Sunnybrook and Women's College Health Sciences Centre,. Toronto, ON, Canada. Objectives: A significant subset of patients presents with new-onset maternal ...
9–12 September 2012, Copenhagen, Denmark
OP06.09 Maternal transient tachycardia following treatment of twin-to-twin transfusion syndrome by laser ablation of placental vascular anastomoses D. Baud1 , T. Van Mieghem1 , B. Van Enter1 , C. Bandeira Margarido2 , J. Keunen1 , R. Windrim1 , G. Ryan1 1
Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; 2 Department of Anesthesia, Sunnybrook and Women’s College Health Sciences Centre, Toronto, ON, Canada Objectives: A significant subset of patients presents with new-onset maternal tachycardia (heart rate > 100 beats per minute) 24 hours after laser coagulation of placenta anastomoses for twin-to-twin transfusion syndrome (TTTS). The clinical and pathophysiologic implications of this tachycardia are unknown. We thus investigated the relation between maternal clinical, surgical and laboratory findings and postoperative maternal tachycardia after fetoscopic laser for TTTS. Methods: Demographic data, surgical characteristics, maternal perioperative vital signs as well as hematologic, coagulation and biochemistry blood work were retrospectively reviewed in 311 patients undergoing fetoscopic laser ablation of placental anastomoses for TTTS. Results: Fifty-four women (17.4%) had new-onset persistent tachycardia 24 hours after laser. Simultaneously, a significant drop of both systolic (- 9mmHg) and diastolic (−8 mmHg) blood pressure (BP) was observed (P < 0.001) compared to pre-operative values. When pre- and post-laser values where compared, a significant drop (P < 0.001) was observed for hemoglobin (−17.2 g/L), hematocrit (−5%), platelets (−37.3 × 109/L), albumine (−6 g/L) and, osmolality (−2.4 mOsm/kg). Electrolytes, urea, creatinine, uric acid and liver function tests were not significantly affected by the laser procedure. Using logistic regression analysis, we identified: amnio-reduction > 3,000 mL (Odds Ratio [OR] 2.0, 95% Confidence Interval [95% CI] 1.1–3.9) and indomethacin use in the post-laser period (OR 0.3, 95% CI 0.1–0.6) as the only variables independently associated with maternal postoperative tachycardia. Maternal tachycardia did not lead to any changes in clinical management. Conclusions: Feto-maternal volume shifts as well as changes in intraabdominal pressure after fetoscopic laser cause a drop in maternal BP and an increase in maternal HR. These changes may be affected by the use of Indomethacin through its effects on maternal pain and diuresis.
OP06.10 Modified sequential laser photocoagulation of communicating vessels in twin-twin transfusion syndrome M. Nakata1 , M. Sumie2 , S. Murata3 , I. Miwa4 , H. Hirata1 , T. Nakagawa1 , K. Ushiro1 , J. Itoh1 , K. Hirabayashi1 , F. Numa1 Tokuyama Central Hospital, Shunan, Japan; 2 National Center for Child Health and Development, Tokyo, Japan; 3 Hamada Medical Center, Hamada, Japan; 4 Yamaguchi Grand Medical Center, Hofu, Japan 1
Objectives: To assess the efficacy and prognosis of modified sequential technique in laser surgery for twin-twin transfusion syndrome (TTTS). Methods: TTTS diagnosed by a combined presence of maximal vertical pocket > 8 cm in a recipient sac and < 2 cm in a donor sac was treated with modified sequential technique. All anastomoses were identified and classified as AVDR (artery-to-vein (AV) from donor to recipient), AVRD (AV from recipient to donor), AA (arteryto-artery) and VV (vein-to-vein). Modified sequential technique was defined if AA or VV were coagulated first and then AVDR was done subsequently. Perinatal prognosis was analyzed if the patient delivered at least 6-month before.
Ultrasound in Obstetrics & Gynecology 2012; 40 (Suppl. 1): 55–170
Short oral presentation abstracts
Results: One hundred and thirty-five TTTS patients underwent surgery from 2004 to 2010. Modified sequential technique was performed in 108 (80%) of all cases. In other 27 cases, conventional laser coagulation was done because of incomplete annotation of anastomoses due to fetal position. On intention to treat analysis, at least one fetal survival rate at 6-month was 94.1% and both survival was 71.9%. Eighty-seven percent of recipient twin and 77% of donor twin were survived. If positive end-diastolic low in umbilical artery of donor twin was noted before surgery, the survival rate was 96%. If absent end-diastolic flow was noted, survival rate was 55%. Both survival rate was likely higher in the group of modified sequential technique than in conventional method (74.4% and 63.0%) but statistical analysis was not done because both group was not assigned randomly. Conclusions: Modified sequential method is associated with a decreased likelihood of an increased rate of dual survivors.
OP07: QUALITY ASSESSMENT OF THE FIRST TRIMESTER SCAN OP07.01 Are qualitative and quantitative NT quality-control processes related? L. J. Salomon1,2 , P. Boukobza2 , R. Mangione2 , N. Fries2 1
Maternit´e, Hopital Necker Enfants Malades, AP-HP, Universit´e Paris Descartes, Paris, France; 2 CFEF, Paris, France
Objectives: Two types of quality assurance processes for NT measurement have been individualized. Qualitative assurance is assessed through the submission of images and the quality can be determined based on marks given by experts. The second aspect is a quantitative one. Individual operator’s specific NT distributions are compared to an internationally accepted reference distribution. The aim of this study was to compare the results of these two approaches on a large set of sonographer. Methods: This was a prospective evaluation of sonographers affiliated to the French Ultrasound College. Sonographer underwent qualitative evaluation based on a published qualitative score based on the analysis of 30 images using 8 criteria (2 for CRL and 6 for NT) clearly defined ultrasound reference marks. During one year, those same songraphers performed routine Down syndrome screening in the general population. Their operator’s specific NT distributions were analysed in relation to their qualitative control results. Results: 1726 sonographers were involved. The mean (SD) and median [IQR] quantitative score was 14.6 (±1.6) and 14.6 [13.6; 15.7]. Sonographers performed a total of 174,722 first trimester examinations with DS screening. The median [IQR] number of examination per sonographer was 69 [37; 123]. The median [range] NT MoM values was 0.81 [0.46; 1.22] demonstrating a clear left shift of the distribution. There was a significant relationship between qualitative and quantitative quality control results (P < 10–4). The higher the NT score the closer to one the NT MoM values. Conclusions: Qualitative assurance have been found too cumbersome to be used for routine quality assessment but it is a valuable tool mainly during the initial training period, or when quantitative assessment indicates the need for further scrutiny. Quantitative assurance has a potential for automation and can be easily implemented in any center. Our results based on a very large population suggest that both processes are clearly related.
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