Oral communication abstracts
OC23.05Inter-twin discordance in mean cerebral artery peak systolic velocity and pregnancy outcome in monochorionic diamniotic twin pregnancies Objectives: To assess the role of inter-twin discrepancy in middle cerebral artery peak systolic velocity (MCA-PSV) for the prediction of small for gestational age (SGA) and inter-twin growth discrepancy (ITGD) at birth in otherwise uncomplicated monochorionic diamniotic (MCDA) twin pregnancies. Methods: Cohort study on all MCDA pregnancies followed in a tertiary fetal medicine unit between 2008 and 2012. Exclusion criteria were: referral after 1st trimester, abnormal karyotype, structural anomalies, twin to twin transfusion syndrome, twin anemia-polycitemia sequence and selective fetal growth restriction with abnormal Umbilical Doppler. MCA-PSV values of both twins were converted in multiple of median (MoM). SGA was defined as birth weight <5th centile, ITGD was defined as a birth weight difference >25%. The relationship between MCA-PSV discrepancy, SGA and ITGD was assessed by logistic regression analysis. Receiver operating characteristic (ROC) curves were used to ascertain the predictive value of MCS-PSV discrepancy for such complications. Results: 117 MCDA twin pregnancies were included in the analysis. 42 (35.9%) had at least one SGA fetus; 13 (11.1%) were complicated with ITGD. Logistic regression analysis showed significant correlation between MCA-PSV discrepancy and both SGA (in the 2nd trimester OR 11.04; 95th CI 0.65−186.78; p = 0.09; in the 3rd trimester OR 110.47; 95th CI 6.12−1993.71; p < 0.001) and ITGD (in the 2nd trimester OR 101.11; 95th CI 1.65−6193.44; p < 0.03; in the 3rd trimester OR 309.28; 95th CI 4.32−22164.69; p < 0.01). Values were adjusted for maternal age, smoke and parity. ROC curves identified 3rd trimester MCA-PSV discrepancy as the best predictor for SGA (AUC 0.70, 95th CI 0.60−0.81; p < 0.001). The optimal cut off point was 0.30 MoM (Sens 0.64; Spec 0.76; LH + 2.68; LH-0.47). Conclusions: In MCDA twin pregnancies, MCA-PSV discrepancy is related to both SGA and ITGD at birth.
Electronic poster abstractsA planned caesarean section at 38 weeks of gestation was performed. A 3110g male was delivered with Apgar scores of 8 and 9 at 1 and 5 min.In third case, vasa previa was Type I, was diagnosed late, during elective caesarean section in 39 weeks of breach lie, with no risk factors for vasa previa. A 2990g female was delivered with Apgar scores of 8 and 9 at 1 and 5 min.In our opinion vaginal 2D and Doppler ultrasound in third trimester of fetal surveillance is of crucial importance in order to rule out the possibility of vasa previa, if risk factors are present.
P15.23Acral necrosis and upper brachial plexus palsy after prenatal fetal thrombosis
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