trimester ultrasound predict obstetrical outcomes in monochorionic diamniotic twin pregnancies?
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Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging
17.4%, RR 1.6, 95% CI 1.1-2.4). In surviving pregnancies unaffected by anomalies, no increased risk of stillbirth, IUGR, NICU admission, or delivery ⬍34 weeks was noted in the discordant group. CONCLUSION: Dichorionic pregnancies where a CRL discordance ⱖ11% is noted at the first ultrasound are at increased risk for SAB and fetal anomalies. However, patients can be reassured that, in the absence of structural anomalies, CRL discordance does not appear to be associated with other adverse outcomes in continuing pregnancies.
Poster Session II
significant difference in the composite obstetrical outcome between twins with and without NT discordance (35.3% vs 23.4%; p⫽ns). There was also no difference in the composite obstetrical outcome between twins with and without CRL discordance (25.9% vs 25.3% p⫽ ns). CONCLUSION: NT or CRL discordance in MCDA twin pregnancies was not associated with an increase in composite obstetrical adverse outcome.
361 Small fetal thymus in preterm prelabor rupture of membranes pregnancies complicated by histological chorioamnionitis and funisitis Marian Kacerovsky1, Ivana Musilova2 1 University Hospital Hradec Kralove, Department of Obstetrics and Gynecology, Hradec Kralove, Czech Republic, 2Hospital Pardubice, Department of Obstetrics and Gynecology, Pardubice, Czech Republic
360 Does first-trimester ultrasound predict obstetrical outcomes in monochorionic diamniotic twin pregnancies? M. Baraa Allaf1, Samadh Ravangard2, Joseph Wax3, Martin R. Chavez1, Adam Borgida4, Amirhoushang A. Shamshirsaz5, Glenn Markenson6, Anthony Vintzileos1, Winston Campbell2, James Egan2, Reinaldo Figueroa1, Angelina Cartia3, Christopher Lee6, Alireza A. Shamshirsaz2 1 Stony Brook-Winthrop University Hospitals, Obstetrics and Gynecology, Long Island, NY, 2University of Connecticut. Health Center, Obstetrics and Gynecology, Farmington, CT, 3Maine Medical Center, Obstetrics and Gynecology, Portland, ME, 4Hartford Hospital, Obstetrics and Gynecology, Hartford, CT, 5St. Francis Hospital, Obstetrics and Gynecology, Hartford, CT, 6Baystate Medical Center, Obstetrics and Gynecology, Springfield, MA
OBJECTIVE: To assess the association between discordant nuchal translucency (NT) and crown-rump length (CRL) measurements with composite obstetrical adverse outcome in monochorionic diamniotic (MCDA) twin fetuses. STUDY DESIGN: We performed a multicenter, retrospective cohort study in 6 regional perinatal centers in the Northeastern United States between 01/2006- 06/2010 of all MCDA twin pregnancies that had an NT screen (11 0/7–13 6/7weeks) and had a follow-up during the pregnancy. Pregnancies with known chromosomal abnormalities or anomalies were excluded. Composite obstetrical outcome included, intra-uterine fetal demise (IUFD), Twin-Twin Transfusion syndrome (TTTs), intra-uterine growth restriction (IUGR) or preterm birth ⱕ32 weeks. NT and CRL discordances were calculated as the difference between two fetuses expressed as a percentage of the larger measurement. We developed receiver operating characteristic (ROC) curves to find NT and CRL discordance cutoffs for identifying composite obstetrical outcome. Our ROC showed 5% cut-off for NT discordance. Our ROC showed a 5% cutoff for NT discordance, we chose to use ⱖ20% due to reported NT measurement intra- and inter-observer errors of about 10% in previous studies . Our ROC for CRL discordance showed 15% cut-off which we used to define CRL discordance. RESULTS: A total of 166 pregnancies met inclusion criteria. Mean (⫹/⫺ SD) gestational age at delivery was 34 ⫹/⫺ 4.3 weeks. 34 (20.5%) twin pregnancies had NT discordance and 27(16.2%) had CRL discordance. Obstetric outcomes were: TTTS in 15 (9.0%) pregnancies, IUGR in 32 (9.6%) fetuses, IUFD in 13 (3.9%) fetuses and 48 (28.9%) pregnancies with preterm birth ⱕ32 weeks. There was no
OBJECTIVE: Fetal thymus is a imune system organ sensitive to intrauterine stress stimuli. The thymic involution has been reported in association with pregnancy complications (e.g. intrauterine inflammation, preeclampsia). The aim of this study was to determine whether measurement of fetal thymic transverse diameter is of value in identification of either histological chorioamnionitis (HCA) or its the most severe form - funisitis in women with preterm prelabor rupture of membranes (PPROM). STUDY DESIGN: A prospective cohort study was performed and 196 women with PPROM signleton pregnancies with with gestation age between 24⫹0 and 36⫹6 weeks were recruited. Thymic transverse diameter was measured three times in the transverse section of the fetal thorax at the level of great heart vessels. The mean size was determined and used for analyses. The small transverse diameter of fetal thymus was defined as the mean size below 5th percentile for gestational age according to our previously published nomogram. Histological examination of the placenta, the fetal membranes, and the umbilical cord was performed in all cases. The degree of polymorphonuclear leukocyte infiltration was assessed separately in the free membranes, the chorionic plate, and the umbilical cord. Diagnosis of HCA was determined based on the presence of histological grades of chorion-decidua 3-4 and/or chorionic plate 3-4 and/or umbilical cord 1-4 and/or amnion 1-4. RESULTS: The presence of HCA and funisitis were found in 60% (117/ 196) and 17% (34/196) of the women, respectively. The small fetal thymus had sensitivity of 79%, specificity of 44%, positive predictive value of 68%, and negative predictive value of 52% for the presence of HCA (p ⫽ 0.0006; OR 2.93) and sensitivity of 88%, specificity of 35%, positive predictive value of 22%, and negative predictive value of 93% for funisitis (p ⫽ 0.008; OR 4.0). CONCLUSION: The presence of small fetal thymus on ultrasound had significance for identification of both HCA and funisitis in PPROM women.
362 Placenta previa: when does resolution occur in twin pregnancies? Matthew Weis1, Lorie Harper1, Kimberly Roehl1, Anthony Odibo1, Alison Cahill1 1 Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO
OBJECTIVE: Data from singleton pregnancies indicate that ⬎80% of all second trimester ultrasound diagnosed previa resolve. We sought to characterize the rate of previa resolution in twins (TIUP) and the gestational age at which resolution occurs. STUDY DESIGN: Retrospective cohort study of all consecutive women with TIUP undergoing serial ultrasound between 15-40 weeks gestation at a single tertiary center. Placenta previa was defined as the presence of either a complete, partial, or marginal previa on ultrasound at ⬎15 weeks. Previa resolution was defined as the absence of a previously diagnosed previa on a follow-up ultrasound. If delivery occurred during a defined period, it was counted as persistent or re-
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S169
Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging
17.4%, RR 1.6, 95% CI 1.1-2.4). In surviving pregnancies unaffected by anomalies, no increased risk of stillbirth, IUGR, NICU admission, or delivery ⬍34 weeks was noted in the discordant group. CONCLUSION: Dichorionic pregnancies where a CRL discordance ⱖ11% is noted at the first ultrasound are at increased risk for SAB and fetal anomalies. However, patients can be reassured that, in the absence of structural anomalies, CRL discordance does not appear to be associated with other adverse outcomes in continuing pregnancies.
Poster Session II
significant difference in the composite obstetrical outcome between twins with and without NT discordance (35.3% vs 23.4%; p⫽ns). There was also no difference in the composite obstetrical outcome between twins with and without CRL discordance (25.9% vs 25.3% p⫽ ns). CONCLUSION: NT or CRL discordance in MCDA twin pregnancies was not associated with an increase in composite obstetrical adverse outcome.
361 Small fetal thymus in preterm prelabor rupture of membranes pregnancies complicated by histological chorioamnionitis and funisitis Marian Kacerovsky1, Ivana Musilova2 1 University Hospital Hradec Kralove, Department of Obstetrics and Gynecology, Hradec Kralove, Czech Republic, 2Hospital Pardubice, Department of Obstetrics and Gynecology, Pardubice, Czech Republic
360 Does first-trimester ultrasound predict obstetrical outcomes in monochorionic diamniotic twin pregnancies? M. Baraa Allaf1, Samadh Ravangard2, Joseph Wax3, Martin R. Chavez1, Adam Borgida4, Amirhoushang A. Shamshirsaz5, Glenn Markenson6, Anthony Vintzileos1, Winston Campbell2, James Egan2, Reinaldo Figueroa1, Angelina Cartia3, Christopher Lee6, Alireza A. Shamshirsaz2 1 Stony Brook-Winthrop University Hospitals, Obstetrics and Gynecology, Long Island, NY, 2University of Connecticut. Health Center, Obstetrics and Gynecology, Farmington, CT, 3Maine Medical Center, Obstetrics and Gynecology, Portland, ME, 4Hartford Hospital, Obstetrics and Gynecology, Hartford, CT, 5St. Francis Hospital, Obstetrics and Gynecology, Hartford, CT, 6Baystate Medical Center, Obstetrics and Gynecology, Springfield, MA
OBJECTIVE: To assess the association between discordant nuchal translucency (NT) and crown-rump length (CRL) measurements with composite obstetrical adverse outcome in monochorionic diamniotic (MCDA) twin fetuses. STUDY DESIGN: We performed a multicenter, retrospective cohort study in 6 regional perinatal centers in the Northeastern United States between 01/2006- 06/2010 of all MCDA twin pregnancies that had an NT screen (11 0/7–13 6/7weeks) and had a follow-up during the pregnancy. Pregnancies with known chromosomal abnormalities or anomalies were excluded. Composite obstetrical outcome included, intra-uterine fetal demise (IUFD), Twin-Twin Transfusion syndrome (TTTs), intra-uterine growth restriction (IUGR) or preterm birth ⱕ32 weeks. NT and CRL discordances were calculated as the difference between two fetuses expressed as a percentage of the larger measurement. We developed receiver operating characteristic (ROC) curves to find NT and CRL discordance cutoffs for identifying composite obstetrical outcome. Our ROC showed 5% cut-off for NT discordance. Our ROC showed a 5% cutoff for NT discordance, we chose to use ⱖ20% due to reported NT measurement intra- and inter-observer errors of about 10% in previous studies . Our ROC for CRL discordance showed 15% cut-off which we used to define CRL discordance. RESULTS: A total of 166 pregnancies met inclusion criteria. Mean (⫹/⫺ SD) gestational age at delivery was 34 ⫹/⫺ 4.3 weeks. 34 (20.5%) twin pregnancies had NT discordance and 27(16.2%) had CRL discordance. Obstetric outcomes were: TTTS in 15 (9.0%) pregnancies, IUGR in 32 (9.6%) fetuses, IUFD in 13 (3.9%) fetuses and 48 (28.9%) pregnancies with preterm birth ⱕ32 weeks. There was no
OBJECTIVE: Fetal thymus is a imune system organ sensitive to intrauterine stress stimuli. The thymic involution has been reported in association with pregnancy complications (e.g. intrauterine inflammation, preeclampsia). The aim of this study was to determine whether measurement of fetal thymic transverse diameter is of value in identification of either histological chorioamnionitis (HCA) or its the most severe form - funisitis in women with preterm prelabor rupture of membranes (PPROM). STUDY DESIGN: A prospective cohort study was performed and 196 women with PPROM signleton pregnancies with with gestation age between 24⫹0 and 36⫹6 weeks were recruited. Thymic transverse diameter was measured three times in the transverse section of the fetal thorax at the level of great heart vessels. The mean size was determined and used for analyses. The small transverse diameter of fetal thymus was defined as the mean size below 5th percentile for gestational age according to our previously published nomogram. Histological examination of the placenta, the fetal membranes, and the umbilical cord was performed in all cases. The degree of polymorphonuclear leukocyte infiltration was assessed separately in the free membranes, the chorionic plate, and the umbilical cord. Diagnosis of HCA was determined based on the presence of histological grades of chorion-decidua 3-4 and/or chorionic plate 3-4 and/or umbilical cord 1-4 and/or amnion 1-4. RESULTS: The presence of HCA and funisitis were found in 60% (117/ 196) and 17% (34/196) of the women, respectively. The small fetal thymus had sensitivity of 79%, specificity of 44%, positive predictive value of 68%, and negative predictive value of 52% for the presence of HCA (p ⫽ 0.0006; OR 2.93) and sensitivity of 88%, specificity of 35%, positive predictive value of 22%, and negative predictive value of 93% for funisitis (p ⫽ 0.008; OR 4.0). CONCLUSION: The presence of small fetal thymus on ultrasound had significance for identification of both HCA and funisitis in PPROM women.
362 Placenta previa: when does resolution occur in twin pregnancies? Matthew Weis1, Lorie Harper1, Kimberly Roehl1, Anthony Odibo1, Alison Cahill1 1 Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO
OBJECTIVE: Data from singleton pregnancies indicate that ⬎80% of all second trimester ultrasound diagnosed previa resolve. We sought to characterize the rate of previa resolution in twins (TIUP) and the gestational age at which resolution occurs. STUDY DESIGN: Retrospective cohort study of all consecutive women with TIUP undergoing serial ultrasound between 15-40 weeks gestation at a single tertiary center. Placenta previa was defined as the presence of either a complete, partial, or marginal previa on ultrasound at ⬎15 weeks. Previa resolution was defined as the absence of a previously diagnosed previa on a follow-up ultrasound. If delivery occurred during a defined period, it was counted as persistent or re-
Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S169