Volume 166 Number I, Part 2

197 ADVERSB FETAL OUTCOMB ASSOCIATED WITH VARIX 0 .. THE FETAL IHTRAABDOMIHAL UllBILlCAL VBIN. DP Reisner, BS Mahony,X JP McGahan,x DA Nyberg,X Swedish HOsp. Med. Ctr., Seattle WA and Univ. California-Davis, Sacramento CA

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Varix of the fetal intraabdominal umbili­cal vein (FIUV) is a rare finding of uncer­tain etiology. We followed 11 fetuses with FIUV varix detected with prenatal ultrasound (US). US indications included elevated MSAFP (N=5), family history of congenital abnormal­ities (N=2), vaginal bleeding (N=l), abdomi­nal mass on outside US (N=l), size/dates discrepancy (N=l), and preterm labor (N=l). Maternal age ranged from 21-35 years. One fetus, born to a 35-year-old, had Trisomy-21. Seven of .11 fetuses were males. One pregnancy is ongoing.

• IVFD (1 w/ Trisomy-21) ........................... 4/10 (40%) • Abnormal karyotype (4 not tested) .................... 1/7 (14%) • Elevated MSAFP (4 not tested) ...................... 5/7 (71%)

CllNICAL OUfCOMIlS (N=11) • 2nd trimester dx w/ IUFD at 27-30 wits ..................... 4/6 • 3rd trimester dx w/ survival (1 premature w/ hydrops) .......... 4/4 • Ongoing pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1

One neonate had IUGR. Three macerated fetus-es precluded accurate weights. Three of 4 fetuses with IUFD underwent ClutOpSY, which did not reveal cause of death. Second tri-mester detection of FIUV varix may be associ­ated with increased fetal morbidity and mor­tality and warrants close fetal surveillance.

1"11IDVFMENf OF UMBILICAL ARTERY DIASTOLIC F1..GJ PREDICTS BElTER NFrnATAL CUIIDIE. JG l'ellx , A Ludonnirsky,x J PotlaJ icoX, S Weiner, Pennsylvania Hospilal, l11i ladelphia, PA

Fetuse s that show absent end rllastolic flow in the umbilical artery have a high risk of developing ILCR and 01 igohydramnios, have increased stillborn rates, and have significant per inala I and neonalal morbidiLy and rrnrlal ity. llsing doppler flow rreasurarent as a cl inic<11 pararrcter for de I i very liming is st i 11 very controversial. EfJ pregn;:m-­cies with a diagnosis of absent diastolic flow were studied. Fetuses were followed by traditional well being tesl ing(IlPP,NST, felal "DVment a.sscssrent) and del ivery decisions hased on these pararreters or worsening matemal condition. In II of (f) cases(l8%), diastolic flow improved as the pregnancy progressed and gestat i on was pro longed ,;i til improved outccme. Results:

TmprovEIlEnt No ¥7Zrovment 01 igohydrumnios '3/11(17%) 2/49(43%) nCR by US(<lct'S) 5/11(4'5%) 29/49(59%) Ox to IRI ivery (days) 49(rangc 9-121) ll(range 0-')7) SLi 11Ixlnl l/ll( 91.) 6/49(12%) Cesl. at Deliv(,,ks) 32.3(range28-37.6) 29.3(range 21--35) Avg. Birthwt.(gms) 1418(range499-24CD) 964(range2ED-H379) Neonatal DeatJl l/ll( 9%) 12/49(25%) Avg.# Jays in nursery 34(range 5--B6) 69(range 25--186) Survivors. 9/11(82%) :ll/49(61%) C.onc1usion: 1he data emphasize tJle possibility of umbiJ­ical artery diastol ic flow improverent in a group of [et uses that seared Lo be in a decanpensated slate.

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spa Abstracts 333

FETAL DESCENDING AORTA (DA) DOPPLER IN RESPONSE TO MATERNAL INGESTION OF LOW DOSE ASPIRIN (ASA). J.C. Veille, R. Hanson, L. Henderson, M. Swain, M. Sivakoff, Dept. of Ob/Gyn, Bowman Gray School of Medicine, Winston-Salem, NC and Case Western Reserve University, Cleveland, OIr.

The effect(s) of chronic maternal ingestion of low dose ASA (40-80 mg) on the fetal DA blood flow (DAF) has not been documented. Pulsed Doppler was used to study DAF in fetuses exposed to ASA and compared to a control group. This was done at 3 different gestational periodx: Groups (GRP) I = 12=23; II = 24-32; III = 33-41 weeks. A total of 230 studies were done throughout gestation. Six Doppler waveform were analyzed and averaged. The size of the DA was determined during systole, using a frame grabber. ResuU. are reported as X ± SD. ANOV A was used to determine significance.

DAPFYc DAPt'V"", DATVI. DATVI ... 45.0 ± 2 46.2 ± 3 5.6 ± 0.3 6.1 ± 0.6 59.0 ± 3 58.5 ± 2 7.8 ± 0.4 7.3 ± 0.4 63.4 ± 3 56.5 ± 5 7.8 ± 0.4 7.2 ± 0.6

DA"SV" DA"SV" DA"O" DA"O" 0.47 ± .OS 0.35 ± .07 58.4 ± 8.6 57.4 ± 12.2 1.21 ± .11 1.03 ± .09 166.4 ± 16.7 143.6 ± 11.9 1.97 ± .19

0.0000 O.

Legend: DAPFV = Descending aorta peak flow velocity (cmlsec); DA1VI = descending aorta time velocity integral; DASV = descending aorta "stroke volume' (ml); DAO = Descending aorta output (ml/min); C = Control; ASA = Aspirin. Results: (I) No significant differences were found in PFV and 1VI with advancing GA and among the "C' and "ASA" group. (2) Both the "SV' and '0" significantly increased with GA. No difference in the !Ie' and" ASA" groups were found. Conclusions: Maternal ingestion of daily low dose ASA DOES NOT significantly affect DA flow velocity and output. (Supported by NIH Grant IIL38296).

t:H'ECT OF LOW DOSE ASPIRIN (ASA) ON HUMAN FETAL RENAL BLOOD now (t"RBF). J.e. Veiile, R. IIanson, L. Henderson, M. Swain, Dept. of Ob/Gyn, Bowman Gray School of Medicine, Winston-Salem, NC

Low dose ASA has been used to prevent certain obstetrical complications. lbe effect of ASA on the FRBF has not yet been studied. FRill' was determined using pulsed Doppler in two groups of patients. One group of patients was uscd as a control group, the other group was taking 40-80 mg of ASA daily from the 12th week onward. Analysis was done at two different gestational (i.e. ~28 weeks and >29 weeks) age) to determine any effect of maturity on FRIlF in the control and in the ASA groups. A total of 143 studies were done (94 in control and 49 in ASA group). 'Ihrce to six waveforms/study were analyzed and averaged. Results arc expres.",ed as X and SD. ANOV A test for repeated measurements was used to detect statistical significance.

Groups 1(:::;28 wks) p II (;:29 wks) p

SiD ASA 7.33±3.l NS 6.83±1.1 NS SID ('.ontrol 8.02+2.2 5.88+2.5 PI'YASA 33.65±9.6 NS 36.25±9.7' <0.02 PI·Y ('.ontrol 29.50+10.2 24.49+10.4 ·IVI ASA 5.28:2.0 NS 6.27±2.4· <0.02 ·IVI Control 5.0l±I.S 4.29±1.6

(Legends: SiD=sySlolic/diastolic ratio; PFV=peak flow velocity (cm/sec); ·IVI=time velocity integral; ASA=aspirin) Results: 1) The SID waveform was not different between the two groups at the both gestational ages; 2) In the "early" gestational age group no difference was found in PFV and "IVI between the two groups; 3) In the "more advanced" gestational agc, PI'Y and ·IVI were significantly greater in the ASA group when compared to control. (,.onclusions: ASA was found to significantly affect the human fetal renal vascular bed at or after the 29th week. This may be through a direct or an indirect effect of a prolonged maternal ingestion of ASA on this vascular bed or other vascular beds like the duclus, the aorta, the ventricles or the systemic vasculature. (Supported by NIH Grant 11138296).