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Case report: complete hydatiform mole coexisting with a twin live fetus
percentile were evaluated for the Collaborative Perinatal Project. AsymIUGR markers were BW/length ratio, ponderal index, and BW/head circumference. AsymIUGR markers and BW/placenta weight less than the 10th percentile for gestation and gender were considered low. Five-minute Apgar score of 0 –3 (low Apgar) was judged low. Relative risks with 95% confidence intervals, excluding 1.0, and P values ⬍0.05 were considered significant. Results: Low BW/placental weight ratio occurred in 1,912 (5.5%) infants and was associated with increased rates of low BW/length ratio, low ponderal index, low BW/head circumference ratio (relative risks 1.6, 1.3, and 2.0, respectively, all P ⬍0.002), and low Apgar (relative risk 1.8, P ⬍0.001). Conclusions: Low BW/placental weight ratio is correlated with increased risk for AsymIUGR and low Apgar in term, nonanomalous, normal BW infants. Low BW/placental weight ratio may represent a useful, readily available marker for poor nutritional status at birth when birth length or head circumference are unavailable for analysis.
Case Report: Complete Hydatiform Mole Coexisting with a Twin Live Fetus Elena-Maria Buruiana, MD Nassau County Medical Center, East Meadow, NY
Elsie Santana-Fox, MD Objective: To discuss a case of complete hydatiform mole fetus (CHMF) with a twin live fetus. Case description: A 30-year-old black woman, gravida 4, para 2, was seen at 25 weeks of gestation with vaginal bleeding and premature contractions. A sonogram revealed a single fetus of 25 weeks of gestation, consistent with LMP and fundal height and a 7 ⫻ 6 cm intrauterine soft tissue mass separate from the placenta. On day 10, she delivered a breech-presenting, 732-g male with normal appearing placenta by cesarean birth. A 7 ⫻ 6 cm brownish-colored cystic mass was expelled vaginally while the patient was en route to the operating room. Postoperatively, the patient remained stable and -human chorionic gonadotropin levels were negative at 8 weeks. Results: A CHMF coexisting with a twin surviving fetus is rare. Only nine cases have been documented since 1966. CHMFs are diagnosed at a later gestational age and have a greater propensity for developing persistent gestational trophoblastic disease. This may be due to a delay in diagnosis or an intrinsic aggressive propensity of this phenomenon. The twin molar gestation resulting in a viable live-born infant also had a significantly smaller discrepancy between uterine size at evacuation than expected by dates (1.0 week in viable group versus 8.1 weeks in a previable group). Conclusions: More cases are needed to establish treatment criteria. Expectant management to fetal viability can be accomplished in patients with declining serum human chorionic gonadotropin level and normal fetal karyotype.
VOL. 95, NO. 4 (SUPPLEMENT), APRIL 2000
Risks of Hypertensive Disorders in the Second Pregnancy Jim Zhang, MB, PhD Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
J. Troendle and R. Levine Objective: To examine the incidence of and risk factors for recurrent and newly developed hypertensive disorders in the second pregnancy; and to determine if hypertension in the first pregnancy is associated with adverse perinatal outcomes in the second pregnancy. Methods: We analyzed data on 1,641 women who had both the first and second births recorded in the Collaborative Perinatal Project, a large prospective cohort study at 12 U.S. hospitals that collected extensive prenatal and perinatal information. Incidence of and risk factors for hypertension in the second pregnancy were computed according to hypertensive status in the first pregnancy. Birth weight and gestational age at delivery of the second birth were examined by hypertensive status of the first and second pregnancies. Results: Nineteen percent (95% CI 14 –24%) of women who had gestational hypertension in the first pregnancy, 32% (95% CI 17– 48%) of those with preeclampsia, and 46% (95% CI 32– 60%) of patients with gestational hypertension or preeclampsia superimposed on chronic hypertension had recurrent hypertensive disorders in the second pregnancy. The earlier the onset of hypertension in the first pregnancy, the higher the overall recurrence rate. Seventy-six percent of recurrent cases had mild hypertension, which did not affect perinatal outcomes in the second pregnancy. However, patients with a history of hypertension in the first pregnancy and severe hypertension in the second pregnancy had a sixfold increased risk of very premature birth (⬍34 weeks) and ninefold increased risk of severe intrauterine growth restriction (⬍5th percentile) (P ⬍0.05). Conclusions: Hypertensive disorders have a 20 –50% recurrence rate in the second pregnancy. Most recurrent cases are mild and do not have adverse effects on perinatal outcomes.
Dietary Intake of Polyunsaturated Fatty Acids by Pregnant or Lactating Women in the United States Diane Benisek, MBA, RD, LD Martek Biosciences Corporation, Columbia, MD
Judith Shabert, MD, MPH, RD, and Ronee Skornik, MD Dietary intakes of specific polyunsaturated fatty acids (PUFAs), particularly docosahexaenoic acid, and the ratio between ome-
Wednesday Posters 77S
Case Report: Complete Hydatiform Mole Coexisting with a Twin Live Fetus Elena-Maria Buruiana, MD Nassau County Medical Center, East Meadow, NY
Elsie Santana-Fox, MD Objective: To discuss a case of complete hydatiform mole fetus (CHMF) with a twin live fetus. Case description: A 30-year-old black woman, gravida 4, para 2, was seen at 25 weeks of gestation with vaginal bleeding and premature contractions. A sonogram revealed a single fetus of 25 weeks of gestation, consistent with LMP and fundal height and a 7 ⫻ 6 cm intrauterine soft tissue mass separate from the placenta. On day 10, she delivered a breech-presenting, 732-g male with normal appearing placenta by cesarean birth. A 7 ⫻ 6 cm brownish-colored cystic mass was expelled vaginally while the patient was en route to the operating room. Postoperatively, the patient remained stable and -human chorionic gonadotropin levels were negative at 8 weeks. Results: A CHMF coexisting with a twin surviving fetus is rare. Only nine cases have been documented since 1966. CHMFs are diagnosed at a later gestational age and have a greater propensity for developing persistent gestational trophoblastic disease. This may be due to a delay in diagnosis or an intrinsic aggressive propensity of this phenomenon. The twin molar gestation resulting in a viable live-born infant also had a significantly smaller discrepancy between uterine size at evacuation than expected by dates (1.0 week in viable group versus 8.1 weeks in a previable group). Conclusions: More cases are needed to establish treatment criteria. Expectant management to fetal viability can be accomplished in patients with declining serum human chorionic gonadotropin level and normal fetal karyotype.
VOL. 95, NO. 4 (SUPPLEMENT), APRIL 2000
Risks of Hypertensive Disorders in the Second Pregnancy Jim Zhang, MB, PhD Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
J. Troendle and R. Levine Objective: To examine the incidence of and risk factors for recurrent and newly developed hypertensive disorders in the second pregnancy; and to determine if hypertension in the first pregnancy is associated with adverse perinatal outcomes in the second pregnancy. Methods: We analyzed data on 1,641 women who had both the first and second births recorded in the Collaborative Perinatal Project, a large prospective cohort study at 12 U.S. hospitals that collected extensive prenatal and perinatal information. Incidence of and risk factors for hypertension in the second pregnancy were computed according to hypertensive status in the first pregnancy. Birth weight and gestational age at delivery of the second birth were examined by hypertensive status of the first and second pregnancies. Results: Nineteen percent (95% CI 14 –24%) of women who had gestational hypertension in the first pregnancy, 32% (95% CI 17– 48%) of those with preeclampsia, and 46% (95% CI 32– 60%) of patients with gestational hypertension or preeclampsia superimposed on chronic hypertension had recurrent hypertensive disorders in the second pregnancy. The earlier the onset of hypertension in the first pregnancy, the higher the overall recurrence rate. Seventy-six percent of recurrent cases had mild hypertension, which did not affect perinatal outcomes in the second pregnancy. However, patients with a history of hypertension in the first pregnancy and severe hypertension in the second pregnancy had a sixfold increased risk of very premature birth (⬍34 weeks) and ninefold increased risk of severe intrauterine growth restriction (⬍5th percentile) (P ⬍0.05). Conclusions: Hypertensive disorders have a 20 –50% recurrence rate in the second pregnancy. Most recurrent cases are mild and do not have adverse effects on perinatal outcomes.
Dietary Intake of Polyunsaturated Fatty Acids by Pregnant or Lactating Women in the United States Diane Benisek, MBA, RD, LD Martek Biosciences Corporation, Columbia, MD
Judith Shabert, MD, MPH, RD, and Ronee Skornik, MD Dietary intakes of specific polyunsaturated fatty acids (PUFAs), particularly docosahexaenoic acid, and the ratio between ome-
Wednesday Posters 77S