OP35.02: Prenatal detection of congenital heart defects is hampered by overweight and obesity: review on 19,687 pregnant women

Abstract

Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem, Israel Objectives: 3D transperineal ultrasound (3DTUS) examination performed in women following III • or IV • intrapartum tears repaired with the overlapping technique demonstrates characteristic sonographic signs. The aim of the present study was to examine the possible correlation of these signs with clinical complaints of incontinence. Methods: Prospective observational study. 60 primiparous women underwent 3DTUS follow up 3-42 months after surgical repair of III • or IV • postpartum sphincter tears with overlapping technique and were evaluated for clinical degree of incontinence with the St. Mark's incontinence score (SMIS) questionnaire. 27 primiparous women after normal vaginal delivery, without clinically recognized anal sphincter tears, were similarly evaluated 3-37 months postpartum as a comparison group. Results: Sonographic signs were apparent in 35/60 (58.3%) women; 39/60 (65%) had some clinical complaints of incontinence 3-42 months after delivery, most of mild degree. Rates of incontinence were similar between the late examination group with normal U/S and the comparison group (9/25 vs. 10/27, respectively, RR 0.97, 95% CI 0.47-1.97). Significantly higher rate of clinical complaints was found in women with abnormal US (RR 2.38, 95% CI, 1.49-4.29). Conclusions: Sonographic signs of anal sphincter tear and repair disappeared in almost half of patients: this examination should be deferred from the early postpartum period. A substantial proportion of women after sphincter repair report some complaint of incontinence, most of slight degree. Such complaints are associated with abnormal late 3DTUS findings, while in women with normal late 3DTUS the rate of incontinence complaints is similar to women after normal delivery. Objectives: Isolated total anomalous pulmonary venous return (TAPVR) is a rare cardiac defect. Its prevalence is probably underestimated and may have a high hidden mortality. Since timely surgery dramatically improves the overall prognosis in obstructive cases diagnosed prenatally, improvement of prenatal detection is an important issue. The purpose is to describe the prenatal echocardiographic findings in fetuses diagnosed with TAPVR. Methods: A retrospective review of all consecutive cases of isolated TAPVR referred to our unit over a 30-year period (1980-2010). Cases with associated cardiac defects or extra-cardiac anatomical anomalies were excluded. The indications for referral as well as echocardiographic findings were reviewed. In all cases, the diagnosis was confirmed prenatally and postnatally by a cardiologist. In case of prenatally suspected TAPVR, women were delivered in our unit for early neonatal monitoring and neonatal surgery when needed. Results: After exclusion of associated forms of TAPVR, 14 anatomically isolated cases of TAPVR were reviewed. The diagnosis was confirmed at birth in all but 2 cases. In one case, prenatal echocardiography had refuted the diagnosis. Postnatal...