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Fetal growth velocity in women who develop superimposed preeclampsia
S170 SMFM Abstracts 602
NON-INVASIVE INVESTIGATION OF HEART RATE VARIABILITY IN GROWTH RESTRICTED AND NORMAL FETUSES USING MAGNETOCARDIOGRAPHY JOSHUA CAMPBELL1, HARI ESWARAN2, HUBERT PREISSL3, JAMES WILSON4, PAM MURPHY3, CURTIS LOWERY JR5, 1University of Arkansas, Applied Science, Little Rock, Arkansas, 2University of Arkansas for Medical Sciences, Obstetrics and Gynecology, Little Rock, Arkansas, 3University of Arkansas for Medical Sciences, Ob/Gyn, Little Rock, Arkansas, 4University of Arkansas at Little Rock, Graduate Institute of Technology, Little Rock, Arkansas, 5University of Arkansas for Medical Sciences, Little Rock, Arkansas OBJECTIVE: To investigate differences in common heart rate variability parameters in normal and intra-uterine growth restricted (IUGR) fetuses using non-invasively recorded fetal magnetocardiograms. STUDY DESIGN: We recorded fetal magnetocardiograms (fMCG) in 18 IUGR fetuses and 83 healthy fetuses with gestational ages ranging from 25 to 38 weeks at UAMS SARA (Squid Array for Reproductive Assessment) fetal cardiac research center. The fMCG traces are analogous to a surface ECG (with an orthogonal vector) and provide more information than can be obtained with other noninvasive techniques. Post-processing was performed to attenuate the maternal cardiographic signals. After attenuation of the maternal cardiographic signals, the fetal RR intervals were acquired using a peak detection algorithm. The heart rate of all fetuses was calculated from the RR intervals, and various heart rate variability (HRV) parameters were calculated. The Mann-Whitney U Test was implemented to compare differences between the healthy fetuses and the IUGR fetuses. Statistical significance was defined by a P ! .05. RESULTS: Calculation of the heart rate and HRV parameters was successful for all healthy and IUGR fetuses. Using the HRV parameters calculated from the heart rate of the healthy and IUGR fetuses, significant differences between the groups were found in the maximum heart rate(P ! .005), standard deviation (P ! .001), and approximate entropy (ApEN) P ! .001). CONCLUSION: FMCG has proven to be a rapid, safe, non-invasive, and reliable technique for monitoring fetal cardiac function in healthy and IUGR fetuses. The findings presented support the fact that fetal HRV parameters can be used as indicator of fetal development as demonstrated by the significant differences between the various HRV parameters.
604
ELECTIVE CESAREAN DELIVERY IS INEFFECTIVE IN PROTECTING AGAINST IN-UTERO MECONIUM EXPOSURE OF FETAL MYELOMENINGOCELE CARL ROSE1, JOSEPHINE WYATT-ASHMEAD2, ANDREW PARENT3, JAMES BOFILL1, ALEXANDRA ASHMEAD4, JOHN MORRISON1, 1University of Mississippi Medical Center, Obstetrics & Gynecology, Jackson, Mississippi, 2University of Mississippi Medical Center, Pathology, Jackson, California, 3University of Mississippi Medical Center, Neurosurgery, Jackson, Mississippi, 4University of Mississippi Medical Center, Jackson, Mississippi OBJECTIVE: To determine if elective cesarean section following confirmation of fetal lung maturity but prior to onset of labor prevents in-utero meconium exposure of neural tissue in parturients with fetal myelomeningocele. STUDY DESIGN: In this retrospective case series 32 (17 male/15 female) with prenatally-diagnosed myelomeningocele underwent elective cesarean birth over a 4.5 year period. The mean EGA was 37.2 weeks and delivery followed confirmation of fetal lung maturity. All myelomeningoceles were repaired promptly (2.4 days) and the sacs were sent for pathologic examination. Amniotic membranes were also examined for evidence of microscopic meconium and intrauterine infection. Additionally, 23 placentas underwent histopathologic gross and microscopic examination. RESULTS: Gross meconium staining was noted in 3 cases. Meconium staining was detected microscopically in 32/32 (100%) of amniotic membrane samples and all (23/23) placental specimens demonstrated meconium histiocytosis while features of acute infection were noted in only 3/23 (13%). CONCLUSION: Fetuses with myelomeningoceles typically have intrinsically defective gastrointestinal function and are likely to pass meconium in-utero remote from term. Unfortunately, elective cesarean delivery prior to labor does not protect against exposure to potentially toxic meconium. Antenatal surgical repair could prove effective at reducing or mitigating destructive effects of meconium on open neural tissue.
603
FETAL GROWTH VELOCITY IN WOMEN WHO DEVELOP SUPERIMPOSED PREECLAMPSIA JULIE GAINER1, JAMES ALEXANDER1, DONALD MCINTIRE1, KENNETH LEVENO1, 1University of Texas Southwestern Medical Center at Dallas, Obstetrics and Gynecology, Dallas, Texas OBJECTIVE: To compare growth velocity in chronic hypertensive women who develop preeclampsia to those who do not. STUDY DESIGN: From 8/20/1998 to 4/25/2004 all chronic hypertensive women requiring medication were referred to and followed in a specialty clinic staffed by MFM faculty and fellows. Sequential sonograms beginning prior to 20 weeks, at 28 to 32 weeks, and again at 36 to 38 weeks were obtained routinely in this population during the study period. For this study growth velocity was compared in those women who developed preeclampsia versus those who did not. Superimposed preeclampsia was defined using the criteria established by the Working Group Report on High Blood Pressure in Pregnancy. RESULTS: 186 women were available for analysis, 63 (34%) of which developed superimposed preeclampsia. Both groups showed appropriate growth velocity over time and no patient developed growth restriction, however, the women who developed preeclampsia showed a significantly slower growth velocity than those who did not. The difference in the two groups becomes statistically significant at 23.4 weeks, P = ! .001 and increases until 32 weeks where it peaks at 160 gms. This 160 gm difference persists and remains significant until delivery. CONCLUSION: Fetal growth velocity is slower in chronic hypertensive women who develop superimposed preeclampsia than those who do not. This difference is seen as early as 23 weeks and persists until delivery.
605
ASSOCIATION OF A19G POLYMORPHISM IN THE LEPTIN GENE WITH CORD SERUM LEPTIN LEVEL AND BIRTH WEIGHT HAN-SUNG KWON1, YOUNG-HAN KIM1, JAYOUNG KWON1, BOK-JA KIM1, YONG-WON PARK1, 1Yonsei University College of Medicine, Obstetrics and Gynecology, Seoul, Korea, South Korea OBJECTIVE: Some polymorphisms in the leptin gene are known to be associated with the obesity and serum leptin level in adults. Our study was performed to find out the relationship of the leptin gene A19G polymorphism with birth weight and serum leptin levels in the cord blood. STUDY DESIGN: The cord blood was withdrawn from 62 pregnant women who delivered at term without any medical or obstetrical complication such as preeclampsia, IUGR, or DM. Serum leptin levels of the cord blood were assessed by radioimmunoassay. The DNA was extracted from the cord blood and the frequency of each A19G polymorphism(AA, AG, GG) genotype in the leptin gene was evaluated through PCR-RFLP. RESULTS: Among the total 62 subjects, 34 expressed GG genotype, 28 did AG, and none did AA. The birth weights and placental weights were not significantly different between two groups. The mean serum leptin level was higher in the AG group(8.14 G 5.39) than the GG (7.10 G 5.20), but there was no statistical significance. The mean serum leptin level was higher in the female fetus group(9.94 G 5.53) than the male group(5.34 G 3.87), with the male fetus group expressing more GG genotype(68.8% vs 40.0%). The frequency of GG genotype was significantly higher in those weighing more than 3400g(61.5% vs 52.9%). CONCLUSION: The A19G polymorphism in the leptin gene does not seem to have a major role in regulating the cord serum leptin level or fetal birth weight. But, our study results indicate that variations in the leptin locus might be associated with fetal overweight.
NON-INVASIVE INVESTIGATION OF HEART RATE VARIABILITY IN GROWTH RESTRICTED AND NORMAL FETUSES USING MAGNETOCARDIOGRAPHY JOSHUA CAMPBELL1, HARI ESWARAN2, HUBERT PREISSL3, JAMES WILSON4, PAM MURPHY3, CURTIS LOWERY JR5, 1University of Arkansas, Applied Science, Little Rock, Arkansas, 2University of Arkansas for Medical Sciences, Obstetrics and Gynecology, Little Rock, Arkansas, 3University of Arkansas for Medical Sciences, Ob/Gyn, Little Rock, Arkansas, 4University of Arkansas at Little Rock, Graduate Institute of Technology, Little Rock, Arkansas, 5University of Arkansas for Medical Sciences, Little Rock, Arkansas OBJECTIVE: To investigate differences in common heart rate variability parameters in normal and intra-uterine growth restricted (IUGR) fetuses using non-invasively recorded fetal magnetocardiograms. STUDY DESIGN: We recorded fetal magnetocardiograms (fMCG) in 18 IUGR fetuses and 83 healthy fetuses with gestational ages ranging from 25 to 38 weeks at UAMS SARA (Squid Array for Reproductive Assessment) fetal cardiac research center. The fMCG traces are analogous to a surface ECG (with an orthogonal vector) and provide more information than can be obtained with other noninvasive techniques. Post-processing was performed to attenuate the maternal cardiographic signals. After attenuation of the maternal cardiographic signals, the fetal RR intervals were acquired using a peak detection algorithm. The heart rate of all fetuses was calculated from the RR intervals, and various heart rate variability (HRV) parameters were calculated. The Mann-Whitney U Test was implemented to compare differences between the healthy fetuses and the IUGR fetuses. Statistical significance was defined by a P ! .05. RESULTS: Calculation of the heart rate and HRV parameters was successful for all healthy and IUGR fetuses. Using the HRV parameters calculated from the heart rate of the healthy and IUGR fetuses, significant differences between the groups were found in the maximum heart rate(P ! .005), standard deviation (P ! .001), and approximate entropy (ApEN) P ! .001). CONCLUSION: FMCG has proven to be a rapid, safe, non-invasive, and reliable technique for monitoring fetal cardiac function in healthy and IUGR fetuses. The findings presented support the fact that fetal HRV parameters can be used as indicator of fetal development as demonstrated by the significant differences between the various HRV parameters.
604
ELECTIVE CESAREAN DELIVERY IS INEFFECTIVE IN PROTECTING AGAINST IN-UTERO MECONIUM EXPOSURE OF FETAL MYELOMENINGOCELE CARL ROSE1, JOSEPHINE WYATT-ASHMEAD2, ANDREW PARENT3, JAMES BOFILL1, ALEXANDRA ASHMEAD4, JOHN MORRISON1, 1University of Mississippi Medical Center, Obstetrics & Gynecology, Jackson, Mississippi, 2University of Mississippi Medical Center, Pathology, Jackson, California, 3University of Mississippi Medical Center, Neurosurgery, Jackson, Mississippi, 4University of Mississippi Medical Center, Jackson, Mississippi OBJECTIVE: To determine if elective cesarean section following confirmation of fetal lung maturity but prior to onset of labor prevents in-utero meconium exposure of neural tissue in parturients with fetal myelomeningocele. STUDY DESIGN: In this retrospective case series 32 (17 male/15 female) with prenatally-diagnosed myelomeningocele underwent elective cesarean birth over a 4.5 year period. The mean EGA was 37.2 weeks and delivery followed confirmation of fetal lung maturity. All myelomeningoceles were repaired promptly (2.4 days) and the sacs were sent for pathologic examination. Amniotic membranes were also examined for evidence of microscopic meconium and intrauterine infection. Additionally, 23 placentas underwent histopathologic gross and microscopic examination. RESULTS: Gross meconium staining was noted in 3 cases. Meconium staining was detected microscopically in 32/32 (100%) of amniotic membrane samples and all (23/23) placental specimens demonstrated meconium histiocytosis while features of acute infection were noted in only 3/23 (13%). CONCLUSION: Fetuses with myelomeningoceles typically have intrinsically defective gastrointestinal function and are likely to pass meconium in-utero remote from term. Unfortunately, elective cesarean delivery prior to labor does not protect against exposure to potentially toxic meconium. Antenatal surgical repair could prove effective at reducing or mitigating destructive effects of meconium on open neural tissue.
603
FETAL GROWTH VELOCITY IN WOMEN WHO DEVELOP SUPERIMPOSED PREECLAMPSIA JULIE GAINER1, JAMES ALEXANDER1, DONALD MCINTIRE1, KENNETH LEVENO1, 1University of Texas Southwestern Medical Center at Dallas, Obstetrics and Gynecology, Dallas, Texas OBJECTIVE: To compare growth velocity in chronic hypertensive women who develop preeclampsia to those who do not. STUDY DESIGN: From 8/20/1998 to 4/25/2004 all chronic hypertensive women requiring medication were referred to and followed in a specialty clinic staffed by MFM faculty and fellows. Sequential sonograms beginning prior to 20 weeks, at 28 to 32 weeks, and again at 36 to 38 weeks were obtained routinely in this population during the study period. For this study growth velocity was compared in those women who developed preeclampsia versus those who did not. Superimposed preeclampsia was defined using the criteria established by the Working Group Report on High Blood Pressure in Pregnancy. RESULTS: 186 women were available for analysis, 63 (34%) of which developed superimposed preeclampsia. Both groups showed appropriate growth velocity over time and no patient developed growth restriction, however, the women who developed preeclampsia showed a significantly slower growth velocity than those who did not. The difference in the two groups becomes statistically significant at 23.4 weeks, P = ! .001 and increases until 32 weeks where it peaks at 160 gms. This 160 gm difference persists and remains significant until delivery. CONCLUSION: Fetal growth velocity is slower in chronic hypertensive women who develop superimposed preeclampsia than those who do not. This difference is seen as early as 23 weeks and persists until delivery.
605
ASSOCIATION OF A19G POLYMORPHISM IN THE LEPTIN GENE WITH CORD SERUM LEPTIN LEVEL AND BIRTH WEIGHT HAN-SUNG KWON1, YOUNG-HAN KIM1, JAYOUNG KWON1, BOK-JA KIM1, YONG-WON PARK1, 1Yonsei University College of Medicine, Obstetrics and Gynecology, Seoul, Korea, South Korea OBJECTIVE: Some polymorphisms in the leptin gene are known to be associated with the obesity and serum leptin level in adults. Our study was performed to find out the relationship of the leptin gene A19G polymorphism with birth weight and serum leptin levels in the cord blood. STUDY DESIGN: The cord blood was withdrawn from 62 pregnant women who delivered at term without any medical or obstetrical complication such as preeclampsia, IUGR, or DM. Serum leptin levels of the cord blood were assessed by radioimmunoassay. The DNA was extracted from the cord blood and the frequency of each A19G polymorphism(AA, AG, GG) genotype in the leptin gene was evaluated through PCR-RFLP. RESULTS: Among the total 62 subjects, 34 expressed GG genotype, 28 did AG, and none did AA. The birth weights and placental weights were not significantly different between two groups. The mean serum leptin level was higher in the AG group(8.14 G 5.39) than the GG (7.10 G 5.20), but there was no statistical significance. The mean serum leptin level was higher in the female fetus group(9.94 G 5.53) than the male group(5.34 G 3.87), with the male fetus group expressing more GG genotype(68.8% vs 40.0%). The frequency of GG genotype was significantly higher in those weighing more than 3400g(61.5% vs 52.9%). CONCLUSION: The A19G polymorphism in the leptin gene does not seem to have a major role in regulating the cord serum leptin level or fetal birth weight. But, our study results indicate that variations in the leptin locus might be associated with fetal overweight.