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Isolated dangling choroid: A marker for development of ventriculomegaly?
S46 SMFM Abstracts 112 PRETERM PROM: MANDATORY NATURAL CHILDBIRTH? MELANIE CHICHESTER1, MATTHEW HOFFMAN2, PHILIP SHLOSSMAN3, GARRETT COLMORGEN4, 1Christiana Care Health Systems, Labor & Delivery, Newark, Delaware, 2Christiana Hospital, Obstetrics & Gynecology, Newark, Delaware, 3Christiana Hospital, Newark, Delaware, 4Christiana Care, Newark, Delaware OBJECTIVE: Digital examination is precluded amongst women with preterm premature rupture of the membranes. This obscures our ability to assess the onset of labor and institute timely epidural analgesia. Our objective was to determine whether a second maternal request for analgesia in a 2 hour time period successfully predicted onset of labor and delivery within 24 hours to allow appropriate epidural placement. STUDY DESIGN: We conducted a retrospective review of all admissions to Christiana Care Health Systems with confirmed PPROM from January 2004 to July of 2005. For the purpose of analysis women with rupture of membranes after 24 weeks and before 34 weeks were categorized as PPROM (!34) and those with rupture of membranes 34 weeks or later were designated as PROM (34C). Our primary outcome was the percentage of women with PPROM (!34) who delivered within 24 hours from the time of the second analgesia request due to painful contractions. Our secondary outcome was to compare the different rates of epidural analgesia amongst women with PPROM (!34) and PROM (34C). RESULTS: A total of 74 women with PPROM (!34) and 1,608 with PROM (34C) were identified. Amongst women with PPROM (!34), the median time to delivery was 398.5 minutes (6.62 hours) from the time of second request for analgesia. From their second request for analgesia, 82% percent of women with PPROM (!34) delivered within 24 hours and 96% by 48 hours. Women with PPROM (!34) were significantly less likely to receive an epidural compared with women with PROM (34C) (42% vs.79 %- p-value !0.001). CONCLUSION: Women with PPROM with regular uterine contractions sufficient to cause a second request for pain medication within 2 hours should be offered epidural analgesia, as they are highly likely to deliver within the ensuing 24 hours. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.128
114 PREDICTORS OF PATIENT MISPERCEPTION OF THE DIAGNOSTIC SENSITIVITY OF SECOND TRIMESTER ULTRASOUND JUSTIN COLLINGHAM1, WILLIAM GROBMAN2, STACEY PLAGA3, 1Stanford University, Obstetrics and Gynecology, Stanford, California, 2Northwestern University, Obstetrics and Gynecology, Chicago, Illinois, 3Northwestern University, Reproductive Genetics, Chicago, Illinois OBJECTIVE: To determine what factors are associated with patient misperception of the diagnostic sensitivity of second trimester ultrasound (US). STUDY DESIGN: Women presenting for routine second trimester US were asked to complete a questionnaire. Information collected included demographic characteristics, answers to questions regarding the diagnostic sensitivity of US, and the sources of information used by patients to prepare for their US. Univariable and multivariable analyses were used to assess the factors associated with patient misperception of the diagnostic sensitivity of US, defined to occur when a patient believed that US would detect all chromosomal or anatomic abnormalities. RESULTS: Of the 150 women approached for the study, 5 declined enrollment. Of the remaining 145, 47% misperceived the diagnostic sensitivity of US. Univariable analysis revealed the following factors to be more frequently associated with this misperception: younger maternal age, greater GA at US, non-Caucasian ethnicity, less education, lower annual income and the primary use of interpersonal relations (e.g., significant other, friends) to gather information about US. In logistic regression, variables that remained independently associated with misperception are presented in the table below. CONCLUSION: Almost half of patients undergoing routine second trimester US misperceive its diagnostic sensitivity. Receiving an US at a later gestational age, exposure to lesser education and gathering information about US primarily from interpersonal sources were factors independently associated with this misperception. Independent Predictors of Ultrasound Misperception Variable
OR
95% CI
GAR22 w at US GA 20-22 w at US GA!20 w at US %HS education Ranking interpersonal influences first
8.9 3.3 1.0 6.0 4.8
1.3-27.5 1.2-9.4 — 2.1-17.2 1.8-13.0
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.130
113 CD13/AMINOPEPTIDASE N EXPRESSION IN PLACENTAS OF PREGNANCIES COMPLICATED BY ANTENATAL CYTOMEGALOVIRUS INFECTION DORIS CHOU1, LINDA ERNST2, SARAH RATCLIFFE3, SAMUEL PARRY1, 1University of Pennsylvania, Obstetrics and Gynecology, Philadelphia, Pennsylvania, 2Children’s Hospital of Philadelphia, University of Pennsylvania, Pathology and Laboratory Medicine, Philadelphia, Pennsylvania, 3University of Pennsylvania, Biostatistics, Philadelphia, Pennsylvania OBJECTIVE: CD13/amniopeptidase N is an N-terminal exopeptidase/metalloproteinase present on multiple cell types which functions as a Cytomegalovirus (CMV)-associated protein. CD13 has been implicated in the pathogenesis of CMV infection and Graft versus Host disease in immuno-compromised transplant patients. In this study, we sought to characterize the expression of CD13 in placentas of CMV infected pregnancies. STUDY DESIGN: Immunohistochemical staining of formalin-fixed, paraffinembedded placental sections from CMV negative controls (n = 5) and cases of antenatally acquired CMV infection (n = 5), as determined by pathologic evidence of CMV viral cytopathic changes in the placenta and/or fetal organs, was performed. Slides were examined under light microscopy by a placental pathologist (LE) blinded to clinical outcome and scored for CD13 staining. A scoring system was developed; scoring included characterization of the intensity and quantity of cells staining for CD13 in cases vs. controls and was compared by the Wilcoxon Rank Sum test. RESULTS: CD13 expression was significantly greater in the basal plate of CMV infected cases than control placentas (exact p = 0.008). CD13 was found predominately in the basal plate region of placentas and in areas with basal plate necrosis. CONCLUSION: CD13 expression is greater in regions of basal plate necrosis in CMV infected placentas than controls. These findings suggest that CD13 and the host immune response may play a role in the pathophysiology associated with antenatally acquired CMV infection. Further studies to characterize the immunological response to CMV infection at the maternalfetal interface are warranted. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.129
115 ISOLATED DANGLING CHOROID: A MARKER FOR DEVELOPMENT OF VENTRICULOMEGALY? ALICE COOTAUCO1, JUDE CRINO1, CYRETHIA MCSHANE1, JANICE HENDERSON1, 1Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland OBJECTIVE: The choroid plexus normally fills the atrium of the lateral ventricles of the brain in a fetus. However, when ventriculomegaly is present, the choroid plexus often separates or ‘‘dangles’’ from the medial ventricular wall. The objective of this study was to determine if fetuses with isolated dangling choroids (DC) are at risk for developing ventriculomegaly. STUDY DESIGN: An IRB-approved retrospective chart review of fetuses diagnosed with DC on antenatal ultrasounds was conducted. DC was defined as 3 mm separation between the choroid plexus and the medial ventricular wall with a normal sized ventricle (10 mm). Fetuses with other anomalies and lack of follow-up ultrasounds were excluded. T-test analysis was performed. RESULTS: Using our ultrasound database, we identified 94 cases of isolated DC between 01/03 and 05/06. Of the 69 cases with follow-up scans, ventriculomegaly developed in 9. All cases of ventriculomegaly were mild (10-15 mm). Three cases spontaneously resolved, resulting in a ventriculomegaly rate of 9% (6 of 69). The DC (p = 0.12), ventricle size (p = 0.07), and choroid to ventricle ratio (p = 0.75) did not predict progression to ventriculomegaly. Resolution of the dangling choroid occurred in 71% of cases. There was no significant correlation of DC (p = 0.09), ventricle size (p = 0.19), or the choroid to ventricle ratio (p = 0.47) with spontaneous resolution. Perinatal outcome was available in 49% of patients. All fetuses were liveborn and had normal neurologic examinations. No anomalies were identified at birth. CONCLUSION: The degree of DC is not a predictor of development of ventriculomegaly. However, 9% of cases of isolated dangling choroid progressed to mild ventriculomegaly. The significance of this is unknown. In our study, all infants had a normal neurologic examination at birth. Further study with long-term follow-up is warranted. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.131
114 PREDICTORS OF PATIENT MISPERCEPTION OF THE DIAGNOSTIC SENSITIVITY OF SECOND TRIMESTER ULTRASOUND JUSTIN COLLINGHAM1, WILLIAM GROBMAN2, STACEY PLAGA3, 1Stanford University, Obstetrics and Gynecology, Stanford, California, 2Northwestern University, Obstetrics and Gynecology, Chicago, Illinois, 3Northwestern University, Reproductive Genetics, Chicago, Illinois OBJECTIVE: To determine what factors are associated with patient misperception of the diagnostic sensitivity of second trimester ultrasound (US). STUDY DESIGN: Women presenting for routine second trimester US were asked to complete a questionnaire. Information collected included demographic characteristics, answers to questions regarding the diagnostic sensitivity of US, and the sources of information used by patients to prepare for their US. Univariable and multivariable analyses were used to assess the factors associated with patient misperception of the diagnostic sensitivity of US, defined to occur when a patient believed that US would detect all chromosomal or anatomic abnormalities. RESULTS: Of the 150 women approached for the study, 5 declined enrollment. Of the remaining 145, 47% misperceived the diagnostic sensitivity of US. Univariable analysis revealed the following factors to be more frequently associated with this misperception: younger maternal age, greater GA at US, non-Caucasian ethnicity, less education, lower annual income and the primary use of interpersonal relations (e.g., significant other, friends) to gather information about US. In logistic regression, variables that remained independently associated with misperception are presented in the table below. CONCLUSION: Almost half of patients undergoing routine second trimester US misperceive its diagnostic sensitivity. Receiving an US at a later gestational age, exposure to lesser education and gathering information about US primarily from interpersonal sources were factors independently associated with this misperception. Independent Predictors of Ultrasound Misperception Variable
OR
95% CI
GAR22 w at US GA 20-22 w at US GA!20 w at US %HS education Ranking interpersonal influences first
8.9 3.3 1.0 6.0 4.8
1.3-27.5 1.2-9.4 — 2.1-17.2 1.8-13.0
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.130
113 CD13/AMINOPEPTIDASE N EXPRESSION IN PLACENTAS OF PREGNANCIES COMPLICATED BY ANTENATAL CYTOMEGALOVIRUS INFECTION DORIS CHOU1, LINDA ERNST2, SARAH RATCLIFFE3, SAMUEL PARRY1, 1University of Pennsylvania, Obstetrics and Gynecology, Philadelphia, Pennsylvania, 2Children’s Hospital of Philadelphia, University of Pennsylvania, Pathology and Laboratory Medicine, Philadelphia, Pennsylvania, 3University of Pennsylvania, Biostatistics, Philadelphia, Pennsylvania OBJECTIVE: CD13/amniopeptidase N is an N-terminal exopeptidase/metalloproteinase present on multiple cell types which functions as a Cytomegalovirus (CMV)-associated protein. CD13 has been implicated in the pathogenesis of CMV infection and Graft versus Host disease in immuno-compromised transplant patients. In this study, we sought to characterize the expression of CD13 in placentas of CMV infected pregnancies. STUDY DESIGN: Immunohistochemical staining of formalin-fixed, paraffinembedded placental sections from CMV negative controls (n = 5) and cases of antenatally acquired CMV infection (n = 5), as determined by pathologic evidence of CMV viral cytopathic changes in the placenta and/or fetal organs, was performed. Slides were examined under light microscopy by a placental pathologist (LE) blinded to clinical outcome and scored for CD13 staining. A scoring system was developed; scoring included characterization of the intensity and quantity of cells staining for CD13 in cases vs. controls and was compared by the Wilcoxon Rank Sum test. RESULTS: CD13 expression was significantly greater in the basal plate of CMV infected cases than control placentas (exact p = 0.008). CD13 was found predominately in the basal plate region of placentas and in areas with basal plate necrosis. CONCLUSION: CD13 expression is greater in regions of basal plate necrosis in CMV infected placentas than controls. These findings suggest that CD13 and the host immune response may play a role in the pathophysiology associated with antenatally acquired CMV infection. Further studies to characterize the immunological response to CMV infection at the maternalfetal interface are warranted. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.129
115 ISOLATED DANGLING CHOROID: A MARKER FOR DEVELOPMENT OF VENTRICULOMEGALY? ALICE COOTAUCO1, JUDE CRINO1, CYRETHIA MCSHANE1, JANICE HENDERSON1, 1Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland OBJECTIVE: The choroid plexus normally fills the atrium of the lateral ventricles of the brain in a fetus. However, when ventriculomegaly is present, the choroid plexus often separates or ‘‘dangles’’ from the medial ventricular wall. The objective of this study was to determine if fetuses with isolated dangling choroids (DC) are at risk for developing ventriculomegaly. STUDY DESIGN: An IRB-approved retrospective chart review of fetuses diagnosed with DC on antenatal ultrasounds was conducted. DC was defined as 3 mm separation between the choroid plexus and the medial ventricular wall with a normal sized ventricle (10 mm). Fetuses with other anomalies and lack of follow-up ultrasounds were excluded. T-test analysis was performed. RESULTS: Using our ultrasound database, we identified 94 cases of isolated DC between 01/03 and 05/06. Of the 69 cases with follow-up scans, ventriculomegaly developed in 9. All cases of ventriculomegaly were mild (10-15 mm). Three cases spontaneously resolved, resulting in a ventriculomegaly rate of 9% (6 of 69). The DC (p = 0.12), ventricle size (p = 0.07), and choroid to ventricle ratio (p = 0.75) did not predict progression to ventriculomegaly. Resolution of the dangling choroid occurred in 71% of cases. There was no significant correlation of DC (p = 0.09), ventricle size (p = 0.19), or the choroid to ventricle ratio (p = 0.47) with spontaneous resolution. Perinatal outcome was available in 49% of patients. All fetuses were liveborn and had normal neurologic examinations. No anomalies were identified at birth. CONCLUSION: The degree of DC is not a predictor of development of ventriculomegaly. However, 9% of cases of isolated dangling choroid progressed to mild ventriculomegaly. The significance of this is unknown. In our study, all infants had a normal neurologic examination at birth. Further study with long-term follow-up is warranted. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.131