Sep 17, 2009 - 2University Medical Center Utrecht, Utrecht University,. Utrecht, Netherlands ... Objective: Antenatal ultrasound is a powerful tool in obstetric care, but is still not ... Although several training programs for local healthworkers have started, ... order to diagnose CMV infection nPCR and real-time that detects.
13–17 September 2009, Hamburg, Germany
Methods: This was a prospective observational cohort study of 1435 women presenting to an early pregnancy unit. Prior to TVS women completed a detailed menstrual, prior obstetric and demographic questionnaire, a visual analogue score (VAS) for pain and pictorial assessment of blood loss (score 0-4). The main outcome measure was pregnancy viability at 11–14 weeks. Results: At 11–14 weeks 885 (61.7%) of pregnancies were viable with the remainder confirmed to have failed. The odds ratio for viability was 0.81 (95%CI 0.75–0.88) for age > 35 years, 0.21 (CI 0.16–0.28) for any bleeding, 0.75 (CI0.58–0.98) for any pain, 3.52 (CI2.48–4.99) for women requesting dating and 2.39 (CI1.17–4.86) for women with anxiety. VAS, prior obstetric history and ethnicity were not significant. Multivariate analysis showed age had no effect < 35 years but that the odds of a viable outcome dropped by 21.3% with each year of age thereafter. Bleeding score was highly significant with odds of viability dropping by 62.3% for each increase in score. Period-type pain in isolation was associated with 3x higher odds of viability but in the presence of bleeding was associated with 89% decrease in odds. A mathematical model gave an area under the curve of 0.736 (0.689–0.783) to predict 11–14 week viability. Conclusions: Only 62% of women presenting for early pregnancy assessment have ongoing pregnancies. Maternal age, bleeding score and period type pain are significant features for viability but in a model do not provide helpful prediction of outcome. This suggests such maternal variables are unlikely to provide useful information regarding likely viability, or appropriateness or timing of TVS.
OC08: OBSTETRIC COMPLICATIONS OC08.01 Quality assessment of fetal biometry in locally trained sonographers in a developing country setting M. Rijken1,2 , S. Lee1,4 , G. H. Visser2 , A. Papageorghiou3 , F. Nosten1,4 , R. McGready1,4 1
Shoklo Malaria Research Unit (SMRU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; 2 University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; 3 Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom; 4 Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom Objective: Antenatal ultrasound is a powerful tool in obstetric care, but is still not available in many developing countries. One of the reasons for this is the lack of qualified ultrasonographers. Although several training programs for local healthworkers have started, quality assessment has not been reported. We present a study of quality assurance of locally trained sonographers in a refugee camp on the Thai Burmese border. Methods: 349 women were scanned for standard fetal biometry measurements (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL)). All measurements were obtained twice by examiner 1 (to assess intra observer variability) and once by examiner 2 (to assess inter observer variability), resulting in 12 measurements per woman (i.e., 3 sets of 4 measurements). Each examiner was blinded to their own results and to the results of the other examiner. Results: The intraclass correlation coefficient (ICC) for all four parameters was greater than 0.99 for all ultrasonographers (range 0.996 to 0.998). For the inter observer variability we found that 95% of measurements by the second sonographer could be expected to be between 0.93 to 1.07 times the measurement by the first sonographer, with the highest error in the abdominal circumference measurements. In the second trimester the differences were within 1 week. Plots and figures will be shown during the meeting. Conclusions: This study demonstrates that locally trained health workers are able to perform and reproduce basic fetal biometry (BPD, HC, AC and FL) satisfactorily and comparable to other published quality assurance studies of expert sonographers.
Ultrasound in Obstetrics & Gynecology 2009; 34 (Suppl. 1): 1–61
Oral communication abstracts
OC08.02 Congenital cytomegalvirus infection: viral load and fetal symptoms D. Nowakowska1 , E. Paradowska2 , W. Sobala3 , M. Studzinska2 , M. Rycel4 , M. Grzesiak1 , Z. J. Lesnikowski2 , J. Wilczynski1 1
Department of Fetal-Maternal Medicine and Gynecology, Research Institute Polish Mother’s Memorial Hospital, Lodz, Poland; 2 Laboratory of Virology and Biological Chemistry, Institute for Molecular Biology Polish Academy of Sciences, Lodz, Poland; 3 Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland; 4 Department of Fetal-Maternal Medicine and Gynecology, Medical University, Lodz, Poland
Objectives: The goal was to evaluate the relationship between CMV DNA load in maternal and neonatal blood and the fetal symptoms in prenatal ultrasound. Methods: Thirty women with specific IgG and IgM or/IgA detected in the blood during pregnancy and their 31 neonates we included. In order to diagnose CMV infection nPCR and real-time that detects PCR UL155 gene were assessed. Results: Based on the presence of CMV DNA in the blood, all mothers and 23 neonates were considered infected. There was a correlation in number of CMV DNA copies between mothers and their neonates (p=0.0003, rho=0.06). In 14 (61%) out of 23 infected neonates ultrasound scan was abnormal but there was no relation with the viral load. The median CMV DNA viral load in neonates with congenital defects was 5.2 × 103 copies/ml and without 5.5 × 103 copies/ml (p=0.68). The ultrasound findings included fetal death (n=2), hydrocephaly (n=7), microcephaly (n=1), IUGR (n=7), ascites (n=3) and oligohydramnios (n=4). The median CMV viral load was higher in neonates with hydrocephaly (12.9 × 103 copies/ml) than in asymptomatic ones (4.5 × 103 copies/ml), however this difference was not significant p=0.29. No difference between neonates with IUGR (5.85 × 103 copies/ml) and those with normal fetal growth (3.65 × 103 copies/ml, p=0.64) was observed. Conclusions: There was a correlation between viral load in mothers and their neonates. Our results indicate lack of relation between CMV DNA load in neonatal blood and symptoms of infection in prenatal ultrasound.
OC08.03 Cytomegalovirus: a retrospective comparative analysis of fetal ultrasound and magnetic resonance imaging in predicting fetal outcome L. Lannoo1 , B. De Becker1 , F. Claus2 , S. Dymarkowski2 , N. El handouni1 , K. Lagrou3 , M. Hanssens1 , R. Devlieger1 , L. De Catte1 1
Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium; Radiology, UZ Leuven, Leuven, Belgium; 3 Medical Diagnostic Sciences, UZ Leuven, Leuven, Belgium 2
Objective: To analyze the combined use of fetal ultrasound (US) and fetal magnetic resonance imaging (MRI) to predict cytomegalovirus (CMV) related sequellae. Methods: In 42 pregnancies with proven fetal infection prenatal US was performed repetitively in addition to at least one MRI scan at 30–34 weeks of gestation. Postnatal neurological and auditive outcome was evaluated over a mean period of 17 months (range 1.5–40). In cases of termination of pregnancy (TOP) pathologic examination was obtained. Results: Neonatal outcome was incomplete in 3 patients. Four groups were analyzed, group 1: no imaging abnormalities, group 2: abnormal US and normal MRI, group 3: normal US and abnormal MRI, group 4: abnormal US and MRI.
13
19th World Congress on Ultrasound in Obstetrics and Gynecology In the first group (n=22) there were 2 symptomatic children with unilateral hearing loss. In 4 neonates, brain imaging revealed cerebral abnormalities, but long-term clinical follow-up was normal. The second group (n=10) included abnormal cerebral findings in 5 cases. TOP was performed twice. Six children were born asymptomatically, 2 children suffered from hearing loss. In group 3 (n=4), cerebral abnormalities were present in 3 cases. There was 1 symptomatic child with bilateral hearing loss, showing periventricular signal alterations in the white tissue on prenatal MRI. In group 4 (n=6), 4 fetuses had multiple cerebral and extracerebral abnormalities. Pathological examination confirmed fetal infection in 3 cases after TOP. One neonate received antiviral treatment with normal clinical findings on follow-up. In the other remaining cases there were only solitary minor abnormalities resulting in a normal neonatal outcome. Conclusions: Most often, MRI confirms the US findings. Occasionally MRI adds important prognostic information. In case US and MRI reveal multiple infection related abnormalities, fetal outcome is poor. Both fetal imaging modalities lack sensitivity to predict hearing loss.
OC08.04 Modulation of total vascular resistance in early mild gestational hypertension decreases the rate of complications G. Gagliardi1 , B. Vasapollo1,2 , G. P. Novelli3 , D. Manfellotto2 , H. Valensise1 1
Obstetrics Gynecology, Tor Vergata University, Rome, Italy; 2 AFaR, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; 3 Cardiology, San Sebastiano Martire Hospital, Frascati, Rome, Italy
Objective: Our aim was to assess the possible advantage on the rate of complications of the reduction of elevated total vascular resistance (TVR) in women with early appearance (between 20 and 27 weeks gestation) of mild gestational hypertension (Systolic blood pressure 140–149 mmHg and diastolic blood pressure90-99) (EMGH). Methods: A group of 200 EMGH underwent maternal echocardiography with the calculation of TVR; when TVR was > 1350 dyne patients were treated pharmacologically (group A) to obtain a 10% reduction of TVR or more. To this purpose the echocardiographic examination was repeated every 7–10 days to calculate TVR, increasing therapy if TVR had not dropped to the targeted value. A group of 210 matched EMGH (group B) was also enrolled and patients were not pharmacologically treated according to the guidelines. Both groups were followed until term, and severe maternal and fetal complications were noted (fetal growth restriction, appearance of preeclampsia, abruptio placenta, etc). Results: In group A, 103 patients had TVR > 1350 and were pharmacologically treated. A 10% reduction of TVR of at least 10% was obtained in 68 out of the 103 patients (66.0%). In group B, 102 patients had TVR > 1350. 36 patients of group A and 69 patients of group B showed a complication (18.0% vs 32.9%, p
