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Prenatal ultrasound assessment of the umbilical cord in twin gestations
ultrasound database. Serial (two to four weekly) measurements of the biparietal diameter, head and abdominal circumferences, and femur length (FL) were extracted. We analyzed growth patterns of these variables by regression and Rossavik modeling and compared our results with previously published reference ranges for triplets (Rodis et al. Am J Obstet Gynecol 1999;181:1128 –32) using the Fisher F test. RESULTS: We analyzed 484 sonograms performed in 34 pregnancies. The parabolic regression approximation and the Rossavik model fit our data well. The parabolic regression equation published by Rodis et al statistically significantly differs from ours (F ⫽ 217.87, P ⬍ .001). CONCLUSIONS: Rodis et al were the first to present reference ranges for fetal growth parameters carefully determined in a similar sample size of triplet gestations. Apparent statistical differences to our population indicate the importance of developing local standard growth curves for higher order multiple gestations.
Upper Quadrant Abnormality Detection at Time of Indicated Obstetric or Gynecologic Ultrasound Chuka B. Jenkins, MD Harbor Hospital Center, Baltimore, MD
Ahmet A. Baschat, MD, and John J. Schruefer, MD OBJECTIVE: Obstetric-gynecologic (OB/GYN) ultrasound evaluation primarily focuses on uterine and pelvic contents. The objective was to determine the prevalence and spectrum of intraabdominal lesions that are detected when upper quadrant evaluation is incorporated into routine OB/GYN ultrasound. STUDY DESIGN: During indicated ultrasound performed at the master OB/GYN ultrasound laboratory at Georgetown University Hospital the examination was extended to the upper quadrants, adding approximately 5 minutes to the examination duration. The upper quadrant examination was considered complete when the liver, gallbladder, spleen, pancreas, costophrenic angles, kidneys, and heart were visualized. Results of 2996 consecutive patients examined between July 1989 and December 1992 were analyzed. RESULTS: Among the total 2996 evaluated patients 1854 (62%) presented for GYN ultrasound and 1142 (38%) for OB ultrasound. 660 (22%) patients had abnormal findings on upper quadrant ultrasound survey. 473 (26%) of the 1854 GYN and 187 (16%) of the OB ultrasounds demonstrated abnormalities (Table 1). CONCLUSIONS: Upper quadrant examination of the OB/ GYN patient is easily accomplished and can detect various lesions, and in this series led to lifesaving intervention in some cases.
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
Table 1.
Organ system
No. of abnormal GYN examinations
No. of abnormal of examinations
Renal Gall bladder Hepatic Splenic Epigastric Cardiac Pleural Other Total no. of abnormal Total no. of examinations % abnormal
123 142 102 43 28 26 2 6 473 1854 26
56 62 39 16 3 5 4 2 187 1142 16
Prenatal Ultrasound Assessment of the Umbilical Cord in Twin Gestations Robin B. Kalish, MD Weill Medical College of Cornell University, New York, NY
Stephen T. Chasen, MD, Geeta Sharma, MD, Tiffany Hunter, and Frank A. Chervenak, MD OBJECTIVE: To determine whether prenatal assessment of the umbilical cord (UC) can identify twin gestations at risk for discordant growth. STUDY DESIGN: Ultrasound assessment of fetal biometry, amniotic fluid amount, and UC characteristics of twin pairs undergoing routine sonographic evaluation at our center was performed. UC parameters assessed included total cross-sectional area (UCA), vein area (VA), total vessel area (TVA), and Wharton jelly area (WJA). Discordancy was defined as greater than 20% difference in weight and was assessed at the time of ultrasound and at birth. UC parameters of discordant twins were compared with those of concordant twins. Mann-Whitney U, 2 analysis, and Spearman correlation were used in statistical analysis. RESULTS: 69 ultrasound assessments were performed on 55 twin gestations between 18 and 37 weeks. Nine (16.4%) twin pairs had discordant birth weights (BWs). BW discordancy was significantly correlated with discordancy in estimated fetal weight (EFW) on prenatal ultrasound (r ⫽ .47, P ⬍ .01). Sonographic EFW was positively correlated with UCA (r ⫽ .66, P ⬍ .01), VA (r ⫽ .71, P ⬍ .01), TVA (r ⫽ .73, P ⬍ .01), and WJA (r ⫽ .50, P ⬍ .01). Twin pairs with discordant EFW were more likely to have discordant UCA than concordant twin pairs (P ⫽ .013). CONCLUSIONS: Twins with discordant UCA have discordant growth. Differential umbilical blood flow may lead to this phenomenon. This information may be helpful in identifying fetuses in multiple gestations at risk for uteroplacental insufficiency and subsequent growth restriction.
WEDNESDAY POSTERS
119S
Upper Quadrant Abnormality Detection at Time of Indicated Obstetric or Gynecologic Ultrasound Chuka B. Jenkins, MD Harbor Hospital Center, Baltimore, MD
Ahmet A. Baschat, MD, and John J. Schruefer, MD OBJECTIVE: Obstetric-gynecologic (OB/GYN) ultrasound evaluation primarily focuses on uterine and pelvic contents. The objective was to determine the prevalence and spectrum of intraabdominal lesions that are detected when upper quadrant evaluation is incorporated into routine OB/GYN ultrasound. STUDY DESIGN: During indicated ultrasound performed at the master OB/GYN ultrasound laboratory at Georgetown University Hospital the examination was extended to the upper quadrants, adding approximately 5 minutes to the examination duration. The upper quadrant examination was considered complete when the liver, gallbladder, spleen, pancreas, costophrenic angles, kidneys, and heart were visualized. Results of 2996 consecutive patients examined between July 1989 and December 1992 were analyzed. RESULTS: Among the total 2996 evaluated patients 1854 (62%) presented for GYN ultrasound and 1142 (38%) for OB ultrasound. 660 (22%) patients had abnormal findings on upper quadrant ultrasound survey. 473 (26%) of the 1854 GYN and 187 (16%) of the OB ultrasounds demonstrated abnormalities (Table 1). CONCLUSIONS: Upper quadrant examination of the OB/ GYN patient is easily accomplished and can detect various lesions, and in this series led to lifesaving intervention in some cases.
VOL. 101, NO. 4 (SUPPLEMENT), APRIL 2003
Table 1.
Organ system
No. of abnormal GYN examinations
No. of abnormal of examinations
Renal Gall bladder Hepatic Splenic Epigastric Cardiac Pleural Other Total no. of abnormal Total no. of examinations % abnormal
123 142 102 43 28 26 2 6 473 1854 26
56 62 39 16 3 5 4 2 187 1142 16
Prenatal Ultrasound Assessment of the Umbilical Cord in Twin Gestations Robin B. Kalish, MD Weill Medical College of Cornell University, New York, NY
Stephen T. Chasen, MD, Geeta Sharma, MD, Tiffany Hunter, and Frank A. Chervenak, MD OBJECTIVE: To determine whether prenatal assessment of the umbilical cord (UC) can identify twin gestations at risk for discordant growth. STUDY DESIGN: Ultrasound assessment of fetal biometry, amniotic fluid amount, and UC characteristics of twin pairs undergoing routine sonographic evaluation at our center was performed. UC parameters assessed included total cross-sectional area (UCA), vein area (VA), total vessel area (TVA), and Wharton jelly area (WJA). Discordancy was defined as greater than 20% difference in weight and was assessed at the time of ultrasound and at birth. UC parameters of discordant twins were compared with those of concordant twins. Mann-Whitney U, 2 analysis, and Spearman correlation were used in statistical analysis. RESULTS: 69 ultrasound assessments were performed on 55 twin gestations between 18 and 37 weeks. Nine (16.4%) twin pairs had discordant birth weights (BWs). BW discordancy was significantly correlated with discordancy in estimated fetal weight (EFW) on prenatal ultrasound (r ⫽ .47, P ⬍ .01). Sonographic EFW was positively correlated with UCA (r ⫽ .66, P ⬍ .01), VA (r ⫽ .71, P ⬍ .01), TVA (r ⫽ .73, P ⬍ .01), and WJA (r ⫽ .50, P ⬍ .01). Twin pairs with discordant EFW were more likely to have discordant UCA than concordant twin pairs (P ⫽ .013). CONCLUSIONS: Twins with discordant UCA have discordant growth. Differential umbilical blood flow may lead to this phenomenon. This information may be helpful in identifying fetuses in multiple gestations at risk for uteroplacental insufficiency and subsequent growth restriction.
WEDNESDAY POSTERS
119S