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397 Pregnancy outcome in patients with unexplained low maternal serum alpha fetoprotein
354
SPO Abstracts
Jdnuary 1991
Am
J Ob,tet Gynecol
396 PERClJl'ANEXXlS TRANSVESICAL CHORIOtaC VILLUS SAMPLDlG: AN ALTERNA'rIYl! APPROACH TO THE
398 MSAFP AS A PREDICTOR OF PREGNANCY OUTCOMES IN WOMEN UNDERGOING AN EARLY AMNIOCENTESIS FROM 11-14 WEEKS. CG Brumf ield, GA Cloud x , RO Davis, SC FinleyX, LR Boots X , SC Baileyx. The University of Alabama School of Medicine, Birmingham, AL. From August 1, 1988 through July 31, 1990, women underwent an early genetic 476 amniocentesis (11-14 weeks) at our institution. Prior to each ultrasound and amniocentesis, a MSAFP was obtained. Complete pregnancy outcome data was available for 315 patients. The table depicts the distribution of MSAFP values expressed in multiples of the median (MOMS). Pearson's correlation coefficient was used to compare MSAFP values with later adverse pregnancy events. There was no correlation between MSAFP and complications within 30 days of the procedure, fetal death after 20 wks, pre term delivery, or IUGR. AFP MOMS # Patients (% Total) ~ 2.5 4 1.3 2.0 - 2.4 7 2.2 1 .0 - 1.99 158 50.1 0.5 - 0.99 132 42.0 ( 0.5 13 4.4 Conclusions: MSAFP values obtained at 11-14 wks in this study were more narrowly distributed around the medians for each week of gestation, with few values being as high as 2.0 or 2.5 MOM. Thus, MSAFP in these early gestations may not prove to be a clinically useful predictor of adverse events in later gestation. Further studies are needed to answer this question.
397 PREGNANCY OUTCOME IN PATIENTS WITH UNEXPLAINED LOW MATERNAL SERUM ALPHA FETOPROTEIN Mark Neerhof DO, Philip Schlossman MD, Linda x Dunn MD, Stuart Weiner MD, Lynn Godmilow MSW Pennsylvania Hospital, Philadelphia, PA From January 1, 1986 to December 30,1989, amniocentesis was performed on 908 patients referred because of a low maternal serum alpha fetoprotein(MSAFP)', as defined by each respective reference laboratory. Follow-up via questionaire was obtained from 810(89%) of these patients(study group). Follow-up was also obtained for 836(95%) of 874 patients undergoing amniocentesis for advanced maternal age (control group). Pregnancy outcome for these two groups are compared in the table below. We conclude that in the absence of aneuploidy, patients with low MSAFP do not appear to be at an increased risk of perinatal morbidity or mortality. Study Control n=810 n=836 Abnormal karyotype 12(1.3%) 19(2.2%) 2(0.2%) 5(0.6%) Fetal demise()28w) 10(1.1%) Pregnancy 10ss«28w) 2(0.2%) 3(0.4%) 5(0.6%) Neonatal loss 121(14.9%) 97(11.6%) Birthweight>4000g 27(3.3%) 51(6.1%) Birthweight(2500g
399 CITOGENETIC ABNORMALITIES AMONG PERINATAL
RETROVERTED Ul'ERUS RK Silve,r, SN MacGr~or JK WaLdeeA Northwestern Un1versity Med1cai Sdlool., Evanston Hqspital Evanston, Illinois In 458 cO}1s~tive r:;VS procedures, we cbserved a s1gnif1Cant mfluence of uterine positi.oo upol} sampling efficiency. Compared to anteverted (n=243) or aX1al (n=149) locations, the retroverted uterus (RVi n=66) was associated with a lower mean sample weight .per aspiration (22, 18, and 15 mg, r~speqt;i:velYi p <.01) and a greater fr~uenqy of mult;iple pass procedur~s (23, 31, 5;1%, respElCtiy'elYi p <.(001). To 1mprove sampling effl.C1.el1CY In Selected Rv cases, we adopted a transves1cal (TV) approach, using a coaxial syl?1:em to traverse th~ bladder (20 gauge g~ude needle) and asprrate a villus sample (22 gauge sampling needle). Of the 30 TV cases ~rmed to date, only 1 required three p tal passa:;, comparea to 9 Qf the other ~6 retroverted uter1 sampled W1thOUt bladder entry (p <.05). The mean TV sample weight was 1t; mg and at least 10 mg were retrieved in all c;ases, Post-procedure bleeding occurred 1n 2 1nstances and an additional patient suffered a spontaneous loss at 16 weeks of gestat:.i.oo. Aneuploidy was found iq 4 TV bioR~ies and the rema1ning pregnancws have delivered at term (n=14), or are c:cntin~:V"Jn=l1). Procedure acce~ce appeared • • to transabdominal sampling al:fhough a vasoyagal respon~e occu.rred in 4 women. Our preliJnihary ~ce Wl.th TV CVS suggests that select:.eCi use of this met:h¢. may .j.mprov.e samp;I.in.q efficiencY'. w1~hout mcreasmg the mC1aence of comp:licat1ons.
DEATHS DEMONSTRATING A SINGLE UMBILICAL ARlERY. D N Saller Jr. R Neiger. Brown University/Women & Infants Hospital, Providence, Rhode Island. The presence of a single umbilical artery is associated with congenital malformations. The association of a single umbilical artery with cytogenetic abnormalities has also been observed. but the percentage of chromosomal abnormalities in pregnancies complicated by a single umbilical artery is unknown. We studied the proportion of cytogenetic abnormalities associated with a single umbilical artery among perinatal deaths undergoing autopsy. The autopsies of all stillbirths and neonatal deaths from January of 1981 through June of 1990 were reviewed. Those autopsies demonstrating a single umbilical artery were evaluated in order to ascertain whether chromosome analysis had been done at time of autopsy or antenatally. Of 1,078 autopsies reviewed. 42 (3.9%) were identifed with a single umbilical artery. Chromosome analysis was attempted in 21 of the 42 cases (50%). There were 5 culture failures from macerated stillborns leaving 16 successful chromosome analyses. Of these 16 karyotypes, 3 (18.75%) were abnormal including two cases of trisomy 13 and one unbalanced translocation [46,XY,der(15)t(5;15)(pll:pll)pat]. All three of the chromosomally abnormal fetuses had major congenital malformations which may have been detectable on ultrasound examination. These data suggest that a single umbilical artery is associated with cytogenetic abnormalities when found in the presence of other congenital malformations, follOWing a perinatal death.
SPO Abstracts
Jdnuary 1991
Am
J Ob,tet Gynecol
396 PERClJl'ANEXXlS TRANSVESICAL CHORIOtaC VILLUS SAMPLDlG: AN ALTERNA'rIYl! APPROACH TO THE
398 MSAFP AS A PREDICTOR OF PREGNANCY OUTCOMES IN WOMEN UNDERGOING AN EARLY AMNIOCENTESIS FROM 11-14 WEEKS. CG Brumf ield, GA Cloud x , RO Davis, SC FinleyX, LR Boots X , SC Baileyx. The University of Alabama School of Medicine, Birmingham, AL. From August 1, 1988 through July 31, 1990, women underwent an early genetic 476 amniocentesis (11-14 weeks) at our institution. Prior to each ultrasound and amniocentesis, a MSAFP was obtained. Complete pregnancy outcome data was available for 315 patients. The table depicts the distribution of MSAFP values expressed in multiples of the median (MOMS). Pearson's correlation coefficient was used to compare MSAFP values with later adverse pregnancy events. There was no correlation between MSAFP and complications within 30 days of the procedure, fetal death after 20 wks, pre term delivery, or IUGR. AFP MOMS # Patients (% Total) ~ 2.5 4 1.3 2.0 - 2.4 7 2.2 1 .0 - 1.99 158 50.1 0.5 - 0.99 132 42.0 ( 0.5 13 4.4 Conclusions: MSAFP values obtained at 11-14 wks in this study were more narrowly distributed around the medians for each week of gestation, with few values being as high as 2.0 or 2.5 MOM. Thus, MSAFP in these early gestations may not prove to be a clinically useful predictor of adverse events in later gestation. Further studies are needed to answer this question.
397 PREGNANCY OUTCOME IN PATIENTS WITH UNEXPLAINED LOW MATERNAL SERUM ALPHA FETOPROTEIN Mark Neerhof DO, Philip Schlossman MD, Linda x Dunn MD, Stuart Weiner MD, Lynn Godmilow MSW Pennsylvania Hospital, Philadelphia, PA From January 1, 1986 to December 30,1989, amniocentesis was performed on 908 patients referred because of a low maternal serum alpha fetoprotein(MSAFP)', as defined by each respective reference laboratory. Follow-up via questionaire was obtained from 810(89%) of these patients(study group). Follow-up was also obtained for 836(95%) of 874 patients undergoing amniocentesis for advanced maternal age (control group). Pregnancy outcome for these two groups are compared in the table below. We conclude that in the absence of aneuploidy, patients with low MSAFP do not appear to be at an increased risk of perinatal morbidity or mortality. Study Control n=810 n=836 Abnormal karyotype 12(1.3%) 19(2.2%) 2(0.2%) 5(0.6%) Fetal demise()28w) 10(1.1%) Pregnancy 10ss«28w) 2(0.2%) 3(0.4%) 5(0.6%) Neonatal loss 121(14.9%) 97(11.6%) Birthweight>4000g 27(3.3%) 51(6.1%) Birthweight(2500g
399 CITOGENETIC ABNORMALITIES AMONG PERINATAL
RETROVERTED Ul'ERUS RK Silve,r, SN MacGr~or JK WaLdeeA Northwestern Un1versity Med1cai Sdlool., Evanston Hqspital Evanston, Illinois In 458 cO}1s~tive r:;VS procedures, we cbserved a s1gnif1Cant mfluence of uterine positi.oo upol} sampling efficiency. Compared to anteverted (n=243) or aX1al (n=149) locations, the retroverted uterus (RVi n=66) was associated with a lower mean sample weight .per aspiration (22, 18, and 15 mg, r~speqt;i:velYi p <.01) and a greater fr~uenqy of mult;iple pass procedur~s (23, 31, 5;1%, respElCtiy'elYi p <.(001). To 1mprove sampling effl.C1.el1CY In Selected Rv cases, we adopted a transves1cal (TV) approach, using a coaxial syl?1:em to traverse th~ bladder (20 gauge g~ude needle) and asprrate a villus sample (22 gauge sampling needle). Of the 30 TV cases ~rmed to date, only 1 required three p tal passa:;, comparea to 9 Qf the other ~6 retroverted uter1 sampled W1thOUt bladder entry (p <.05). The mean TV sample weight was 1t; mg and at least 10 mg were retrieved in all c;ases, Post-procedure bleeding occurred 1n 2 1nstances and an additional patient suffered a spontaneous loss at 16 weeks of gestat:.i.oo. Aneuploidy was found iq 4 TV bioR~ies and the rema1ning pregnancws have delivered at term (n=14), or are c:cntin~:V"Jn=l1). Procedure acce~ce appeared • • to transabdominal sampling al:fhough a vasoyagal respon~e occu.rred in 4 women. Our preliJnihary ~ce Wl.th TV CVS suggests that select:.eCi use of this met:h¢. may .j.mprov.e samp;I.in.q efficiencY'. w1~hout mcreasmg the mC1aence of comp:licat1ons.
DEATHS DEMONSTRATING A SINGLE UMBILICAL ARlERY. D N Saller Jr. R Neiger. Brown University/Women & Infants Hospital, Providence, Rhode Island. The presence of a single umbilical artery is associated with congenital malformations. The association of a single umbilical artery with cytogenetic abnormalities has also been observed. but the percentage of chromosomal abnormalities in pregnancies complicated by a single umbilical artery is unknown. We studied the proportion of cytogenetic abnormalities associated with a single umbilical artery among perinatal deaths undergoing autopsy. The autopsies of all stillbirths and neonatal deaths from January of 1981 through June of 1990 were reviewed. Those autopsies demonstrating a single umbilical artery were evaluated in order to ascertain whether chromosome analysis had been done at time of autopsy or antenatally. Of 1,078 autopsies reviewed. 42 (3.9%) were identifed with a single umbilical artery. Chromosome analysis was attempted in 21 of the 42 cases (50%). There were 5 culture failures from macerated stillborns leaving 16 successful chromosome analyses. Of these 16 karyotypes, 3 (18.75%) were abnormal including two cases of trisomy 13 and one unbalanced translocation [46,XY,der(15)t(5;15)(pll:pll)pat]. All three of the chromosomally abnormal fetuses had major congenital malformations which may have been detectable on ultrasound examination. These data suggest that a single umbilical artery is associated with cytogenetic abnormalities when found in the presence of other congenital malformations, follOWing a perinatal death.