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Lung volume assessment with 3D ultrasound and liver position to predict postnatal outcome in fetuses with isolated congenital diaphragmatic hernia
SMFM Abstracts S61 167 LUNG VOLUME ASSESSMENT WITH 3D ULTRASOUND AND LIVER POSITION TO PREDICT POSTNATAL OUTCOME IN FETUSES WITH ISOLATED CONGENITAL DIAPHRAGMATIC HERNIA JACQUES JANI1, FABIO PERALTA2, ALEXANDRA BENACHI3, RODRIGO RUANO3, KYPROS NICOLAIDES2, JAN DEPREST1, 1University Hospital Leuven, Obstetrics and Gynecology, Leuven, Belgium, 2King’s College Hospital, Harris Birthright Research Centre, London, United Kingdom, 3Hoˆpital Necker-Enfants Malades, Obstetrics and Gynecology, Paris, France OBJECTIVE: To predict neonatal survival of fetuses with isolated congenital diaphragmatic hernia (CDH) by assessment of total fetal lung volume (FLV) using 3D ultrasound and liver position. STUDY DESIGN: Prospective study in 3 tertiary units from 2003 onwards including 34 left and 4 right CDH, who were expectantly managed and live born after 34 wks gestation (GA). Outcome measures were position of the liver by ultrasound or in doubt MRI, total FLV, calculated observed/expected (O/ E) total FLV ratio based on the mean for gestation (Peralta, Ultrasound Obstet Gynecol 2006; 27:128-33) and survival at discharge from neonatal intensive care unit. RESULTS: Mean gestational age at lung assessment was 26.8 wks (range 21-36) and at delivery 38.5 wks (range 36-41). There were no postnatal diagnoses of structural or chromosomal anomalies. Overall survival rate was 71% (27/38; right: 3/4; left 24/34). For left sided cases with the liver up, survival was 12% when O/E ratio was !30% (1/8; O/E ratio=21.5%), increasing to 62% (5/8) when O/E R 30%. In the liver down group, all fetuses but one survived (21/22). On average their O/E ratio was 40.1% (range: 17.7-90%); the fetus that died had an O/E ratio=29.6%. CONCLUSION: In fetuses with isolated CDH and liver up, survival can be predicted by low (O/E!30%) lung volume. Fetuses with liver down are likely to survive, irrespective of their lung volume as assessed by the O/E ratio. This confirms earlier findings in a study looking at 2D- assessment of the lungs (Jani Ultrasound Obstet Gynecol 2006; 27:18-22).
169 FETAL INFLAMMATION AND PROVEN MICROBIAL INFECTION OF THE AMNIOTIC CAVITY IS PRESENT IN APPROXIMATELY 75% AND 50% OF CASES WITH PRETERM PROM BEFORE 30 WEEKS: IS EXPECTANT MANAGEMENT AT THIS GESTATIONAL AGE SAFE? YUN DAN KANG1, HYUN SOO PARK1, SI EUN LEE1, CHAN-WOOK PARK1, JOONG SHIN PARK1, ROBERTO ROMERO2, BO HYUN YOON1, 1Seoul National University College of Medicine, Obstetrics and Gynecology, Seoul, South Korea, 2Grosse Pointe, Michigan OBJECTIVE: The purpose of this study was to determine the frequency of intra-amniotic infection, intra-amniotic inflammation (IAI) and placental inflammation in PPROM. The central issue is whether the infection/inflammation is so prevalent that expectant management may be unsafe. STUDY DESIGN: The presence or absence of inflammation of placenta, umbilical cord and amniotic fluid (AF) obtained within 7 days of birth was examined in 124 patients with early preterm births (GA 20-33 weeks) with PPROM. AF was cultured for aerobic and anaerobic bacterias and Mycoplasmas. In addition, AF WBC count and matrix metalloproteinase-8 (MMP-8) determinations were performed. IAI was defined as the presence of a positive AF culture or elevated AF MMP-8 concentration (O23 ng/ml). RESULTS: 1) The prevalence of proven AF infection, IAI, funisitis and histologic chorioamnionitis was 38%, 79%, 59% and 80%, respectively; 2) The lower gestational age at birth, the higher the frequency of proven AF infection, IAI, funisitis and histologic chorioamnionitis, and elevated AF WBC count (p!.05) for each. CONCLUSION: Preterm delivery at an early gestational age (!30 weeks) is associated with a high rate of fetal inflammation (around 75%) and a 50% frequency of proven infection. Since most of these infections are asymptomatic, a pertinent clinical question is whether expectant management of a patient with a chronically infected amniotic cavity is safe for the fetus.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.186
168 INTRACRANIAL ANOMALIES: THE PATTERN OF ASSOCIATION WITH OTHER ANOMALIES LILLIAN KAMINSKY1, MARTIN CHAVEZ1, JOHN SMULIAN1, CANDE ANANTH1, LAMI YEO1, ANTHONY VINTZILEOS1, 1University of Medicine and Dentistry of New Jersey, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, New Jersey OBJECTIVE: The objective of the study was to determine the frequency of extracranial anomalies in the presence of prenatally diagnosed intracranial anomalies. STUDY DESIGN: Singletons that had anatomical surveys performed between 16-24 weeks gestation in our unit from 1994-2006 were included. The data was retrieved from the perinatal ultrasound database. Extracranial anomalies were grouped as spine, face/neck, cardiac, urinary tract, thorax, abdomen, stomach, abdominal wall, and genital. Frequency of malformations associated with intracranial anomalies were determined. Odds ratio (OR) was used to estimate the odds of identifying other anomalies in fetuses with intracranial anomalies as compared to fetuses without. RESULTS: There were 33,232 pregnancies, of which 308 (0.93%) had an intracranial anomaly. The results are depicted in the Table.
Spine Cardiac Face/Neck Abdomen Thorax Stomach Urinary tract Abdominal wall Genital
Frequency of associated anomalies (n)
OR (95% CI)
20.5% 20.5% 15.6% 12.3% 8.8% 8.8% 7.8% 3.3% 2.0%
324.9 28.2 67.3 17.7 44.4 30.6 14.7 35.6 28.4
(63) (63) (48) (38) (27) (27) (24) (10) (6)
(202.3-521.8) (20.9-38.1) (46.4-97.5) (12.4-25.4) (28.1-70.2) (19.7-47.5) (9.5-22.8) (17.3-73.2) (11.5-70.2)
CONCLUSION: This study established the pattern of association of intracranial anomalies with other congenital abnormalities. In the presence of intracranial anomalies, cardiac and spine anomalies were most frequently seen. Intracranial anomalies were also highly correlated with face/neck anomalies. We believe our findings will help guide targeted sonogrpaphic examination of a fetus with intracranial anomaly. In addition, the degree of association as expressed by OR may provide insights to a pattern of pathogenesis. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.187
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.188
170 THE FETAL CHEEK-TO-CHEEK DIAMETER AND ABDOMINAL CIRCUMFERENCE: ARE THEY CORRELATED? HEATHER KERRICK1, EYAL SHEINER2, CHERYL MANDELL1, HOWARD STRASSNER1, DIANA GUSE1, XAVIER POMBAR1, MICHAEL J. HUSSEY1, JACQUES ABRAMOWICZ1, 1Rush University Medical Center, Obstetrics and Gynecology, Chicago, Illinois, 2Soroka University, Beer-Sheva, Israel OBJECTIVE: The cheek-to-cheek diameter (CCD) has been shown to be an indicator of subcutaneous tissue mass in the fetus. However, the correlation between CCD and the abdominal circumference (AC) has not been investigated yet. The objective of the present study was to demonstrate whether a correlation exists between fetal CCD, AC, estimated fetal weight (EFW), and the 1-hour, 50 gm, glucose challenge test (GCT) levels in diabetic and nondiabetic mothers. STUDY DESIGN: A prospective, institutional review board approved study was performed. The CCD was obtained as part of the ultrasound for obstetric interval growth scans and biophysical profiles. Exams were performed during the third trimester. The CCD was obtained on a coronal view of the fetal face, at the level of the nostrils and lips. Patients were enrolled between November 2005 and May 2006. Pearson correlation coefficient and linear regression modeling were used as appropriate. RESULTS: Eighty-three patients were enrolled, 29 (33%) of them were diabetic. The mean gestational age was 34.8 G 3 weeks and the mean maternal age was 29.9 G 5.1. A significant linear association was found between CCD and EFW (Pearson coefficient of correlation being 0.51; P=0.01). The Pearson correlation coefficient of the relationship between the CCD and AC was 0.47 (P = 0.01). Using a linear regression model, controlling for gestational age at performance of the ultrasound, the association between CCD and EFW remained significant (P=0.021). There were no significant differences between diabetic and non-diabetic patients regarding the CCD (6.2G0.9 vs. 6.3G0.9 respectively; P=0.669) or the EFW (2527.9 gm G 705 vs. 2645 G 760 gm). While AC was significantly correlated with the GCT levels (Pearson coefficient of correlation=0.46, P=0.024), no such correlation was demonstrated for CCD (Pearson correlation coefficient=0.23, P=0.160). CONCLUSION: The cheek-to-cheek diameter is significantly correlated to the AC and the EFW. However, the AC has a tighter correlation with the GCT. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.189
169 FETAL INFLAMMATION AND PROVEN MICROBIAL INFECTION OF THE AMNIOTIC CAVITY IS PRESENT IN APPROXIMATELY 75% AND 50% OF CASES WITH PRETERM PROM BEFORE 30 WEEKS: IS EXPECTANT MANAGEMENT AT THIS GESTATIONAL AGE SAFE? YUN DAN KANG1, HYUN SOO PARK1, SI EUN LEE1, CHAN-WOOK PARK1, JOONG SHIN PARK1, ROBERTO ROMERO2, BO HYUN YOON1, 1Seoul National University College of Medicine, Obstetrics and Gynecology, Seoul, South Korea, 2Grosse Pointe, Michigan OBJECTIVE: The purpose of this study was to determine the frequency of intra-amniotic infection, intra-amniotic inflammation (IAI) and placental inflammation in PPROM. The central issue is whether the infection/inflammation is so prevalent that expectant management may be unsafe. STUDY DESIGN: The presence or absence of inflammation of placenta, umbilical cord and amniotic fluid (AF) obtained within 7 days of birth was examined in 124 patients with early preterm births (GA 20-33 weeks) with PPROM. AF was cultured for aerobic and anaerobic bacterias and Mycoplasmas. In addition, AF WBC count and matrix metalloproteinase-8 (MMP-8) determinations were performed. IAI was defined as the presence of a positive AF culture or elevated AF MMP-8 concentration (O23 ng/ml). RESULTS: 1) The prevalence of proven AF infection, IAI, funisitis and histologic chorioamnionitis was 38%, 79%, 59% and 80%, respectively; 2) The lower gestational age at birth, the higher the frequency of proven AF infection, IAI, funisitis and histologic chorioamnionitis, and elevated AF WBC count (p!.05) for each. CONCLUSION: Preterm delivery at an early gestational age (!30 weeks) is associated with a high rate of fetal inflammation (around 75%) and a 50% frequency of proven infection. Since most of these infections are asymptomatic, a pertinent clinical question is whether expectant management of a patient with a chronically infected amniotic cavity is safe for the fetus.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.186
168 INTRACRANIAL ANOMALIES: THE PATTERN OF ASSOCIATION WITH OTHER ANOMALIES LILLIAN KAMINSKY1, MARTIN CHAVEZ1, JOHN SMULIAN1, CANDE ANANTH1, LAMI YEO1, ANTHONY VINTZILEOS1, 1University of Medicine and Dentistry of New Jersey, Obstetrics, Gynecology and Reproductive Sciences, New Brunswick, New Jersey OBJECTIVE: The objective of the study was to determine the frequency of extracranial anomalies in the presence of prenatally diagnosed intracranial anomalies. STUDY DESIGN: Singletons that had anatomical surveys performed between 16-24 weeks gestation in our unit from 1994-2006 were included. The data was retrieved from the perinatal ultrasound database. Extracranial anomalies were grouped as spine, face/neck, cardiac, urinary tract, thorax, abdomen, stomach, abdominal wall, and genital. Frequency of malformations associated with intracranial anomalies were determined. Odds ratio (OR) was used to estimate the odds of identifying other anomalies in fetuses with intracranial anomalies as compared to fetuses without. RESULTS: There were 33,232 pregnancies, of which 308 (0.93%) had an intracranial anomaly. The results are depicted in the Table.
Spine Cardiac Face/Neck Abdomen Thorax Stomach Urinary tract Abdominal wall Genital
Frequency of associated anomalies (n)
OR (95% CI)
20.5% 20.5% 15.6% 12.3% 8.8% 8.8% 7.8% 3.3% 2.0%
324.9 28.2 67.3 17.7 44.4 30.6 14.7 35.6 28.4
(63) (63) (48) (38) (27) (27) (24) (10) (6)
(202.3-521.8) (20.9-38.1) (46.4-97.5) (12.4-25.4) (28.1-70.2) (19.7-47.5) (9.5-22.8) (17.3-73.2) (11.5-70.2)
CONCLUSION: This study established the pattern of association of intracranial anomalies with other congenital abnormalities. In the presence of intracranial anomalies, cardiac and spine anomalies were most frequently seen. Intracranial anomalies were also highly correlated with face/neck anomalies. We believe our findings will help guide targeted sonogrpaphic examination of a fetus with intracranial anomaly. In addition, the degree of association as expressed by OR may provide insights to a pattern of pathogenesis. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.187
0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.188
170 THE FETAL CHEEK-TO-CHEEK DIAMETER AND ABDOMINAL CIRCUMFERENCE: ARE THEY CORRELATED? HEATHER KERRICK1, EYAL SHEINER2, CHERYL MANDELL1, HOWARD STRASSNER1, DIANA GUSE1, XAVIER POMBAR1, MICHAEL J. HUSSEY1, JACQUES ABRAMOWICZ1, 1Rush University Medical Center, Obstetrics and Gynecology, Chicago, Illinois, 2Soroka University, Beer-Sheva, Israel OBJECTIVE: The cheek-to-cheek diameter (CCD) has been shown to be an indicator of subcutaneous tissue mass in the fetus. However, the correlation between CCD and the abdominal circumference (AC) has not been investigated yet. The objective of the present study was to demonstrate whether a correlation exists between fetal CCD, AC, estimated fetal weight (EFW), and the 1-hour, 50 gm, glucose challenge test (GCT) levels in diabetic and nondiabetic mothers. STUDY DESIGN: A prospective, institutional review board approved study was performed. The CCD was obtained as part of the ultrasound for obstetric interval growth scans and biophysical profiles. Exams were performed during the third trimester. The CCD was obtained on a coronal view of the fetal face, at the level of the nostrils and lips. Patients were enrolled between November 2005 and May 2006. Pearson correlation coefficient and linear regression modeling were used as appropriate. RESULTS: Eighty-three patients were enrolled, 29 (33%) of them were diabetic. The mean gestational age was 34.8 G 3 weeks and the mean maternal age was 29.9 G 5.1. A significant linear association was found between CCD and EFW (Pearson coefficient of correlation being 0.51; P=0.01). The Pearson correlation coefficient of the relationship between the CCD and AC was 0.47 (P = 0.01). Using a linear regression model, controlling for gestational age at performance of the ultrasound, the association between CCD and EFW remained significant (P=0.021). There were no significant differences between diabetic and non-diabetic patients regarding the CCD (6.2G0.9 vs. 6.3G0.9 respectively; P=0.669) or the EFW (2527.9 gm G 705 vs. 2645 G 760 gm). While AC was significantly correlated with the GCT levels (Pearson coefficient of correlation=0.46, P=0.024), no such correlation was demonstrated for CCD (Pearson correlation coefficient=0.23, P=0.160). CONCLUSION: The cheek-to-cheek diameter is significantly correlated to the AC and the EFW. However, the AC has a tighter correlation with the GCT. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2006.10.189