Obstetrics

Prenatal stress is associated with altered patterns of cord blood cytokine production that may raise a child's asthma risk later in life, according to findings of one study.

“Prenatal stress appears to affect immune responses to both innate and adaptive stimuli at the time of birth—effects that may result in enhanced susceptibility to asthma or other atopic disorders,” said Dr. Rosalind J. Wright of Harvard Medical School in Boston and her associates (Am. J. Respir. Crit. Care Med. 2010 March 1 [doi:10.1164/rccm.200904-0637OC

The findings on seemingly stress-induced perinatal immune modulation may offer some new insight into the disproportionately high prevalence of asthma among ethnic minorities and disadvantaged urban communities.

In a prospective birth cohort study of urban, largely minority women, the investigators collected cord blood at birth and examined cord blood mononuclear cell (CBMC) cytokine responses to various innate and adaptive stimuli. Cytokine responses to both types of stimuli were significantly different in babies born to mothers with high levels of reported cumulative stress, compared with babies born to lower-stressed mothers.

In each case, the infants were at high risk for atopic diseases based on family history; either the mother or father had a history of asthma or allergy. Higher prenatal stress was related to increased production of interleukin-8 (IL-8) and tumor necrosis factor–alpha, for example, following microbial (CpG, PIC) stimuli.

For adaptive response, there was evidence that higher stress is tied to lower levels of interferon-gamma production in response to stimulation with PHA (a nonspecific mitogen), which has been linked to an increased risk for later atopic disease. Higher stress was also linked with an increased IL-13 response to dust mite antigen, which has been associated with allergic sensitization in older children.

The investigators studied 560 newborns and their mothers who live in Baltimore, Boston, New York, and St. Louis, and who were participating in the Urban Environment and Childhood Asthma Study. The mothers were primarily minorities (71% black and 19% Hispanic); 69% reported an annual income of less than $15,000.

Families answered detailed questions about various stressors in their lives, including financial hardship, community violence, and neighborhood and housing conditions.

The cohort will continue to be followed, enabling further assessment of the effects of prenatal and postnatal stress on infant immune development, and clinical outcomes, as the infants grow.

Disclosures: The study received funding from the National Institutes of Health. Dr. Wright also received funding from an NIH grant.

Prenatal stress is associated with altered patterns of cord blood cytokine production that may raise a child's asthma risk later in life, according to findings of one study.

“Prenatal stress appears to affect immune responses to both innate and adaptive stimuli at the time of birth—effects that may result in enhanced susceptibility to asthma or other atopic disorders,” said Dr. Rosalind J. Wright of Harvard Medical School in Boston and her associates (Am. J. Respir. Crit. Care Med. 2010 March 1 [doi:10.1164/rccm.200904-0637OC

The findings on seemingly stress-induced perinatal immune modulation may offer some new insight into the disproportionately high prevalence of asthma among ethnic minorities and disadvantaged urban communities.

In a prospective birth cohort study of urban, largely minority women, the investigators collected cord blood at birth and examined cord blood mononuclear cell (CBMC) cytokine responses to various innate and adaptive stimuli. Cytokine responses to both types of stimuli were significantly different in babies born to mothers with high levels of reported cumulative stress, compared with babies born to lower-stressed mothers.

In each case, the infants were at high risk for atopic diseases based on family history; either the mother or father had a history of asthma or allergy. Higher prenatal stress was related to increased production of interleukin-8 (IL-8) and tumor necrosis factor–alpha, for example, following microbial (CpG, PIC) stimuli.

For adaptive response, there was evidence that higher stress is tied to lower levels of interferon-gamma production in response to stimulation with PHA (a nonspecific mitogen), which has been linked to an increased risk for later atopic disease. Higher stress was also linked with an increased IL-13 response to dust mite antigen, which has been associated with allergic sensitization in older children.

The investigators studied 560 newborns and their mothers who live in Baltimore, Boston, New York, and St. Louis, and who were participating in the Urban Environment and Childhood Asthma Study. The mothers were primarily minorities (71% black and 19% Hispanic); 69% reported an annual income of less than $15,000.

Families answered detailed questions about various stressors in their lives, including financial hardship, community violence, and neighborhood and housing conditions.

The cohort will continue to be followed, enabling further assessment of the effects of prenatal and postnatal stress on infant immune development, and clinical outcomes, as the infants grow.

Disclosures: The study received funding from the National Institutes of Health. Dr. Wright also received funding from an NIH grant.

Prenatal stress is associated with altered patterns of cord blood cytokine production that may raise a child's asthma risk later in life, according to findings of one study.

“Prenatal stress appears to affect immune responses to both innate and adaptive stimuli at the time of birth—effects that may result in enhanced susceptibility to asthma or other atopic disorders,” said Dr. Rosalind J. Wright of Harvard Medical School in Boston and her associates (Am. J. Respir. Crit. Care Med. 2010 March 1 [doi:10.1164/rccm.200904-0637OC

The findings on seemingly stress-induced perinatal immune modulation may offer some new insight into the disproportionately high prevalence of asthma among ethnic minorities and disadvantaged urban communities.

In a prospective birth cohort study of urban, largely minority women, the investigators collected cord blood at birth and examined cord blood mononuclear cell (CBMC) cytokine responses to various innate and adaptive stimuli. Cytokine responses to both types of stimuli were significantly different in babies born to mothers with high levels of reported cumulative stress, compared with babies born to lower-stressed mothers.

In each case, the infants were at high risk for atopic diseases based on family history; either the mother or father had a history of asthma or allergy. Higher prenatal stress was related to increased production of interleukin-8 (IL-8) and tumor necrosis factor–alpha, for example, following microbial (CpG, PIC) stimuli.

For adaptive response, there was evidence that higher stress is tied to lower levels of interferon-gamma production in response to stimulation with PHA (a nonspecific mitogen), which has been linked to an increased risk for later atopic disease. Higher stress was also linked with an increased IL-13 response to dust mite antigen, which has been associated with allergic sensitization in older children.

The investigators studied 560 newborns and their mothers who live in Baltimore, Boston, New York, and St. Louis, and who were participating in the Urban Environment and Childhood Asthma Study. The mothers were primarily minorities (71% black and 19% Hispanic); 69% reported an annual income of less than $15,000.

Families answered detailed questions about various stressors in their lives, including financial hardship, community violence, and neighborhood and housing conditions.

The cohort will continue to be followed, enabling further assessment of the effects of prenatal and postnatal stress on infant immune development, and clinical outcomes, as the infants grow.

Disclosures: The study received funding from the National Institutes of Health. Dr. Wright also received funding from an NIH grant.

MIAMI — Obstetricians may be lacking adequate information on the proper management of pregnancies affected by epidermolysis bullosa, findings from a survey suggested.

Of 195 Australian obstetricians who responded to the survey, 111 (57%) said information on epidermolysis bullosa (EB) is needed in prenatal clinics, Dr. Lizbeth Intong reported at the annual meeting of the American Academy of Dermatology.

Of the 195 (7%) respondents, 14 had encountered a pregnancy affected by EB; only 6 (43%) of the 14 said they conducted a literature search for information on the disease to help in their patient management, and only 4 (29%) comanaged their EB patients with a dermatologist, said Dr. Intong, a dermatologist at St. George Hospital in Sydney.

Mothers who had given birth to babies with EB, and mothers with EB who had given birth were also surveyed as part of the study. A total of 58 mothers who had babies with EB responded, and they had 130 babies, including 67 (52%) born with EB. Most babies were born by normal vaginal delivery, with a 5:1 ratio of normal vaginal deliveries to cesarean sections; the more severe the EB type, the more blistering was seen at birth.

Forty-one mothers with EB also responded to the survey. These mothers gave birth to 104 babies, including 50 (48%) born with EB, mostly by normal vaginal delivery. In this group there was a 4:1 ratio of normal vaginal deliveries to C-sections. Two of the mothers with EB reported that their condition worsened during pregnancy, and two said it improved; EB-related problems that were reported included blistering at the site of the adhesive tape used during an epidural and nipple blistering during breastfeeding, which led to a switch from breastfeeding to bottle feeding.

Based on the survey results, Dr. Intong saidshermal vaginal delivery (no forceps or vacuum assistance) is generally safe, that C-section should be considered in severe cases to reduce birth trauma, that nonadhesive tapes and dressings should be used on mothers with EB, and that mothers with EB should get counseling about proper care during breastfeeding, such as the use of nipple shields to help prevent blistering.

Disclosures: None was reported.

MIAMI — Obstetricians may be lacking adequate information on the proper management of pregnancies affected by epidermolysis bullosa, findings from a survey suggested.

Of 195 Australian obstetricians who responded to the survey, 111 (57%) said information on epidermolysis bullosa (EB) is needed in prenatal clinics, Dr. Lizbeth Intong reported at the annual meeting of the American Academy of Dermatology.

Of the 195 (7%) respondents, 14 had encountered a pregnancy affected by EB; only 6 (43%) of the 14 said they conducted a literature search for information on the disease to help in their patient management, and only 4 (29%) comanaged their EB patients with a dermatologist, said Dr. Intong, a dermatologist at St. George Hospital in Sydney.

Mothers who had given birth to babies with EB, and mothers with EB who had given birth were also surveyed as part of the study. A total of 58 mothers who had babies with EB responded, and they had 130 babies, including 67 (52%) born with EB. Most babies were born by normal vaginal delivery, with a 5:1 ratio of normal vaginal deliveries to cesarean sections; the more severe the EB type, the more blistering was seen at birth.

Forty-one mothers with EB also responded to the survey. These mothers gave birth to 104 babies, including 50 (48%) born with EB, mostly by normal vaginal delivery. In this group there was a 4:1 ratio of normal vaginal deliveries to C-sections. Two of the mothers with EB reported that their condition worsened during pregnancy, and two said it improved; EB-related problems that were reported included blistering at the site of the adhesive tape used during an epidural and nipple blistering during breastfeeding, which led to a switch from breastfeeding to bottle feeding.

Based on the survey results, Dr. Intong saidshermal vaginal delivery (no forceps or vacuum assistance) is generally safe, that C-section should be considered in severe cases to reduce birth trauma, that nonadhesive tapes and dressings should be used on mothers with EB, and that mothers with EB should get counseling about proper care during breastfeeding, such as the use of nipple shields to help prevent blistering.

Disclosures: None was reported.

MIAMI — Obstetricians may be lacking adequate information on the proper management of pregnancies affected by epidermolysis bullosa, findings from a survey suggested.

Of 195 Australian obstetricians who responded to the survey, 111 (57%) said information on epidermolysis bullosa (EB) is needed in prenatal clinics, Dr. Lizbeth Intong reported at the annual meeting of the American Academy of Dermatology.

Of the 195 (7%) respondents, 14 had encountered a pregnancy affected by EB; only 6 (43%) of the 14 said they conducted a literature search for information on the disease to help in their patient management, and only 4 (29%) comanaged their EB patients with a dermatologist, said Dr. Intong, a dermatologist at St. George Hospital in Sydney.

Mothers who had given birth to babies with EB, and mothers with EB who had given birth were also surveyed as part of the study. A total of 58 mothers who had babies with EB responded, and they had 130 babies, including 67 (52%) born with EB. Most babies were born by normal vaginal delivery, with a 5:1 ratio of normal vaginal deliveries to cesarean sections; the more severe the EB type, the more blistering was seen at birth.

Forty-one mothers with EB also responded to the survey. These mothers gave birth to 104 babies, including 50 (48%) born with EB, mostly by normal vaginal delivery. In this group there was a 4:1 ratio of normal vaginal deliveries to C-sections. Two of the mothers with EB reported that their condition worsened during pregnancy, and two said it improved; EB-related problems that were reported included blistering at the site of the adhesive tape used during an epidural and nipple blistering during breastfeeding, which led to a switch from breastfeeding to bottle feeding.

Based on the survey results, Dr. Intong saidshermal vaginal delivery (no forceps or vacuum assistance) is generally safe, that C-section should be considered in severe cases to reduce birth trauma, that nonadhesive tapes and dressings should be used on mothers with EB, and that mothers with EB should get counseling about proper care during breastfeeding, such as the use of nipple shields to help prevent blistering.

Disclosures: None was reported.

Major Finding: In the group who gave birth prior to surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group were.

Data Source: A study of claims data from seven private insurance plans to find 585 U.S. women who were aged16-45, had undergone bariatric surgery for weight loss, and had at least one prior pregnancy and delivery.

Disclosures: None was reported.

Women who have had bariatric surgery are far less likely to experience serious hypertensive disorders during pregnancy, including preeclampsia and eclampsia, than women who have yet to undergo the surgery, study results showed.

Investigators found a 75% reduction in the odds of being diagnosed with a hypertensive disorder in pregnancy in those who had undergone the surgery, compared with their counterparts.

For their study, Dr. Wendy L. Bennett and her colleagues at the Johns Hopkins University, Baltimore, evaluated claims data from seven private insurance plans to find 585 U.S. women aged 16-45 who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery (BMJ 2010 April 13;340:c1662 [doi: 10.1136/bmj.c1662

A total of 269 of the women gave birth before gastric bypass surgery or another weight-loss surgery, and 316 were delivered afterward. For the first group, the mean time from delivery to surgery was 17.9 months, and for the second, the mean time from surgery to delivery was 23.6 months. Gastric bypass surgery accounted for 81.5% of procedures overall, with other surgeries, such as adjustable gastric banding, making up the rest. The mean age of the women was 31.9 years at delivery and 31.5 years at surgery.

In the group who gave birth before having surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group were, even after adjustment for such factors as age at delivery, multiple pregnancy, the type of surgery, and preexisting diabetes.

Preeclampsia or eclampsia was diagnosed in 14.5% of women in the presurgery group and 2.5% in the postsurgery group. “We went 2 weeks post partum, because we wanted to make sure we got all the diagnoses,” Dr. Bennett said in an interview. “Women can get postpartum preeclampsia.”

The Hopkins findings confirm those from an earlier Israeli study of similar design (Int. J. Gynecol. Obstet. 2008;103:246-51), which found the rate of a composite of hypertensive disorders during pregnancy to be more than halved after bariatric surgery.

The Hopkins team saw an even more dramatic reduction—about 75%—in the odds of all hypertensive disorders in pregnancy, and was able to isolate all severities of hypertensive disorders by analyzing outpatient and inpatient codes for each. Further, Dr. Bennett and her colleagues wrote that they were “able to describe outcomes of chronic hypertension complicating a pregnancy and preeclampsia superimposed on chronic hypertension among women who have had bariatric surgery.” Chronic hypertension in pregnancy and preeclampsia, the authors noted, can increase the long-term risk of chronic disease in the mother, including cardiovascular and renal disease.

Dr. Bennett noted that her team reviewed relatively new and geographically diverse data (the claims were dated from 2002 to 2006 and were from more than one region of the United States), compared with other recent studies on bariatric surgery and pregnancy. This afforded the authors an up-to-date picture reflecting outcomes from surgeries currently performed, she said.

The team's data set lacked height and weight information for the subjects before and after surgeries, though all had been diagnosed as obese (having a body mass index of 35 kg/m

The authors noted a further limitation to their study, which was the possibility of selection bias and confounding by indication. For example, they wrote, “an obese woman with gestational hypertension might have been more likely to subsequently undergo bariatric surgery if she developed chronic hypertension after her pregnancy or had other comorbidities associated with obesity making her eligible for bariatric surgery. If this occurred, the number of diagnoses of hypertensive disorder in pregnancy in the women who delivered before surgery could be increased and bias our results.”

Major Finding: In the group who gave birth prior to surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group were.

Data Source: A study of claims data from seven private insurance plans to find 585 U.S. women who were aged16-45, had undergone bariatric surgery for weight loss, and had at least one prior pregnancy and delivery.

Disclosures: None was reported.

Women who have had bariatric surgery are far less likely to experience serious hypertensive disorders during pregnancy, including preeclampsia and eclampsia, than women who have yet to undergo the surgery, study results showed.

Investigators found a 75% reduction in the odds of being diagnosed with a hypertensive disorder in pregnancy in those who had undergone the surgery, compared with their counterparts.

For their study, Dr. Wendy L. Bennett and her colleagues at the Johns Hopkins University, Baltimore, evaluated claims data from seven private insurance plans to find 585 U.S. women aged 16-45 who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery (BMJ 2010 April 13;340:c1662 [doi: 10.1136/bmj.c1662

A total of 269 of the women gave birth before gastric bypass surgery or another weight-loss surgery, and 316 were delivered afterward. For the first group, the mean time from delivery to surgery was 17.9 months, and for the second, the mean time from surgery to delivery was 23.6 months. Gastric bypass surgery accounted for 81.5% of procedures overall, with other surgeries, such as adjustable gastric banding, making up the rest. The mean age of the women was 31.9 years at delivery and 31.5 years at surgery.

In the group who gave birth before having surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group were, even after adjustment for such factors as age at delivery, multiple pregnancy, the type of surgery, and preexisting diabetes.

Preeclampsia or eclampsia was diagnosed in 14.5% of women in the presurgery group and 2.5% in the postsurgery group. “We went 2 weeks post partum, because we wanted to make sure we got all the diagnoses,” Dr. Bennett said in an interview. “Women can get postpartum preeclampsia.”

The Hopkins findings confirm those from an earlier Israeli study of similar design (Int. J. Gynecol. Obstet. 2008;103:246-51), which found the rate of a composite of hypertensive disorders during pregnancy to be more than halved after bariatric surgery.

The Hopkins team saw an even more dramatic reduction—about 75%—in the odds of all hypertensive disorders in pregnancy, and was able to isolate all severities of hypertensive disorders by analyzing outpatient and inpatient codes for each. Further, Dr. Bennett and her colleagues wrote that they were “able to describe outcomes of chronic hypertension complicating a pregnancy and preeclampsia superimposed on chronic hypertension among women who have had bariatric surgery.” Chronic hypertension in pregnancy and preeclampsia, the authors noted, can increase the long-term risk of chronic disease in the mother, including cardiovascular and renal disease.

Dr. Bennett noted that her team reviewed relatively new and geographically diverse data (the claims were dated from 2002 to 2006 and were from more than one region of the United States), compared with other recent studies on bariatric surgery and pregnancy. This afforded the authors an up-to-date picture reflecting outcomes from surgeries currently performed, she said.

The team's data set lacked height and weight information for the subjects before and after surgeries, though all had been diagnosed as obese (having a body mass index of 35 kg/m

The authors noted a further limitation to their study, which was the possibility of selection bias and confounding by indication. For example, they wrote, “an obese woman with gestational hypertension might have been more likely to subsequently undergo bariatric surgery if she developed chronic hypertension after her pregnancy or had other comorbidities associated with obesity making her eligible for bariatric surgery. If this occurred, the number of diagnoses of hypertensive disorder in pregnancy in the women who delivered before surgery could be increased and bias our results.”

Major Finding: In the group who gave birth prior to surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group were.

Data Source: A study of claims data from seven private insurance plans to find 585 U.S. women who were aged16-45, had undergone bariatric surgery for weight loss, and had at least one prior pregnancy and delivery.

Disclosures: None was reported.

Women who have had bariatric surgery are far less likely to experience serious hypertensive disorders during pregnancy, including preeclampsia and eclampsia, than women who have yet to undergo the surgery, study results showed.

Investigators found a 75% reduction in the odds of being diagnosed with a hypertensive disorder in pregnancy in those who had undergone the surgery, compared with their counterparts.

For their study, Dr. Wendy L. Bennett and her colleagues at the Johns Hopkins University, Baltimore, evaluated claims data from seven private insurance plans to find 585 U.S. women aged 16-45 who had undergone bariatric surgery for weight loss and had at least one prior pregnancy and delivery (BMJ 2010 April 13;340:c1662 [doi: 10.1136/bmj.c1662

A total of 269 of the women gave birth before gastric bypass surgery or another weight-loss surgery, and 316 were delivered afterward. For the first group, the mean time from delivery to surgery was 17.9 months, and for the second, the mean time from surgery to delivery was 23.6 months. Gastric bypass surgery accounted for 81.5% of procedures overall, with other surgeries, such as adjustable gastric banding, making up the rest. The mean age of the women was 31.9 years at delivery and 31.5 years at surgery.

In the group who gave birth before having surgery, 31.2% of the women were diagnosed with a hypertensive disorder—from chronic and gestational hypertension to preeclampsia and eclampsia alone or superimposed on hypertension—between the start of pregnancy and 2 weeks after birth, while only 9.8% of the postsurgery group were, even after adjustment for such factors as age at delivery, multiple pregnancy, the type of surgery, and preexisting diabetes.

Preeclampsia or eclampsia was diagnosed in 14.5% of women in the presurgery group and 2.5% in the postsurgery group. “We went 2 weeks post partum, because we wanted to make sure we got all the diagnoses,” Dr. Bennett said in an interview. “Women can get postpartum preeclampsia.”

The Hopkins findings confirm those from an earlier Israeli study of similar design (Int. J. Gynecol. Obstet. 2008;103:246-51), which found the rate of a composite of hypertensive disorders during pregnancy to be more than halved after bariatric surgery.

The Hopkins team saw an even more dramatic reduction—about 75%—in the odds of all hypertensive disorders in pregnancy, and was able to isolate all severities of hypertensive disorders by analyzing outpatient and inpatient codes for each. Further, Dr. Bennett and her colleagues wrote that they were “able to describe outcomes of chronic hypertension complicating a pregnancy and preeclampsia superimposed on chronic hypertension among women who have had bariatric surgery.” Chronic hypertension in pregnancy and preeclampsia, the authors noted, can increase the long-term risk of chronic disease in the mother, including cardiovascular and renal disease.

Dr. Bennett noted that her team reviewed relatively new and geographically diverse data (the claims were dated from 2002 to 2006 and were from more than one region of the United States), compared with other recent studies on bariatric surgery and pregnancy. This afforded the authors an up-to-date picture reflecting outcomes from surgeries currently performed, she said.

The team's data set lacked height and weight information for the subjects before and after surgeries, though all had been diagnosed as obese (having a body mass index of 35 kg/m

The authors noted a further limitation to their study, which was the possibility of selection bias and confounding by indication. For example, they wrote, “an obese woman with gestational hypertension might have been more likely to subsequently undergo bariatric surgery if she developed chronic hypertension after her pregnancy or had other comorbidities associated with obesity making her eligible for bariatric surgery. If this occurred, the number of diagnoses of hypertensive disorder in pregnancy in the women who delivered before surgery could be increased and bias our results.”

Severe liver injuries have been associated with use of the antithyroid drug propylthiouracil, and the Food and Drug Administration has added a boxed warning to the product's label conveying this risk, the agency announced.

The warning for propylthiouracil (PTU) says that there have been reports of severe liver injury and acute liver failure—including fatalities—in adults and children who've been treated with the drug.

The warning also includes a statement concerning preferential prescribing of the drug for patients in early pregnancy. The warning notes that because birth defects have been associated with use of the antithyroid drug methimazole during the first trimester, “propylthiouracil may be the treatment of choice during and just before the first trimester of pregnancy.”

Information about PTU use during early pregnancy was based on a review of postmarketing data on PTU and methimazole. The review indicated that reports of congenital malformations were about threefold greater with methimazole than PTU, and there was a “distinct and consistent” pattern of congenital malformations associated with methimazole but not PTU.

Serious adverse events associated with PTU should be reported to the FDA at www.fda.gov/medwatch

Severe liver injuries have been associated with use of the antithyroid drug propylthiouracil, and the Food and Drug Administration has added a boxed warning to the product's label conveying this risk, the agency announced.

The warning for propylthiouracil (PTU) says that there have been reports of severe liver injury and acute liver failure—including fatalities—in adults and children who've been treated with the drug.

The warning also includes a statement concerning preferential prescribing of the drug for patients in early pregnancy. The warning notes that because birth defects have been associated with use of the antithyroid drug methimazole during the first trimester, “propylthiouracil may be the treatment of choice during and just before the first trimester of pregnancy.”

Information about PTU use during early pregnancy was based on a review of postmarketing data on PTU and methimazole. The review indicated that reports of congenital malformations were about threefold greater with methimazole than PTU, and there was a “distinct and consistent” pattern of congenital malformations associated with methimazole but not PTU.

Serious adverse events associated with PTU should be reported to the FDA at www.fda.gov/medwatch

Severe liver injuries have been associated with use of the antithyroid drug propylthiouracil, and the Food and Drug Administration has added a boxed warning to the product's label conveying this risk, the agency announced.

The warning for propylthiouracil (PTU) says that there have been reports of severe liver injury and acute liver failure—including fatalities—in adults and children who've been treated with the drug.

The warning also includes a statement concerning preferential prescribing of the drug for patients in early pregnancy. The warning notes that because birth defects have been associated with use of the antithyroid drug methimazole during the first trimester, “propylthiouracil may be the treatment of choice during and just before the first trimester of pregnancy.”

Information about PTU use during early pregnancy was based on a review of postmarketing data on PTU and methimazole. The review indicated that reports of congenital malformations were about threefold greater with methimazole than PTU, and there was a “distinct and consistent” pattern of congenital malformations associated with methimazole but not PTU.

Serious adverse events associated with PTU should be reported to the FDA at www.fda.gov/medwatch

Major Finding: Depth of fetal zone enlargement was 58% in the 21 women who gave birth within 7 days of initial assessment, compared with 40% in the 41 women who were delivered more than 7 days after assessment, a significant difference.

Data Source: A prospective study of 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation.

Disclosures: The University of Maryland and Yale University provided support for the study. Dr. Turan disclosed no relevant conflicts of interest.

CHICAGO — A simple two-dimensional ultrasound measurement of the depth of the fetal adrenal gland zone enlargement is a better predictor of preterm birth than cervical length, and is able to predict preterm birth within 7 days, according to Dr. Ozhan Turan.

The 2-D measurement is also as accurate as 3-D ultrasonography, which is less widely available, more complex, and more time consuming, Dr. Turan reported at the annual meeting of the Society for Maternal-Fetal Medicine. “It is plausible that these observations are due to the fact that ultrasound measurement of the fetal zone provides a noninvasive tool to study an essential component of the physiology that initiates the preterm birth process,” he said. “If this can be confirmed, it holds great promise in the study and the management of preterm birth.”

The researchers previously showed that fetal adrenal gland volume using 3-D ultrasound was able to predict preterm birth within 5 days of assessment (Obstet. Gynecol. 2007;109:855-62). The fetal zone makes up the majority of the adrenal cortex in fetuses, but begins to disappear the first few days after birth.

In the current analysis, 3-D ultrasound with virtual organ computer-aided analysis technology was used to determine corrected adrenal gland volume, and 2-D ultrasound was used to measure the whole gland and fetal zone in singleton pregnancies, in 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation. The fetal zone to whole gland ratio was calculated as an index of the depth of fetal zone enlargement.

In the whole population, mean depth of fetal zone enlargement was 46%, mean corrected adrenal gland volume was 400 mm

Twenty-one women gave birth within 7 days of initial assessment and 41, more than 7 days after assessment. The depth of fetal zone enlargement was 58% in the group who were delivered within 7 days of initial assessment, compared with 40% in the group who were delivered more than 7 days after assessment. Adrenal gland volume was 553.5 mm

In receiver operating characteristic area under the curve analyses, the sensitivity and specificity of fetal zone depth was 100% and 88% in the earlier and later delivery groups, compared with 85% and 90% for adrenal gland volume and 56% and 57% for cervical length. For comparison, he noted that assuming a false-positive rate of 10%, the ability to predict preterm birth in clinical practice is just 18% for uterine contractions, 60% for cervical length, 50% for fetal fibronectin testing, 71% for combined cervical length and fetal fibronectin, and 82% for interleukin-6.

During a discussion of the study, attendees asked what impact steroids had on adrenal measurements and how much time 2-D ultrasound adds to an evaluation. Dr. Turan responded that there was no significant difference in adrenal volume 24 hours after second steroid administration, and that the method adds only a few minutes to an evaluation once the clinician is trained.

Major Finding: Depth of fetal zone enlargement was 58% in the 21 women who gave birth within 7 days of initial assessment, compared with 40% in the 41 women who were delivered more than 7 days after assessment, a significant difference.

Data Source: A prospective study of 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation.

Disclosures: The University of Maryland and Yale University provided support for the study. Dr. Turan disclosed no relevant conflicts of interest.

CHICAGO — A simple two-dimensional ultrasound measurement of the depth of the fetal adrenal gland zone enlargement is a better predictor of preterm birth than cervical length, and is able to predict preterm birth within 7 days, according to Dr. Ozhan Turan.

The 2-D measurement is also as accurate as 3-D ultrasonography, which is less widely available, more complex, and more time consuming, Dr. Turan reported at the annual meeting of the Society for Maternal-Fetal Medicine. “It is plausible that these observations are due to the fact that ultrasound measurement of the fetal zone provides a noninvasive tool to study an essential component of the physiology that initiates the preterm birth process,” he said. “If this can be confirmed, it holds great promise in the study and the management of preterm birth.”

The researchers previously showed that fetal adrenal gland volume using 3-D ultrasound was able to predict preterm birth within 5 days of assessment (Obstet. Gynecol. 2007;109:855-62). The fetal zone makes up the majority of the adrenal cortex in fetuses, but begins to disappear the first few days after birth.

In the current analysis, 3-D ultrasound with virtual organ computer-aided analysis technology was used to determine corrected adrenal gland volume, and 2-D ultrasound was used to measure the whole gland and fetal zone in singleton pregnancies, in 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation. The fetal zone to whole gland ratio was calculated as an index of the depth of fetal zone enlargement.

In the whole population, mean depth of fetal zone enlargement was 46%, mean corrected adrenal gland volume was 400 mm

Twenty-one women gave birth within 7 days of initial assessment and 41, more than 7 days after assessment. The depth of fetal zone enlargement was 58% in the group who were delivered within 7 days of initial assessment, compared with 40% in the group who were delivered more than 7 days after assessment. Adrenal gland volume was 553.5 mm

In receiver operating characteristic area under the curve analyses, the sensitivity and specificity of fetal zone depth was 100% and 88% in the earlier and later delivery groups, compared with 85% and 90% for adrenal gland volume and 56% and 57% for cervical length. For comparison, he noted that assuming a false-positive rate of 10%, the ability to predict preterm birth in clinical practice is just 18% for uterine contractions, 60% for cervical length, 50% for fetal fibronectin testing, 71% for combined cervical length and fetal fibronectin, and 82% for interleukin-6.

During a discussion of the study, attendees asked what impact steroids had on adrenal measurements and how much time 2-D ultrasound adds to an evaluation. Dr. Turan responded that there was no significant difference in adrenal volume 24 hours after second steroid administration, and that the method adds only a few minutes to an evaluation once the clinician is trained.

Major Finding: Depth of fetal zone enlargement was 58% in the 21 women who gave birth within 7 days of initial assessment, compared with 40% in the 41 women who were delivered more than 7 days after assessment, a significant difference.

Data Source: A prospective study of 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation.

Disclosures: The University of Maryland and Yale University provided support for the study. Dr. Turan disclosed no relevant conflicts of interest.

CHICAGO — A simple two-dimensional ultrasound measurement of the depth of the fetal adrenal gland zone enlargement is a better predictor of preterm birth than cervical length, and is able to predict preterm birth within 7 days, according to Dr. Ozhan Turan.

The 2-D measurement is also as accurate as 3-D ultrasonography, which is less widely available, more complex, and more time consuming, Dr. Turan reported at the annual meeting of the Society for Maternal-Fetal Medicine. “It is plausible that these observations are due to the fact that ultrasound measurement of the fetal zone provides a noninvasive tool to study an essential component of the physiology that initiates the preterm birth process,” he said. “If this can be confirmed, it holds great promise in the study and the management of preterm birth.”

The researchers previously showed that fetal adrenal gland volume using 3-D ultrasound was able to predict preterm birth within 5 days of assessment (Obstet. Gynecol. 2007;109:855-62). The fetal zone makes up the majority of the adrenal cortex in fetuses, but begins to disappear the first few days after birth.

In the current analysis, 3-D ultrasound with virtual organ computer-aided analysis technology was used to determine corrected adrenal gland volume, and 2-D ultrasound was used to measure the whole gland and fetal zone in singleton pregnancies, in 62 women presenting with preterm labor symptoms at 23-37 weeks' gestation. The fetal zone to whole gland ratio was calculated as an index of the depth of fetal zone enlargement.

In the whole population, mean depth of fetal zone enlargement was 46%, mean corrected adrenal gland volume was 400 mm

Twenty-one women gave birth within 7 days of initial assessment and 41, more than 7 days after assessment. The depth of fetal zone enlargement was 58% in the group who were delivered within 7 days of initial assessment, compared with 40% in the group who were delivered more than 7 days after assessment. Adrenal gland volume was 553.5 mm

In receiver operating characteristic area under the curve analyses, the sensitivity and specificity of fetal zone depth was 100% and 88% in the earlier and later delivery groups, compared with 85% and 90% for adrenal gland volume and 56% and 57% for cervical length. For comparison, he noted that assuming a false-positive rate of 10%, the ability to predict preterm birth in clinical practice is just 18% for uterine contractions, 60% for cervical length, 50% for fetal fibronectin testing, 71% for combined cervical length and fetal fibronectin, and 82% for interleukin-6.

During a discussion of the study, attendees asked what impact steroids had on adrenal measurements and how much time 2-D ultrasound adds to an evaluation. Dr. Turan responded that there was no significant difference in adrenal volume 24 hours after second steroid administration, and that the method adds only a few minutes to an evaluation once the clinician is trained.

NEW ORLEANS — Maternal asthma has a significant effect on several adverse pregnancy outcomes including preeclampsia, preterm delivery, and low birth weight, based on a meta-analysis of 30 studies.

Pregnant asthmatic women have been reported to have an overall increased risk of adverse perinatal outcomes, but study results are conflicting, Dr. Jennifer Namazy said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“Our meta-analysis was conducted to see whether the risks were real,” said Dr. Namazy of Scripps Health in San Diego.

Dr. Namazy and her colleagues' review included prospective cohort studies and retrospective studies conducted between 1975 and 2009, in which pregnancy outcomes were compared between women with asthma and nonasthmatic controls. The 30 studies included 8 studies involving asthma management.

Compared with control women without asthma, asthmatic women had a significantly increased risk of preeclampsia (relative risk, 1.54). Low birth weight (defined as 2,500 g or less) was significantly more likely in babies of women with asthma (RR, 1.46). Babies born prematurely (birth after less than 37 weeks' gestation) or small for gestational age were significantly more likely among women with asthma compared with controls (RR, 1.41 and 1.22). Neonatal death was significantly more likely in babies of women with asthma (RR, 1.49). Perinatal mortality (stillbirth plus neonatal death) was significantly more likely in babies of women with asthma (RR, 1.25). No significant associations were seen between maternal asthma and an increased risk of congenital anomalies (RR, 1.08).

“The data suggest that active management may reduce some, but not other perinatal complications,” she said. But active management may not ensure adequate asthma control, and more research is needed to specifically assess the effect of asthma control on perinatal outcomes.

Disclosures: Dr. Namazy has served as a consultant for Genentech.

NEW ORLEANS — Maternal asthma has a significant effect on several adverse pregnancy outcomes including preeclampsia, preterm delivery, and low birth weight, based on a meta-analysis of 30 studies.

Pregnant asthmatic women have been reported to have an overall increased risk of adverse perinatal outcomes, but study results are conflicting, Dr. Jennifer Namazy said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“Our meta-analysis was conducted to see whether the risks were real,” said Dr. Namazy of Scripps Health in San Diego.

Dr. Namazy and her colleagues' review included prospective cohort studies and retrospective studies conducted between 1975 and 2009, in which pregnancy outcomes were compared between women with asthma and nonasthmatic controls. The 30 studies included 8 studies involving asthma management.

Compared with control women without asthma, asthmatic women had a significantly increased risk of preeclampsia (relative risk, 1.54). Low birth weight (defined as 2,500 g or less) was significantly more likely in babies of women with asthma (RR, 1.46). Babies born prematurely (birth after less than 37 weeks' gestation) or small for gestational age were significantly more likely among women with asthma compared with controls (RR, 1.41 and 1.22). Neonatal death was significantly more likely in babies of women with asthma (RR, 1.49). Perinatal mortality (stillbirth plus neonatal death) was significantly more likely in babies of women with asthma (RR, 1.25). No significant associations were seen between maternal asthma and an increased risk of congenital anomalies (RR, 1.08).

“The data suggest that active management may reduce some, but not other perinatal complications,” she said. But active management may not ensure adequate asthma control, and more research is needed to specifically assess the effect of asthma control on perinatal outcomes.

Disclosures: Dr. Namazy has served as a consultant for Genentech.

NEW ORLEANS — Maternal asthma has a significant effect on several adverse pregnancy outcomes including preeclampsia, preterm delivery, and low birth weight, based on a meta-analysis of 30 studies.

Pregnant asthmatic women have been reported to have an overall increased risk of adverse perinatal outcomes, but study results are conflicting, Dr. Jennifer Namazy said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“Our meta-analysis was conducted to see whether the risks were real,” said Dr. Namazy of Scripps Health in San Diego.

Dr. Namazy and her colleagues' review included prospective cohort studies and retrospective studies conducted between 1975 and 2009, in which pregnancy outcomes were compared between women with asthma and nonasthmatic controls. The 30 studies included 8 studies involving asthma management.

Compared with control women without asthma, asthmatic women had a significantly increased risk of preeclampsia (relative risk, 1.54). Low birth weight (defined as 2,500 g or less) was significantly more likely in babies of women with asthma (RR, 1.46). Babies born prematurely (birth after less than 37 weeks' gestation) or small for gestational age were significantly more likely among women with asthma compared with controls (RR, 1.41 and 1.22). Neonatal death was significantly more likely in babies of women with asthma (RR, 1.49). Perinatal mortality (stillbirth plus neonatal death) was significantly more likely in babies of women with asthma (RR, 1.25). No significant associations were seen between maternal asthma and an increased risk of congenital anomalies (RR, 1.08).

“The data suggest that active management may reduce some, but not other perinatal complications,” she said. But active management may not ensure adequate asthma control, and more research is needed to specifically assess the effect of asthma control on perinatal outcomes.

Disclosures: Dr. Namazy has served as a consultant for Genentech.

Major Finding: High-risk women with a U-shaped cervical funnel gave birth significantly earlier at 31.8 weeks' gestation, versus 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel.

Data Source: Secondary analysis of 301 women in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Mancuso disclosed no conflicts of interest.

CHICAGO — The presence of a U-shaped cervical funnel was significantly associated with earlier birth in high-risk women in a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

Women with a U-shaped funnel gave birth nearly 3 weeks earlier at a gestational age of 31.8 weeks, compared with 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel, Dr. Melissa Mancuso reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The relationship was independent of cervical length in the women, all of whom had a prior spontaneous preterm birth and a shortened midtrimester cervical length of less than 25 mm.

Women with a U-shaped funnel also were found to have the greatest benefit from cerclage. During a discussion of the study, one attendee asked if the findings suggest that the benefit of cerclage is only in women with a U-shaped funnel.

“What we know from the parent randomized trial is that there is a benefit from cerclage and that benefit increases as your cervical length decreases,” she said. “If there is a U funnel present, that benefit is increased further.”

It's been nearly 2 decades since researchers first described dilation and effacement in normal, term pregnancies as a progression of the funnel- or T-shaped internal cervical os to a Y shape, then a V shape, and finally a U shape (J. Ultrasound Med. 1995;14:719-24). While funneling has been found to be a risk factor for preterm birth in some reports, controversy lingers over its clinical utility and whether the clinical implications of a U- and V-shaped funnel are the same.

Dr. Mancuso reported on 301 women who were randomized to cerclage or no cerclage and underwent serial vaginal ultrasound between 16 and nearly 23 weeks, revealing no funnel in 154 women, a V-shaped funnel in 99, and a U-shaped funnel in 48. At baseline, women with a U funnel had a significantly shorter mean cervical length of 13 mm, compared with 19 mm for women with a V funnel and 21 mm for those with no funnel, said Dr. Mancuso of the University of Alabama at Birmingham. Twice as many women with a U funnel were treated with cerclage vs. no cerclage (32 vs. 16), which was a significant difference.

In a univariate analysis, the presence of a U funnel, but not a V funnel, was significantly associated with an increased risk of preterm birth at all four time points measured. Preterm birth rates in the U-funnel, V-funnel, and no-funnel groups were 23% vs. 6% vs. 8.4% at less than 24 weeks, 38% vs. 17% vs. 12% at less than 28 weeks, 60% vs. 34% vs. 32% at less than 35 weeks, and 73% vs. 50% vs. 47% at less than 37 weeks. There was no significant difference between the no-funnel and V-funnel groups.

After investigators controlled for baseline cervical length and cerclage, a U-shaped funnel remained significantly associated with preterm birth, with adjusted odds ratios ranging from 2.4 to 2.1, Dr. Mancuso said.

Because U-funnel outcomes appeared to be appreciably worse, the researchers investigated the possibility of an interaction between the U funnel and cerclage. Indeed, women with a U-shaped funnel gave birth a mean 4.9 weeks later in gestation with a cerclage than without a cerclage. This relationship remained significant, even after cervical length was controlled for, she said.

Session moderator Dr. Joshua Copel of Yale University in New Haven, Conn., described the findings as interesting and provocative.

Major Finding: High-risk women with a U-shaped cervical funnel gave birth significantly earlier at 31.8 weeks' gestation, versus 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel.

Data Source: Secondary analysis of 301 women in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Mancuso disclosed no conflicts of interest.

CHICAGO — The presence of a U-shaped cervical funnel was significantly associated with earlier birth in high-risk women in a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

Women with a U-shaped funnel gave birth nearly 3 weeks earlier at a gestational age of 31.8 weeks, compared with 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel, Dr. Melissa Mancuso reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The relationship was independent of cervical length in the women, all of whom had a prior spontaneous preterm birth and a shortened midtrimester cervical length of less than 25 mm.

Women with a U-shaped funnel also were found to have the greatest benefit from cerclage. During a discussion of the study, one attendee asked if the findings suggest that the benefit of cerclage is only in women with a U-shaped funnel.

“What we know from the parent randomized trial is that there is a benefit from cerclage and that benefit increases as your cervical length decreases,” she said. “If there is a U funnel present, that benefit is increased further.”

It's been nearly 2 decades since researchers first described dilation and effacement in normal, term pregnancies as a progression of the funnel- or T-shaped internal cervical os to a Y shape, then a V shape, and finally a U shape (J. Ultrasound Med. 1995;14:719-24). While funneling has been found to be a risk factor for preterm birth in some reports, controversy lingers over its clinical utility and whether the clinical implications of a U- and V-shaped funnel are the same.

Dr. Mancuso reported on 301 women who were randomized to cerclage or no cerclage and underwent serial vaginal ultrasound between 16 and nearly 23 weeks, revealing no funnel in 154 women, a V-shaped funnel in 99, and a U-shaped funnel in 48. At baseline, women with a U funnel had a significantly shorter mean cervical length of 13 mm, compared with 19 mm for women with a V funnel and 21 mm for those with no funnel, said Dr. Mancuso of the University of Alabama at Birmingham. Twice as many women with a U funnel were treated with cerclage vs. no cerclage (32 vs. 16), which was a significant difference.

In a univariate analysis, the presence of a U funnel, but not a V funnel, was significantly associated with an increased risk of preterm birth at all four time points measured. Preterm birth rates in the U-funnel, V-funnel, and no-funnel groups were 23% vs. 6% vs. 8.4% at less than 24 weeks, 38% vs. 17% vs. 12% at less than 28 weeks, 60% vs. 34% vs. 32% at less than 35 weeks, and 73% vs. 50% vs. 47% at less than 37 weeks. There was no significant difference between the no-funnel and V-funnel groups.

After investigators controlled for baseline cervical length and cerclage, a U-shaped funnel remained significantly associated with preterm birth, with adjusted odds ratios ranging from 2.4 to 2.1, Dr. Mancuso said.

Because U-funnel outcomes appeared to be appreciably worse, the researchers investigated the possibility of an interaction between the U funnel and cerclage. Indeed, women with a U-shaped funnel gave birth a mean 4.9 weeks later in gestation with a cerclage than without a cerclage. This relationship remained significant, even after cervical length was controlled for, she said.

Session moderator Dr. Joshua Copel of Yale University in New Haven, Conn., described the findings as interesting and provocative.

Major Finding: High-risk women with a U-shaped cervical funnel gave birth significantly earlier at 31.8 weeks' gestation, versus 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel.

Data Source: Secondary analysis of 301 women in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Mancuso disclosed no conflicts of interest.

CHICAGO — The presence of a U-shaped cervical funnel was significantly associated with earlier birth in high-risk women in a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

Women with a U-shaped funnel gave birth nearly 3 weeks earlier at a gestational age of 31.8 weeks, compared with 34.6 weeks for women with a V-shaped funnel and 34.7 weeks for those with no funnel, Dr. Melissa Mancuso reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The relationship was independent of cervical length in the women, all of whom had a prior spontaneous preterm birth and a shortened midtrimester cervical length of less than 25 mm.

Women with a U-shaped funnel also were found to have the greatest benefit from cerclage. During a discussion of the study, one attendee asked if the findings suggest that the benefit of cerclage is only in women with a U-shaped funnel.

“What we know from the parent randomized trial is that there is a benefit from cerclage and that benefit increases as your cervical length decreases,” she said. “If there is a U funnel present, that benefit is increased further.”

It's been nearly 2 decades since researchers first described dilation and effacement in normal, term pregnancies as a progression of the funnel- or T-shaped internal cervical os to a Y shape, then a V shape, and finally a U shape (J. Ultrasound Med. 1995;14:719-24). While funneling has been found to be a risk factor for preterm birth in some reports, controversy lingers over its clinical utility and whether the clinical implications of a U- and V-shaped funnel are the same.

Dr. Mancuso reported on 301 women who were randomized to cerclage or no cerclage and underwent serial vaginal ultrasound between 16 and nearly 23 weeks, revealing no funnel in 154 women, a V-shaped funnel in 99, and a U-shaped funnel in 48. At baseline, women with a U funnel had a significantly shorter mean cervical length of 13 mm, compared with 19 mm for women with a V funnel and 21 mm for those with no funnel, said Dr. Mancuso of the University of Alabama at Birmingham. Twice as many women with a U funnel were treated with cerclage vs. no cerclage (32 vs. 16), which was a significant difference.

In a univariate analysis, the presence of a U funnel, but not a V funnel, was significantly associated with an increased risk of preterm birth at all four time points measured. Preterm birth rates in the U-funnel, V-funnel, and no-funnel groups were 23% vs. 6% vs. 8.4% at less than 24 weeks, 38% vs. 17% vs. 12% at less than 28 weeks, 60% vs. 34% vs. 32% at less than 35 weeks, and 73% vs. 50% vs. 47% at less than 37 weeks. There was no significant difference between the no-funnel and V-funnel groups.

After investigators controlled for baseline cervical length and cerclage, a U-shaped funnel remained significantly associated with preterm birth, with adjusted odds ratios ranging from 2.4 to 2.1, Dr. Mancuso said.

Because U-funnel outcomes appeared to be appreciably worse, the researchers investigated the possibility of an interaction between the U funnel and cerclage. Indeed, women with a U-shaped funnel gave birth a mean 4.9 weeks later in gestation with a cerclage than without a cerclage. This relationship remained significant, even after cervical length was controlled for, she said.

Session moderator Dr. Joshua Copel of Yale University in New Haven, Conn., described the findings as interesting and provocative.

Major Finding: In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18). There was no significant effect of 17P in women with a cervical length of less than 15 mm.

Data Source: Secondary analysis of 300 patients in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Berghella disclosed no conflicts of interest.

CHICAGO — The effect of 17-alpha-hydroxyprogesterone caproate on preterm birth varies depending on the presence or absence of cerclage in high-risk women, according to a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

In women with prior spontaneous preterm birth and a cervical length of less than 25 mm, the hormone had no effect if cerclage was present, but significantly reduced preterm births at less than 24 weeks and perinatal mortality if cerclage was absent, Dr. Vincenzo Berghella reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The use of 17-alpha-hydroxyprogesterone caproate (17P) had no effect on the primary outcome of preterm birth at less than 35 weeks in either the cerclage or no-cerclage groups.

Among the 148 women randomized to cerclage, the primary outcome occurred in 30% of the 47 women receiving 17P and in 34% of the 101 women with no 17P (odds ratio, 0.84).

Among the 152 women with no cerclage, the primary outcome occurred in 39% of the 52 women who received 17P and in 44% of the 100 women with no 17P (OR, 0.80). Women given 17P in either group received an average of 11 injections, beginning at an average gestational age of 18-19 weeks (range, 16-28 weeks).

In the presence of cerclage, the use of 17P had no significant effect on the outcomes of preterm birth at less than 24 weeks (OR, 0.60); less than 28 weeks (OR, 0.46); less than 32 weeks (OR, 0.62); or less than 37 weeks (OR, 1.29). The use of 17P in the presence of cerclage also had no significant effect on perinatal death (OR, 0.62), said Dr. Berghella, professor of ob.gyn. at Jefferson Medical College in Philadelphia.

In the absence of cerclage, the use of 17P had a significant effect only on preterm birth at less than 24 weeks, occurring in 2% of women given 17P vs. 20% with no 17P (OR, 0.08), and on perinatal death, occurring in 4% of women given 17P and 23% with no 17P (OR, 0.14).

Because cervical length was a significant predictor of preterm birth in both groups in a logistic regression analysis, the researchers analyzed the effect of 17P using different cervical length cutoffs. In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18), while there was no significant effect of 17P in women with a cervical length of less than 15 mm, Dr. Berghella said.

During a discussion of the findings, an attendee said the study provides a clear clinical effect of 17P, but that the researchers may have “de-powered” the study by separately analyzing the women based on cerclage status. Dr. Berghella said the researchers felt that women who receive cerclage are different from those who do not, and that the design was influenced by the original analysis showing that cerclage had an influence on preterm birth (Am. J. Obstet. Gynecol. 2009;201:375:e1-8).

Major Finding: In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18). There was no significant effect of 17P in women with a cervical length of less than 15 mm.

Data Source: Secondary analysis of 300 patients in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Berghella disclosed no conflicts of interest.

CHICAGO — The effect of 17-alpha-hydroxyprogesterone caproate on preterm birth varies depending on the presence or absence of cerclage in high-risk women, according to a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

In women with prior spontaneous preterm birth and a cervical length of less than 25 mm, the hormone had no effect if cerclage was present, but significantly reduced preterm births at less than 24 weeks and perinatal mortality if cerclage was absent, Dr. Vincenzo Berghella reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The use of 17-alpha-hydroxyprogesterone caproate (17P) had no effect on the primary outcome of preterm birth at less than 35 weeks in either the cerclage or no-cerclage groups.

Among the 148 women randomized to cerclage, the primary outcome occurred in 30% of the 47 women receiving 17P and in 34% of the 101 women with no 17P (odds ratio, 0.84).

Among the 152 women with no cerclage, the primary outcome occurred in 39% of the 52 women who received 17P and in 44% of the 100 women with no 17P (OR, 0.80). Women given 17P in either group received an average of 11 injections, beginning at an average gestational age of 18-19 weeks (range, 16-28 weeks).

In the presence of cerclage, the use of 17P had no significant effect on the outcomes of preterm birth at less than 24 weeks (OR, 0.60); less than 28 weeks (OR, 0.46); less than 32 weeks (OR, 0.62); or less than 37 weeks (OR, 1.29). The use of 17P in the presence of cerclage also had no significant effect on perinatal death (OR, 0.62), said Dr. Berghella, professor of ob.gyn. at Jefferson Medical College in Philadelphia.

In the absence of cerclage, the use of 17P had a significant effect only on preterm birth at less than 24 weeks, occurring in 2% of women given 17P vs. 20% with no 17P (OR, 0.08), and on perinatal death, occurring in 4% of women given 17P and 23% with no 17P (OR, 0.14).

Because cervical length was a significant predictor of preterm birth in both groups in a logistic regression analysis, the researchers analyzed the effect of 17P using different cervical length cutoffs. In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18), while there was no significant effect of 17P in women with a cervical length of less than 15 mm, Dr. Berghella said.

During a discussion of the findings, an attendee said the study provides a clear clinical effect of 17P, but that the researchers may have “de-powered” the study by separately analyzing the women based on cerclage status. Dr. Berghella said the researchers felt that women who receive cerclage are different from those who do not, and that the design was influenced by the original analysis showing that cerclage had an influence on preterm birth (Am. J. Obstet. Gynecol. 2009;201:375:e1-8).

Major Finding: In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18). There was no significant effect of 17P in women with a cervical length of less than 15 mm.

Data Source: Secondary analysis of 300 patients in the Vaginal Ultrasound Cerclage Trial.

Disclosures: The study was funded by the National Institute of Child Health and Human Development. Dr. Berghella disclosed no conflicts of interest.

CHICAGO — The effect of 17-alpha-hydroxyprogesterone caproate on preterm birth varies depending on the presence or absence of cerclage in high-risk women, according to a planned secondary analysis of the Vaginal Ultrasound Cerclage Trial.

In women with prior spontaneous preterm birth and a cervical length of less than 25 mm, the hormone had no effect if cerclage was present, but significantly reduced preterm births at less than 24 weeks and perinatal mortality if cerclage was absent, Dr. Vincenzo Berghella reported at the annual meeting of the Society for Maternal-Fetal Medicine.

The use of 17-alpha-hydroxyprogesterone caproate (17P) had no effect on the primary outcome of preterm birth at less than 35 weeks in either the cerclage or no-cerclage groups.

Among the 148 women randomized to cerclage, the primary outcome occurred in 30% of the 47 women receiving 17P and in 34% of the 101 women with no 17P (odds ratio, 0.84).

Among the 152 women with no cerclage, the primary outcome occurred in 39% of the 52 women who received 17P and in 44% of the 100 women with no 17P (OR, 0.80). Women given 17P in either group received an average of 11 injections, beginning at an average gestational age of 18-19 weeks (range, 16-28 weeks).

In the presence of cerclage, the use of 17P had no significant effect on the outcomes of preterm birth at less than 24 weeks (OR, 0.60); less than 28 weeks (OR, 0.46); less than 32 weeks (OR, 0.62); or less than 37 weeks (OR, 1.29). The use of 17P in the presence of cerclage also had no significant effect on perinatal death (OR, 0.62), said Dr. Berghella, professor of ob.gyn. at Jefferson Medical College in Philadelphia.

In the absence of cerclage, the use of 17P had a significant effect only on preterm birth at less than 24 weeks, occurring in 2% of women given 17P vs. 20% with no 17P (OR, 0.08), and on perinatal death, occurring in 4% of women given 17P and 23% with no 17P (OR, 0.14).

Because cervical length was a significant predictor of preterm birth in both groups in a logistic regression analysis, the researchers analyzed the effect of 17P using different cervical length cutoffs. In women with a cervical length of 15-24 mm, 17P was associated with statistically significant decreases in both preterm birth at less than 24 weeks (OR, 0.11) and perinatal mortality (OR, 0.18), while there was no significant effect of 17P in women with a cervical length of less than 15 mm, Dr. Berghella said.

During a discussion of the findings, an attendee said the study provides a clear clinical effect of 17P, but that the researchers may have “de-powered” the study by separately analyzing the women based on cerclage status. Dr. Berghella said the researchers felt that women who receive cerclage are different from those who do not, and that the design was influenced by the original analysis showing that cerclage had an influence on preterm birth (Am. J. Obstet. Gynecol. 2009;201:375:e1-8).

Major Finding: A test based on five marker proteins in cervicovaginal fluid was able to discriminate intra-amniotic infection in 13 of 14 cases in which infection was present and in 7 of 84 in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

Data Source: Multicenter trial involving 105 women with preterm labor.

Disclosures: Dr. Combs has received honorarium from ProteoGenix Inc., the sponsor of the study.

CHICAGO — A noninvasive test that discriminates between the presence and absence of intra-amniotic infection in women with preterm labor could reduce the need for amniocentesis in this population, according to Dr. C. Andrew Combs.

The test, based on five distinct proteins in cervicovaginal fluid, also may be useful in the management of preterm labor, which is dependent on infection status. Antibiotics and prompt delivery are indicated when infection is present, while tocolysis and prenatal steroids are used when it is absent, he said at the annual meeting of the Society for Maternal-Fetal Medicine.

Amniocentesis is often needed to make an accurate diagnosis of intra-amniotic infection (IAI), but is frequently refused by women in preterm labor because of the associated risk of miscarriage. Even when amniocentesis is used, rapid results are somewhat limited, said Dr. Combs, a perinatalogist in group practice in Campbell, Calif.

IAI is subclinical in 80% of cases, and clinical signs such as fever, uterine tenderness, white blood count, and tachycardia are often absent. A culture takes 2-5 days and is negative in up to one-third of IAI cases, he said. Finally, cultures specific for Mycoplasma and Ureaplasma species, which may be important in many of these infections, are not available in most hospital laboratories.

Dr. Combs and his associates hypothesized that proteins in cervicovaginal fluid would be differentially expressed in infected vs. noninfected cases, and tested this hypothesis in a multicenter trial involving 105 women with preterm labor at a gestational age of more than 22 weeks with intact membranes. IAI was present in 14 (13%) based on a positive amniocentesis fluid culture and/or 16S ribosomal DNA polymerase chain reaction test result. Cervicovaginal swabs were used for protein analysis.

Screening was performed on 178 proteins likely to have an association with IAI, with 42 entered into statistical models. Five proteins were included in a final model: one plasma protein, two cytokine/chemokines, one cell adhesion protein, and one peroxidase. Dr. Combs declined to specifically identify the proteins, citing proprietary reasons on behalf of ProteoGenix Inc. (Costa Mesa, Calif.), which sponsored the study and is developing a commercial test.

The final model had a “mediocre” area under the receiver operating characteristic curve of 0.84 with only a single protein, improving to 0.94 with three proteins and to 0.98 with all five proteins, Dr. Combs said. The five-marker test was positive in 13 of 14 cases in which infection was present and in 7 of 84 cases in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

“We think this is an excellent diagnostic performance,” he said.

An audience member expressed concern about using a test with such a low positive predictive value. Dr. Combs said he shared this skepticism if the test were used as the basis for prescribing antibiotics and delivering the infant in a mother with an intra-amniotic infection. He added that he would use a positive result to direct him to perform amniocentesis.

Validation of the test is underway in an independent population, with 300 patients already enrolled, he said.

Major Finding: A test based on five marker proteins in cervicovaginal fluid was able to discriminate intra-amniotic infection in 13 of 14 cases in which infection was present and in 7 of 84 in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

Data Source: Multicenter trial involving 105 women with preterm labor.

Disclosures: Dr. Combs has received honorarium from ProteoGenix Inc., the sponsor of the study.

CHICAGO — A noninvasive test that discriminates between the presence and absence of intra-amniotic infection in women with preterm labor could reduce the need for amniocentesis in this population, according to Dr. C. Andrew Combs.

The test, based on five distinct proteins in cervicovaginal fluid, also may be useful in the management of preterm labor, which is dependent on infection status. Antibiotics and prompt delivery are indicated when infection is present, while tocolysis and prenatal steroids are used when it is absent, he said at the annual meeting of the Society for Maternal-Fetal Medicine.

Amniocentesis is often needed to make an accurate diagnosis of intra-amniotic infection (IAI), but is frequently refused by women in preterm labor because of the associated risk of miscarriage. Even when amniocentesis is used, rapid results are somewhat limited, said Dr. Combs, a perinatalogist in group practice in Campbell, Calif.

IAI is subclinical in 80% of cases, and clinical signs such as fever, uterine tenderness, white blood count, and tachycardia are often absent. A culture takes 2-5 days and is negative in up to one-third of IAI cases, he said. Finally, cultures specific for Mycoplasma and Ureaplasma species, which may be important in many of these infections, are not available in most hospital laboratories.

Dr. Combs and his associates hypothesized that proteins in cervicovaginal fluid would be differentially expressed in infected vs. noninfected cases, and tested this hypothesis in a multicenter trial involving 105 women with preterm labor at a gestational age of more than 22 weeks with intact membranes. IAI was present in 14 (13%) based on a positive amniocentesis fluid culture and/or 16S ribosomal DNA polymerase chain reaction test result. Cervicovaginal swabs were used for protein analysis.

Screening was performed on 178 proteins likely to have an association with IAI, with 42 entered into statistical models. Five proteins were included in a final model: one plasma protein, two cytokine/chemokines, one cell adhesion protein, and one peroxidase. Dr. Combs declined to specifically identify the proteins, citing proprietary reasons on behalf of ProteoGenix Inc. (Costa Mesa, Calif.), which sponsored the study and is developing a commercial test.

The final model had a “mediocre” area under the receiver operating characteristic curve of 0.84 with only a single protein, improving to 0.94 with three proteins and to 0.98 with all five proteins, Dr. Combs said. The five-marker test was positive in 13 of 14 cases in which infection was present and in 7 of 84 cases in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

“We think this is an excellent diagnostic performance,” he said.

An audience member expressed concern about using a test with such a low positive predictive value. Dr. Combs said he shared this skepticism if the test were used as the basis for prescribing antibiotics and delivering the infant in a mother with an intra-amniotic infection. He added that he would use a positive result to direct him to perform amniocentesis.

Validation of the test is underway in an independent population, with 300 patients already enrolled, he said.

Major Finding: A test based on five marker proteins in cervicovaginal fluid was able to discriminate intra-amniotic infection in 13 of 14 cases in which infection was present and in 7 of 84 in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

Data Source: Multicenter trial involving 105 women with preterm labor.

Disclosures: Dr. Combs has received honorarium from ProteoGenix Inc., the sponsor of the study.

CHICAGO — A noninvasive test that discriminates between the presence and absence of intra-amniotic infection in women with preterm labor could reduce the need for amniocentesis in this population, according to Dr. C. Andrew Combs.

The test, based on five distinct proteins in cervicovaginal fluid, also may be useful in the management of preterm labor, which is dependent on infection status. Antibiotics and prompt delivery are indicated when infection is present, while tocolysis and prenatal steroids are used when it is absent, he said at the annual meeting of the Society for Maternal-Fetal Medicine.

Amniocentesis is often needed to make an accurate diagnosis of intra-amniotic infection (IAI), but is frequently refused by women in preterm labor because of the associated risk of miscarriage. Even when amniocentesis is used, rapid results are somewhat limited, said Dr. Combs, a perinatalogist in group practice in Campbell, Calif.

IAI is subclinical in 80% of cases, and clinical signs such as fever, uterine tenderness, white blood count, and tachycardia are often absent. A culture takes 2-5 days and is negative in up to one-third of IAI cases, he said. Finally, cultures specific for Mycoplasma and Ureaplasma species, which may be important in many of these infections, are not available in most hospital laboratories.

Dr. Combs and his associates hypothesized that proteins in cervicovaginal fluid would be differentially expressed in infected vs. noninfected cases, and tested this hypothesis in a multicenter trial involving 105 women with preterm labor at a gestational age of more than 22 weeks with intact membranes. IAI was present in 14 (13%) based on a positive amniocentesis fluid culture and/or 16S ribosomal DNA polymerase chain reaction test result. Cervicovaginal swabs were used for protein analysis.

Screening was performed on 178 proteins likely to have an association with IAI, with 42 entered into statistical models. Five proteins were included in a final model: one plasma protein, two cytokine/chemokines, one cell adhesion protein, and one peroxidase. Dr. Combs declined to specifically identify the proteins, citing proprietary reasons on behalf of ProteoGenix Inc. (Costa Mesa, Calif.), which sponsored the study and is developing a commercial test.

The final model had a “mediocre” area under the receiver operating characteristic curve of 0.84 with only a single protein, improving to 0.94 with three proteins and to 0.98 with all five proteins, Dr. Combs said. The five-marker test was positive in 13 of 14 cases in which infection was present and in 7 of 84 cases in which infection was absent, resulting in a sensitivity of 93%, specificity of 92%, positive predictive value of 65%, and negative predictive value of 99%.

“We think this is an excellent diagnostic performance,” he said.

An audience member expressed concern about using a test with such a low positive predictive value. Dr. Combs said he shared this skepticism if the test were used as the basis for prescribing antibiotics and delivering the infant in a mother with an intra-amniotic infection. He added that he would use a positive result to direct him to perform amniocentesis.

Validation of the test is underway in an independent population, with 300 patients already enrolled, he said.

Major Finding: The diagnosis of ventriculomegaly was confirmed on fetal MRI in 21 cases (84%), while the fetal brain appeared normal on fetal MRI in the remaining 4 cases (16%).

Data Source: A single-center retrospective study of 25 cases of isolated lateral ventriculomegaly.

Disclosures: None was reported.

SAN DIEGO — Fetal magnetic resonance imaging can be considered when isolated lateral ventriculomegaly is suspected on ultrasound, results from a single-center study demonstrated.

At the annual meeting of the American Institute of Ultrasound in Medicine, Dr. Fadi Mirza presented findings from a retrospective study of sonographically suspected cases of isolated ventriculomegaly seen at Columbia University Medical Center, New York, between 2004 and 2008 that subsequently underwent fetal brain MRI. The researchers compared the results of the fetal MRI and the last prenatal ultrasound before it.

Fetal ventriculomegaly was defined as dilated lateral ventricles with a mean transverse diameter of 10 mm or greater. The condition can be unilateral or bilateral and is often referred to as severe when the diameter is greater than 15 mm, said Dr. Mirza of the division of maternal-fetal medicine in the department of obstetrics and gynecology at the medical center.

It's regarded as isolated when the fetus has no other anomalies.

Isolated ventriculomegaly has been associated with multiple etiologies, “yet it's most often secondary to congenital aqueductal stenosis,” he said.

“Narrowing may be developmental or acquired, such as by infection, intraventricular hemorrhage, or a mass.

Diagnosis is generally based on prenatal ultrasound, but in recent years there has been a growing role for fetal MRI.”

In this small, retrospective study, there were 25 suspected cases of isolated ventriculomegaly on prenatal ultrasound that subsequently underwent fetal MRI during the 4-year study period. The mean gestational age at the time of the index ultrasound was 28.1 weeks while the mean gestational age at the time of the fetal MRI was 29.5 weeks.

Of the 25 cases, Dr. Mirza reported that 16 (64%) were unilateral and 22 (88%) were mild. The diagnosis of ventriculomegaly was confirmed on fetal MRI in 21 (84%) cases, while the fetal brain appeared normal on fetal MRI in the remaining 4 cases (16%).

Additional intracranial abnormalities that were not seen on prenatal ultrasound were identified in 5 of the 21 (24%) abnormal cases. These included three cases of agenesis of the corpus callosum, one case of interventricular hemorrhage, and one case of focal encephalomalacia.

Dr. Mirza acknowledged limitations of the study, including its retrospective design and small sample size, making it difficult to generalize its results and make management recommendations.

When asked by a meeting attendee what the clinical implications of the findings are, Dr. Mirza said that “the jury's still out on this question.

“In our small series, we did identify some cases where MRI did show other abnormalities, although I think it's still hard to appreciate what this practice would change in terms of our management.

“With the growing role of fetal MRI, we should have a better idea in the future.”

He said more prospective studies with a systematic approach are needed to better evaluate and refine the role of fetal MRI in cases of isolated ventriculomegaly.

This MRI shows dilatation of the occipital horns of the lateral ventricles.

Source Courtesy Dr. Fadi Mirza

Major Finding: The diagnosis of ventriculomegaly was confirmed on fetal MRI in 21 cases (84%), while the fetal brain appeared normal on fetal MRI in the remaining 4 cases (16%).

Data Source: A single-center retrospective study of 25 cases of isolated lateral ventriculomegaly.

Disclosures: None was reported.

SAN DIEGO — Fetal magnetic resonance imaging can be considered when isolated lateral ventriculomegaly is suspected on ultrasound, results from a single-center study demonstrated.

At the annual meeting of the American Institute of Ultrasound in Medicine, Dr. Fadi Mirza presented findings from a retrospective study of sonographically suspected cases of isolated ventriculomegaly seen at Columbia University Medical Center, New York, between 2004 and 2008 that subsequently underwent fetal brain MRI. The researchers compared the results of the fetal MRI and the last prenatal ultrasound before it.

Fetal ventriculomegaly was defined as dilated lateral ventricles with a mean transverse diameter of 10 mm or greater. The condition can be unilateral or bilateral and is often referred to as severe when the diameter is greater than 15 mm, said Dr. Mirza of the division of maternal-fetal medicine in the department of obstetrics and gynecology at the medical center.

It's regarded as isolated when the fetus has no other anomalies.

Isolated ventriculomegaly has been associated with multiple etiologies, “yet it's most often secondary to congenital aqueductal stenosis,” he said.

“Narrowing may be developmental or acquired, such as by infection, intraventricular hemorrhage, or a mass.

Diagnosis is generally based on prenatal ultrasound, but in recent years there has been a growing role for fetal MRI.”

In this small, retrospective study, there were 25 suspected cases of isolated ventriculomegaly on prenatal ultrasound that subsequently underwent fetal MRI during the 4-year study period. The mean gestational age at the time of the index ultrasound was 28.1 weeks while the mean gestational age at the time of the fetal MRI was 29.5 weeks.

Of the 25 cases, Dr. Mirza reported that 16 (64%) were unilateral and 22 (88%) were mild. The diagnosis of ventriculomegaly was confirmed on fetal MRI in 21 (84%) cases, while the fetal brain appeared normal on fetal MRI in the remaining 4 cases (16%).

Additional intracranial abnormalities that were not seen on prenatal ultrasound were identified in 5 of the 21 (24%) abnormal cases. These included three cases of agenesis of the corpus callosum, one case of interventricular hemorrhage, and one case of focal encephalomalacia.

Dr. Mirza acknowledged limitations of the study, including its retrospective design and small sample size, making it difficult to generalize its results and make management recommendations.

When asked by a meeting attendee what the clinical implications of the findings are, Dr. Mirza said that “the jury's still out on this question.

“In our small series, we did identify some cases where MRI did show other abnormalities, although I think it's still hard to appreciate what this practice would change in terms of our management.

“With the growing role of fetal MRI, we should have a better idea in the future.”

He said more prospective studies with a systematic approach are needed to better evaluate and refine the role of fetal MRI in cases of isolated ventriculomegaly.

This MRI shows dilatation of the occipital horns of the lateral ventricles.

Source Courtesy Dr. Fadi Mirza

Major Finding: The diagnosis of ventriculomegaly was confirmed on fetal MRI in 21 cases (84%), while the fetal brain appeared normal on fetal MRI in the remaining 4 cases (16%).

Data Source: A single-center retrospective study of 25 cases of isolated lateral ventriculomegaly.

Disclosures: None was reported.

SAN DIEGO — Fetal magnetic resonance imaging can be considered when isolated lateral ventriculomegaly is suspected on ultrasound, results from a single-center study demonstrated.

At the annual meeting of the American Institute of Ultrasound in Medicine, Dr. Fadi Mirza presented findings from a retrospective study of sonographically suspected cases of isolated ventriculomegaly seen at Columbia University Medical Center, New York, between 2004 and 2008 that subsequently underwent fetal brain MRI. The researchers compared the results of the fetal MRI and the last prenatal ultrasound before it.

Fetal ventriculomegaly was defined as dilated lateral ventricles with a mean transverse diameter of 10 mm or greater. The condition can be unilateral or bilateral and is often referred to as severe when the diameter is greater than 15 mm, said Dr. Mirza of the division of maternal-fetal medicine in the department of obstetrics and gynecology at the medical center.

It's regarded as isolated when the fetus has no other anomalies.

Isolated ventriculomegaly has been associated with multiple etiologies, “yet it's most often secondary to congenital aqueductal stenosis,” he said.

“Narrowing may be developmental or acquired, such as by infection, intraventricular hemorrhage, or a mass.

Diagnosis is generally based on prenatal ultrasound, but in recent years there has been a growing role for fetal MRI.”

In this small, retrospective study, there were 25 suspected cases of isolated ventriculomegaly on prenatal ultrasound that subsequently underwent fetal MRI during the 4-year study period. The mean gestational age at the time of the index ultrasound was 28.1 weeks while the mean gestational age at the time of the fetal MRI was 29.5 weeks.

Of the 25 cases, Dr. Mirza reported that 16 (64%) were unilateral and 22 (88%) were mild. The diagnosis of ventriculomegaly was confirmed on fetal MRI in 21 (84%) cases, while the fetal brain appeared normal on fetal MRI in the remaining 4 cases (16%).

Additional intracranial abnormalities that were not seen on prenatal ultrasound were identified in 5 of the 21 (24%) abnormal cases. These included three cases of agenesis of the corpus callosum, one case of interventricular hemorrhage, and one case of focal encephalomalacia.

Dr. Mirza acknowledged limitations of the study, including its retrospective design and small sample size, making it difficult to generalize its results and make management recommendations.

When asked by a meeting attendee what the clinical implications of the findings are, Dr. Mirza said that “the jury's still out on this question.

“In our small series, we did identify some cases where MRI did show other abnormalities, although I think it's still hard to appreciate what this practice would change in terms of our management.

“With the growing role of fetal MRI, we should have a better idea in the future.”

He said more prospective studies with a systematic approach are needed to better evaluate and refine the role of fetal MRI in cases of isolated ventriculomegaly.

This MRI shows dilatation of the occipital horns of the lateral ventricles.

Source Courtesy Dr. Fadi Mirza