twin transfusion syndrome (TTTS). STUDY DESIGN: We reviewed our database of patients treated for TTTS by laser coagulation between 2002 and 2007 with ...
SMFM Abstracts 698
MIDDLE CEREBRAL ARTERY PEAK SYSTOLIC VELOCITIES IN TWIN-TO-TWIN TRANSFUSION SYNDROME FETUSES AROUND THE TIME OF FETOSCOPIC LASER COAGULATION LÉONARDO GUCCIARDO1, PHILIPP KLARITSCH1, TIM VAN MIEGHEM1, ELISA DONE1, JACQUES JANI1, PAUL LEWI1, LIESBETH LEWI1, JAN DEPREST1, 1University Hospitals Leuven, Obstetrics and Gynaecology, Leuven, Belgium OBJECTIVE: To determine the impact of laser ablation on fetal cerebrovascular blood flow by assessing middle cerebral artery peak systolic velocity (MCA-PSV) in monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-totwin transfusion syndrome (TTTS). STUDY DESIGN: We reviewed our database of patients treated for TTTS by laser coagulation between 2002 and 2007 with available fetal MCA-PSV values. Measures were transformed to multiples of the median (MoM) based on reference ranges established in MC twins. Paired analysis was performed to compare values 24h before with 48h after laser. Fetuses with MCA-PSV ⬎1.5 MoM within 48h after laser were analyzed separately. RESULTS: 118 fetuses had measurements both 24h before and 48h after laser. Laser was followed by an increase in MCA-PSV in all fetuses. Of the 109 ex-recipients and 105 ex-donors with available measurements 48h after laser, 27 (12.6%) had MCA-PSV ⬎1.5 MoM. Ex-recipients (20;18.3%) had more often MCAPSV⬎1.5Mom than ex-donors (7; 6.7%). 16/20 (80%) ex-recipients and 6/7 (85.7%) ex-donors with MCA-PSV ⬎1.5 MoM subsequently survived, compared to 90/98 (91.8%) and 89/90 (98.9%) with normal values 48h after laser (not significantly different). When both survived 40% (7/18) of ex-recipients but no ex-donors with elevated MCA-PSV had a co-twin with MCA-PSV ⬍0.8 MoM, consistent with a twin-anemia-polycythemia-sequence (TAPS). One of these had an intrauterine transfusion, another one opted for selective feticide and the others resolved spontaneously within the next weeks. CONCLUSION: There was an overall increase in MCA-PSV 48h after laser therapy. MCA-PSV⬎1.5 MoM was observed in 13% of fetuses but more frequently in ex-recipients. Overall, outcome of fetuses with elevated PSV shortly after laser is favorable. In 40% of these TAPS was diagnosed which also resolved spontaneously in the majority of cases.
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0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.729
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IMPACT OF 17-ALPHA-HYDROXYPROGESTERONE CAPROATE ON GLUCOSE INTOLERANCE IN PREGNANCY THADDEUS WATERS1, BRETT SCHULTZ1, BRIAN MERCER1, PATRICK CATALANO1, 1MetroHealth Medical Center - Case Western Reserve University, Department of Ob/Gyn, Cleveland, Ohio OBJECTIVE: To determine if 17-alpha-OH-progesterone caproate (17OHPC) treatment in pregnancy increases the frequency of abnormal glucose screening and gestational diabetes (GDM). STUDY DESIGN: This is a retrospective cohort study of women treated with weekly 17OHPC because of a prior singleton preterm birth. Women with pregestational diabetes and multiple gestations were excluded. 17OHPC exposed subjects were matched to 3 unexposed controls by maternal age and pre-pregnancy body mass index (BMI). The primary outcomes were abnormal 1 hour glucose screen and GDM. RESULTS: Individual chart review was performed on 440 women (110 17OHPC matched to 330 controls). Maternal characteristics between 17OHPC and controls were similar including age (29 vs 29 yrs, p⫽0.77), pre-pregnancy BMI (27 vs 27 kg/m2, p⫽0.99) and race (46 vs 39% African-American, 17 vs 18% Hispanic, 36 vs 40% Caucasian, p⫽0.57). Abnormal 1 hour glucose screens were more frequent in the 17OHPC group (26.6 vs 11.2%, p⫽0.001) and mean 1 hour glucose values were increased in the 17OHPC group (p⫽0.01) regardless of maternal BMI (figure). GDM was more frequent in the 17OHPC group (10.9 vs. 3.6%, p⫽0.004). 17OHPC remained independently associated with the diagnosis of GDM (OR: 3.3; 1.42-7.67, p⫽0.005) in a logistic regression analysis controlling for maternal BMI, age, and race. CONCLUSION: Women receiving weekly intramuscular 17OHPC have more frequent abnormal glucose testing and gestational diabetes compared with unexposed controls. These results are consistent with published data regarding the impact of progesterone on insulin resistance.
A COMPARISON OF GLYBURIDE/METFORMIN AND INSULIN FOR GESTATIONAL DIABETES AMANDA HUTCHINSON1, CLARISA HAUGABROOK2, LINDA LONG2, LORRIE MASON2, JOSEPH KIPIKASA3, DAVID ADAIR4, 1University of Tennessee Health Science Center, Chattanooga, Tennessee, 2University of Tennessee Health Science Center, Tennessee, 3University of Tennessee College of Medicine, Chattanooga Unit, Maternal Fetal Medicine, Chattanooga, Tennessee, 4University of Tennessee College of Medicine, Chattanooga, Tennessee OBJECTIVE: The objective of this study is to compare glycemic control with glyburide/metformin, an oral hypoglycemic, to injected insulin in type 2 and gestational diabetic pregnancies requiring medication. STUDY DESIGN: We recruited patients seen in consultation with our perinatologists for gestational diabetes or type 2 diabetes not previously requiring insulin. Subjects were assigned either an insulin (control) or glyburide/metformin (study) regimen. Subjects monitored their glucose levels at home and reported weekly. Medication changes were made by the perinatologist for optimal glucose control. In addition to routine obstetrical care, patients were seen twice weekly after 28 weeks. At delivery, umbilical cord glucose, hemoglobin A1C, fructosamine, and infant 1 hour glucose levels were collected to assess long and short-term glycemic control. RESULTS: Variables compared included gestational age at delivery, birth weight, umbilical cord glucose, fructosamine, and glycosylated hemoglobin, neonatal 1-hour glucose, NICU admissions, and infant length of stay. We enrolled 172 patients with 80 in the insulin arm and 92 in the glyburide/ metformin arm. Statistical analyses of the data using the Chi-squared and t-tests revealed no significant differences at p⬍0.05 between the two groups. Mean gestational age at delivery was 37.2 and 37.3 weeks in the control and study groups respectively. Mean birth weights were 3105.6 (control) and 3289.9 grams (study). The mean HA1C was 3.93% (control) and 3.4% (study). Mean fructosamine was 169.22 umol/L (control) and 162.51 umol/L (study). Mean glucose was 68.01 mg/dl (control) and 71.72 mg/dl (study). The 1 hour neonatal glucose means were 62.43 mg/dl (control) and 53.43 mg/dl (study). NICU admissions, NICU admissions for hypoglycemia, and infant lengths of stay were not significantly different. CONCLUSION: Glyburide/metformin is an effective agent in the management of gestational diabetes and type 2 diabetics in pregnancy. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.731
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SERUM CONCENTRATION OF PLACENTAL PROTEIN 13 (PP13) IN PREGNANT WOMEN IS INFLUENCED BY MATERNAL BLOOD GROUP NANDOR GABOR THAN1, RON ACKERMAN2, ILANA CHEFETZ2, YAEL-INNA GRIMPLE2, MAREI SAMMAR2, TAL OTIKER3, HAMUTAL MEIRI2, RON GONEN4, 1Semmelweis University, Budapest, Hungary, 2Diagnostic Technologies, Yokneam, Israel, 3TechnoSTAT, Ra’anana, Israel, 4Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel OBJECTIVE: Placental Protein 13 (PP13) is a galectin, which binds beta-galactosides. In previous studies, maternal serum PP13 multiple of the medians (MoM) adjusted to gestational age (GA), body mass index, maternal age, ethnicity, and parity was found to predict preeclampsia with sensitivity of 85% at 20% false positive rate (FPR) based on first trimester MoM. For the same sensitivity, FPR reduced to 6% when the slope between PP13 concentrations during the first and second trimesters were sequentially evaluated with first trimester PP13 MoM. The objective of this study was to examine maternal serum PP13 MoMs in the first and second trimesters of pregnancy in relation to maternal ABO and Rhesus (Rh) blood groups. STUDY DESIGN: Sequential blood samples were obtained from 1366 women with singelton viable pregnancies at 6-10, 16-20 and 24-28 weeks. PP13 concentrations were measured by ELISA. ABO and Rh blood groups were determined by a standard tile technique. ABO and Rh blood groups were added as additional confounders to the PP13 MoM algorithm. P⬍0.05 was considered significant. RESULTS: The prevalence of blood groups in the cohort was 46% O, 43% A, 8% B and 3% AB. Rh negative women were 6%. Median PP13 MoMs were higher in women with blood group B than in women with other blood groups in all three comparisons [at GA 6-10: B⫽1.26, AB⫽0.93(P⬍0.01), O⫽1.07, A⫽0.78; at GA 16-20: B⫽1.84, AB⫽0.94(P⬍0.01), O⫽1.05, A⫽0.88; and at GA 24-28: B⫽1.32, AB⫽0.72(P⬍0.01), O⫽1.12(P⬍0.05), A⫽0.87]. The Rh factor had no effect on PP13 MoMs at any of the time periods examined. CONCLUSION: The results are consistent with the high-affinity of PP13 to Nacetyl-galactosamine present on group A antigen and its lower affinity to galactose present on group B antigen. Our results suggest that maternal blood group should be considered as another important confounder in adjustment of PP13 MoMs that may improve preeclampsia prediction. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.732
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.730
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American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2008
