BackgroundBabies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome.Methods/DesignWomen with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial. Intervention: random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05).DiscussionThis study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure.Trial registrationNTR3492 Dutch Trial Register (http://www.trialregister.nl).
BackgroundFetal growth restriction is, despite advances in neonatal care and uptake of antenatal ultrasound scanning, still a major cause of perinatal morbidity. Neonates with birth weight > 10th percentile are assumed to be appropriate-for-gestational-age (AGA), although many are at increased risk of perinatal morbidity, because of undetected mild restriction of growth potential. We hypothesized that within AGA neonates, reduced fetal growth velocities are associated with adverse neonatal outcome.MethodsA retrospective cohort study of singleton pregnancies, in the Maastricht University Medical Centre (MUMC) between 2010 and 2016. Women had two fetal biometry scans (18–22 weeks and 30–34 weeks of gestational age) and delivered a newborn with a birth weight between the 10th–80th percentile.Differences in growth velocities of the abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and femur length (FL) were compared between the suboptimal AGA (sAGA) (birth weight centiles 10–50) and optimal AGA (oAGA) (birth weight centiles 50–80) group. We assessed the association between velocities and neonatal outcomes.ResultsWe included 934 singleton pregnancies. In the suboptimal AGA group, fetal growth velocities were lower (in mm/week): AC 10.72 ± 1.00 vs 11.23 ± 1.00 (p < .001), HC 10.50 ± 0.80 vs 10.68 ± 0.77 (p = 0.001), BPD 3.01 ± 0.28 vs 3.08 ± 0.27 (p < .0001) and FL 2.47 ± 0.21 vs 2.50 ± 0.22 (p = 0.014), compared to the optimal AGA group. Neonates with an adverse neonatal outcome had significantly lower growth velocities (in mm/week) of: AC 10.57 vs 10.94 (p = 0.034), HC 10.28 vs 10.59 (p = 0.003) and BPD 2.97 vs 3.04 (p = 0.043) compared to those with normal outcome. An inverse association was observed between the AC velocity and a composite adverse neonatal outcome (OR) = 0.667 (95%CI 0.507–0.879, p = 0.004), and between the AC velocity and neonates with NICU stay (OR) = 0.733 (95%CI 0.570–0.942, p = 0.015). Neonates with a birthweight lower than expected (based on the abdominal circumference at 20 weeks) had significantly more composite adverse neonatal outcomes 8.5% vs 5.0% (p = 0.047), NICU stays 9.6% vs 3.8% (p < .0001) and hospital stays 44.4% vs 35.6% (p = 0.006).ConclusionsAppropriate-for-gestational-age neonates are a heterogeneous group with some showing suboptimal fetal growth. Abnormal fetal growth velocities, especially abdominal circumference velocity, are associated with adverse neonatal outcome and can potentially improve the detection of mild growth restriction when used in multivariate models.
Conclusion: Prenatal diagnosis of Williams-Beuren syndrome in the second trimester have been previously reported but is uncommon. We describe the atypical features of nuchal edema, small stomach and echogenic cardiac focus at the second trimester. Our case underscores the value of microdeletion screening in fetal growth restriction in association with (mild) softmarkers.
the department of Gynecology and Obstetrics of the MUMC+. 3D power Doppler images were obtained using a 4-8 MHz Voluson E8 (GE Medical Systems, Europe) abdominal transducer between 24-42 weeks of gestation. Vascularisation Index (VI), Flow Index (FI) and Vascularisation-Flow Index (VFI) were calculated with a novel sonobiopsy method in central and peripheral parts of the placenta. Differences between healthy and PS-pregnancies were tested using independent t-test and Mann-whitney U test. Results: VI and VFI were significantly lower in PS-pregnancies compared to healthy pregnancies (VI: 16.98 ± 14.90 vs. 30.03 ± 22.92, p = 0.001 and VFI: 4.31 ± 2.76 vs. 7.83 ± 4.88, p < 0.001). However, FI did not differ significantly between both groups (p = 0.796). The area under the ROC curve discriminating between healthy and PS-pregnancies was 0.74 and 0.78 for VI and VFI, respectively. Furthermore, we found significant differences in VI and VFI between healthy and PS-pregnancies in both central (VI: 30.95 ± 25.61 vs. 20.32 ± 19.67, p=0.009 and VFI: 11.97 ± 4.46 vs. 9.69 ± 3.40, p=0.042) and peripheral (VI: 25.61 ± 18.61 vs. 16.46 ± 13.97, p= 0.018 and VFI: 11.97 ± 4.46 vs. 9.54 ± 3.06, p=0.045) biopsies. Conclusions: VI and VFI are significantly reduced in PS-pregnancies compared to healthy pregnancies, reflecting pathological process underlying placental insufficiency. These results provide promising possibilities for further placental perfusion ultrasound evaluations in PS-pregnancies.
Results: The US signs of critical congenital structural anomalies, associated with a risk of perinatal losses and serious neonatal complications were collected. US and Doppler prenatal predictors and their combinations that had the strongest significant correlations with adverse perinatal and postnatal outcomes (p<0,001 and p<0.05) were identified. When oligohydramnios or /and maternal arterial hypertension were associated with the abnormalities of US monitoring adverse postnatal outcomes prevailed (p<0.05). Conclusions:The perinatal risk scale according to the results of antenatal US monitoring was provided. There were proposed the US gradations of an extremely high, high or uncertain perinatal risk. The scale can be used for prenatal counselling, patients contingent selection for referral to perinatal centres, and for postnatal prospective follow-up. This scale can improve the understanding between different professionals working in the general perinatal space: obstetricians, radiologists and neonatologists. P17.05Relationship between uterine artery Doppler and the risk of stillbirth in our population
in the first trimester. We aimed to explore pregnancy outcomes in women with a positive PE screening test using the Fetal Medicine Foundation (FMF) algorithm. Methods: We conducted a prospective cohort study of Canadian pregnant women with singleton fetus recruited at 11-14 weeks. Lethal anomalies and medical termination of pregnancies were excluded. Maternal age, body mass index, methods of conception, personal history of PE, ethnicity, mean arterial blood pressure, PAPP-A, PlGF and mean uterine artery pulsatility index were submitted into the online FMF algorithm. Simple imputation was used for the treatment of missing values. Pregnancy outcomes, including PE, small for gestational age (SGA) <3rd centile and fetal death, were reported for women with a positive preterm PE screening test (≥1/70) and compared to women with a negative (<1/70) screening test. Results: We included 6067 participants, including 672 (11%) with a positive FMF screening test. The latter were at greater risk of PE (13.4% vs. 3.4%), preterm PE (3.7% vs. 0.3%), PE<34 weeks (1.3% vs. 0.09%), SGA<3rd centile (4.1% vs. 1.4%), preterm SGA<3rd centile (0.7% vs. 0.04%), fetal death (1.2% vs. 0.4%; p=0.004), miscarriage at 14-20 weeks (0.6% vs. 0.2%; p=0.04), or any of the above complications (16.8% vs. 5.0%) than women with negative screening test (all with p<0.0001, except if otherwise specified). Thirty (4.5%) women with a positive test developed one of the severe complications (preterm PE, preterm SGA, fetal death) compared to 31 (0.6%) women with a negative screening test (p<0.0001) after exclusion of miscarriages. Conclusions: Women with a first-trimester positive FMF preterm PE screening test are at high-risk of severe pregnancy complications that are preventable with low-dose aspirin in early pregnancy. OP17.04Predictive value of serial sFlt-1, PlGF and sFlt-1/PlGF ratio measurement in predicting the development of placental syndrome in women at high risk: a pilot study Objectives: Circulating angiogenic factors, e.g. sFlt-1 and PlGF, have a leading role in predicting pre-eclampsia mainly among women at high risk. We aimed to study the predictive value of serial sFlt-1/PlGF measurement in predicting the development of placental syndrome (PS) in women at high risk. Methods: We retrospectively studied data from 78 women with singleton pregnancies at high risk of PS based on previous obstetric or medical history, from the obstetrics and gynecology department, Maastricht UMC (MUMC + ), between January 2015 and February 2017. All women had serial measurement of sFlt-1 using the Kryptor platform (Thermo Fischer). We evaluated the absolute differences in serum concentrations (delta) of sFlt-1, PlGF and sFlt-1/PlGF ratio at different sampling intervals (12-30, 16-30 and 20-30 weeks), as well as the relative change of each factor normalised to its concentration at 12. PS was defined as the development of any of the following: pre-eclampsia, IUGR, HELLP syndrome and placental abruption. Results: Ten out of 78 women developed PS (13%). There were no ...
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