Bianca Nogrady

SYDNEY, AUSTRALIA – Elevated plasma levels of osteopontin were predictive of 3-year recurrence rates and second primary cancers in patients with stage 1 non–small-cell lung cancer, based on data from a prospective cohort study presented at a world conference on lung cancer.

Based on preoperative plasma specimens from 137 patients undergoing resection of stage 1 adenocarcinoma of the lung, a preoperative cut-off point of 49.6 ng/mL for plasma osteopontin was predictive of 3-year recurrence. In a multivariate analysis, patients with levels above the cut-off had a fourfold increase in the risk of recurrence (HR 4.2, 95% CI 1.8-10.2, P = .001).

The cohort was followed for at least 3 years, with a median follow-up of 44 months. There was a recurrence in 56 patients (41%) over the study period; 31 patients (22.5%) had recurrences within 3 years and 23 of those patients had high osteopontin levels. Thirteen had systematic progression, ten had local or regional progression, and eight patients had a second primary non–small-cell lung cancer.

After adjustment for variants such as stage, gender, and tumor size, osteopontin levels were not significantly associated with 5-year survival; however, 3-year systemic or local progression was highly predictive of 5-year mortality, reported Dr. Jessica Donington, associate professor of cardiothoracic surgery at NYU Langone Medical Center, New York, and her colleagues.

"We would like to think that this would be something you would use to help guide adjuvant therapy or cancer surveillance or prevention protocols," Dr. Donington said.

Osteopontin is associated with increased inflammation. Previous research had shown that higher levels of osteopontin predicted poor response to chemotherapy in patients with advanced lung cancer. Also, osteopontin levels are known to have prognostic implications in breast and prostate cancers.

Osteopontin levels above the cut-off point also were predictive of second primary lung cancers. The association wasn’t as strong for second cancers as it was for recurrence, but the association was still significant and may help to guide follow-up.

"This might be the group that you’re going to decide to scan every 3 months," Dr. Donington said.

The conference was sponsored by the International Association for the Study of Lung Cancer. The study was supported by an Early Detection Research Network Grant, the Stephen Banner Lung Cancer Foundation, and an IASLC/Lung Cancer Foundation of America grant.

SYDNEY, AUSTRALIA – Elevated plasma levels of osteopontin were predictive of 3-year recurrence rates and second primary cancers in patients with stage 1 non–small-cell lung cancer, based on data from a prospective cohort study presented at a world conference on lung cancer.

Based on preoperative plasma specimens from 137 patients undergoing resection of stage 1 adenocarcinoma of the lung, a preoperative cut-off point of 49.6 ng/mL for plasma osteopontin was predictive of 3-year recurrence. In a multivariate analysis, patients with levels above the cut-off had a fourfold increase in the risk of recurrence (HR 4.2, 95% CI 1.8-10.2, P = .001).

The cohort was followed for at least 3 years, with a median follow-up of 44 months. There was a recurrence in 56 patients (41%) over the study period; 31 patients (22.5%) had recurrences within 3 years and 23 of those patients had high osteopontin levels. Thirteen had systematic progression, ten had local or regional progression, and eight patients had a second primary non–small-cell lung cancer.

After adjustment for variants such as stage, gender, and tumor size, osteopontin levels were not significantly associated with 5-year survival; however, 3-year systemic or local progression was highly predictive of 5-year mortality, reported Dr. Jessica Donington, associate professor of cardiothoracic surgery at NYU Langone Medical Center, New York, and her colleagues.

"We would like to think that this would be something you would use to help guide adjuvant therapy or cancer surveillance or prevention protocols," Dr. Donington said.

Osteopontin is associated with increased inflammation. Previous research had shown that higher levels of osteopontin predicted poor response to chemotherapy in patients with advanced lung cancer. Also, osteopontin levels are known to have prognostic implications in breast and prostate cancers.

Osteopontin levels above the cut-off point also were predictive of second primary lung cancers. The association wasn’t as strong for second cancers as it was for recurrence, but the association was still significant and may help to guide follow-up.

"This might be the group that you’re going to decide to scan every 3 months," Dr. Donington said.

The conference was sponsored by the International Association for the Study of Lung Cancer. The study was supported by an Early Detection Research Network Grant, the Stephen Banner Lung Cancer Foundation, and an IASLC/Lung Cancer Foundation of America grant.

SYDNEY, AUSTRALIA – Elevated plasma levels of osteopontin were predictive of 3-year recurrence rates and second primary cancers in patients with stage 1 non–small-cell lung cancer, based on data from a prospective cohort study presented at a world conference on lung cancer.

Based on preoperative plasma specimens from 137 patients undergoing resection of stage 1 adenocarcinoma of the lung, a preoperative cut-off point of 49.6 ng/mL for plasma osteopontin was predictive of 3-year recurrence. In a multivariate analysis, patients with levels above the cut-off had a fourfold increase in the risk of recurrence (HR 4.2, 95% CI 1.8-10.2, P = .001).

The cohort was followed for at least 3 years, with a median follow-up of 44 months. There was a recurrence in 56 patients (41%) over the study period; 31 patients (22.5%) had recurrences within 3 years and 23 of those patients had high osteopontin levels. Thirteen had systematic progression, ten had local or regional progression, and eight patients had a second primary non–small-cell lung cancer.

After adjustment for variants such as stage, gender, and tumor size, osteopontin levels were not significantly associated with 5-year survival; however, 3-year systemic or local progression was highly predictive of 5-year mortality, reported Dr. Jessica Donington, associate professor of cardiothoracic surgery at NYU Langone Medical Center, New York, and her colleagues.

"We would like to think that this would be something you would use to help guide adjuvant therapy or cancer surveillance or prevention protocols," Dr. Donington said.

Osteopontin is associated with increased inflammation. Previous research had shown that higher levels of osteopontin predicted poor response to chemotherapy in patients with advanced lung cancer. Also, osteopontin levels are known to have prognostic implications in breast and prostate cancers.

Osteopontin levels above the cut-off point also were predictive of second primary lung cancers. The association wasn’t as strong for second cancers as it was for recurrence, but the association was still significant and may help to guide follow-up.

"This might be the group that you’re going to decide to scan every 3 months," Dr. Donington said.

The conference was sponsored by the International Association for the Study of Lung Cancer. The study was supported by an Early Detection Research Network Grant, the Stephen Banner Lung Cancer Foundation, and an IASLC/Lung Cancer Foundation of America grant.

The implementation of state-based parity legislation for specialty substance use disorder treatment is associated with significant improvements in access to treatment and treatment rates, new data show.

"These findings suggest that the [Mental Health Parity and Addiction Equity Act] of 2008 and the [Affordable Care Act] of 2010 hold the potential to improve access to [substance use disorder] treatment," wrote Hefei Wen of Emory University, Atlanta, and her colleagues. "Specialty SUD treatment services, such as outpatient psychosocial therapy and opioid maintenance therapy, have proved to be effective in improving health, reducing crime, increasing employment, and producing a wide range of social benefits."

The researchers used data from the National Survey of Substance Abuse Treatment Services, or N-SSATS, a database maintained by the Substance Abuse and Mental Health Services Administration that tracks all of the known specialty SUD treatment facilities in the United States.

N-SSATS defines specialty SUD facilities as "a hospital, a residential SUD facility, an outpatient SUD treatment facility, a mental health facility with an SUD treatment program, or other facility with an SUD treatment program" that provides numerous services (JAMA Psychiatry 2013 Oct. 23 [doi:10.1001/jamapsychiatry.2013.2169]).

In the past 2 decades, more than half of the states introduced SUD parity laws requiring employment-related group health plans to provide coverage for SUD treatment equal to that for comparable medical/surgical treatment.

The study found that implementation of any SUD parity law was associated with a 9% increase (P less than .001) in treatment rates in all specialty SUD treatment facilities, and a 15% increase (P= .02) in treatment rates at facilities accepting private insurance, according to data published online Oct. 23 in JAMA Psychiatry.

Ms. Wen and her associates also created three categories to distinguish between the levels of comprehensiveness in parity: full parity; partial parity, which that requires that SUD coverage be offered but allows for some discrepancies between SUD coverage and comparable medical or surgical coverage; and "parity-if-offered," in which SUD coverage is not required to be offered but if offered, should be on a par with comparable medical and surgical coverage.

If full parity or parity-if-offered were legislated, the treatment rates in all facilities climbed by 13% (P = .02) and 8% (P = .04), respectively. In facilities accepting private insurance, treatment rates rose by 21% (P = .03) and 10% (P = .04), respectively. "The influence of partial parity on the treatment rate was not statistically significant across models," the researchers wrote.

The researchers showed that among the 10 states that first implemented or extended SUD parity laws from 2000 to 2008, there was an 11% increase in the mean SUD treatment rate from the year immediately before parity laws were introduced to the first year after implementation. However, among states that did not change their SUD parity status, a 4% mean decrease was found in the treatment rate over the same period.

Ms. Wen and her associates cited a few limitations. For example, it was impossible to establish causality between the implementation of SUD parity laws and patients’ access to treatment. "However, the rigorous methods and robust results strongly suggest that parity improved access," they wrote.

No conflicts of interest disclosures were reported.

The implementation of state-based parity legislation for specialty substance use disorder treatment is associated with significant improvements in access to treatment and treatment rates, new data show.

"These findings suggest that the [Mental Health Parity and Addiction Equity Act] of 2008 and the [Affordable Care Act] of 2010 hold the potential to improve access to [substance use disorder] treatment," wrote Hefei Wen of Emory University, Atlanta, and her colleagues. "Specialty SUD treatment services, such as outpatient psychosocial therapy and opioid maintenance therapy, have proved to be effective in improving health, reducing crime, increasing employment, and producing a wide range of social benefits."

The researchers used data from the National Survey of Substance Abuse Treatment Services, or N-SSATS, a database maintained by the Substance Abuse and Mental Health Services Administration that tracks all of the known specialty SUD treatment facilities in the United States.

N-SSATS defines specialty SUD facilities as "a hospital, a residential SUD facility, an outpatient SUD treatment facility, a mental health facility with an SUD treatment program, or other facility with an SUD treatment program" that provides numerous services (JAMA Psychiatry 2013 Oct. 23 [doi:10.1001/jamapsychiatry.2013.2169]).

In the past 2 decades, more than half of the states introduced SUD parity laws requiring employment-related group health plans to provide coverage for SUD treatment equal to that for comparable medical/surgical treatment.

The study found that implementation of any SUD parity law was associated with a 9% increase (P less than .001) in treatment rates in all specialty SUD treatment facilities, and a 15% increase (P= .02) in treatment rates at facilities accepting private insurance, according to data published online Oct. 23 in JAMA Psychiatry.

Ms. Wen and her associates also created three categories to distinguish between the levels of comprehensiveness in parity: full parity; partial parity, which that requires that SUD coverage be offered but allows for some discrepancies between SUD coverage and comparable medical or surgical coverage; and "parity-if-offered," in which SUD coverage is not required to be offered but if offered, should be on a par with comparable medical and surgical coverage.

If full parity or parity-if-offered were legislated, the treatment rates in all facilities climbed by 13% (P = .02) and 8% (P = .04), respectively. In facilities accepting private insurance, treatment rates rose by 21% (P = .03) and 10% (P = .04), respectively. "The influence of partial parity on the treatment rate was not statistically significant across models," the researchers wrote.

The researchers showed that among the 10 states that first implemented or extended SUD parity laws from 2000 to 2008, there was an 11% increase in the mean SUD treatment rate from the year immediately before parity laws were introduced to the first year after implementation. However, among states that did not change their SUD parity status, a 4% mean decrease was found in the treatment rate over the same period.

Ms. Wen and her associates cited a few limitations. For example, it was impossible to establish causality between the implementation of SUD parity laws and patients’ access to treatment. "However, the rigorous methods and robust results strongly suggest that parity improved access," they wrote.

No conflicts of interest disclosures were reported.

The implementation of state-based parity legislation for specialty substance use disorder treatment is associated with significant improvements in access to treatment and treatment rates, new data show.

"These findings suggest that the [Mental Health Parity and Addiction Equity Act] of 2008 and the [Affordable Care Act] of 2010 hold the potential to improve access to [substance use disorder] treatment," wrote Hefei Wen of Emory University, Atlanta, and her colleagues. "Specialty SUD treatment services, such as outpatient psychosocial therapy and opioid maintenance therapy, have proved to be effective in improving health, reducing crime, increasing employment, and producing a wide range of social benefits."

The researchers used data from the National Survey of Substance Abuse Treatment Services, or N-SSATS, a database maintained by the Substance Abuse and Mental Health Services Administration that tracks all of the known specialty SUD treatment facilities in the United States.

N-SSATS defines specialty SUD facilities as "a hospital, a residential SUD facility, an outpatient SUD treatment facility, a mental health facility with an SUD treatment program, or other facility with an SUD treatment program" that provides numerous services (JAMA Psychiatry 2013 Oct. 23 [doi:10.1001/jamapsychiatry.2013.2169]).

In the past 2 decades, more than half of the states introduced SUD parity laws requiring employment-related group health plans to provide coverage for SUD treatment equal to that for comparable medical/surgical treatment.

The study found that implementation of any SUD parity law was associated with a 9% increase (P less than .001) in treatment rates in all specialty SUD treatment facilities, and a 15% increase (P= .02) in treatment rates at facilities accepting private insurance, according to data published online Oct. 23 in JAMA Psychiatry.

Ms. Wen and her associates also created three categories to distinguish between the levels of comprehensiveness in parity: full parity; partial parity, which that requires that SUD coverage be offered but allows for some discrepancies between SUD coverage and comparable medical or surgical coverage; and "parity-if-offered," in which SUD coverage is not required to be offered but if offered, should be on a par with comparable medical and surgical coverage.

If full parity or parity-if-offered were legislated, the treatment rates in all facilities climbed by 13% (P = .02) and 8% (P = .04), respectively. In facilities accepting private insurance, treatment rates rose by 21% (P = .03) and 10% (P = .04), respectively. "The influence of partial parity on the treatment rate was not statistically significant across models," the researchers wrote.

The researchers showed that among the 10 states that first implemented or extended SUD parity laws from 2000 to 2008, there was an 11% increase in the mean SUD treatment rate from the year immediately before parity laws were introduced to the first year after implementation. However, among states that did not change their SUD parity status, a 4% mean decrease was found in the treatment rate over the same period.

Ms. Wen and her associates cited a few limitations. For example, it was impossible to establish causality between the implementation of SUD parity laws and patients’ access to treatment. "However, the rigorous methods and robust results strongly suggest that parity improved access," they wrote.

No conflicts of interest disclosures were reported.

Longer duration of buprenorphine tapering regime is significantly associated with superior outcomes in treatment for prescription opioid addiction, a double-blind randomized trial has found. The study was published online Oct. 23 in JAMA Psychiatry.

"Our results suggest that a subset of [prescription opioid] abusers may respond favorably to a brief but carefully crafted outpatient treatment involving buprenorphine detoxification, naltrexone maintenance, and behavioral therapy," wrote Stacey C. Sigmon, Ph.D., of the University of Vermont, Burlington, and her colleagues.

In the trial, 70 prescription opioid–dependent adults aged 18 and older were randomized to 1-, 2-, or 4-week buprenorphine tapering regimes after initial stabilization with buprenorphine and naloxone hydrochloride dihydrate, the investigators reported.

All of the adults met the DSM-IV criteria for opioid dependence. The mean age was 27 years; 35 of the patients (49%) were aged 25 or younger. Patients requiring opioids for pain, pregnant or nursing women, and individuals with significant or unstable psychiatric or medical illnesses were excluded (JAMA Psychiatry 2013 Oct 23 [doi:10.1001/jamapsychiatry.2013.2216]).

Half of patients randomized to the 4-week regime were retained, abstinent, and receiving naltrexone at the end of the study (6-12 weeks after randomization), compared with 17% of patients on the 2-week regime and 21% of patients on the 1-week regime (P = 0.03).

The 4-week taper was associated with fourfold greater odds of favorable treatment response, compared with the 1-week taper (odds ratio 4.1; 95%CI, 1.1-16.0, P = .04) and nearly sixfold greater odds than the 2-week taper (OR 5.9; 95% CI, 1.4-24.7; P = .01), according to the study.

"When percentage of opioid-negative specimens was collapsed across all study visits, the percentage of negative specimens observed in the 4-, 2-, and 1-week conditions was 58% (n = 13), 35% (n = 8), and 38% (n = 9), respectively (P = .07)," Dr. Sigmon reported.

A recent review had suggested a positive association between buprenorphine taper duration and treatment outcomes, but the researchers said there was generally a dearth of empirical data on treatments for prescription opioid dependence.

The medications were administered in a double-blind, double-dummy manner, and participants received naltrexone maintenance therapy after the tapering period to reduce the likelihood of relapse. All participants were given individual behavioral therapy based on the Community Reinforcement Approach, which the investigators said has been shown to be efficacious with alcohol, cocaine, and opioid-dependent outpatients.

Patients visited the clinical daily during phase 1 of the trial (weeks 1-5 after randomization), then three times weekly in phase 2 (6-12 weeks after randomization).

One study limitation cited by the authors was the absence of a comparison group receiving buprenorphine maintenance therapy, which would have enabled a comparison between taper and continued administration.

"Although this study offers a rigorous evaluation of buprenorphine taper duration and naltrexone maintenance in [prescription opioid–dependent patients], there was no effort to isolate the effects of the behavioral therapy," the researchers wrote. "Thus, the contribution of the Community Reinforcement Approach to outcomes is unknown."

They also said the results might not be generalizable to the larger population, because adults in their study were mainly white and reported oxycodone as the main drug of abuse. "However, most [prescription opioid] users are white, and oxycodone is one of the most commonly used [prescription opioids]," Dr. Sigmon and colleagues said.

Future studies might seek to "disentangle abstinence and retention, perhaps by offering financial incentives contingent on study completion," they wrote.

Dr. Sigmon disclosed ties with Alkermes and Titan Pharmaceuticals. The study was funded by the National Institute on Drug Abuse (NIDA), and medications and placebo tablets were provided by Reckitt Benckiser Pharmaceuticals through NIDA.

Longer duration of buprenorphine tapering regime is significantly associated with superior outcomes in treatment for prescription opioid addiction, a double-blind randomized trial has found. The study was published online Oct. 23 in JAMA Psychiatry.

"Our results suggest that a subset of [prescription opioid] abusers may respond favorably to a brief but carefully crafted outpatient treatment involving buprenorphine detoxification, naltrexone maintenance, and behavioral therapy," wrote Stacey C. Sigmon, Ph.D., of the University of Vermont, Burlington, and her colleagues.

In the trial, 70 prescription opioid–dependent adults aged 18 and older were randomized to 1-, 2-, or 4-week buprenorphine tapering regimes after initial stabilization with buprenorphine and naloxone hydrochloride dihydrate, the investigators reported.

All of the adults met the DSM-IV criteria for opioid dependence. The mean age was 27 years; 35 of the patients (49%) were aged 25 or younger. Patients requiring opioids for pain, pregnant or nursing women, and individuals with significant or unstable psychiatric or medical illnesses were excluded (JAMA Psychiatry 2013 Oct 23 [doi:10.1001/jamapsychiatry.2013.2216]).

Half of patients randomized to the 4-week regime were retained, abstinent, and receiving naltrexone at the end of the study (6-12 weeks after randomization), compared with 17% of patients on the 2-week regime and 21% of patients on the 1-week regime (P = 0.03).

The 4-week taper was associated with fourfold greater odds of favorable treatment response, compared with the 1-week taper (odds ratio 4.1; 95%CI, 1.1-16.0, P = .04) and nearly sixfold greater odds than the 2-week taper (OR 5.9; 95% CI, 1.4-24.7; P = .01), according to the study.

"When percentage of opioid-negative specimens was collapsed across all study visits, the percentage of negative specimens observed in the 4-, 2-, and 1-week conditions was 58% (n = 13), 35% (n = 8), and 38% (n = 9), respectively (P = .07)," Dr. Sigmon reported.

A recent review had suggested a positive association between buprenorphine taper duration and treatment outcomes, but the researchers said there was generally a dearth of empirical data on treatments for prescription opioid dependence.

The medications were administered in a double-blind, double-dummy manner, and participants received naltrexone maintenance therapy after the tapering period to reduce the likelihood of relapse. All participants were given individual behavioral therapy based on the Community Reinforcement Approach, which the investigators said has been shown to be efficacious with alcohol, cocaine, and opioid-dependent outpatients.

Patients visited the clinical daily during phase 1 of the trial (weeks 1-5 after randomization), then three times weekly in phase 2 (6-12 weeks after randomization).

One study limitation cited by the authors was the absence of a comparison group receiving buprenorphine maintenance therapy, which would have enabled a comparison between taper and continued administration.

"Although this study offers a rigorous evaluation of buprenorphine taper duration and naltrexone maintenance in [prescription opioid–dependent patients], there was no effort to isolate the effects of the behavioral therapy," the researchers wrote. "Thus, the contribution of the Community Reinforcement Approach to outcomes is unknown."

They also said the results might not be generalizable to the larger population, because adults in their study were mainly white and reported oxycodone as the main drug of abuse. "However, most [prescription opioid] users are white, and oxycodone is one of the most commonly used [prescription opioids]," Dr. Sigmon and colleagues said.

Future studies might seek to "disentangle abstinence and retention, perhaps by offering financial incentives contingent on study completion," they wrote.

Dr. Sigmon disclosed ties with Alkermes and Titan Pharmaceuticals. The study was funded by the National Institute on Drug Abuse (NIDA), and medications and placebo tablets were provided by Reckitt Benckiser Pharmaceuticals through NIDA.

Longer duration of buprenorphine tapering regime is significantly associated with superior outcomes in treatment for prescription opioid addiction, a double-blind randomized trial has found. The study was published online Oct. 23 in JAMA Psychiatry.

"Our results suggest that a subset of [prescription opioid] abusers may respond favorably to a brief but carefully crafted outpatient treatment involving buprenorphine detoxification, naltrexone maintenance, and behavioral therapy," wrote Stacey C. Sigmon, Ph.D., of the University of Vermont, Burlington, and her colleagues.

In the trial, 70 prescription opioid–dependent adults aged 18 and older were randomized to 1-, 2-, or 4-week buprenorphine tapering regimes after initial stabilization with buprenorphine and naloxone hydrochloride dihydrate, the investigators reported.

All of the adults met the DSM-IV criteria for opioid dependence. The mean age was 27 years; 35 of the patients (49%) were aged 25 or younger. Patients requiring opioids for pain, pregnant or nursing women, and individuals with significant or unstable psychiatric or medical illnesses were excluded (JAMA Psychiatry 2013 Oct 23 [doi:10.1001/jamapsychiatry.2013.2216]).

Half of patients randomized to the 4-week regime were retained, abstinent, and receiving naltrexone at the end of the study (6-12 weeks after randomization), compared with 17% of patients on the 2-week regime and 21% of patients on the 1-week regime (P = 0.03).

The 4-week taper was associated with fourfold greater odds of favorable treatment response, compared with the 1-week taper (odds ratio 4.1; 95%CI, 1.1-16.0, P = .04) and nearly sixfold greater odds than the 2-week taper (OR 5.9; 95% CI, 1.4-24.7; P = .01), according to the study.

"When percentage of opioid-negative specimens was collapsed across all study visits, the percentage of negative specimens observed in the 4-, 2-, and 1-week conditions was 58% (n = 13), 35% (n = 8), and 38% (n = 9), respectively (P = .07)," Dr. Sigmon reported.

A recent review had suggested a positive association between buprenorphine taper duration and treatment outcomes, but the researchers said there was generally a dearth of empirical data on treatments for prescription opioid dependence.

The medications were administered in a double-blind, double-dummy manner, and participants received naltrexone maintenance therapy after the tapering period to reduce the likelihood of relapse. All participants were given individual behavioral therapy based on the Community Reinforcement Approach, which the investigators said has been shown to be efficacious with alcohol, cocaine, and opioid-dependent outpatients.

Patients visited the clinical daily during phase 1 of the trial (weeks 1-5 after randomization), then three times weekly in phase 2 (6-12 weeks after randomization).

One study limitation cited by the authors was the absence of a comparison group receiving buprenorphine maintenance therapy, which would have enabled a comparison between taper and continued administration.

"Although this study offers a rigorous evaluation of buprenorphine taper duration and naltrexone maintenance in [prescription opioid–dependent patients], there was no effort to isolate the effects of the behavioral therapy," the researchers wrote. "Thus, the contribution of the Community Reinforcement Approach to outcomes is unknown."

They also said the results might not be generalizable to the larger population, because adults in their study were mainly white and reported oxycodone as the main drug of abuse. "However, most [prescription opioid] users are white, and oxycodone is one of the most commonly used [prescription opioids]," Dr. Sigmon and colleagues said.

Future studies might seek to "disentangle abstinence and retention, perhaps by offering financial incentives contingent on study completion," they wrote.

Dr. Sigmon disclosed ties with Alkermes and Titan Pharmaceuticals. The study was funded by the National Institute on Drug Abuse (NIDA), and medications and placebo tablets were provided by Reckitt Benckiser Pharmaceuticals through NIDA.

SYDNEY, AUSTRALIA – Embryonic growth discordance at 7.0-9.6 weeks’ gestation is predictive of spontaneous single fetal loss in the first trimester, regardless of chorionicity, a retrospective study has found.

Researchers examined the association between crown rump length (CRL) discordance in 1,356 twin pregnancies, measured by ultrasound at 7.0-9.6 weeks, and spontaneous single fetal demise diagnosed at the 11- to 14-week scan, and presented the data at the International Society of Ultrasound in Obstetrics and Gynecology world congress,.

Data from the STORK (Southwest Thames Obstetric Research Collaborative) cohort showed CRL discordance was associated with a significant increase in single fetal loss at 11-14 weeks (odds ratio, 1.2).

Bianca Nogrady/IMNG Medical Media

The study found a predictive accuracy of CRL discordance at 7.0-9.6 weeks of area under the curve (AUC) equals 0.93, and the degree of discordance was significantly associated with the likelihood of early fetal loss.

At least one twin having a CRL below the fifth centile also was significantly associated with single fetal loss (OR, 2.21). However, there was no relationship between single fetal loss and maternal age or chorionicity.

At the same time, another retrospective cohort study of 1,733 dichorionic twin pregnancies presented in the same session concluded that CRL discordance at 11-14 weeks was associated with, but was not a strong predictor of, adverse outcomes such as fetal loss or preterm birth.

Dr. Francesco D’Antonio, a researcher for the first study, said evidence was building that CRL discordance at the 11- to 14-week mark was not a useful indicator of pregnancy outcomes.

"This is a big issue, because most of the doctors believe that actually this is useful, and they counsel the patient about a possible occurrence of adverse outcomes," said Dr. D’Antonio of the fetal medicine unit at St George’s, University of London.

"If you see there is a discrepancy in the first trimester, don’t tell the patient that the baby is going to die, or something bad is going to happen, because the predictivity is poor," Dr. D’Antonio said in an interview.

Dr. D’Antonio said the association between CRL discordance at 7.0-9.6 weeks and fetal loss by 11-14 weeks likely reflected the fact that a not-insignificant proportion of singleton pregnancies started as multiple pregnancies, but one fetus was lost before the 11- to 14-week scan.

"We didn’t pick these up in the past because we used to scan patients at 11 weeks, so when the IVF specialists started to scan patients at 4-5-6 weeks, this phenomenon became evident," he said.

The study observed 111 cases (8.2%) of single fetal loss at 11-14 weeks.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Embryonic growth discordance at 7.0-9.6 weeks’ gestation is predictive of spontaneous single fetal loss in the first trimester, regardless of chorionicity, a retrospective study has found.

Researchers examined the association between crown rump length (CRL) discordance in 1,356 twin pregnancies, measured by ultrasound at 7.0-9.6 weeks, and spontaneous single fetal demise diagnosed at the 11- to 14-week scan, and presented the data at the International Society of Ultrasound in Obstetrics and Gynecology world congress,.

Data from the STORK (Southwest Thames Obstetric Research Collaborative) cohort showed CRL discordance was associated with a significant increase in single fetal loss at 11-14 weeks (odds ratio, 1.2).

Bianca Nogrady/IMNG Medical Media

The study found a predictive accuracy of CRL discordance at 7.0-9.6 weeks of area under the curve (AUC) equals 0.93, and the degree of discordance was significantly associated with the likelihood of early fetal loss.

At least one twin having a CRL below the fifth centile also was significantly associated with single fetal loss (OR, 2.21). However, there was no relationship between single fetal loss and maternal age or chorionicity.

At the same time, another retrospective cohort study of 1,733 dichorionic twin pregnancies presented in the same session concluded that CRL discordance at 11-14 weeks was associated with, but was not a strong predictor of, adverse outcomes such as fetal loss or preterm birth.

Dr. Francesco D’Antonio, a researcher for the first study, said evidence was building that CRL discordance at the 11- to 14-week mark was not a useful indicator of pregnancy outcomes.

"This is a big issue, because most of the doctors believe that actually this is useful, and they counsel the patient about a possible occurrence of adverse outcomes," said Dr. D’Antonio of the fetal medicine unit at St George’s, University of London.

"If you see there is a discrepancy in the first trimester, don’t tell the patient that the baby is going to die, or something bad is going to happen, because the predictivity is poor," Dr. D’Antonio said in an interview.

Dr. D’Antonio said the association between CRL discordance at 7.0-9.6 weeks and fetal loss by 11-14 weeks likely reflected the fact that a not-insignificant proportion of singleton pregnancies started as multiple pregnancies, but one fetus was lost before the 11- to 14-week scan.

"We didn’t pick these up in the past because we used to scan patients at 11 weeks, so when the IVF specialists started to scan patients at 4-5-6 weeks, this phenomenon became evident," he said.

The study observed 111 cases (8.2%) of single fetal loss at 11-14 weeks.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Embryonic growth discordance at 7.0-9.6 weeks’ gestation is predictive of spontaneous single fetal loss in the first trimester, regardless of chorionicity, a retrospective study has found.

Researchers examined the association between crown rump length (CRL) discordance in 1,356 twin pregnancies, measured by ultrasound at 7.0-9.6 weeks, and spontaneous single fetal demise diagnosed at the 11- to 14-week scan, and presented the data at the International Society of Ultrasound in Obstetrics and Gynecology world congress,.

Data from the STORK (Southwest Thames Obstetric Research Collaborative) cohort showed CRL discordance was associated with a significant increase in single fetal loss at 11-14 weeks (odds ratio, 1.2).

Bianca Nogrady/IMNG Medical Media

The study found a predictive accuracy of CRL discordance at 7.0-9.6 weeks of area under the curve (AUC) equals 0.93, and the degree of discordance was significantly associated with the likelihood of early fetal loss.

At least one twin having a CRL below the fifth centile also was significantly associated with single fetal loss (OR, 2.21). However, there was no relationship between single fetal loss and maternal age or chorionicity.

At the same time, another retrospective cohort study of 1,733 dichorionic twin pregnancies presented in the same session concluded that CRL discordance at 11-14 weeks was associated with, but was not a strong predictor of, adverse outcomes such as fetal loss or preterm birth.

Dr. Francesco D’Antonio, a researcher for the first study, said evidence was building that CRL discordance at the 11- to 14-week mark was not a useful indicator of pregnancy outcomes.

"This is a big issue, because most of the doctors believe that actually this is useful, and they counsel the patient about a possible occurrence of adverse outcomes," said Dr. D’Antonio of the fetal medicine unit at St George’s, University of London.

"If you see there is a discrepancy in the first trimester, don’t tell the patient that the baby is going to die, or something bad is going to happen, because the predictivity is poor," Dr. D’Antonio said in an interview.

Dr. D’Antonio said the association between CRL discordance at 7.0-9.6 weeks and fetal loss by 11-14 weeks likely reflected the fact that a not-insignificant proportion of singleton pregnancies started as multiple pregnancies, but one fetus was lost before the 11- to 14-week scan.

"We didn’t pick these up in the past because we used to scan patients at 11 weeks, so when the IVF specialists started to scan patients at 4-5-6 weeks, this phenomenon became evident," he said.

The study observed 111 cases (8.2%) of single fetal loss at 11-14 weeks.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Assisted reproductive technologies are associated with cardiovascular remodeling that is present early in fetal life, a study has shown.

The prospective cohort study of 70 fetuses conceived using assisted reproductive technologies (ART) and 70 fetuses conceived spontaneously found significantly increased aortic mean intima-media thickness in ART fetuses compared with controls (0.55 vs. 0.46 mm, P = 0.016).

ART fetuses had dilated atria compared with controls, as measured by the right atrium/heart ratio (1.6% vs. 1.45%, P = 0.011), more globular hearts, thicker myocardial walls (interventricular septum thickness, 2.8 vs. 2.4 mm; P = 0.001), and impaired relaxation (mitral e’, 8 vs. 8.4 cm/s, P = 0.002).

While the results were statistically highly significant, Dr. Fátima Crispi said that clinically these changes did not represent a disease state, but rather a risk factor.

"To have, for example, increased intima-media thickness or a more hypertrophic heart is not a disease, so it doesn’t mean that these children will have symptoms or problems in the short term, but some of the changes that we are reporting are well-known risk factors for later in life," Dr. Crispi said in an interview.

The study also found ART fetuses had significantly decreased tricuspid ring displacement (5.5 vs. 6.5 mm, P less than 0.001), according to a presentation at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Dr. Crispi said awareness of cardiovascular issues in ART children had come about only relatively recently, with studies suggesting an increased incidence of hypertension and vascular dysfunction. However, she said this was the first study to examine the cardiovascular systems of ART babies in utero.

"Just by our experience in other prenatal conditions that are remodeling [the cardiovascular system], then you could see that the children have hypertension, so we could infer that if these [in vitro fertilization] children had changes in blood pressure, we would be able to see something prenatally," said Dr. Crispi, a fetal medicine specialist at the fetal medicine research center, Hospital Clinic of Barcelona.

"We did echocardiography and we looked at everything that could be measured; we looked at all the function because we really didn’t know what we were going to find."

Researchers conducted fetal echocardiography at 28 weeks’ gestation, including cardiac morphometry and tissue Doppler ultrasound, and the results were adjusted for birth weight and preeclampsia.

The mechanism of the association is unclear; however, Dr. Crispi suggested it was likely to be a combination of maternal risk and the impact of fertility treatments.

"We have these couples who have some infertility problems; usually the mothers are older – although we adjusted by age; they have more medical diseases, and they have most probably more genetic predisposition to have problems," Dr. Crispi said. "Then this couple goes through all this manipulation of the embryo, and then they receive treatment – hormones and things that could also affect the fetus – so we don’t know if it’s one factor or several factors."

While Dr Crispi stressed that the cardiovascular remodeling did not represent cardiovascular disease, she said awareness of the potential increased risk could help with early prevention and risk factor management in later life.

No conflicts of interest were reported.

SYDNEY, AUSTRALIA – Assisted reproductive technologies are associated with cardiovascular remodeling that is present early in fetal life, a study has shown.

The prospective cohort study of 70 fetuses conceived using assisted reproductive technologies (ART) and 70 fetuses conceived spontaneously found significantly increased aortic mean intima-media thickness in ART fetuses compared with controls (0.55 vs. 0.46 mm, P = 0.016).

ART fetuses had dilated atria compared with controls, as measured by the right atrium/heart ratio (1.6% vs. 1.45%, P = 0.011), more globular hearts, thicker myocardial walls (interventricular septum thickness, 2.8 vs. 2.4 mm; P = 0.001), and impaired relaxation (mitral e’, 8 vs. 8.4 cm/s, P = 0.002).

While the results were statistically highly significant, Dr. Fátima Crispi said that clinically these changes did not represent a disease state, but rather a risk factor.

"To have, for example, increased intima-media thickness or a more hypertrophic heart is not a disease, so it doesn’t mean that these children will have symptoms or problems in the short term, but some of the changes that we are reporting are well-known risk factors for later in life," Dr. Crispi said in an interview.

The study also found ART fetuses had significantly decreased tricuspid ring displacement (5.5 vs. 6.5 mm, P less than 0.001), according to a presentation at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Dr. Crispi said awareness of cardiovascular issues in ART children had come about only relatively recently, with studies suggesting an increased incidence of hypertension and vascular dysfunction. However, she said this was the first study to examine the cardiovascular systems of ART babies in utero.

"Just by our experience in other prenatal conditions that are remodeling [the cardiovascular system], then you could see that the children have hypertension, so we could infer that if these [in vitro fertilization] children had changes in blood pressure, we would be able to see something prenatally," said Dr. Crispi, a fetal medicine specialist at the fetal medicine research center, Hospital Clinic of Barcelona.

"We did echocardiography and we looked at everything that could be measured; we looked at all the function because we really didn’t know what we were going to find."

Researchers conducted fetal echocardiography at 28 weeks’ gestation, including cardiac morphometry and tissue Doppler ultrasound, and the results were adjusted for birth weight and preeclampsia.

The mechanism of the association is unclear; however, Dr. Crispi suggested it was likely to be a combination of maternal risk and the impact of fertility treatments.

"We have these couples who have some infertility problems; usually the mothers are older – although we adjusted by age; they have more medical diseases, and they have most probably more genetic predisposition to have problems," Dr. Crispi said. "Then this couple goes through all this manipulation of the embryo, and then they receive treatment – hormones and things that could also affect the fetus – so we don’t know if it’s one factor or several factors."

While Dr Crispi stressed that the cardiovascular remodeling did not represent cardiovascular disease, she said awareness of the potential increased risk could help with early prevention and risk factor management in later life.

No conflicts of interest were reported.

SYDNEY, AUSTRALIA – Assisted reproductive technologies are associated with cardiovascular remodeling that is present early in fetal life, a study has shown.

The prospective cohort study of 70 fetuses conceived using assisted reproductive technologies (ART) and 70 fetuses conceived spontaneously found significantly increased aortic mean intima-media thickness in ART fetuses compared with controls (0.55 vs. 0.46 mm, P = 0.016).

ART fetuses had dilated atria compared with controls, as measured by the right atrium/heart ratio (1.6% vs. 1.45%, P = 0.011), more globular hearts, thicker myocardial walls (interventricular septum thickness, 2.8 vs. 2.4 mm; P = 0.001), and impaired relaxation (mitral e’, 8 vs. 8.4 cm/s, P = 0.002).

While the results were statistically highly significant, Dr. Fátima Crispi said that clinically these changes did not represent a disease state, but rather a risk factor.

"To have, for example, increased intima-media thickness or a more hypertrophic heart is not a disease, so it doesn’t mean that these children will have symptoms or problems in the short term, but some of the changes that we are reporting are well-known risk factors for later in life," Dr. Crispi said in an interview.

The study also found ART fetuses had significantly decreased tricuspid ring displacement (5.5 vs. 6.5 mm, P less than 0.001), according to a presentation at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Dr. Crispi said awareness of cardiovascular issues in ART children had come about only relatively recently, with studies suggesting an increased incidence of hypertension and vascular dysfunction. However, she said this was the first study to examine the cardiovascular systems of ART babies in utero.

"Just by our experience in other prenatal conditions that are remodeling [the cardiovascular system], then you could see that the children have hypertension, so we could infer that if these [in vitro fertilization] children had changes in blood pressure, we would be able to see something prenatally," said Dr. Crispi, a fetal medicine specialist at the fetal medicine research center, Hospital Clinic of Barcelona.

"We did echocardiography and we looked at everything that could be measured; we looked at all the function because we really didn’t know what we were going to find."

Researchers conducted fetal echocardiography at 28 weeks’ gestation, including cardiac morphometry and tissue Doppler ultrasound, and the results were adjusted for birth weight and preeclampsia.

The mechanism of the association is unclear; however, Dr. Crispi suggested it was likely to be a combination of maternal risk and the impact of fertility treatments.

"We have these couples who have some infertility problems; usually the mothers are older – although we adjusted by age; they have more medical diseases, and they have most probably more genetic predisposition to have problems," Dr. Crispi said. "Then this couple goes through all this manipulation of the embryo, and then they receive treatment – hormones and things that could also affect the fetus – so we don’t know if it’s one factor or several factors."

While Dr Crispi stressed that the cardiovascular remodeling did not represent cardiovascular disease, she said awareness of the potential increased risk could help with early prevention and risk factor management in later life.

No conflicts of interest were reported.

SYDNEY, AUSTRALIA – Women undergoing surgery for endometriosis have a high prevalence of sonographic signs of adenomyosis, which has significant implications for fertility treatment and secondary prevention, said the lead author of a new study.

Of 103 women having surgery for endometriosis, 91 (88.4%) showed at least one sonographic sign of adenomyosis, according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

An irregular endometrial-myometrial junction was the most common finding (86.3%), followed by myometrial cysts (85.3%), hyperechoic islands (80%), and asymmetrical myometrial thickening (75.6%). Other sonographic signs included parallel shadowing, localized adenomyomas, and linear striations.

The presence of sonographic findings of adenomyosis was associated with age, dysmenorrhea, dyspareunia, and infertility.

Adenomyosis has long been associated with endometriosis, but lead author Dr. Vered Eisenberg said she was still surprised by the high prevalence of the sonographic signs of adenomyosis in this population of women.

"We know that they coexist, and I noticed when I was doing the scans that there was a lot of adenomyosis in the women that I was seeing, as opposed to women that I knew did not have endometriosis who had less adenomyosis," said Dr. Eisenberg, senior obstetrician and gynecologist at the Sheba Medical Centre, Tel Hashomer, Israel. She is a specialist in obstetric and gynecologic ultrasound.

The average age of the patients in the study was 34 years, and just over half were nulliparous. Nearly one-third of the patients presented with infertility, and 23% were undergoing in vitro fertilization (IVF).

Dr. Eisenberg said the finding had direct implications for treatment of these women, both for the adenomyosis and fertility problems, with growing awareness that adenomyosis may be independently responsible for fertility problems.

"There are several reviews that have looked into that, suggesting that the structure of the endometrial lining, which is affected by adenomyosis, is hindering the implantation of the embryo; that could be how it affects fertility," Dr. Eisenberg said in an interview.

"If you treat the endometriosis and you send the woman for IVF, for example, you might not manage to get her pregnant because the lining will still be problematic; so if you know that in advance, you may adjust your IVF accordingly," she said.

The coexistence of adenomyosis and endometriosis, as well as the patient’s fertility desires, may influence surgeons’ treatment decisions, Dr. Eisenberg said.

"When you consider operating on a woman [with endometriosis], you would either operate on her for intractable pain or for infertility. If she desires fertility, then you would want to save time, so you would end up doing the surgery much sooner," she said.

However, surgery would not resolve the adenomyosis, which would still require treatment.

In women who are not concerned about fertility, it might instead be possible to delay or avoid an operation altogether, and instead manage both the endometriosis and adenomyosis with treatments such as Mirena, a levonorgestrel-releasing intrauterine system.

Dr. Eisenberg stressed that the findings were sonographic only and were not histologically confirmed, as none of the women underwent a hysterectomy.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women undergoing surgery for endometriosis have a high prevalence of sonographic signs of adenomyosis, which has significant implications for fertility treatment and secondary prevention, said the lead author of a new study.

Of 103 women having surgery for endometriosis, 91 (88.4%) showed at least one sonographic sign of adenomyosis, according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

An irregular endometrial-myometrial junction was the most common finding (86.3%), followed by myometrial cysts (85.3%), hyperechoic islands (80%), and asymmetrical myometrial thickening (75.6%). Other sonographic signs included parallel shadowing, localized adenomyomas, and linear striations.

The presence of sonographic findings of adenomyosis was associated with age, dysmenorrhea, dyspareunia, and infertility.

Adenomyosis has long been associated with endometriosis, but lead author Dr. Vered Eisenberg said she was still surprised by the high prevalence of the sonographic signs of adenomyosis in this population of women.

"We know that they coexist, and I noticed when I was doing the scans that there was a lot of adenomyosis in the women that I was seeing, as opposed to women that I knew did not have endometriosis who had less adenomyosis," said Dr. Eisenberg, senior obstetrician and gynecologist at the Sheba Medical Centre, Tel Hashomer, Israel. She is a specialist in obstetric and gynecologic ultrasound.

The average age of the patients in the study was 34 years, and just over half were nulliparous. Nearly one-third of the patients presented with infertility, and 23% were undergoing in vitro fertilization (IVF).

Dr. Eisenberg said the finding had direct implications for treatment of these women, both for the adenomyosis and fertility problems, with growing awareness that adenomyosis may be independently responsible for fertility problems.

"There are several reviews that have looked into that, suggesting that the structure of the endometrial lining, which is affected by adenomyosis, is hindering the implantation of the embryo; that could be how it affects fertility," Dr. Eisenberg said in an interview.

"If you treat the endometriosis and you send the woman for IVF, for example, you might not manage to get her pregnant because the lining will still be problematic; so if you know that in advance, you may adjust your IVF accordingly," she said.

The coexistence of adenomyosis and endometriosis, as well as the patient’s fertility desires, may influence surgeons’ treatment decisions, Dr. Eisenberg said.

"When you consider operating on a woman [with endometriosis], you would either operate on her for intractable pain or for infertility. If she desires fertility, then you would want to save time, so you would end up doing the surgery much sooner," she said.

However, surgery would not resolve the adenomyosis, which would still require treatment.

In women who are not concerned about fertility, it might instead be possible to delay or avoid an operation altogether, and instead manage both the endometriosis and adenomyosis with treatments such as Mirena, a levonorgestrel-releasing intrauterine system.

Dr. Eisenberg stressed that the findings were sonographic only and were not histologically confirmed, as none of the women underwent a hysterectomy.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women undergoing surgery for endometriosis have a high prevalence of sonographic signs of adenomyosis, which has significant implications for fertility treatment and secondary prevention, said the lead author of a new study.

Of 103 women having surgery for endometriosis, 91 (88.4%) showed at least one sonographic sign of adenomyosis, according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

An irregular endometrial-myometrial junction was the most common finding (86.3%), followed by myometrial cysts (85.3%), hyperechoic islands (80%), and asymmetrical myometrial thickening (75.6%). Other sonographic signs included parallel shadowing, localized adenomyomas, and linear striations.

The presence of sonographic findings of adenomyosis was associated with age, dysmenorrhea, dyspareunia, and infertility.

Adenomyosis has long been associated with endometriosis, but lead author Dr. Vered Eisenberg said she was still surprised by the high prevalence of the sonographic signs of adenomyosis in this population of women.

"We know that they coexist, and I noticed when I was doing the scans that there was a lot of adenomyosis in the women that I was seeing, as opposed to women that I knew did not have endometriosis who had less adenomyosis," said Dr. Eisenberg, senior obstetrician and gynecologist at the Sheba Medical Centre, Tel Hashomer, Israel. She is a specialist in obstetric and gynecologic ultrasound.

The average age of the patients in the study was 34 years, and just over half were nulliparous. Nearly one-third of the patients presented with infertility, and 23% were undergoing in vitro fertilization (IVF).

Dr. Eisenberg said the finding had direct implications for treatment of these women, both for the adenomyosis and fertility problems, with growing awareness that adenomyosis may be independently responsible for fertility problems.

"There are several reviews that have looked into that, suggesting that the structure of the endometrial lining, which is affected by adenomyosis, is hindering the implantation of the embryo; that could be how it affects fertility," Dr. Eisenberg said in an interview.

"If you treat the endometriosis and you send the woman for IVF, for example, you might not manage to get her pregnant because the lining will still be problematic; so if you know that in advance, you may adjust your IVF accordingly," she said.

The coexistence of adenomyosis and endometriosis, as well as the patient’s fertility desires, may influence surgeons’ treatment decisions, Dr. Eisenberg said.

"When you consider operating on a woman [with endometriosis], you would either operate on her for intractable pain or for infertility. If she desires fertility, then you would want to save time, so you would end up doing the surgery much sooner," she said.

However, surgery would not resolve the adenomyosis, which would still require treatment.

In women who are not concerned about fertility, it might instead be possible to delay or avoid an operation altogether, and instead manage both the endometriosis and adenomyosis with treatments such as Mirena, a levonorgestrel-releasing intrauterine system.

Dr. Eisenberg stressed that the findings were sonographic only and were not histologically confirmed, as none of the women underwent a hysterectomy.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.

A prospective cohort study in 36 women at high risk for early preeclampsia (at less than 34 weeks’ gestation) showed that those who experienced adverse outcomes had significantly higher total peripheral resistance at 14 weeks (1,710 vs. 1,307 dyne/sec/cm^–5, P = .02), 24 weeks (1,564 vs. 1,305 dyne/sec/cm^–5, P less than .001), and 30 weeks (1,603 vs. 1,323 dyne/sec/cm^–5, P = .002) of gestation, compared with high-risk women who had normal outcomes.

According to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, cardiac output also was significantly lower at 14 weeks (4.41 vs. 5.18 L/min, P = .04) and 30 weeks (4.79 vs. 5.36 L/min, P = .04) of gestation in women who experienced adverse outcomes.

The results suggest that women at high risk for early preeclampsia and a subsequent adverse pregnancy outcome show signs of abnormal cardiac function as early as 14 weeks’ gestation, the researchers said.

Researcher Kate Russo said the results could help to differentiate between those who are likely to have a normal outcome and those who may develop an adverse outcome, in women who have already been identified as high risk through preeclampsia screening.

"We want to reduce the 10% false-positive rate of this screening, which has a 90% detection rate for early-onset preeclampsia," said Ms. Russo, a sonographer and Ph.D. candidate in the fetal medicine unit at the Royal Prince Alfred Hospital in Sydney.

"Performing a maternal echocardiogram in high-risk women is an easy, well-tolerated examination that can be utilized for the assessment of the women’s hemodynamic profile," she said.

The adverse outcomes, observed in 15 (42%) of the women enrolled in the study, included preeclampsia (11%), gestational hypertension (14%), low birth weight (14%), and preterm birth (3%).

Being able to identify women who were at greater risk of adverse pregnancy outcomes might help reduce the anxiety of some women deemed at high risk of early preeclampsia, as well as guide treatment, Ms. Russo said in an interview.

"You know who to look at, and potentially, if women develop hypertension, you can target their antihypertensive medication depending on their hemodynamic profile," she said.

The study is continuing to recruit participants, with the aim of comparing the hemodynamic profiles of women with early-onset preeclampsia, late-onset preeclampsia, and small-for-gestational-age babies.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.

A prospective cohort study in 36 women at high risk for early preeclampsia (at less than 34 weeks’ gestation) showed that those who experienced adverse outcomes had significantly higher total peripheral resistance at 14 weeks (1,710 vs. 1,307 dyne/sec/cm^–5, P = .02), 24 weeks (1,564 vs. 1,305 dyne/sec/cm^–5, P less than .001), and 30 weeks (1,603 vs. 1,323 dyne/sec/cm^–5, P = .002) of gestation, compared with high-risk women who had normal outcomes.

According to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, cardiac output also was significantly lower at 14 weeks (4.41 vs. 5.18 L/min, P = .04) and 30 weeks (4.79 vs. 5.36 L/min, P = .04) of gestation in women who experienced adverse outcomes.

The results suggest that women at high risk for early preeclampsia and a subsequent adverse pregnancy outcome show signs of abnormal cardiac function as early as 14 weeks’ gestation, the researchers said.

Researcher Kate Russo said the results could help to differentiate between those who are likely to have a normal outcome and those who may develop an adverse outcome, in women who have already been identified as high risk through preeclampsia screening.

"We want to reduce the 10% false-positive rate of this screening, which has a 90% detection rate for early-onset preeclampsia," said Ms. Russo, a sonographer and Ph.D. candidate in the fetal medicine unit at the Royal Prince Alfred Hospital in Sydney.

"Performing a maternal echocardiogram in high-risk women is an easy, well-tolerated examination that can be utilized for the assessment of the women’s hemodynamic profile," she said.

The adverse outcomes, observed in 15 (42%) of the women enrolled in the study, included preeclampsia (11%), gestational hypertension (14%), low birth weight (14%), and preterm birth (3%).

Being able to identify women who were at greater risk of adverse pregnancy outcomes might help reduce the anxiety of some women deemed at high risk of early preeclampsia, as well as guide treatment, Ms. Russo said in an interview.

"You know who to look at, and potentially, if women develop hypertension, you can target their antihypertensive medication depending on their hemodynamic profile," she said.

The study is continuing to recruit participants, with the aim of comparing the hemodynamic profiles of women with early-onset preeclampsia, late-onset preeclampsia, and small-for-gestational-age babies.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.

A prospective cohort study in 36 women at high risk for early preeclampsia (at less than 34 weeks’ gestation) showed that those who experienced adverse outcomes had significantly higher total peripheral resistance at 14 weeks (1,710 vs. 1,307 dyne/sec/cm^–5, P = .02), 24 weeks (1,564 vs. 1,305 dyne/sec/cm^–5, P less than .001), and 30 weeks (1,603 vs. 1,323 dyne/sec/cm^–5, P = .002) of gestation, compared with high-risk women who had normal outcomes.

According to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, cardiac output also was significantly lower at 14 weeks (4.41 vs. 5.18 L/min, P = .04) and 30 weeks (4.79 vs. 5.36 L/min, P = .04) of gestation in women who experienced adverse outcomes.

The results suggest that women at high risk for early preeclampsia and a subsequent adverse pregnancy outcome show signs of abnormal cardiac function as early as 14 weeks’ gestation, the researchers said.

Researcher Kate Russo said the results could help to differentiate between those who are likely to have a normal outcome and those who may develop an adverse outcome, in women who have already been identified as high risk through preeclampsia screening.

"We want to reduce the 10% false-positive rate of this screening, which has a 90% detection rate for early-onset preeclampsia," said Ms. Russo, a sonographer and Ph.D. candidate in the fetal medicine unit at the Royal Prince Alfred Hospital in Sydney.

"Performing a maternal echocardiogram in high-risk women is an easy, well-tolerated examination that can be utilized for the assessment of the women’s hemodynamic profile," she said.

The adverse outcomes, observed in 15 (42%) of the women enrolled in the study, included preeclampsia (11%), gestational hypertension (14%), low birth weight (14%), and preterm birth (3%).

Being able to identify women who were at greater risk of adverse pregnancy outcomes might help reduce the anxiety of some women deemed at high risk of early preeclampsia, as well as guide treatment, Ms. Russo said in an interview.

"You know who to look at, and potentially, if women develop hypertension, you can target their antihypertensive medication depending on their hemodynamic profile," she said.

The study is continuing to recruit participants, with the aim of comparing the hemodynamic profiles of women with early-onset preeclampsia, late-onset preeclampsia, and small-for-gestational-age babies.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Short fetal femur length in the second trimester was associated with a significantly increased risk of Down syndrome, trisomy 13 and 18, and unbalanced autosomal structural abnormality in a large population study.

The study of 147,766 Danish singleton pregnancies with a second-trimester malformation scan showed that short femur length – defined as below the fifth percentile – was present in 16.2% of the fetuses affected by trisomy 21 (odds ratio, 10.3).

The data were collected from the Danish National Fetal Medicine database and presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Individuals with trisomy 13/18 also had a significantly higher incidence of short femur length (OR, 7.3), as did individuals with unbalanced autosomal structural abnormality (OR, 23.8).

Researchers also found that pregnancies in which the fetus had a short femur length also were more likely to result in delivery before 34 weeks’ gestation (OR, 4.2) and small-for-gestational-age infants (OR, 4.3).

Dr. Ann Tabor said the first-trimester screening program in Denmark was extremely rigorous, resulting in detection of the vast majority of cases of Down syndrome; some cases, however, still slip through the net.

"We only have a detection rate of around 90%-92%, so we inform women that we will not be able to detect all of the Down syndrome fetuses," said Dr. Tabor, professor of fetal medicine at Copenhagen University Hospital. "This would offer a way to pick up some of the ones we haven’t found the first time."

The overall incidence of short femur length in the cohort was 2,718 cases (1.8%).

Dr. Tabor said that short femur length was a well-known feature of Down syndrome, although she was surprised by the strength of the association between short femur length and unbalanced autosomal structural abnormality.

"Every day in your clinical life, when you have a fetus where you measure this short femur length, you wonder ‘Should I do something about it or do I just ignore it?’ " Dr. Tabor said in an interview. "Do you want to do an amniocentesis if you don’t have a karyotype for the fetus, or should you really monitor the growth because they are more likely to be growth retarded or to be delivered preterm?"

Dr. Tabor said her decision about whether to act on a short femur length detected in the second trimester would depend a lot on the mother’s risk of abnormality in the first trimester.

"So if she had a risk estimate like 1 in 10,000, you probably wouldn’t do anything, but if it was 1 in 400, then you’d have to counsel her," she said.

There were no conflicts of interest declared.

[email protected]

SYDNEY, AUSTRALIA – Short fetal femur length in the second trimester was associated with a significantly increased risk of Down syndrome, trisomy 13 and 18, and unbalanced autosomal structural abnormality in a large population study.

The study of 147,766 Danish singleton pregnancies with a second-trimester malformation scan showed that short femur length – defined as below the fifth percentile – was present in 16.2% of the fetuses affected by trisomy 21 (odds ratio, 10.3).

The data were collected from the Danish National Fetal Medicine database and presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Individuals with trisomy 13/18 also had a significantly higher incidence of short femur length (OR, 7.3), as did individuals with unbalanced autosomal structural abnormality (OR, 23.8).

Researchers also found that pregnancies in which the fetus had a short femur length also were more likely to result in delivery before 34 weeks’ gestation (OR, 4.2) and small-for-gestational-age infants (OR, 4.3).

Dr. Ann Tabor said the first-trimester screening program in Denmark was extremely rigorous, resulting in detection of the vast majority of cases of Down syndrome; some cases, however, still slip through the net.

"We only have a detection rate of around 90%-92%, so we inform women that we will not be able to detect all of the Down syndrome fetuses," said Dr. Tabor, professor of fetal medicine at Copenhagen University Hospital. "This would offer a way to pick up some of the ones we haven’t found the first time."

The overall incidence of short femur length in the cohort was 2,718 cases (1.8%).

Dr. Tabor said that short femur length was a well-known feature of Down syndrome, although she was surprised by the strength of the association between short femur length and unbalanced autosomal structural abnormality.

"Every day in your clinical life, when you have a fetus where you measure this short femur length, you wonder ‘Should I do something about it or do I just ignore it?’ " Dr. Tabor said in an interview. "Do you want to do an amniocentesis if you don’t have a karyotype for the fetus, or should you really monitor the growth because they are more likely to be growth retarded or to be delivered preterm?"

Dr. Tabor said her decision about whether to act on a short femur length detected in the second trimester would depend a lot on the mother’s risk of abnormality in the first trimester.

"So if she had a risk estimate like 1 in 10,000, you probably wouldn’t do anything, but if it was 1 in 400, then you’d have to counsel her," she said.

There were no conflicts of interest declared.

[email protected]

SYDNEY, AUSTRALIA – Short fetal femur length in the second trimester was associated with a significantly increased risk of Down syndrome, trisomy 13 and 18, and unbalanced autosomal structural abnormality in a large population study.

The study of 147,766 Danish singleton pregnancies with a second-trimester malformation scan showed that short femur length – defined as below the fifth percentile – was present in 16.2% of the fetuses affected by trisomy 21 (odds ratio, 10.3).

The data were collected from the Danish National Fetal Medicine database and presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Individuals with trisomy 13/18 also had a significantly higher incidence of short femur length (OR, 7.3), as did individuals with unbalanced autosomal structural abnormality (OR, 23.8).

Researchers also found that pregnancies in which the fetus had a short femur length also were more likely to result in delivery before 34 weeks’ gestation (OR, 4.2) and small-for-gestational-age infants (OR, 4.3).

Dr. Ann Tabor said the first-trimester screening program in Denmark was extremely rigorous, resulting in detection of the vast majority of cases of Down syndrome; some cases, however, still slip through the net.

"We only have a detection rate of around 90%-92%, so we inform women that we will not be able to detect all of the Down syndrome fetuses," said Dr. Tabor, professor of fetal medicine at Copenhagen University Hospital. "This would offer a way to pick up some of the ones we haven’t found the first time."

The overall incidence of short femur length in the cohort was 2,718 cases (1.8%).

Dr. Tabor said that short femur length was a well-known feature of Down syndrome, although she was surprised by the strength of the association between short femur length and unbalanced autosomal structural abnormality.

"Every day in your clinical life, when you have a fetus where you measure this short femur length, you wonder ‘Should I do something about it or do I just ignore it?’ " Dr. Tabor said in an interview. "Do you want to do an amniocentesis if you don’t have a karyotype for the fetus, or should you really monitor the growth because they are more likely to be growth retarded or to be delivered preterm?"

Dr. Tabor said her decision about whether to act on a short femur length detected in the second trimester would depend a lot on the mother’s risk of abnormality in the first trimester.

"So if she had a risk estimate like 1 in 10,000, you probably wouldn’t do anything, but if it was 1 in 400, then you’d have to counsel her," she said.

There were no conflicts of interest declared.

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SYDNEY, AUSTRALIA – A single round of endometrial scratching during oral contraceptive pill pretreatment can significantly increase the clinical pregnancy rate in women undergoing assisted reproductive treatment, a randomized controlled trial showed.

The study, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed an 83% increase in the chance of a live birth (41.8% vs. 22.8%) and a 70% increase in the chance of clinical pregnancy (49.4% vs. 29.1%) in women who had endometrial scratching, compared with women who underwent a sham procedure.

Endometrial scratching did not have any significant effect on the rate of miscarriage (15.4% vs. 21.7%,) and multiple pregnancy (22.5% vs. 25.0%), according to data that was also published online in the Sept. 2 issue of Ultrasound in Obstetrics and Gynecology (2013;42:375-82 [doi: 10.1002/uog.12539]).

The 77 women randomized to endometrial scratching reported significantly higher pain scores during the procedure than the 79 women given the sham therapy. No major fetal malformations were reported by study participants.

The procedure, which was performed 7-14 days before the planned start of controlled ovarian stimulation, involved introducing the Pipelle suction curette through the cervix and up to the uterine fundus, then applying suction and moving the device around with the aim of covering the entire endometrium.

The sham procedure consisted of drying the cervix with gauze for 30 seconds.

A link between endometrial scratching and the increased chance of pregnancy was first identified in 2003; however, coauthor Dr. Wellington Martins said this was the first study to examine its use during oral contraceptive pill (OCP) pretreatment.

"No previous study has studied endometrial injury performed during OCP pretreatment, only in natural cycles, but in our center we use OCP pre-treatment for all women undergoing assisted reproductive therapy," said Dr. Martins of the University of São Paolo (Brazil).

Dr. Martins said the study also included all women undergoing assisted reproductive therapy, not just those with repeated implantation failure, although the majority of participants had had at least two previous, unsuccessful embryo transfers.

The effect of endometrial scratching is thought to be possibly mediated by inflammation, with the injury causing increased secretion of cytokines, interleukins, growth factors, and dendritic cells, which could aid embryo implantation.

Another mechanism may be the improved synchronization between the endometrium and implanted embryo.

"In assisted reproduction, the higher estrogen levels make the endometrium a little advanced, but it is possible that the injury or the healing process retard the maturity and development of the endometrium and promote a better synchronization," Dr. Martins said in an interview.

The study was terminated before full enrollment was achieved because of the significant benefit noted in an interim analysis, and while research is continuing, Dr. Martins said the treatment was already being offered to women attending their clinic.

No financial conflicts were reported.

This story was updated on October 29, 2013.

SYDNEY, AUSTRALIA – A single round of endometrial scratching during oral contraceptive pill pretreatment can significantly increase the clinical pregnancy rate in women undergoing assisted reproductive treatment, a randomized controlled trial showed.

The study, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed an 83% increase in the chance of a live birth (41.8% vs. 22.8%) and a 70% increase in the chance of clinical pregnancy (49.4% vs. 29.1%) in women who had endometrial scratching, compared with women who underwent a sham procedure.

Endometrial scratching did not have any significant effect on the rate of miscarriage (15.4% vs. 21.7%,) and multiple pregnancy (22.5% vs. 25.0%), according to data that was also published online in the Sept. 2 issue of Ultrasound in Obstetrics and Gynecology (2013;42:375-82 [doi: 10.1002/uog.12539]).

The 77 women randomized to endometrial scratching reported significantly higher pain scores during the procedure than the 79 women given the sham therapy. No major fetal malformations were reported by study participants.

The procedure, which was performed 7-14 days before the planned start of controlled ovarian stimulation, involved introducing the Pipelle suction curette through the cervix and up to the uterine fundus, then applying suction and moving the device around with the aim of covering the entire endometrium.

The sham procedure consisted of drying the cervix with gauze for 30 seconds.

A link between endometrial scratching and the increased chance of pregnancy was first identified in 2003; however, coauthor Dr. Wellington Martins said this was the first study to examine its use during oral contraceptive pill (OCP) pretreatment.

"No previous study has studied endometrial injury performed during OCP pretreatment, only in natural cycles, but in our center we use OCP pre-treatment for all women undergoing assisted reproductive therapy," said Dr. Martins of the University of São Paolo (Brazil).

Dr. Martins said the study also included all women undergoing assisted reproductive therapy, not just those with repeated implantation failure, although the majority of participants had had at least two previous, unsuccessful embryo transfers.

The effect of endometrial scratching is thought to be possibly mediated by inflammation, with the injury causing increased secretion of cytokines, interleukins, growth factors, and dendritic cells, which could aid embryo implantation.

Another mechanism may be the improved synchronization between the endometrium and implanted embryo.

"In assisted reproduction, the higher estrogen levels make the endometrium a little advanced, but it is possible that the injury or the healing process retard the maturity and development of the endometrium and promote a better synchronization," Dr. Martins said in an interview.

The study was terminated before full enrollment was achieved because of the significant benefit noted in an interim analysis, and while research is continuing, Dr. Martins said the treatment was already being offered to women attending their clinic.

No financial conflicts were reported.

This story was updated on October 29, 2013.

SYDNEY, AUSTRALIA – A single round of endometrial scratching during oral contraceptive pill pretreatment can significantly increase the clinical pregnancy rate in women undergoing assisted reproductive treatment, a randomized controlled trial showed.

The study, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed an 83% increase in the chance of a live birth (41.8% vs. 22.8%) and a 70% increase in the chance of clinical pregnancy (49.4% vs. 29.1%) in women who had endometrial scratching, compared with women who underwent a sham procedure.

Endometrial scratching did not have any significant effect on the rate of miscarriage (15.4% vs. 21.7%,) and multiple pregnancy (22.5% vs. 25.0%), according to data that was also published online in the Sept. 2 issue of Ultrasound in Obstetrics and Gynecology (2013;42:375-82 [doi: 10.1002/uog.12539]).

The 77 women randomized to endometrial scratching reported significantly higher pain scores during the procedure than the 79 women given the sham therapy. No major fetal malformations were reported by study participants.

The procedure, which was performed 7-14 days before the planned start of controlled ovarian stimulation, involved introducing the Pipelle suction curette through the cervix and up to the uterine fundus, then applying suction and moving the device around with the aim of covering the entire endometrium.

The sham procedure consisted of drying the cervix with gauze for 30 seconds.

A link between endometrial scratching and the increased chance of pregnancy was first identified in 2003; however, coauthor Dr. Wellington Martins said this was the first study to examine its use during oral contraceptive pill (OCP) pretreatment.

"No previous study has studied endometrial injury performed during OCP pretreatment, only in natural cycles, but in our center we use OCP pre-treatment for all women undergoing assisted reproductive therapy," said Dr. Martins of the University of São Paolo (Brazil).

Dr. Martins said the study also included all women undergoing assisted reproductive therapy, not just those with repeated implantation failure, although the majority of participants had had at least two previous, unsuccessful embryo transfers.

The effect of endometrial scratching is thought to be possibly mediated by inflammation, with the injury causing increased secretion of cytokines, interleukins, growth factors, and dendritic cells, which could aid embryo implantation.

Another mechanism may be the improved synchronization between the endometrium and implanted embryo.

"In assisted reproduction, the higher estrogen levels make the endometrium a little advanced, but it is possible that the injury or the healing process retard the maturity and development of the endometrium and promote a better synchronization," Dr. Martins said in an interview.

The study was terminated before full enrollment was achieved because of the significant benefit noted in an interim analysis, and while research is continuing, Dr. Martins said the treatment was already being offered to women attending their clinic.

No financial conflicts were reported.

This story was updated on October 29, 2013.

SYDNEY, AUSTRALIA – The brain shadowing sign – a sharply demarcated area of acoustic shadowing on ultrasound – is a novel and easily identifiable marker for fetal craniosynostosis, a small multicenter retrospective study showed.

An analysis of ultrasound images from 16 patients with a postnatal diagnosis of fetal craniosynostosis, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed the brain shadowing sign was clearly depicted in all cases, even when the suture was only partly closed.

Coauthor Gustavo Malinger, director of the ob.gyn. ultrasound unit at the Tel Aviv Sourasky Medical Centre, said prenatal diagnosis of fetal craniosynostosis is often difficult, particularly if it involves the sagittal suture and occurs in the absence of a family history. As a result, most cases are delivered without a diagnosis.

"With the metopic suture, you have a chance to make a diagnosis because the shape of the head is quite characteristic. So with the third-trimester examination, when you perform a weight estimation or something like that, you see that something is wrong," Dr. Malinger said in an interview.

"But when the sagittal suture is closed, you don’t see it because you come from the side; you obtain axial planes and you never reach the sagittal suture."

The brain shadowing sign occurs because of a failure of the acoustic wave to cross the cortical bone, and appears as a line separating a zone of clearly defined brain anatomy and a zone of relative shadow.

The sign is easily identifiable, is not dependent on fetal position, and does not require visualization with high-definition 3D transducers.

All patients underwent a multiplanar neurosonographic exam with transvaginal and transabdominal ultrasound.

The mean gestational age at diagnosis was 29 weeks, and the diagnosis was made in the second trimester in only five cases. Dr. Malinger said that while it was possible in some cases to diagnose very severe cases at 22 weeks, fetal craniosynostosis tends to develop later in the pregnancy.

Prenatal diagnosis did not necessarily enable any kind of intervention, he added, but it was important in enabling counselling to be provided to families to prepare them for what to expect.

"They are ready to know, and we send them to a neurosurgical consultation in utero, so the neurosurgeon can explain that in most of the cases, it’s going to be OK, and that we’ll follow up," Dr. Malinger said.

Of the 16 patients included in the study, 14 presented with single-suture craniosynostosis: 6 involved metopic suture; 5, sagittal suture; and 3, coronal suture.

Nine cases were isolated fetal craniosynostosis, three were cases of Apert syndrome, and four also presented with associated CNS and non-CNS anomalies.

Dr. Malinger said the earlier diagnosis of fetal craniosynostosis could enable discovery of other related malformations that might otherwise have been missed.

No financial conflicts were reported.

SYDNEY, AUSTRALIA – The brain shadowing sign – a sharply demarcated area of acoustic shadowing on ultrasound – is a novel and easily identifiable marker for fetal craniosynostosis, a small multicenter retrospective study showed.

An analysis of ultrasound images from 16 patients with a postnatal diagnosis of fetal craniosynostosis, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed the brain shadowing sign was clearly depicted in all cases, even when the suture was only partly closed.

Coauthor Gustavo Malinger, director of the ob.gyn. ultrasound unit at the Tel Aviv Sourasky Medical Centre, said prenatal diagnosis of fetal craniosynostosis is often difficult, particularly if it involves the sagittal suture and occurs in the absence of a family history. As a result, most cases are delivered without a diagnosis.

"With the metopic suture, you have a chance to make a diagnosis because the shape of the head is quite characteristic. So with the third-trimester examination, when you perform a weight estimation or something like that, you see that something is wrong," Dr. Malinger said in an interview.

"But when the sagittal suture is closed, you don’t see it because you come from the side; you obtain axial planes and you never reach the sagittal suture."

The brain shadowing sign occurs because of a failure of the acoustic wave to cross the cortical bone, and appears as a line separating a zone of clearly defined brain anatomy and a zone of relative shadow.

The sign is easily identifiable, is not dependent on fetal position, and does not require visualization with high-definition 3D transducers.

All patients underwent a multiplanar neurosonographic exam with transvaginal and transabdominal ultrasound.

The mean gestational age at diagnosis was 29 weeks, and the diagnosis was made in the second trimester in only five cases. Dr. Malinger said that while it was possible in some cases to diagnose very severe cases at 22 weeks, fetal craniosynostosis tends to develop later in the pregnancy.

Prenatal diagnosis did not necessarily enable any kind of intervention, he added, but it was important in enabling counselling to be provided to families to prepare them for what to expect.

"They are ready to know, and we send them to a neurosurgical consultation in utero, so the neurosurgeon can explain that in most of the cases, it’s going to be OK, and that we’ll follow up," Dr. Malinger said.

Of the 16 patients included in the study, 14 presented with single-suture craniosynostosis: 6 involved metopic suture; 5, sagittal suture; and 3, coronal suture.

Nine cases were isolated fetal craniosynostosis, three were cases of Apert syndrome, and four also presented with associated CNS and non-CNS anomalies.

Dr. Malinger said the earlier diagnosis of fetal craniosynostosis could enable discovery of other related malformations that might otherwise have been missed.

No financial conflicts were reported.

SYDNEY, AUSTRALIA – The brain shadowing sign – a sharply demarcated area of acoustic shadowing on ultrasound – is a novel and easily identifiable marker for fetal craniosynostosis, a small multicenter retrospective study showed.

An analysis of ultrasound images from 16 patients with a postnatal diagnosis of fetal craniosynostosis, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed the brain shadowing sign was clearly depicted in all cases, even when the suture was only partly closed.

Coauthor Gustavo Malinger, director of the ob.gyn. ultrasound unit at the Tel Aviv Sourasky Medical Centre, said prenatal diagnosis of fetal craniosynostosis is often difficult, particularly if it involves the sagittal suture and occurs in the absence of a family history. As a result, most cases are delivered without a diagnosis.

"With the metopic suture, you have a chance to make a diagnosis because the shape of the head is quite characteristic. So with the third-trimester examination, when you perform a weight estimation or something like that, you see that something is wrong," Dr. Malinger said in an interview.

"But when the sagittal suture is closed, you don’t see it because you come from the side; you obtain axial planes and you never reach the sagittal suture."

The brain shadowing sign occurs because of a failure of the acoustic wave to cross the cortical bone, and appears as a line separating a zone of clearly defined brain anatomy and a zone of relative shadow.

The sign is easily identifiable, is not dependent on fetal position, and does not require visualization with high-definition 3D transducers.

All patients underwent a multiplanar neurosonographic exam with transvaginal and transabdominal ultrasound.

The mean gestational age at diagnosis was 29 weeks, and the diagnosis was made in the second trimester in only five cases. Dr. Malinger said that while it was possible in some cases to diagnose very severe cases at 22 weeks, fetal craniosynostosis tends to develop later in the pregnancy.

Prenatal diagnosis did not necessarily enable any kind of intervention, he added, but it was important in enabling counselling to be provided to families to prepare them for what to expect.

"They are ready to know, and we send them to a neurosurgical consultation in utero, so the neurosurgeon can explain that in most of the cases, it’s going to be OK, and that we’ll follow up," Dr. Malinger said.

Of the 16 patients included in the study, 14 presented with single-suture craniosynostosis: 6 involved metopic suture; 5, sagittal suture; and 3, coronal suture.

Nine cases were isolated fetal craniosynostosis, three were cases of Apert syndrome, and four also presented with associated CNS and non-CNS anomalies.

Dr. Malinger said the earlier diagnosis of fetal craniosynostosis could enable discovery of other related malformations that might otherwise have been missed.

No financial conflicts were reported.