Splenic artery doppler in alloimmunized pregnancies

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Splenic artery doppler in alloimmunized pregnancies
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  625 PULMONARY ARTERY MUSCULARIZATION IS REDUCED BY FETAL GLUCOCORTI-COIDS (GC) IN LAMBS WITH DIAPHRAGMATIC HERNIA (DH) FOLLOWINGTRACHEAL OCCLUSION (TO)  MARCUS DAVEY 1 , SHINCY SHEGU 1 ,ENRICO DANZER 1 , EDUARDO RUCHELLI 1 , N. SCOTT ADZICK 1 , ALAN FLAKE 1 ,HOLLY HEDRICK 1 ,  1 Children’s Hospital of Philadelphia, Center of Fetal Re-search, Philadelphia, Pennsylvania OBJECTIVE:  Prenatal GC therapy improves respiratory function in lambswith DH that undergo TO therapy (Davey et al., Ped.Res.2006), which may bedue to improved pulmonary vascular structure. In lambs with DH thatunderwent prolonged TO, we have examined the effects of prenatal GC onmuscularization of small pulmonary arteries. STUDY DESIGN:  DH was surgically created in 24 fetal sheep at 65 daysgestation. TO was performed in 17 of 24 fetuses between 110-140 days; 10 of these fetuses received Betamethasone (0.5mg/kg BW) 48 hours before delivery.6 Sham-operated animals served as controls. Right lungs were pressure fixedvia the trachea with 4% paraformaldehyde-PBS, embedded in paraffin,sectioned (3um) and stained with Elastin-Van Gieson. External diameter(ED) and medial wall thickness (MWT) of small pulmonary arteries weremeasured (n=629). % MWT was calculated as: (2xMWT/ED)x100. RESULTS:  %MWT was increased by DH, and not improved by fetal TO(Figure 1). Average %MWT was significantly lower in GC-treated fetusescompared to non GC-treated animals. CONCLUSION:  Prenatal GC reduced aberrant muscularization of pulmo-nary arteries in lambs that underwent TO therapy for DH. Increased luminaldiameter would be expected to reduce pulmonary vascular resistance, andimprove gas exchange.0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.679 626 SPLENIC ARTERY DOPPLER IN ALLOIMMUNIZED PREGNANCIES  MARIO DIASCORREA 1 , MARIO JORGE CASTRO 1 , ANTONIO CARLOS CABRAL 1 , HENRIQUE VITORLEITE 1 ,  1 Universidade Federal de Minas Gerais, Departamento de Ginecologiae Obstetricia, Belo Horizonte, MG, Brazil OBJECTIVE:  To verify the correlation between fetal splenic artery doppler-velocimetry and fetal hemoglobin levels in Rh alloimmunization and toevaluate the accuracy of this method in the prediction of fetal anemia. STUDY DESIGN:  Splenic artery Doppler peak systolic velocity (PSV) andpulsatility index (PI) were obtained before cordocentesis in rhesus alloimmu-nized fetuses. Doppler was performed before 80 cordocentesis in 36 patientswith gestational age between 20 and 35 weeks. Anemia overall was defined as ahemoglobin deficit of ¡Y ´ 2g/dL. Moderate and severe anemia were defined as ahemoglobin deficit of ¡Y ´ 5 and ¡Y ´ 7g/dL respectively. RESULTS:  Anemia was noted on 64% of the fetuses and moderate andsevere anemia on 18% and 21%. Splenic artery PSV was higher in groups withmoderate (p=0,001) and severe (p=0,000) anemia but not in the group withmild anemia (p=0,189) when compared to non anemic fetuses. Splenic arteryPI was higher only in the severely anemic group (p=0,001). Splenic artery PSVshowed positive correlation with fetal hemoglobin deficit (R2: 27,8%;p=0,000), and so did the splenic artery PI (R2: 8,3%; p=0,000). Thesefindings were most important after 28 weeks gestation. There were nodifferences among previously transfused fetuses. Sensitivity and specificity inthe diagnosis of moderate and severe anemia in the overall group were 45% e98% and 64% e 96% in fetuses with 28 weeks gestation or more. CONCLUSION:  Fetal hemoglobin deficit correlates with splenic artery PSV.This finding is more important in gestations over 28 weeks. The splenic arteryPI is higher in fetuses with severe anemia. The accuracy of splenic arteryDoppler in the prediction of fetal anemia improves after the 28th week.0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.681 627 CONGENITAL ANOMALIES: IMPACT OF PRENATAL DIAGNOSIS ON MODE OFDELIVERY  MARK DEMPSEY 1 , FIONNUALA M. BREATHNACH 1 , MICHAEL GEARY 2 ,CHRIS FITZPATRICK 3 , MICHAEL ROBSON 4 , FERGAL D. MALONE 1 ,  1 Royal Collegeof Surgeons in Ireland, Dublin, Ireland,  2 Rotunda Hospital, Dublin, Ireland, 3 Coombe Women’s Hospital, Dublin, Ireland,  4 National Maternity Hospital,Dublin, Ireland OBJECTIVE:  When an infant does not survive, the consequences of emergency Caesarean section (CS), with its attendant maternal morbidityand implications for subsequent pregnancy, may be far-reaching. We sought toexplore congenital anomaly mortality over 10 years in our population toascertain how prenatal diagnosis impacts on mode of delivery. STUDY DESIGN:  A consecutive cohort of 211,163 women, delivered of infants weighing 500g or more in 3 tertiary referral centers from 01/95 to 12/04, was analyzed for perinatal death attributed to congenital malformation.Two comparative cohorts were created, comprising diagnosed and undiag-nosed anomalies. Women who received no antenatal care and those in whomperinatal death was attributed to an anomaly not amenable to prenataldiagnosis were excluded from the analysis. Continuous data were compared byindependent sample t-test and categorical data by chi-square test. RESULTS:  Perinatal death attributable to congenital malformation occurredin 692 pregnancies during the study period (incidence 0.33%). The inclusioncriteria for this study were met by 634 women. The proportion in whom ananomaly was diagnosed prenatally was 62.1% (394/634). No significantdifference was identified between the diagnosed and undiagnosed groupswith respect to maternal age, parity, gestation at delivery or infant birthweight. Perinatal death occurred in utero in 37.4% of cases (237/634). In thegroup that died in the neonatal period, the emergency CS rate was significantlylower where anomaly was detected versus undetected (17.5% vs 31.1%; p =0.004). In contrast to undiagnosed anomalies, the indication for emergency CSwas more often maternal in the diagnosed group (42% vs 19%; p = 0.019). CONCLUSION:  An important aspect of prenatal diagnosis is the avoidanceof emergency CS in fetal interest in cases where an infant will not survive.Where a diagnosis of congenital anomaly has been made in the prenatalperiod, the reduction in emergency CS rate by almost half in this studysupports a pivotal role for prenatal diagnosis in optimizing maternal care.0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.682 628 AUTOMATED ROBOTIC IDENTIFICATION AND ENRICHMENT OF RARE FETAL CELLSIN MATERNAL CIRCULATION (FCMC)  MARK EVANS 1 , MICHAEL KILPATRICK 2 ,TRIANTAFYLLOS TAFAS 2 , ILIA ICHETOVKIN 2 , ANTTI SEPPO 2 , YOUNGMIN KIM 2 ,YANNING ZHU 2 , PETROS TSIPOURAS 2 ,  1 Comprehensive Genetics, New York,New York,  2 Ikonisys Inc., New Haven, Connecticut OBJECTIVE:  For 20 years, attempts to isolate FCMC suffered from thedaunting task of isolating the rare FCMC and inadequate specific markersunique to fetal material. We have developed the Ikonisys fastFISH   fullyrobotic fluorescence microscopy platform, to identify and enumerate cellsbearing X and Y FISH signals. More than 4,000 optical fields per slide can beanalysed. Previously, we have identified rare XY cells, with a false positive ratebelow 0.00005%. Here, we have added an enrichment process, to reduce thecell/slide number needed to generate sufficient FCMC for routine clinicaltesting. STUDY DESIGN:  Based on X and centromeric and telomeric-Y FISHsignals, the Ikonisys fastFISH   system robotically identifies putative fetalcells at 10X magnification which are verified at 100X. 33 maternal samples, 13first trimester and 20 second trimester, were analysed. Samples were analyzedbefore and after density gradient centrifugation. RESULTS:  Fetal cells were identified in 28 of the 30 samples frompregnancies with male fetuses. For whole blood, 0.3 XY fetal cells per slide(0.5 XY fetal cells per million) were identified. Following simple densitygradient enrichment, 1.4 XY fetal cells per slide (2.3 XY fetal cells per million)were identified. CONCLUSION:  FISH with robotic microscopy, identified XY fetal cells inboth first and second trimester maternal blood samples. On average, densitygradient centrifugation gives a 4-5 fold enrichment over whole blood. Use of specific markers for initial identification of fetal cells could allow analysis of both male and female fetus pregnancies. Our ongoing studies suggest such anapproach, integrating ICC or RNA-FISH for fetal cell identification withFISH for chromosome counting, might facilitate non-invasive prenatal diag-nosis of chromosomal aneuploidies.0002-9378/$ - see front matterdoi:10.1016/j.ajog.2006.10.683 S190 SMFM Abstracts
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