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370 Spectral analysis of the fetal heart in labour
SPO Abstracts
Vohmlc 164
i': umue r I . Part 2
347
368 EVALUATION OF FETAL SONOGRAPHIC MEASURE f 1ENTS 370 SPECTRAL ANALYSIS 0' TIlE FETAL HEART IN LABOUR IN FIRST TRIMESTER BY TRANSVAGINAL snN0GRAPHY Royal Maternity Hospital, Belfast. Nonhern Ireland. L. Izquierdo, O. Kushnir~ G. Gilson, J. Srlith, x M. Chatterjee, C. nualls , G. Del Valle , S. Dr P,Fogany Dr. J.C. Doman, Prof. G. McClure. Prof. W. Joffe~ and L. Curet Thompson University of New Me xico Ho sn ital, Alhunuernue, New Mexico The accurate diagnosis of genuine fetal distress is extremely To assess the reliahility of earl y biometric difficult and the effects of undiagnosed distress bas far-reaching measurements in nregnancv, transva~inal sonoconsequences for the neonate and resulting adull. Using a locaiiy graohy was nerfor~ed in q2 nregnancies in the developed on-line microprocessor based system, spectral analysis of first trimester. "1easurernpI1ts incll1rlprl crownthe fetal ECG has been carried 0lIl. on high risk pregnancies and the rumn length (CRL), bioarietal diameter (BPD), spectral analysis correlated with the clinical interpretation of the fetal head and abdominal circumference (H( I AC), and heart rate and to the condition of the infants at binh. Data was femur length (FL). Stenwise reqression analvcollected fonn 169 high risk patients. There were 23 infants delivered for fetal distress by caesarian section. 66 infants with cord pH <7.2 • sis of gestational age was nerformed. CrOl'm26 with a base excess < -8.0. and there were 16 cases of binh rumn length maintained the highest correlation asphyxia. Power spectral analysis of these fetal hean traces revealed with gestational a~e. RPD, HC, and AC also a significant rise (p
369
PREDICTABlE
UL~C
F'IN[)IN3S OF EARLY
ABJFITIGl
Scx:Jn Ae Jun,M.d:, MYung O::k Ahn,M.D . , M. P .H. of Radiology and Oostetrics and Gynecology, CHA 'M:Irere fbspital of SeJul, SeJul ,Korea.
De~nts
Early fetal ~h delay and early oliwhyd.rcarnios have been suspected as sig)1s of anbryonal Joopan::ly.fb.iever, scant informati oo is available 00 the predictioo of early alxlrtioo. Prospective exaninati m of 68 early pregranc:ies betMeen the 6th and 8th week with reg).Ilar 28-day rrenstrual cycles was performed to investigpte predictabl e ultra9Jrographic findi.ng3 of early alxlrtim. Ult~c ~ts of the gestaticml sac,cro.-m runp length (CRL) and fetal heart rate were performed using a linear array real tiJre transducer with doppler. All ultras:::un:l evaluations were done by the primary autmr. Eleven cases arrong U3 pregpancies (16 .2'/0) terminated in missed alxlrtim at around 13 days after exanination . All rrea.sur'E!lfflts of 51 normal cases were canpared to tmse of 11 missed alxlrtions . In cases of missed alxlrtions , mean gestatimal sac size was sraller than - 2 standard deviatioo (3)) aTrXlg 4 cases (36 .4%) ,and -1 3) arong 6 cases (54 .5%) . CRL was snaller than - 23) aTrXlg 2 cases (18. 2'/0), and -1 :'D aTrXlg 6 cases (54.5%). Interval grUNth during 13 days was belCNI the normal~ . In &ITIII3l'Y ,ul t~c findings of early fetal grUNth delay and / or early oliglhydroamios can be predictable sigls of {XXlt' prognsis of early pre@13l1Cies .
371 FETAL ECHOCARDIOGRAPHY IN INSULIN-DEPENDENT DIABETIC PREGNANCIES LA Davis', HJ Landy, RA Ratner', GR Martin'; George Washington UniverSity Medical Center and Children's Natlonal Medical Center, Washington, DC Maternal insulin-dependent diabetes mellitus (IDDM), a risk factor for congenital heart disease (CHD), is a common indication for fetal echocardiography (FEcho). Reports Indicate that up to 8% of infants of IDDM mothers have CHD. We evaluated the reliability of FEcho in 29 IDDM gravidas 1987-90, 24 requiring insulin prepregnancy. Four infants had CHO (13.8%). FEcho correctly predicted 2 cases of CHD but failed to identify 2 cases (1 with multiple cardiac anomalies and 1 with septal hypertrophy ISH] with a 4-month interval between FEcho and birth). ~Echo incorrectly diagnosed 2 normal infants as having ventricular septal defects (VSDs). FEcho was normal in the 23 Infants with normal hearts (in 16 cases, small VSDs could not be completely excluded, a complexity Inherent to FEcho). Although the highest first trimester glycosylated hemoglobin (Hgb A 1c) value (12.25%) occurred in a patient with an affected child, there were no statistical differences in average first trimester Hgb A1c values (Student t test). Average third trimester Hgb A1c values in unaffected pregnancies was 6.75% compared with 8.13% in the case affected by SH. This study shows that second trimester FEcho in IDOM gravidas has a sensitivity of 50%, specificity of 95.8%, predictive value of positlve of 66.7% and predictive value of negative of 92%. FEcho is a reliable Indicator of CHD in patients with IDDM. Repeat FEcho in the third trimester should be considered to evaluate for SH.
Vohmlc 164
i': umue r I . Part 2
347
368 EVALUATION OF FETAL SONOGRAPHIC MEASURE f 1ENTS 370 SPECTRAL ANALYSIS 0' TIlE FETAL HEART IN LABOUR IN FIRST TRIMESTER BY TRANSVAGINAL snN0GRAPHY Royal Maternity Hospital, Belfast. Nonhern Ireland. L. Izquierdo, O. Kushnir~ G. Gilson, J. Srlith, x M. Chatterjee, C. nualls , G. Del Valle , S. Dr P,Fogany Dr. J.C. Doman, Prof. G. McClure. Prof. W. Joffe~ and L. Curet Thompson University of New Me xico Ho sn ital, Alhunuernue, New Mexico The accurate diagnosis of genuine fetal distress is extremely To assess the reliahility of earl y biometric difficult and the effects of undiagnosed distress bas far-reaching measurements in nregnancv, transva~inal sonoconsequences for the neonate and resulting adull. Using a locaiiy graohy was nerfor~ed in q2 nregnancies in the developed on-line microprocessor based system, spectral analysis of first trimester. "1easurernpI1ts incll1rlprl crownthe fetal ECG has been carried 0lIl. on high risk pregnancies and the rumn length (CRL), bioarietal diameter (BPD), spectral analysis correlated with the clinical interpretation of the fetal head and abdominal circumference (H( I AC), and heart rate and to the condition of the infants at binh. Data was femur length (FL). Stenwise reqression analvcollected fonn 169 high risk patients. There were 23 infants delivered for fetal distress by caesarian section. 66 infants with cord pH <7.2 • sis of gestational age was nerformed. CrOl'm26 with a base excess < -8.0. and there were 16 cases of binh rumn length maintained the highest correlation asphyxia. Power spectral analysis of these fetal hean traces revealed with gestational a~e. RPD, HC, and AC also a significant rise (p
369
PREDICTABlE
UL~C
F'IN[)IN3S OF EARLY
ABJFITIGl
Scx:Jn Ae Jun,M.d:, MYung O::k Ahn,M.D . , M. P .H. of Radiology and Oostetrics and Gynecology, CHA 'M:Irere fbspital of SeJul, SeJul ,Korea.
De~nts
Early fetal ~h delay and early oliwhyd.rcarnios have been suspected as sig)1s of anbryonal Joopan::ly.fb.iever, scant informati oo is available 00 the predictioo of early alxlrtioo. Prospective exaninati m of 68 early pregranc:ies betMeen the 6th and 8th week with reg).Ilar 28-day rrenstrual cycles was performed to investigpte predictabl e ultra9Jrographic findi.ng3 of early alxlrtim. Ult~c ~ts of the gestaticml sac,cro.-m runp length (CRL) and fetal heart rate were performed using a linear array real tiJre transducer with doppler. All ultras:::un:l evaluations were done by the primary autmr. Eleven cases arrong U3 pregpancies (16 .2'/0) terminated in missed alxlrtim at around 13 days after exanination . All rrea.sur'E!lfflts of 51 normal cases were canpared to tmse of 11 missed alxlrtions . In cases of missed alxlrtions , mean gestatimal sac size was sraller than - 2 standard deviatioo (3)) aTrXlg 4 cases (36 .4%) ,and -1 3) arong 6 cases (54 .5%) . CRL was snaller than - 23) aTrXlg 2 cases (18. 2'/0), and -1 :'D aTrXlg 6 cases (54.5%). Interval grUNth during 13 days was belCNI the normal~ . In &ITIII3l'Y ,ul t~c findings of early fetal grUNth delay and / or early oliglhydroamios can be predictable sigls of {XXlt' prognsis of early pre@13l1Cies .
371 FETAL ECHOCARDIOGRAPHY IN INSULIN-DEPENDENT DIABETIC PREGNANCIES LA Davis', HJ Landy, RA Ratner', GR Martin'; George Washington UniverSity Medical Center and Children's Natlonal Medical Center, Washington, DC Maternal insulin-dependent diabetes mellitus (IDDM), a risk factor for congenital heart disease (CHD), is a common indication for fetal echocardiography (FEcho). Reports Indicate that up to 8% of infants of IDDM mothers have CHD. We evaluated the reliability of FEcho in 29 IDDM gravidas 1987-90, 24 requiring insulin prepregnancy. Four infants had CHO (13.8%). FEcho correctly predicted 2 cases of CHD but failed to identify 2 cases (1 with multiple cardiac anomalies and 1 with septal hypertrophy ISH] with a 4-month interval between FEcho and birth). ~Echo incorrectly diagnosed 2 normal infants as having ventricular septal defects (VSDs). FEcho was normal in the 23 Infants with normal hearts (in 16 cases, small VSDs could not be completely excluded, a complexity Inherent to FEcho). Although the highest first trimester glycosylated hemoglobin (Hgb A 1c) value (12.25%) occurred in a patient with an affected child, there were no statistical differences in average first trimester Hgb A1c values (Student t test). Average third trimester Hgb A1c values in unaffected pregnancies was 6.75% compared with 8.13% in the case affected by SH. This study shows that second trimester FEcho in IDOM gravidas has a sensitivity of 50%, specificity of 95.8%, predictive value of positlve of 66.7% and predictive value of negative of 92%. FEcho is a reliable Indicator of CHD in patients with IDDM. Repeat FEcho in the third trimester should be considered to evaluate for SH.