FOLLOWING SELECTIVE FETOSCOPIC LASER PHOTOCOAGULATION:A SINGLE CENTER ... tive fetoscopic laser photocoagulation(SFLP) were reported.
SMFM Abstracts
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ADDITION OF PERFLUOROCARBON TO ENHANCE PULMONARY GROWTH TO TRACHEAL OCCLUSION IN A RABBIT MODEL FOR FETAL LUNG DEVELOPMENT ELISA DONE1, LÉONARDO GUCCIARDO1, LOURENCO SBRAGIA1, XENIA ROUBLIOVA1, STEFFI MAYER1, VERONIKA BECK1, JAN DEPREST1, 1Katholieke Universiteit Leuven, Faculty of Medicine, Centre for Surgical Technologies, Leuven, Belgium OBJECTIVE: Fetal tracheal occlusion (TO) prevents egress of lung fluid, stretching fetal airways hence causing lung growth. Addition of adjuncts increasing airway stretch may cause additional growth. We investigated the effect of intratracheal perfluorocarbon (PFC) in fetal rabbits. STUDY DESIGN: Cornual end fetuses were randomly assigned at 27 d (term⫽31d) to 6 groups: Tracheal Occlusion (TO; n⫽7), TO with addition of 0.5mL PFC (TO⫹PFC; n⫽7) or saline (TO⫹Sal; n⫽7), SHAM (neck dissection; n⫽7). Neighbouring fetuses were used as internal normal controls (CTR; n⫽28). At term, fetuses were delivered by C-section to assess wet lung-to-body weight ratio (LBWR), lung volume/body weight ratio (LVBWR), airway morphometry: linear intercept (Lm-index inversely related to alveolar size), mean terminal bronchiolar density (MTBD-index of number of alveoles) and alveolar septal thickness (Lmw). Number of proliferating cells was determined using PCNA immunostain. RESULTS: LBWR was higher in TO groups than in CTR or SHAM fetuses. Additional PFC but not saline added to LBWR. LVBWR followed the same trends with larger volumes for TO⫹PFC. Linear intercept and alveolar wall thickness were significantly lower in TO⫹PFC compared to others whereas the MTBD remained the same. The number of PCNA-positive cells was not different between groups.(Table1) CONCLUSION: TO increases lung size and volume by term. Adding PFC or saline under the occlusion increases that even more. PFC causes increased air space size and thinner septa compared to TO and TO⫹saline but this was without measurable increases in number of proliferating cells.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.644
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THE EFFECT OF BMI AND OBESITY ON MATERNAL AND CORD BLOOD BETAMETHASONE CONCENTRATIONS CYNTHIA GYAMFI1, 1for the Eunice Kennedy Shriver National Institute of Child Health and Human Development MFMU Network, Bethesda, Maryland OBJECTIVE: Body mass index (BMI, kg/m2) is known to affect the volume of distribution of medications, particularly when they are delivered by the intramuscular route. Antenatal corticosteroids have never been studied in relation to maternal obesity. Thus, we evaluated whether maternal prepregnancy BMI or obesity affect maternal serum or cord blood betamethasone concentrations. STUDY DESIGN: Participants receiving betamethasone in the active group of a double-blind randomized placebo-controlled trial of weekly antenatal corticosteroids who delivered within one week of steroid administration were identified. We analyzed maternal serum and cord blood betamethasone concentrations by BMI, and then compared obese women, defined as a BMI 30, to non-obese women, defined as BMI ⬍30. We controlled for the number of courses received, days since the last course, plurality, and gestational age at delivery. RESULTS: Of 53 mothers that delivered within one week of betamethasone administration with available serum and maternal BMI information, 41 of those were non-obese and 12 were obese. Mean maternal serum betamethasone concentrations were 6.7 ng/mL and 8.5 ng/mL for non-obese and obese women, p⫽0.74, respectively. Cord blood betamethasone concentrations were available for 43 neonates, from 35 non-obese and 8 obese mothers. These concentrations were also similar in both groups, 3.4 ng/mL versus 3.8 ng/mL, p⫽0.82. After controlling for the factors listed above, there was not a linear relationship between BMI and betamethasone concentrations, p⫽0.52.
CONCLUSION: Neither increasing maternal BMI nor obesity affect serum or cord blood betamethasone concentrations. 0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.645
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PREVALENCE OF COMPLICATIONS IN TWIN TWIN TRANSFUSION SYNDROME FOLLOWING SELECTIVE FETOSCOPIC LASER PHOTOCOAGULATION:A SINGLE CENTER EXPERIENCE. MOUNIRA HABLI1, ANNETTE BOMBRYS1, DAVID LEWIS1, FOONG.YEN LIM2, WILLIAM POLZIN3, TIMOTHY CROMBLEHOLME2, 1University of Cincinnati, Cincinnati, Ohio, 2Cincinnati Children’s Hospital Medical Center, Fetal Care Center, Cincinnati, Ohio, 3Good Samaritan Hospital, Cincinnati, Ohio OBJECTIVE: Previously high rates (7%-28%) of complications following selective fetoscopic laser photocoagulation(SFLP) were reported. The aim of this study is to report the prevalence of early and late complications of twin twin transfusion syndrome(TTTS) following SFLP in a single center STUDY DESIGN: A retrospective chart review of all patients treated with SFLP for TTTS at a single center from 9/2005-2/2008. Complications following SFLP are categorized as early (occurred in ⱕ7 days) and late( ⬎ 7days). Pregnancy outcome, survival and complications following SFLP including recurrent TTTS (recurrence of polyhydramnios-oligohydramnios sequence), amniotic band syndrome(ABS), chorioamniotic separation(CAS), iatrogenic monoamnionicity, and twin anemiapolycythemia syndrome(TAPS) (defined as high MCA Dopplers suggestive of anemia) were recorded. Data are presented as mean⫾SD or n(%). RESULTS: A total of 137 TTTS cases (135 twins,2 triplets) were treated by SFLP during the study period. Mean gestational age(GA) at procedure was 20.9⫾2.5 weeks and at delivery was 34.5⫾4.6 weeks. 2/62(3%) with anterior placentation had transplacental trocar placement. We found a range 2 to 7% of early complications and 1.5-7% of late complications following SFLP(table).There were 2(1.5%) cases of monoamnionicity and 2(1.5%) recurrent TTTS treated with SFLP. There were 18(13%) IUFD involving both twins. Overall survival of one or all fetuses was 211/276(76.4%). CONCLUSION: Our findings suggest a lower complication rate as compared to prior reported data. This data is important in patients counselling. It also emphasizes the importance of close follow up and surveillance for early recognition and management of such complications.
0002-9378/$ - see front matter doi:10.1016/j.ajog.2008.09.646
Supplement to DECEMBER 2008 American Journal of Obstetrics & Gynecology
S177
