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Antental diagnosis of hypoplastic left heart syndrome: Clinical characteristics, management and outcomes
S72
SPO Abstracts
Janua. D, 1997 A m J Obstet Gynecol
221
PROSPECTIVE EVALUATION OF FETAL PERICARD1AL EFFUSION IN 508 SECOND TRIMESTER LOW RISK PREGNANCIES. Dizon-Townson D, Dildy GA, Clark SL. Dept of Ob/Gyn, University of Utah, Salt Lake City-, UT. OBJECTIVE: Previous investigators have used a 2 mnr depth as the cutoff of fluid in the fetal pericardial sac across a broad range of gestational ages. Our objective was to quantitate the pericardial fluid in low risk second trimester pregnancies and evaluate outcome for those with fluid measurenlents >2 ram. STUDY DESIGN: 508 wonmn were referred for sonography between 16-25 weeks for common obstetrical indications unrelated to increased risk of anomalies (dating, fetal survey, and placental location). All patients were scanned with n~,o-dimensional and M-mode real-time ultrasound, with the use of mechanical sector transducer. The maximum amount of perieardial fluid in any appropriate image was then recorded. Patient characteristics including maternal age, gravidity, parity, and estimated gestatiooal age were also recorded. Maternal and infant charts for pregnancies with > 2 mm of perieardial fluid were reviewed. RESULTS: Mean maternal age was 26 (15-45). Mean gravidity and parity were 3 (1-14) and 1 (0-11), respectively. Mean estimated gestational age was 21 (16-25). Pericardial fluid was seen in 77% of fetuses. Among the 508 patients, the maximum depth of fluid was 3.0 Into. Ten of the 508 (2%) patients had pericardial fluid measurements >2. In all 10 patients, perinatal outcoule was unremarkable. CONCLUSIONS: During 2nd trimester ultrasonographic examination, visualization of pericardial fluid in the fetus using current high-resolution technology is common and should not be regarded as pathologic. Even with etthsions of up to 3 ram, no adverse perinatal outcome could be demonsn-ated in the absence of structural anomalies or dysrhythmia. Elflasions in excess of 2 3 mm cannot be considered normal. Appropriate management of patients with this isolated finding is as yet undefined.
223
FETAL GASTROSCHISIS: THE PROGNOSTIC VALUE OF ANTENATAL SONOGRAPHIC FINDINGS AND SELECTED OBSTETRIC FACTORS O N NEONATAL OUTCOME. Halcomb R T x, Owen J, George~on KEx, Wenstrom KD, Davis RO, Brumfield CG. Departments of Ob/Gyn and Pediatric Surgery, The University of Alabama at Birmingham, Birmingham, AL. OBJECTIVE: To determine if antenatal sonographic findings or selected obstetric 1actors predict neonatal outcome in cases of fetal gastroschisis. STUDY DESIGN: We retrospectively studied all (N = 59) cases of isolated fetal gastroschisis with prenatal diagnosis and follow-up at our institution from 1986-1996. Obsten-ic factors included gestational age (GA) at delivery, labor, meconimn and oligohydramnios, Abnormal sonographic findings were defined as subjective or objective (~>15 mm max. lumen diameter) bowel dilatation and subjective bowel obstruction or bowel wall thickening. Indicators of neonatal morbidity included a staged repair (silo) or boweI resection and the inter~,al from dCivel3, to tolerance of full enteral feedings. RESULTS: The mean GA at delivery was 36 • 1.8 wks (range 28-39), and the mean birthweight was 2527 + 546 g (range 1135-3760); all but two patients underwent cesarean. Fourteen babies required a silo, and 5 required bowel resection. The median interval to tolerance of enteral feedings was 24 days (range 8-193). There was no significant relationship between GA at delivery and neonatal outcome. However, infants with oligohydramnios (p = .04), labor (p - .006), and meconium (p = .002) had longer intervals to full enteral feedings; labor was also associated with an increased need for bowel resection (p - .05). In the 47 (80%) women whose last scan was pertbrmed < 4 wks prior to delivery, the only sonographic abnormality related to morbidity was subjective obstruction, which increased both the need for a silo (p - .05) and the interval to full enteral feedings (p = .03). In a linear regression model, controlling for GA at delivery, the presence of labor still predicted a longer time to enteral feeding (p - .007). CONCLUSIONS: In cases of fetal gastroschisis, oligohydtamnios, labor and meconium were associated with increased neonatal morbidity. O f the various sonographic findings, only subjective bowel obsu uction predicted neonatal morbidity.
222
ANTENATAL DIAGNOSIS OF HYPOPLASTIC L E F t HEART SYNDROME: CLINICAL CHARACTERISTICS, MANAGEMENT AND OUTCOMES. ~ , C Dutton~, H Leopold~, D Diana~, D Esters, W Campbell: St. Francis Hospital and Medical Center, Hartford CT, Hartford Hospital, Hartford CT, Univ. of CT Health Center, Farmington CT. OBJECTIVE; To evaluate our experience with antenata/ly diagnosed cases of hypoplastic left heart syndrome (HLHS). STUDY DESIGN: We reviewed cases of antenatally diagnosed HLHS in our referral area fi-om 1/90 to 2/96. The ages at diagnosis, karyotypes, associated anomalies, and outcomes for each case were obtained. Each patient was oRhred a consultation with a pediatric cardiologist who also counseled all patients diagnosed afLer 24 weeks. Each diagnosis was confirmed by autopsy or review of the echocardiography with a pediatric cardiologist. RESULTS: Fourteen cases were diagnosed antenatally. Karyotypic abnormalities which were found in 2/14 (14.2%) including: 45 X and 46 X, t (X:19) (q26:p12). Eight were diagnosed prior to 24 weeks; mean, 20.6 weeks (range, 16 23.6). Structural anomalies were [ound in 4 / 8 including: cystic hygrmna (2), omphalocele and club teet (1) and abdominal situs inversus (1). Elective termination was perfornred in 7 of the 8 cases diagnosed at <24 weeks. Six were found after 24 weeks; mean, 31.2 weeks (range, 24.6-35.1). One had amniotic band syndrome; all had normal karyotypes. Of the 7 pregnancies which continued, 6 neonates died in the first week of lille without definitive surgical intervention. The remaining infant died at 5 months after a Stage I NoJ~vood procedure. Compared to other reports, a very small number (1/7) of our antenatally diagnosed HLHS newborns had corrective surgery. CONCLUSIONS: In our region 7/8 mothers with the antenatal diagnosis of HLHS before 24 weeks elected to terminate. The only newborn having corrective surgery died at 5 months of age. Our experience with antenatally diagnosed HLHS shows a 100% mortality rate with a neonatal intervention rate of 14%.
224
PREGNANCY OUTCOMES FOLLOWING SONOGRAPHIC NONVISUALIZATION OF T H E FETAL STOMACH. CG Br~*mlcu'~, RO Davis, J Owen, K Wenshvm, P Mize." Dept. Ob/Gyn, Univ. of AI, Birmingham, AL. OBJECTIVE: To review pregnancy outcome data ,after ultrasound exams persistently tail to visualize the fetal stomach. STUDY DESIGN: A computerized ultrasound database was used to idenfit~,, all fetuses in whom two or more serial ultrasound exams failed to visualize the fetal stomach. Sonographic images were retrospectively reviewed, with tile reviewer blinded to outconae data, to confirm persistent nonvisualization. Pregnancy outcome data was obtained from hospital charts and physician office records. Fetal karyotypes, when performed, were obtained fi-oln amniotic fluid culture. The ultrasound findings were then compared to fetal karyo~pe results and pregnancy outcome data. RESULTS: From 1991-1996, 27 fetuses with persistently nonvisualized stumachs were identified. Fetal structural defects were detected in 17 Ictuses (63%), most ot*en involving either the genitourinary (N = 5), cardiothoracic (N 4), central nervous (N 3), or gastrointestinal systems (N = 2). Fifteen tetal kata/~types were obtained and 4 (27%) of these were abnormal Fetal growth restriction was detected in 5 fetuses (19%) and abnormal mnniotic fluid volumes were found with 19 fetuses (70%) (Poly = 13, OIigo = 6). There were II deliveries <37 weeks (4I%), 7 fetaI deaths (26%), 3 induced abortions (11%), 5 neonatal deaths (19%), and 2 iniant deaths (7%). Ten intants smwived (37%) and only 6 sm~,ivors (22%) did not have a birth defect. CONCLUSIONS: Fetuses with a persistently nonvisualized stomach have an increased incidence of serious structural defects and chromosomal abnormalities and thus are more likely to have a poor pregnancy outcome. A detailed ultrasound examination and fetal karyotype analysis should be pertormed to evaluate fetuses with persistently nonvisualized stomachs.
SPO Abstracts
Janua. D, 1997 A m J Obstet Gynecol
221
PROSPECTIVE EVALUATION OF FETAL PERICARD1AL EFFUSION IN 508 SECOND TRIMESTER LOW RISK PREGNANCIES. Dizon-Townson D, Dildy GA, Clark SL. Dept of Ob/Gyn, University of Utah, Salt Lake City-, UT. OBJECTIVE: Previous investigators have used a 2 mnr depth as the cutoff of fluid in the fetal pericardial sac across a broad range of gestational ages. Our objective was to quantitate the pericardial fluid in low risk second trimester pregnancies and evaluate outcome for those with fluid measurenlents >2 ram. STUDY DESIGN: 508 wonmn were referred for sonography between 16-25 weeks for common obstetrical indications unrelated to increased risk of anomalies (dating, fetal survey, and placental location). All patients were scanned with n~,o-dimensional and M-mode real-time ultrasound, with the use of mechanical sector transducer. The maximum amount of perieardial fluid in any appropriate image was then recorded. Patient characteristics including maternal age, gravidity, parity, and estimated gestatiooal age were also recorded. Maternal and infant charts for pregnancies with > 2 mm of perieardial fluid were reviewed. RESULTS: Mean maternal age was 26 (15-45). Mean gravidity and parity were 3 (1-14) and 1 (0-11), respectively. Mean estimated gestational age was 21 (16-25). Pericardial fluid was seen in 77% of fetuses. Among the 508 patients, the maximum depth of fluid was 3.0 Into. Ten of the 508 (2%) patients had pericardial fluid measurements >2. In all 10 patients, perinatal outcoule was unremarkable. CONCLUSIONS: During 2nd trimester ultrasonographic examination, visualization of pericardial fluid in the fetus using current high-resolution technology is common and should not be regarded as pathologic. Even with etthsions of up to 3 ram, no adverse perinatal outcome could be demonsn-ated in the absence of structural anomalies or dysrhythmia. Elflasions in excess of 2 3 mm cannot be considered normal. Appropriate management of patients with this isolated finding is as yet undefined.
223
FETAL GASTROSCHISIS: THE PROGNOSTIC VALUE OF ANTENATAL SONOGRAPHIC FINDINGS AND SELECTED OBSTETRIC FACTORS O N NEONATAL OUTCOME. Halcomb R T x, Owen J, George~on KEx, Wenstrom KD, Davis RO, Brumfield CG. Departments of Ob/Gyn and Pediatric Surgery, The University of Alabama at Birmingham, Birmingham, AL. OBJECTIVE: To determine if antenatal sonographic findings or selected obstetric 1actors predict neonatal outcome in cases of fetal gastroschisis. STUDY DESIGN: We retrospectively studied all (N = 59) cases of isolated fetal gastroschisis with prenatal diagnosis and follow-up at our institution from 1986-1996. Obsten-ic factors included gestational age (GA) at delivery, labor, meconimn and oligohydramnios, Abnormal sonographic findings were defined as subjective or objective (~>15 mm max. lumen diameter) bowel dilatation and subjective bowel obstruction or bowel wall thickening. Indicators of neonatal morbidity included a staged repair (silo) or boweI resection and the inter~,al from dCivel3, to tolerance of full enteral feedings. RESULTS: The mean GA at delivery was 36 • 1.8 wks (range 28-39), and the mean birthweight was 2527 + 546 g (range 1135-3760); all but two patients underwent cesarean. Fourteen babies required a silo, and 5 required bowel resection. The median interval to tolerance of enteral feedings was 24 days (range 8-193). There was no significant relationship between GA at delivery and neonatal outcome. However, infants with oligohydramnios (p = .04), labor (p - .006), and meconium (p = .002) had longer intervals to full enteral feedings; labor was also associated with an increased need for bowel resection (p - .05). In the 47 (80%) women whose last scan was pertbrmed < 4 wks prior to delivery, the only sonographic abnormality related to morbidity was subjective obstruction, which increased both the need for a silo (p - .05) and the interval to full enteral feedings (p = .03). In a linear regression model, controlling for GA at delivery, the presence of labor still predicted a longer time to enteral feeding (p - .007). CONCLUSIONS: In cases of fetal gastroschisis, oligohydtamnios, labor and meconium were associated with increased neonatal morbidity. O f the various sonographic findings, only subjective bowel obsu uction predicted neonatal morbidity.
222
ANTENATAL DIAGNOSIS OF HYPOPLASTIC L E F t HEART SYNDROME: CLINICAL CHARACTERISTICS, MANAGEMENT AND OUTCOMES. ~ , C Dutton~, H Leopold~, D Diana~, D Esters, W Campbell: St. Francis Hospital and Medical Center, Hartford CT, Hartford Hospital, Hartford CT, Univ. of CT Health Center, Farmington CT. OBJECTIVE; To evaluate our experience with antenata/ly diagnosed cases of hypoplastic left heart syndrome (HLHS). STUDY DESIGN: We reviewed cases of antenatally diagnosed HLHS in our referral area fi-om 1/90 to 2/96. The ages at diagnosis, karyotypes, associated anomalies, and outcomes for each case were obtained. Each patient was oRhred a consultation with a pediatric cardiologist who also counseled all patients diagnosed afLer 24 weeks. Each diagnosis was confirmed by autopsy or review of the echocardiography with a pediatric cardiologist. RESULTS: Fourteen cases were diagnosed antenatally. Karyotypic abnormalities which were found in 2/14 (14.2%) including: 45 X and 46 X, t (X:19) (q26:p12). Eight were diagnosed prior to 24 weeks; mean, 20.6 weeks (range, 16 23.6). Structural anomalies were [ound in 4 / 8 including: cystic hygrmna (2), omphalocele and club teet (1) and abdominal situs inversus (1). Elective termination was perfornred in 7 of the 8 cases diagnosed at <24 weeks. Six were found after 24 weeks; mean, 31.2 weeks (range, 24.6-35.1). One had amniotic band syndrome; all had normal karyotypes. Of the 7 pregnancies which continued, 6 neonates died in the first week of lille without definitive surgical intervention. The remaining infant died at 5 months after a Stage I NoJ~vood procedure. Compared to other reports, a very small number (1/7) of our antenatally diagnosed HLHS newborns had corrective surgery. CONCLUSIONS: In our region 7/8 mothers with the antenatal diagnosis of HLHS before 24 weeks elected to terminate. The only newborn having corrective surgery died at 5 months of age. Our experience with antenatally diagnosed HLHS shows a 100% mortality rate with a neonatal intervention rate of 14%.
224
PREGNANCY OUTCOMES FOLLOWING SONOGRAPHIC NONVISUALIZATION OF T H E FETAL STOMACH. CG Br~*mlcu'~, RO Davis, J Owen, K Wenshvm, P Mize." Dept. Ob/Gyn, Univ. of AI, Birmingham, AL. OBJECTIVE: To review pregnancy outcome data ,after ultrasound exams persistently tail to visualize the fetal stomach. STUDY DESIGN: A computerized ultrasound database was used to idenfit~,, all fetuses in whom two or more serial ultrasound exams failed to visualize the fetal stomach. Sonographic images were retrospectively reviewed, with tile reviewer blinded to outconae data, to confirm persistent nonvisualization. Pregnancy outcome data was obtained from hospital charts and physician office records. Fetal karyotypes, when performed, were obtained fi-oln amniotic fluid culture. The ultrasound findings were then compared to fetal karyo~pe results and pregnancy outcome data. RESULTS: From 1991-1996, 27 fetuses with persistently nonvisualized stumachs were identified. Fetal structural defects were detected in 17 Ictuses (63%), most ot*en involving either the genitourinary (N = 5), cardiothoracic (N 4), central nervous (N 3), or gastrointestinal systems (N = 2). Fifteen tetal kata/~types were obtained and 4 (27%) of these were abnormal Fetal growth restriction was detected in 5 fetuses (19%) and abnormal mnniotic fluid volumes were found with 19 fetuses (70%) (Poly = 13, OIigo = 6). There were II deliveries <37 weeks (4I%), 7 fetaI deaths (26%), 3 induced abortions (11%), 5 neonatal deaths (19%), and 2 iniant deaths (7%). Ten intants smwived (37%) and only 6 sm~,ivors (22%) did not have a birth defect. CONCLUSIONS: Fetuses with a persistently nonvisualized stomach have an increased incidence of serious structural defects and chromosomal abnormalities and thus are more likely to have a poor pregnancy outcome. A detailed ultrasound examination and fetal karyotype analysis should be pertormed to evaluate fetuses with persistently nonvisualized stomachs.