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Pregnancy outcome with a small gestational sac before 9 weeks’ gestation
Abstracts 2D US in defining the exact location of the lesions and evaluating the tumor extension in some cases. However, both modalities failed to detect the portal vein infiltration, epiploon infiltration, peri-cystic duct lymphadenopathy, and peri-aortic lymphadenopathy. Conclusions: 3D US adds no remarkable advantages in the diagnosis of gallstone. Conversely, it is valuable for the differential diagnosis of gallbladder polyps, and may improve the localization and staging for gallbladder carcinoma. 30793 Sonographic appearance of ascaris and typical serpentine movement Hasan M, Ultrasonography, Institute of Ultrasound Imaging, Karachi, Sind, Pakistan Objective: The aim of this study was to share the experience of serpentine movement of ascaris at different places in the abdomen. Methods: Ascaris worm is very common in Pakistan especially in children and infests the human bowels. In our experience, we have seen ascaris in bowels, stomach, CBD, intra-hepatic ducts, and gallbladder on ultrasonography. Some of these ascaris were alive, and they had typical serpentine movement. We recorded these cases on our video, which will be shown during the presentation. The patient had various signs and symptoms ranging from acute intestinal obstruction, intermittent jaundice, right hypochondrium discomfort, mimicking to acute appendicitis. Results: We saw ascaris in bowels, stomach, CBD, intreahepatic ducts, and gallbladder, and recorded their serpentine movement on video tape. Conclusions: This paper will highlight the sonographic features and will show on video the typical serpentine movement.
FIRST TRIMESTER—ECTOPIC PREGNANCY 24030 Combined first- and second-trimester ultrasound screening is effective in reducing postterm labor induction rates: A randomized, controlled trial Bennett KA,*1 Crane J,2 O’Shea P,2 Lacelle J,2 Hutchens D,2 Copel J,3 1. OB/GYN, University of Tennessee Health Sciences Center, Memphis, TN, 2. OB/GYN, Memorial University, St. John’s, NF, Canada, and 3. OB/GYN, Yale University, New Haven, CT Objective: The aim of this study was to test the null hypothesis that first-trimester ultrasound crown rump length (CRL) measurement combined with second-trimester ultrasound biometry for pregnancy dating will result in no difference in rates of postterm pregnancy and labor induction. Methods: Two hundred and eighteen low-risk pregnant women who presented for prenatal care in the first trimester of pregnancy were randomized to receive either combined ultrasound screening (a firsttrimester and a second-trimester ultrasound) or single ultrasound screening (second-trimester ultrasound). Results of all tests were made available to referring physicians. Sample size was calculated (using a two-tailed ␣ ⫽ 0.05 and power [1 ⫺ ] ⫽ 80%) to detect a change in the postterm induction rate from 15% to 7.5%. Categorical data were compared using chi-square or Fisher’s exact tests. An intention-to-treat analysis was performed. Results: Analysis included 104 women in the combined ultrasound group and 92 in the single ultrasound group. Seven of 104 (6.7%) women randomized to the combined group had a gestational age 41 weeks or greater compared to 15 of 92 (16.3%) women in the single ultrasound group (P ⫽ 0.03, relative risk [RR] ⫽ 0.37, 95% confidence interval [CI] [0.14 – 0.92]). Twenty-three of 104 (22.1%) women in the
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combined group had induction of labor compared to 34 of 92 (36.9%) women in the single ultrasound group (P ⫽ 0.02, RR ⫽ 0.48, 95% CI [0.25– 0.90]). Five women in the combined ultrasound group had labor induced for postterm pregnancy compared to 12 in the single ultrasound group (P ⫽ 0.04, RR ⫽ 0.45, 95% CI [0.22– 0.96]). Conclusions: Dating by CRL measurement in first-trimester combined with second-trimester biometry was superior to second-trimester biometry alone in providing an accurate estimate of expected day of confinement. This was manifested in a significant reduction in the rates of postterm pregnancy and labor induction. 30966 Pregnancy outcome with a small gestational sac before 9 weeks’ gestation Hill LM,* Krohn MA, Hill L, Day E, Obstetrics & Gynecology, Magee-Womens Hospital, Pittsburgh, PA Objective: The aims of our study were to evaluate historical and sonographic factors that might contribute to the miscarriage rate associated with a small first-trimester gestational sac; and to determine the outcome in those pregnancies with a small gestational sac who do not miscarry. Methods: 190 patients with a small gestational sac between 5.7 and 9.0 weeks’ gestation, defined as the mean sac diameter minus the embryonic size ⬍ 5.0 mm, were followed prospectively. A control group consisted of 155 patients with a normal gestational sac diameter between the same gestational ages. Pregnancies that did not miscarry were followed until delivery. Results: The spontanenous abortion rate for those pregnancies between 5.7–9.0 weeks’ gestation with a small gestational sac (108/190; 57.0%) was significantly higher than for the control group (10/155; 6.5%) (p⬍0.01). A multivariate analysis among women with a mean sac minus embryonic size ⬍ 5.0 mm evaluated maternal age ⬎ 35 years, first-trimester vaginal bleeding, mean sac diameter minus embryonic size ⬍ 3.0 mm, and a small embryonic size for gestational age for their effect upon the miscarriage rate. First-trimester vaginal bleeding and small embryonic size for gestational age proved to be significant. When compared to controls, women with a small gestational sac were more likely to deliver prematurely and deliver a child of low birth weight. Conclusions: The prediction of miscarriage from a small gestational sac between 5.7–9.0 weeks’ gestation is, at best, fair (miscarriage rate: 57.0%). If the pregnancy continues, the neonate is more likely to deliver prematurely and therefore, have a lower birth weight. 31106 A cost analysis of ultrasound for early pregnancy bleeding Schauberger CW, Obstetrics & Gynecology, Gundersen Lutheran Medical Center, La Crosse, WI Objective: The aim of this study was to perform a cost evaluation of ultrasound assessment, from society’s perspective, in patients with first-trimester vaginal bleeding. Methods: An incremental cost analysis using decision tree methodology was performed of ultrasound for first-trimester bleeding. Costs, risks, patient preference, and physician preferences were considered. Data from the literature and from a study of 68 patients are included in this model. Results: Though the cost of an ultrasound is low ($400 in this study), significant down-the-line costs are generated due to the changes in management that result ($2293.07). A sensitivity analysis demonstrates that patient and physician preference, site of performance of curettage of nonviable pregnancies, and emergent vs. elective status affect cost significantly.
FIRST TRIMESTER—ECTOPIC PREGNANCY 24030 Combined first- and second-trimester ultrasound screening is effective in reducing postterm labor induction rates: A randomized, controlled trial Bennett KA,*1 Crane J,2 O’Shea P,2 Lacelle J,2 Hutchens D,2 Copel J,3 1. OB/GYN, University of Tennessee Health Sciences Center, Memphis, TN, 2. OB/GYN, Memorial University, St. John’s, NF, Canada, and 3. OB/GYN, Yale University, New Haven, CT Objective: The aim of this study was to test the null hypothesis that first-trimester ultrasound crown rump length (CRL) measurement combined with second-trimester ultrasound biometry for pregnancy dating will result in no difference in rates of postterm pregnancy and labor induction. Methods: Two hundred and eighteen low-risk pregnant women who presented for prenatal care in the first trimester of pregnancy were randomized to receive either combined ultrasound screening (a firsttrimester and a second-trimester ultrasound) or single ultrasound screening (second-trimester ultrasound). Results of all tests were made available to referring physicians. Sample size was calculated (using a two-tailed ␣ ⫽ 0.05 and power [1 ⫺ ] ⫽ 80%) to detect a change in the postterm induction rate from 15% to 7.5%. Categorical data were compared using chi-square or Fisher’s exact tests. An intention-to-treat analysis was performed. Results: Analysis included 104 women in the combined ultrasound group and 92 in the single ultrasound group. Seven of 104 (6.7%) women randomized to the combined group had a gestational age 41 weeks or greater compared to 15 of 92 (16.3%) women in the single ultrasound group (P ⫽ 0.03, relative risk [RR] ⫽ 0.37, 95% confidence interval [CI] [0.14 – 0.92]). Twenty-three of 104 (22.1%) women in the
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combined group had induction of labor compared to 34 of 92 (36.9%) women in the single ultrasound group (P ⫽ 0.02, RR ⫽ 0.48, 95% CI [0.25– 0.90]). Five women in the combined ultrasound group had labor induced for postterm pregnancy compared to 12 in the single ultrasound group (P ⫽ 0.04, RR ⫽ 0.45, 95% CI [0.22– 0.96]). Conclusions: Dating by CRL measurement in first-trimester combined with second-trimester biometry was superior to second-trimester biometry alone in providing an accurate estimate of expected day of confinement. This was manifested in a significant reduction in the rates of postterm pregnancy and labor induction. 30966 Pregnancy outcome with a small gestational sac before 9 weeks’ gestation Hill LM,* Krohn MA, Hill L, Day E, Obstetrics & Gynecology, Magee-Womens Hospital, Pittsburgh, PA Objective: The aims of our study were to evaluate historical and sonographic factors that might contribute to the miscarriage rate associated with a small first-trimester gestational sac; and to determine the outcome in those pregnancies with a small gestational sac who do not miscarry. Methods: 190 patients with a small gestational sac between 5.7 and 9.0 weeks’ gestation, defined as the mean sac diameter minus the embryonic size ⬍ 5.0 mm, were followed prospectively. A control group consisted of 155 patients with a normal gestational sac diameter between the same gestational ages. Pregnancies that did not miscarry were followed until delivery. Results: The spontanenous abortion rate for those pregnancies between 5.7–9.0 weeks’ gestation with a small gestational sac (108/190; 57.0%) was significantly higher than for the control group (10/155; 6.5%) (p⬍0.01). A multivariate analysis among women with a mean sac minus embryonic size ⬍ 5.0 mm evaluated maternal age ⬎ 35 years, first-trimester vaginal bleeding, mean sac diameter minus embryonic size ⬍ 3.0 mm, and a small embryonic size for gestational age for their effect upon the miscarriage rate. First-trimester vaginal bleeding and small embryonic size for gestational age proved to be significant. When compared to controls, women with a small gestational sac were more likely to deliver prematurely and deliver a child of low birth weight. Conclusions: The prediction of miscarriage from a small gestational sac between 5.7–9.0 weeks’ gestation is, at best, fair (miscarriage rate: 57.0%). If the pregnancy continues, the neonate is more likely to deliver prematurely and therefore, have a lower birth weight. 31106 A cost analysis of ultrasound for early pregnancy bleeding Schauberger CW, Obstetrics & Gynecology, Gundersen Lutheran Medical Center, La Crosse, WI Objective: The aim of this study was to perform a cost evaluation of ultrasound assessment, from society’s perspective, in patients with first-trimester vaginal bleeding. Methods: An incremental cost analysis using decision tree methodology was performed of ultrasound for first-trimester bleeding. Costs, risks, patient preference, and physician preferences were considered. Data from the literature and from a study of 68 patients are included in this model. Results: Though the cost of an ultrasound is low ($400 in this study), significant down-the-line costs are generated due to the changes in management that result ($2293.07). A sensitivity analysis demonstrates that patient and physician preference, site of performance of curettage of nonviable pregnancies, and emergent vs. elective status affect cost significantly.