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Are umbilical cord knots associated with intrauterine fetal demise in multiple gestations?
one with a twin pregnancy) developed PED during hospitalization with concomitant intravenous magnesium sulfate for preterm labor. Five patients developed PED at 4 –34 days after discontinuing SQT during hospitalization for preterm labor or preeclampsia. Three cardiac events occurred between 2 and 24 days after discontinuation of SQT: one woman with mitral valve prolapse had ventricular arrhythmia, and two patients with twin pregnancy developed peripartum cardiomyopathy postpartum. There was no maternal mortality. CONCLUSION: Given the extremely low incidence of serious adverse events and no maternal mortality in patients receiving SQT, this therapy appears to be a viable and safe option for the outpatient management of preterm labor.
Prevalence of false knots ⬍ 24 wk
24–36 wk
ⱖ 37 wk
5% (1/20)
19% (33/170)
15% (14/92)
IUFD ⬍ 24 wk
P value
24–36 wk
P value
ⱖ 37 wk
P value
0% (0/3)
0.45
0% (0/3)
0.07
0% (0/0)
0.99
CONCLUSION: Umbilical cord knots (true or false) did not appear to be associated with intrauterine fetal demise in multiple gestation pregnancies at any gestational age in this cohort of patients presenting to a tertiary care center.
Clinical Symptoms of Spontaneous Pregnancy Loss Are Umbilical Cord Knots Associated with Intrauterine Fetal Demise in Multiple Gestations? Carlos W. Benito, MD
Carlos W. Benito, MD UMDNJ–Robert Wood Johnson Medical School/Saint Peter’s University Hospital, New Brunswick, NJ
Elaine T. Vostrovsky, RNC, BS, Debra Day-Salvatore, MD, PhD, Susan Shen-Schwarz, MD, Margaret Wu, and Rebecca Gospan
UMDNJ–Robert Wood Johnson Medical School/Saint Peter’s University Hospital, New Brunswick, NJ
OBJECTIVE: To determine what symptoms are associated with spontaneous second-trimester loss.
Susan Shen-Schwarz, MD, Elaine T. Vostrovsky, RNC, BS, and Joseph LaConti
STUDY DESIGN: Patients presenting to the Pregnancy Loss Evaluation Service from July 1994 to June 2001 were included and were evaluated through medical history, review of medical chart, review of placental pathology by a single pathologist, antiphospholipid antibody panel, and evaluation of the uterine cavity with sonohysterography or hysterosalpingography. Second-trimester loss was defined as a loss occurring between 14 and 24 weeks of gestation. Spontaneous second-trimester loss (SSTL) was defined as a loss associated with spontaneous rupture of membranes, contractions leading to delivery, or presentation with advanced cervical dilation. Patients were asked what symptoms they had within 48 hours prior to their loss. These symptoms included abdominal pain, cramping, contractions, increased vaginal discharge, pelvic pressure, vaginal bleeding, leakage of amniotic fluid, fever, and chills. Comparisons were made between patients presenting with spontaneous second-trimester loss versus patients with intrauterine fetal demise (IUFD) occurring in the second trimester. Analysis was performed using contingency tables, and significance was set at P ⬍ 0.05.
OBJECTIVE: To determine if a difference exists in the prevalence of umbilical cord knots in liveborn multiple gestation pregnancies versus that in intrauterine fetal demise (IUFD). METHODS: Placentas from all pregnancies delivered at Saint Peter’s University Hospital from January 1 to December 31, 1993, were included in the study. Intrauterine fetal demise was defined as absence of fetal cardiac activity. Umbilical cords from placentas were examined for the presence of true and false umbilical cord knots. The study population was divided into three groups: ⬍24 weeks, 24 –36 weeks, and ⱖ37 weeks of gestation. Monoamniotic gestations were excluded in the analysis. Comparisons were made within each group for the prevalence of umbilical cord knots (true and false) and IUFD. Significance was set at P ⬍ 0.05. RESULTS: A total of 282 placentas from 130 sets of twins and eight sets of triplet gestations were available for review during the study period. No placenta in the study group was found to have a true knot. Overall prevalence of false umbilical cord knots was 17% (48/283). There was no evidence of arterial or venous occlusion in any cord with a false knot.
64S
TUESDAY POSTERS
RESULTS: A total of 226 patients had second-trimester loss; 156 had spontaneous pregnancy loss, and 70 had IUFD. Historical data were available on 155 patients. CONCLUSION: Patients with SSTL reported having contractions more often than did patients with IUFD. However, the
OBSTETRICS & GYNECOLOGY
Prevalence of false knots ⬍ 24 wk
24–36 wk
ⱖ 37 wk
5% (1/20)
19% (33/170)
15% (14/92)
IUFD ⬍ 24 wk
P value
24–36 wk
P value
ⱖ 37 wk
P value
0% (0/3)
0.45
0% (0/3)
0.07
0% (0/0)
0.99
CONCLUSION: Umbilical cord knots (true or false) did not appear to be associated with intrauterine fetal demise in multiple gestation pregnancies at any gestational age in this cohort of patients presenting to a tertiary care center.
Clinical Symptoms of Spontaneous Pregnancy Loss Are Umbilical Cord Knots Associated with Intrauterine Fetal Demise in Multiple Gestations? Carlos W. Benito, MD
Carlos W. Benito, MD UMDNJ–Robert Wood Johnson Medical School/Saint Peter’s University Hospital, New Brunswick, NJ
Elaine T. Vostrovsky, RNC, BS, Debra Day-Salvatore, MD, PhD, Susan Shen-Schwarz, MD, Margaret Wu, and Rebecca Gospan
UMDNJ–Robert Wood Johnson Medical School/Saint Peter’s University Hospital, New Brunswick, NJ
OBJECTIVE: To determine what symptoms are associated with spontaneous second-trimester loss.
Susan Shen-Schwarz, MD, Elaine T. Vostrovsky, RNC, BS, and Joseph LaConti
STUDY DESIGN: Patients presenting to the Pregnancy Loss Evaluation Service from July 1994 to June 2001 were included and were evaluated through medical history, review of medical chart, review of placental pathology by a single pathologist, antiphospholipid antibody panel, and evaluation of the uterine cavity with sonohysterography or hysterosalpingography. Second-trimester loss was defined as a loss occurring between 14 and 24 weeks of gestation. Spontaneous second-trimester loss (SSTL) was defined as a loss associated with spontaneous rupture of membranes, contractions leading to delivery, or presentation with advanced cervical dilation. Patients were asked what symptoms they had within 48 hours prior to their loss. These symptoms included abdominal pain, cramping, contractions, increased vaginal discharge, pelvic pressure, vaginal bleeding, leakage of amniotic fluid, fever, and chills. Comparisons were made between patients presenting with spontaneous second-trimester loss versus patients with intrauterine fetal demise (IUFD) occurring in the second trimester. Analysis was performed using contingency tables, and significance was set at P ⬍ 0.05.
OBJECTIVE: To determine if a difference exists in the prevalence of umbilical cord knots in liveborn multiple gestation pregnancies versus that in intrauterine fetal demise (IUFD). METHODS: Placentas from all pregnancies delivered at Saint Peter’s University Hospital from January 1 to December 31, 1993, were included in the study. Intrauterine fetal demise was defined as absence of fetal cardiac activity. Umbilical cords from placentas were examined for the presence of true and false umbilical cord knots. The study population was divided into three groups: ⬍24 weeks, 24 –36 weeks, and ⱖ37 weeks of gestation. Monoamniotic gestations were excluded in the analysis. Comparisons were made within each group for the prevalence of umbilical cord knots (true and false) and IUFD. Significance was set at P ⬍ 0.05. RESULTS: A total of 282 placentas from 130 sets of twins and eight sets of triplet gestations were available for review during the study period. No placenta in the study group was found to have a true knot. Overall prevalence of false umbilical cord knots was 17% (48/283). There was no evidence of arterial or venous occlusion in any cord with a false knot.
64S
TUESDAY POSTERS
RESULTS: A total of 226 patients had second-trimester loss; 156 had spontaneous pregnancy loss, and 70 had IUFD. Historical data were available on 155 patients. CONCLUSION: Patients with SSTL reported having contractions more often than did patients with IUFD. However, the
OBSTETRICS & GYNECOLOGY