Background: Antepartum haemorrhage (APH) of unknown origin is a common antenatal complication and is associated with increased risk of preterm delivery.
14th World Congress on Ultrasound in Obstetrics and Gynecology
P02.14 Continuous vacuum depression vs. syringe amnioreduction for polyhydramnios: a prospective randomised study F. Perrotin1 , A. Wagner1 , M. Chevillot1 , P. Arbeille2 1
Fetal Medicine Unit, University Hospital, Tours, France, 2 INSERM U316, University Hospital, France
Objectives: To prospectively compare the efficacy and tolerance of two techniques of amniodrainage used in the treatment of symptomatic polyhydramnios: syringe aspiration (SA) and continuous vacuum depression (VD). Patients and Methods: Prospective randomised study, performed over 37 months. The main comparison criterion was maternal pain, blindly assessed by a midwife using a visual quantitative scale (EVA from 0 to 100 points). Comparison also included: duration and volume of fluid drained, need to stop the procedure because of maternal pain, uterine activity after drainage, foetal tolerance controlled with CTG (FHR blindly analysed by 2 obstetricians) and absence of placenta abruption controlled by histological examination of the placenta. We calculated that 35 patients would be necessary in each group to show a 20 points difference on the EVA with a power of 80% (alpha: 0.05). Results: 80 amnioreductions were performed in 53 patients. The two groups were comparable for the tested variables (age, parity, term, deepest pool and amniotic fluid index before drainage, uterine contractility, tocolysis) as well as for the aetiology of polyhydramnios. Drained volume was significantly higher in the VD group (2540 ml +/− 860 versus 1250 ml +/− 530; p < 0.01) and the drainage duration significantly shorter (12 mn +/− 10 versus 38 mn +/− 25; p < 0.01). Maternal pain was significantly lower in the VD group compared to the SA group (25 +/− 12 vs. 55 +/− 22; p < 0.01). No significant difference was noted in uterine contractility or FHR abnormalities between the two groups and they were no occurrence of clinical placental abruption. In four cases, histological analysis of the placentas revealed the presence of old placental infarctions (three in the SA group and one in the VD group). Conclusion: Continuous vacuum depression appears to be faster and has a better maternal tolerance than syringe aspiration.
Poster abstracts be used alone or serve as an adjunct to experimental percutaneous fetoscopic tracheal occlusion.
P03: ULTRASOUND IN LABOR P03.01 The silent myometrial contraction in pregnancy Y. Romem, A. Romem, P. Romem Ben-Gurion University of the Negev, Israel Objective: Characterization of the silent focal myometrial contraction (SFMC) in pregnancy as observed during routine ultrasound examination. Methods: 544 healthy pregnant patients, 122 of them nulliparas, were scanned during mean time of 15 minutes.The median age of the patients was 27 years with the range of 15–46 years. The median gravidity and parity of G3P2. The majority were referred for routine second trimester malformation screening, or weight estimation at third trimester. The gestational age was established by ultrasound standard parameters. The occurrence, location, and myometrial thickness were analysed versus gestational age and parity. The Chi-square test was implemented in the statistical analysis. Results: The frequency of SFMC was 22%, significantly higher among the multiparas 24% then the nulliparas 15%. No statistical difference was observed between the first and the second trimester among the multiparas and the nulliparas, combined data of 38%, 21% in accordance. No SFMC were observed among the third trimester nulliparas and only 5% among the multiparas. The predominant location was the anterior wall 59% and thereafter the posterior one 30%, 25% were under the placenta. The myometrial thickness measured was in the range of 12–47 mm, with the median of 27.5 mm. 70% of the measurements were in the range of 21–31 mm. Conclusions: The SFMC is a frequent event during pregnancy in the first and the second trimester. The data provided can help to distinguish between the SFMC and leiomyoma.
P02.15 Percutaneous ultrasound-guided drainage of an enlarged intrathoracic stomach may increase lung volume in fetuses with life-threatening congenital diaphragmatic hernia
P03.02 Evaluation of cervical length in threatened preterm labor
G. Bizjak1 , U. Gembruch1 , R. Hering1 , T. Schaible2 , B. Filsinger2 , S. Loff2
University of Istanbul, Faculty of Medicine, Turkey
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2
University of Bonn, Germany, University of Mannheim, Germany
Background: Survival in children with severe left sided congenital diaphragmatic hernia depends on the degree of pulmonary hypoplasia induced by the volume of intrathoracic abdominal organs. We hypothesized that long-term drainage of an enlarged intrathoracic stomach might permit pulmonary distension. Patient and Method: Employing an ultrasound-guided percutaneous technique, a 4-F Pigtail catheter was inserted into the enlarged intrathoracic stomach in a human fetus at 24 + 6 weeks of gestation. Markers of poor prognosis were ‘‘liver-up’’, a low lung-head ratio of 0.9. Before the intervention, the lung volume was 15 ml, as assessed by MRI. Results: Within two weeks following the intervention, the lunghead ratio increased from 0.9 to 1.9 and the lung volume increased from 15 to 20 ml. Therefore, the initial experimental treatment plan of percutaneous fetoscopic tracheal occlusion was abandoned. Following elective Cesarean section at 37 + 0 weeks of gestation, the infant required 6 days of ECMO before closure of the defect could be performed. Conclusion: Percutaneous drainage of an enlarged intrathoracic stomach may permit pulmonary distension in fetuses with lifethreatening congenital diaphragmatic hernia. The procedure may
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˜ ¨ ukkurt ¨ S. Buy H. Delier Sezer, R. Has, I. Kalelioolu,
Objective: The aim of the study was to evaluate the role of cervical length in predicting preterm delivery in patients with threatened preterm labor. Methods: Cervical length was measured by transvaginal sonography according to the guidelines of Fetal Medicine Foundation in 31 patients with singleton pregnancies presenting with threatened preterm labor between 24–36 weeks. Results: Thirty-one patients with painful and regular contractions were included in the study. Sixteen patients were nulliparous and 15 were parous. The mean gestational age on admission, the mean gestational age at delivery, and interval to delivery were 31.3 weeks (26–35), 36.3 weeks (28–40) and 37.3 (7–90) days, respectively. The mean gestational age on admission, gestational age at delivery and cervical length were 30.4 weeks, 33.6 weeks, and 25.9 mm, respectively, in 13 patients who delivered prematurely (< 37 weeks) while the same parameters were 31.9 weeks, 38.2 weeks, and 31.6 mm, respectively, in 18 patients who delivered at term. Comparison of cervical length on admission (25.9 mm vs. 31.6 mm) between preterm and term deliveries did not reveal any significant difference (P = 0.11). The odds ratios for preterm delivery for cervical length < 30 mm and < 20 were 4.1 (CI; 0.90–19.09) and 5.0 (CI; 0.78–31), respectively; however, there was no statistical significance (p > 0.05). The mean gestational age at delivery (35.2 weeks) and admission-to-delivery interval (32.1 days) of 18 patients who had tocolytic therapy were not significantly different
Ultrasound in Obstetrics & Gynecology 2004; 24: 269–372
31 August–4 September 2004, Stockholm, Sweden
Poster abstracts
from those (37.8 weeks and 44.5 days) of 13 patients who were not given tocolytic therapy. Conclusion: In this study, sonographic measurement of cervical length was not able to predict preterm delivery in patients presenting with threatened preterm labor. Increasing the sample size may reveal statistically significant results.
P03.03 Transvaginal ultrasound assessment of cervical length in patients with antepartum haemorrhage of unknown origin 1
1
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3
W. Y. Fok , L. Y. Chan , S. F. Wong , W. L. Lau , K. M. Chow2 1
The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, 2 Princess Margaret Hospital, Hong Kong, SAR, 3 Kwong Wah Hospital, Hong Kong, SAR Background: Antepartum haemorrhage (APH) of unknown origin is a common antenatal complication and is associated with increased risk of preterm delivery. The aim of the present study is to evaluate the ability of cervical length in prediction of preterm delivery in women with APH of unknown origin. Methods: This is a prospective observational study. Women who were at or beyond 24 weeks of gestation presenting with APH of unknown origin at one of 3 tertiary referral centres in Hong Kong were recruited into the study. A transvaginal ultrasound scan was performed to measure cervical length within 24 hours of onset of APH. The predictive power of cervical length in preterm delivery was calculated. Results: Seventy-seven women participated in the study. The mean gestational age at presentation was 31.1 ± 3.2 weeks and the mean gestation at delivery was 38.0 ± 2.1 weeks. Twelve women (16%) delivered before 37 weeks of gestation. Receiver operating characteristics curve was used to evaluate the relationship between cervical length at presentation and preterm delivery (before 37 weeks). The area under the curve was 0.78. Using a cut-off value of 27.5 mm, the sensitivity, specificity, positive and negative predictive values were 0.71, 0.75, 0.32, and 0.94, respectively. Conclusion: Transvaginal ultrasound measurement of cervical length is a useful tool to assess the risk of preterm delivery in women with APH of unknown origin. This serves as a useful tool for management and counseling of women with APH of unknown origin.
P03.04 Ultrasonographic cervical measurement in women with preterm contractions G. Daskalakis, N. Papantoniou, S. Mesogitis, P. Koutra, A. Pilalis, A. Antsaklis
Conclusions: Cervical assessment in women with symptoms of preterm labour can distinguish those at high risk for preterm delivery. Cervical sonography can be a valuable adjunct to the clinical evaluation of these patients.
P03.05 Cervical length versus the biochemical marker igfbp-1 to predict spontaneous preterm delivery in women admitted because of preterm labor before 34 weeks M. Palacio, M. Sanchez, T. Cobo, F. Figueras, O. Coll, V. Cararach Hospital Cl´ınic, Barcelona, Spain Objective: to compare cervical length versus the biochemical marker IGFBP-1 to predict spontaneous preterm delivery in women admitted because of preterm labor before 34 weeks. Methods: Prospective study. Inclusion criteria: Single pregnancy with preterm labor requiring admission, gestational age between 24.0 and 33.6 weeks, no parturition within 24–48 hours after admission, and no clinical signs of chorioamnionitis or non-reassuring fetal status. Intervention: Cervical length and IGFBP-1 were determined 24–48 h after admission. Clinicians were blinded to the results and patients were managed according to our center protocol. Outcomes: spontaneous preterm delivery before 34 and 36 weeks’ gestation. Sensitivity, specificity, positive predictive value and negative predictive value for spontaneous preterm delivery (including subsequent pPROM) before 34.0 and 36.0 weeks were calculated. Results: 62 pregnant women were included for analysis. Mean (SD) gestational age and Bishop score at admission were 30.5 (2.40) weeks and 3.2 (1.2) respectively. Two women were delivered between 34 and 36 weeks because of medical reasons other than preterm rupture of membranes. See table for predictive values of spontaneous preterm delivery. S (%)
E (%)
PPV (%)
NPV (%)
Spontaneous delivery before 34 w n = 8/62 (12.9%) Cervical length < 25 mm IGFBP-1 positive
57 75
85 57
33 21
94 94
Spontaneous delivery before 36 w n = 19/60 (31.7%) Cervical length < 25 mm IGFBP-1 positive
39 68
90 66
64 48
77 82
Conclusions: In women admitted because of preterm labor before 34 weeks’ gestation, IGFBP-1 appears to be more sensitive but less specific than cervical length to predict spontaneous preterm delivery.
Alexandra Hospital, Athens University, Greece Objective: The aim of the study was to examine the clinical value of cervical assessment by transvaginal ultrasonography in women with symptoms of preterm labour. Methods: We prospectively evaluated 172 women with singleton pregnancies and symptoms of preterm labour. Gestational age ranged between 24 and 34 weeks. All women underwent cervical assessment with transvaginal ultrasonography and were given intravenous tocolytics. The only parameter evaluated was cervical length. Women with multiple pregnancies, gestational age < 24 weeks or > 34 weeks, cervical dilatation > 2 cm, placenta previa, premature rupture of membranes, or cervical cerclage were excluded from the study. The outcome measure was delivery before 34 weeks’ gestation. Results: The preterm delivery rate before 34 weeks was 37%. The sensitivity of a cervical length of less than 20 mm was 56%, while the specificity was 96%. A cervical length < 20 mm was also 90% predictive of preterm delivery, while the negative predictive value (NPV) of a cervical length of more than 20 mm was 79%.
Ultrasound in Obstetrics & Gynecology 2004; 24: 269–372
P03.06 Ultrasonographic measurement of the cervical length before labour induction in term nulliparous women G. Daskalakis, N. Thomakos, L. Hatziioanou, S. Mesogitis, N. Papantoniou, D. Papadopoulos, A. Antsaklis Athens University, Greece Objective: To determine if transvaginal sonographic measurement of the cervical length is a useful method to predict successful labour induction in nulliparas. Methods: 137 women who were scheduled for medically indicated induction of labour had a transvaginal sonographic measurement of the cervical length before labour induction. Inclusion criteria were: (1) singleton pregnancy, (2) gestational age between 37–42 weeks, (3) live fetus in cephalic presentation, (4) intact membranes, (5) no vaginal bleeding, (6) no previous history of uterine surgery, (7) nulliparous women and (8) no allergy or asthma in response to prostaglandins.
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