341 What is a low lying placenta?
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340 341 340 SPO Abstracts ULTRASOUND DIAGNOSIS OF MACROSOMIA: DOES IT MAKE A DIFFERENCE? AB LeYine, CJ Lockwood, R Lapinski", B Brown', RL Berkowitz. Mount Sinai School of Medicine, NY, NY. We evaluated 406 women with late third trimester ultrasounds (US) to determine whether the antenatal diagnosis of macrosomia (estimated fetal weight 90%) altered the management of labor and delivery. The accuracy of US in detecting macrosomia was poor (sensitivity 0.5; specificity 0,9). Logistic regression failed to demonstrate a relationship between parity, diabetes, prepregnancy weight or excess weight gain and the accurate US diagnosis of macrosomia. As expected, women with a suspected US diagnosis of macrosomia (68) differed from those without an US diagnosis of macrosomia (338) in the incidence of cesearean sections (60% vs. 37%, p=.001), use of epidural anethesJa (74% vs. 57%, p=.01), and the frequency of abnormal labor patterns (30% vs. 19%, p=.03). We then controlled for actual neonatal birthweight. Among pregnancies with birthweights <90%, there were clinical differences in the incidence of cesearean sections (55% vs. 35%, p<.03) and the frequency of abnormal labor patterns (33% vs. 19%, p<.04) when those diagnosed as being macrosomic (33) were compared with those who were not (303). However, among pregnancies with birthweights there were no clinical differences among those correctly (35) and incorrectly (35) diagnosed as being macrosomic except for the frequency of epidural anesthesia (57% vs. 80%, p=.04). The antenatal diagnosis of macrosomia appears inaccurate and even when accurate, can have marginal or adverse clinical impact. WHAT IS A WW LYING PLACENTA? LW Oppenheimer MD x , D.Farine MD, J. Telford RN x , JWK Ritchie MD. Perinatal Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. The expression "low lying placenta " has served historically as an indistinct clinical classification with minimal prognostic significance. More recently, it has been amenable to diagnosis by ultrasound, although the exact sonographic criteria underlying this diagnosis have not been defmed. r.fty-two patients who were diagnosed to have placenta previa by transabdominal ultrasound scan, underwent transvaginal ultrasonography (TVS). Based upon traditional classification, 7 (14%) would have been labelled as marginal placenta previa and 21 (42%) as low-lying. For these 28 patients, the diagnosis was reevaluated by TVS measurement of the distance of the placental edge from the internal cervical os in centimetres. Seventeen patients had a placental edge 3 cm or more from the internal os. None of these required abdominal delivery for the indication of placenta previa nor did any suffer significant post-partum hemorrhage. Of the 11 patients with a placental edge between 0 and 3 cm from the internal cervical os, 5 (45%) required cesarean section for bleeding characteristic of a placenta previa. Although, by definition, a placenta lying in the lower segment of the uterus is a placenta previa, we suggest that the expression "low lying placenta" has no clinical relevance if the placental edge is greater than 3 cm from the internal cervical os. If it is between 0 and 3 cm, the actual distance is a better predictor of delivery route, than the traditional classification of placenta previa. 342 343 Janua rv 199 1 Am J Obstet G, necol IS PERINATAL COCAINE USE ASSOCIATED WITH AM IIICRWED INCIDENCE OF COII6EIIITAL AIIOIIAlIES7 RR Vi scarell 0, 00 Ferguson', JC Hobbins, Department of OB/GYN, Yale Univ., New Haven, CT The i ncreasi ng prevalence of cocai ne abuse among pregnant wanen has stimulated a surge of interest in the effects of cocaine on both mother and fetus . Mounting evidence indicates that perinatal cocaine use Is associated with an increased risk of spontaneous aborti on, sti llbirth, premature labor, and abruption . Intrauterine growth retardation as well as subsequent neurobehavioral deficits have also been reported. Cocaine's teratogenic effect on the fetus remains more controversial. Several investigators have suggested that cocaine-mediated vasoconstriction can cause fetal ischemia and result in vascular disruption. Certain congenital anomalies have been associated with in utero vascular insults . In order to dete""lne if i!l.....!!1!l.! exposure to cocaine increases the risk of fetal IMlfonnations, we reviewed the ultrasound records of 198 wanen who received prenatal care in our clinic. The cocai ne-exposed group consi sted of 67 women who were i dentifi ed by history and/or urine toxicology. The control group was comprised of 130 women of similar age and gravidity who had no history of cocaine use. The groups did not differ significantly with respect to the number and types of pregnancy compl ications, including PROM, oligohydramnios, polyhydramnios, fetal demise, or spontaneous abort i on . However, peri nata I coca i ne abuse was associated with an increased incidence of congenital malfonnations (8.96% vs 1.53%, p<0.02). decreased birth weight (2711;t699g vs 3088;t617g, p <0 . 001)' and decreased gestational age (37 . 1;t4.5 wk vs 38.5;t2.8 wk, p<0.05). Anomalies detected by ultrasound in the exposed group included: 2 body stalk anomalies; 1 hydrocephaly; 1 hydrocephaly with short limbs and hydrops; 1 diaphragmatic hernia; and 1 unilateral UV junction obstruction with renal cystic mass. Our data suggest that the relative risk of a congenital anomaly is six-times greater in infants exposed to cocaine in utero. In addition, the results confi rm an associ at ion with low bi rth wei ght and decreased gestational age. Primary prevention efforts must be focussed on patient education concerning the harmful effects of perinatal drug use. Routine prenatal care for cocaine-abusing women should Include an ultrasound examination to screen for possible anomalies. CAM FETAL ALCOIIIl SY1IIlIIOIIE BE DETECTED IN UTERO BY ll. TRASOUIID? : PRELIMIIWlY FIIIDIIIGS. RR Viscarello, C Thio*, R Sokol, R Gallagher*, and JC Hobbins, Dept. of OB/GYN, Yale Univ., New Haven, CT; and Wayne State Univ., Detroit, HI. lt has been estimated that 20%-30% of pregnant women drink regularly. Fetal alcohol syndrome (FAS) is the leading known preventable cause of mental retardation, WIth an estimated prevalence of 1.9:1000 nationally. A fonnal diagnosis of FAS can be tnade at birth by noting the classic features of the syndronoe Including mid-facial hypoplasia, microcephaly, and growth retardation. The potential exists for ascertaintnent of these findings using high-resolution ultrasonography (U/S). A convenience sample of 159 pregnant patients at 3 sites including an intercity clinic, a private cl inic, and an U/S lab were screened using an orally adninistered T-ACE questionnaire, which was developed to identify patients at risk for FAS and ARBD. The percentage of T-ACE positives was 42", 40%, and 9% for each group respec- tively, giving an overall 27% prevalence of women whose drinking may have constituted a risk to the fetus. A comprehensive U/S examination was performed which included measurements of the mi d-face and the cavum-thalami c-cerebe 11 ar axi s at 3 i nterva Is: from 16-19; 24-28; and 32-35 weeks of gestation. A 4-chamber view of the heart was visualized in all 159 fetuses. Overall, U/S measurements including BPD, He, 000, 100, and TCO in at- risk fetuses did not differ significantly from a group of fetuses who were not at ri sk. There was a tendency for measurements of He and mid-outer orbital to mid-mandibular distance to be smaller in fetuses at risk at all 3 gestational age ranges. Measurements of cavum to inner skull, thalamus to inner skull, and 100 tended to be smaller in at-ri sk fetuses at both 2nd-trimester examinations, but larger between 32 and 35 weeks gestation. Two fetuses whose mothers drank large quantities of alcohol daily throughout pregnancy and who were thought to have distinctly abnonnal cephalometry by U/S at 16 and 24 weeks were subsequently determined to have FAS after birth . These findings suggest that the distinct craniofacial morphometry characterizing FAS may be detectable in utero using U/S. Further studi es i nvo 1vi ng 1 arge numbers of pregnant women are underway to determine the efficacy as a screening method for fetuses at ri sk for FAS and ARBO.
Transcript of 341 What is a low lying placenta?
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340 SPO Abstracts
ULTRASOUND DIAGNOSIS OF MACROSOMIA: DOES IT MAKE A DIFFERENCE? AB LeYine, CJ Lockwood, R Lapinski", B Brown', RL Berkowitz. Mount Sinai School of Medicine, NY, NY.
We evaluated 406 women with late third trimester ultrasounds (US) to determine whether the antenatal diagnosis of macrosomia (estimated fetal weight ~ 90%) altered the management of labor and delivery. The accuracy of US in detecting macrosomia was poor (sensitivity 0.5; specificity 0,9). Logistic regression failed to demonstrate a relationship between parity, diabetes, prepregnancy weight or excess weight gain and the accurate US diagnosis of macrosomia. As expected, women with a suspected US diagnosis of macrosomia (68) differed from those without an US diagnosis of macrosomia (338) in the incidence of cesearean sections (60% vs. 37%, p=.001), use of epidural anethesJa (74% vs. 57%, p=.01), and the frequency of abnormal labor patterns (30% vs. 19%, p=.03) . We then controlled for actual neonatal birthweight. Among pregnancies with birthweights <90%, there were clinical differences in the incidence of cesearean sections (55% vs. 35%, p<.03) and the frequency of abnormal labor patterns (33% vs. 19%, p<.04) when those diagnosed as being macrosomic (33) were compared with those who were not (303). However, among pregnancies with birthweights ~O%, there were no clinical differences among those correctly (35) and incorrectly (35) diagnosed as being macrosomic except for the frequency of epidural anesthesia (57% vs. 80%, p=.04). The antenatal diagnosis of macrosomia appears inaccurate and even when accurate, can have marginal or adverse clinical impact.
WHAT IS A WW LYING PLACENTA? LW Oppenheimer MDx, D.Farine MD, J. Telford RNx, JWK Ritchie MD. Perinatal Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
The expression "low lying placenta " has served historically as an indistinct clinical classification with minimal prognostic significance. More recently, it has been amenable to diagnosis by ultrasound, although the exact sonographic criteria underlying this diagnosis have not been defmed. r.fty-two patients who were diagnosed to have placenta previa by transabdominal ultrasound scan, underwent transvaginal ultrasonography (TVS). Based upon traditional classification, 7 (14%) would have been labelled as marginal placenta previa and 21 (42%) as low-lying. For these 28 patients, the diagnosis was reevaluated by TVS measurement of the distance of the placental edge from the internal cervical os in centimetres. Seventeen patients had a placental edge 3 cm or more from the internal os. None of these required abdominal delivery for the indication of placenta previa nor did any suffer significant post-partum hemorrhage. Of the 11 patients with a placental edge between 0 and 3 cm from the internal cervical os, 5 (45%) required cesarean section for bleeding characteristic of a placenta previa. Although, by definition, a placenta lying in the lower segment of the uterus is a placenta previa, we suggest that the expression "low lying placenta" has no clinical relevance if the placental edge is greater than 3 cm from the internal cervical os. If it is between 0 and 3 cm, the actual distance is a better predictor of delivery route, than the traditional classification of placenta previa.
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Januarv 1991 Am J Obstet G, neco l
IS PERINATAL COCAINE USE ASSOCIATED WITH AM IIICRWED INCIDENCE OF COII6EIIITAL AIIOIIAlIES7 RR Vi scarell 0, 00 Ferguson', JC Hobbins, Department of OB/GYN, Yale Univ., New Haven, CT
The i ncreasi ng prevalence of cocai ne abuse among pregnant wanen has stimulated a surge of interest in the effects of cocaine on both mother and fetus . Mounting evidence indicates that perinatal cocaine use Is associated with an increased risk of spontaneous aborti on, sti llbirth, premature labor, and abruption . Intrauterine growth retardation as well as subsequent neurobehavioral deficits have also been reported. Cocaine's teratogenic effect on the fetus remains more controversial. Several investigators have suggested that cocaine-mediated vasoconstriction can cause fetal ischemia and result in vascular disruption. Certain congenital anomalies have been associated with in utero vascular insults . In order to dete""lne if i!l.....!!1!l.! exposure to cocaine increases the risk of fetal IMlfonnations, we reviewed the ultrasound records of 198 wanen who received prenatal care in our clinic. The cocai ne-exposed group consi sted of 67 women who were i dentifi ed by history and/or urine toxicology. The control group was comprised of 130 women of similar age and gravidity who had no history of cocaine use. The groups did not differ significantly with respect to the number and types of pregnancy compl ications, including PROM, oligohydramnios, polyhydramnios, fetal demise, or spontaneous abort i on . However, peri nata I coca i ne abuse was associated with an increased incidence of congenital malfonnations (8.96% vs 1.53%, p<0.02). decreased birth weight (2711;t699g vs 3088;t617g, p <0 . 001)' and decreased gestational age (37 . 1;t4.5 wk vs 38.5;t2.8 wk, p<0.05). Anomalies detected by ultrasound in the exposed group included: 2 body stalk anomalies; 1 hydrocephaly; 1 hydrocephaly with short limbs and hydrops; 1 diaphragmatic hernia; and 1 unilateral UV junction obstruction with renal cystic mass. Our data suggest that the relative risk of a congenital anomaly is six-times greater in infants exposed to cocaine in utero. In addition, the results confi rm an associ at ion with low bi rth wei ght and decreased gestational age. Primary prevention efforts must be focussed on patient education concerning the harmful effects of perinatal drug use. Routine prenatal care for cocaine-abusing women should Include an ultrasound examination to screen for possible anomalies.
CAM FETAL ALCOIIIl SY1IIlIIOIIE BE DETECTED IN UTERO BY ll. TRASOUIID? : PRELIMIIWlY FIIIDIIIGS. RR Viscarello, C Thio*, R Sokol, R Gallagher*, and JC Hobbins, Dept. of OB/GYN, Yale Univ., New Haven, CT; and Wayne State Univ., Detroit, HI.
lt has been estimated that 20%-30% of pregnant women drink regularly. Fetal alcohol syndrome (FAS) is the leading known preventable cause of mental retardation, WIth an estimated prevalence of 1.9:1000 nationally. A fonnal diagnosis of FAS can be tnade at birth by noting the classic features of the syndronoe Including mid-facial hypoplasia, microcephaly, and growth retardation. The potential exists for ~ ascertaintnent of these findings using high-resolution ultrasonography (U/S). A convenience sample of 159 pregnant patients at 3 sites including an intercity clinic, a private cl inic, and an U/S lab were screened using an orally adninistered T-ACE questionnaire, which was developed to identify patients at risk for FAS and ARBD. The percentage of T-ACE positives was 42", 40%, and 9% for each group respectively, giving an overall 27% prevalence of women whose drinking may have constituted a risk to the fetus. A comprehensive U/S examination was performed which included measurements of the mi d-face and the cavum-thalami c-cerebe 11 ar axi s at 3 i nterva Is: from 16-19; 24-28; and 32-35 weeks of gestation. A 4-chamber view of the heart was visualized in all 159 fetuses. Overall, U/S measurements including BPD, He, 000, 100, and TCO in atrisk fetuses did not differ significantly from a group of fetuses who were not at ri sk. There was a tendency for measurements of He and mid-outer orbital to mid-mandibular distance to be smaller in fetuses at risk at all 3 gestational age ranges. Measurements of cavum to inner skull, thalamus to inner skull, and 100 tended to be smaller in at-ri sk fetuses at both 2nd-trimester examinations, but larger between 32 and 35 weeks gestation. Two fetuses whose mothers drank large quantities of alcohol daily throughout pregnancy and who were thought to have distinctly abnonnal cephalometry by U/S at 16 and 24 weeks were subsequently determined to have FAS after birth . These findings suggest that the distinct craniofacial morphometry characterizing FAS may be detectable in utero using U/S. Further studi es i nvo 1 vi ng 1 arge numbers of pregnant women are underway to determine the efficacy as a screening method for fetuses at ri sk for FAS and ARBO.
