S98 SMFM Abstracts

61 ULTRASONOGRAPHIC AND BIOCHEMICAL MARKERS OF HUMAN FETAL CARDIAC DYSFUNCTION IN PLACENTAL INSUFFICIENCY KAARIN. M.AKIKALLIO ~, OLLI VUOLTEENAI:tO 2, PENTTI JOUPPILA ~, JUHA RASANENI; tUniversity of Oulu, Obstetr ics a n d Gynecology, Oulu; 2University of Oulu, Physiology, Oulu

OBJECTIVE: To investigate the relat ionship between ul t rasonographic and biochemical markers of fetal cardiac dysfunct ion and myocardial cell damage in pregnancies complicated by p lacent~ insufficiency.

STUDY DESIGN: Group 1 consisted of 12 fetuses with normal serum concentrat ions of umbilical artery N-terminal peptide of proatrial natrinretic peptide (NT-proANP) and cardiac troponin-T (cTnT), In group 2, 25 fetuses had increased NT-proANP (>1145 pmol /L) and normal cTnT values. Group 3 consisted of 11 fetuses with increased NT-proANP and cTnT (>0.10 ng /mL) levels. The propor t ions of r ight (RVCO%) and leit (LVCO%) ventr icular cardiac outputs of combined cardiac output, and right (RVFS) and left (LVFS) ventricular fractional shortenings were calculated. The presence of tricuspid regalrgitation (TR) was noted. Pulsatility indices for veins (PIV) of the ductus venosus (DV) and inferior vena cava (IVC) were calculated and their cot-- relations with NT-proANP values were determined.

RESULTS: The DV and IVC PIVs correlated significantly with NT-proANP levels (Table).

CONCLUSION: Pulsatility in h u m a n fetal systemic veins corre la ted significantly with the cardiac secretion of ANE Fetuses with myocardial cell damage demons t ra te a rise in systemic venous pressure, a shift in cardiac output towards the left ventricle and a rise in right ventricular afterload.

Table

G R O U P I G R O U P 2 G R O U P 3

LVCO% 42.8 (5.2) 40.9 (4.5) 46.7 (13.0)* RVCO% 57.2 (5.2) 59.1 (4.5) 53.3 (13.1)* LVFS% 29.0 (7.3) 32.8 (6.7) 26.2 /12.0) RVFS% 22.6 (7.6) 26.2 (5.0) 13.2 (11.4)* TR% 25.0 12.0 54.5* DVPIV 0.59 (0.34-1.14) 0.55 (0.26-1.24) 1.17 (0.57-3.81)** 1VC PIV 2.32 (l.60-4.36) 2.33 (1.02-5.66) 4.95 (2.46-6.45)** NT-proANP 737 (402-1101) 1652 (1160-7450) 5179 (1755-16030)**

(pmol/L)

Values given are mean (SD) or median (range). *P< .05 vs group 2, **P< .01 vs group l and 2.

63

December 2001 Am J Obstet Gynecol

SECOND OPINION MAGNETIC RESONANCE IMAGING FOR SUS- PECTED FETAL CENTRAL NERVOUS SYSTEM ABNORMALITIES DM TWICKLER 1, KP MAGEE'-', J CAIREJ, M ZARETSKY 3, RM RAMUS:~; tUniversity of Texas Southwestern, Radiology, Dallas, TX; °-Perinatal Associates of Texas, Dallas, TX; ~University of Texas Sonthwestern, Obstetrics a n d Gynecology, Dallas, TX

OBJECTIVE: To evaluate the role of magnetic resonance (MR) imaging in the setting of fetuses with suspected abnormali t ies of the central uervous system (CNS) detected by ul t rasound (US).

STUDY DESIGN: Multiplanar MR studies were per formed in fetuses with suspected CNS abnormalities on US. Findings were compared to US; MR was evaluated for its ability to offer additional information, change the diagnosis, or impact obstetric management . Patients were g rouped by gestational age in weeks (<24, 24-30, >30) at the time of MR imaging; Mantel-Haenszel t rend analysis was per tormed.

RESULTS: MR has presently been per formed in 51 pregnancies, including 6 twin pregnancies . Neonatal diagnoses included: spina bifida- 14, normal variant- 7, posterior fossa lesious- 6, aqueducta l stenosis- 5, agenesis of the coq~us callosum- 4, ufigrational abnormalities- 3, holoprosencephaly- 3, and 9 others. MR provided additional inforumtion (Add Info) in 69%, changed the diagnosis (Ch Dx) in 22% a n d potential ly a l tered the t iming or m o d e of delivery (Ch Mgmt) in 14% of pregnancies . Addit ional informat ion was significantly increased with increasing gestational age (P = .008).

CONCLUSION: 1. Second opinion MR may be cons idered a useful adjunct to evaluation of fetal CNS abnormalit ies 2. Additional information increased with gestational age. 3. In our series the additional anatomic detail provided by fetal MR with suspected CNS abnormalities is most evident beyond 23 weeks gestation. Table MR f'mdings of CNS abnormalities by gestational age

<24WKS 24-30WKS >30WKS # / T O T A L

Add Info 3 15 t7 35/51 Ch Dx 0 4 7 11/51 Ch Mgmt 0 3 4 7/51 Add Inf /Tot 3 /9* 15/22" 17/20" *P= .008

62 PRENATAL DIAGNOSIS OF CYTOMEGALOVIRUS INFECTION BY DE- TECTION OF IGM ANTIBODIES TO 70 KDA HF~T SHOCK PROTEIN IN FETAL SERUM STEFAN GERBER 1, YVAN VIAL2, PATRICK HOHLFELD ~, STEVEN WITKIN 1; 1Cornen Universi~ Medical College, Div. hnmuno logy and Infectious diseases; Dpt OB/GYN, NewYork, NY; 2CHUV, Maternity, Lausanne, VD -~CHUV, DMaternity, Lausanne, VD

OBJECTIVE: H u m a n CMV is the most c o m m o n viral in t rauter ine intection, affecting 0.5-2.5% of all live births. The rate of congenital infection resulting from pr imary maternal infection is about 30%. Congeni ta l CMV syndrome develops in 10% of congenital ly infected infants while 90% are asymptomatic at birth. Detection of CMV in amniotic fluid by culture or PCR, differentiates infected f rom uninfec ted fetuses, but does no t predic t fetal outcome. H u m a n CMV induces a specific activation of the hsp70 gene. The p roduced hsp70 combines with CMV peptides and this association may render the hsp70 immunogenic . We examined fetal sera for IgM anti-hsp70 as a possible umrker for fetal CMV infection.

STUDY DESIGN: Fetal sera were obtained by chordocentesis between 22- 25 week's gestation fi-om 53 mothers with confirmed primary CMV infection and 28 from mothers without CMV infection screened for Rh incompatibily (control). CMV infection in mothers was deterntined by seroconversion and IgG avidity index. Fetal CMV infection was determined by a positive amniotic fluid culture, Fetal sera were tested for IgM anti-hsp70 by ELISA.

RESULTS: Congenital infection was identified in 18 t~tuses (34%). Anti- hsp70 IgM was detected in 17/18 sera (94.4%) from infected, 3 /35 (8.6%) f rom uninfected and 0 /28 from control fetuses (P< .0001). This screening test presented a sensitivity of 94%, specificity of 91%, PPV of 85% and NPP of 97%. Apart t?om a small number of cases, the level of antibody reactivity seemed correlated with pathology.

CONCLUSION: Detection of IgM anti-hsp70 in fetal sera migh t be a sensitive and specific marker of fetal CMV infection in mothers with a pr immy CMV infection. Fur thermore , level of ant ibody reactivity migh t provide information as the extent of fetal CMV infection.

64 ROBOTIC ENDOSCOPIC REPAIR OF SPINA BIFIDA: SHEEP MODEL ORAN AARONSON l, NOEL TULIPAN 1, HAKAN SUNDELL 2, JOSEPH BRUNER ~, GEORGE DAVIS 4, WILLIAM RICHARDS 5, ROB CNWES6; 1Vanderbilt University Medical Center, Pediatric Neurosurgery, Nashville, TN; 2Vanderbilt University Medical Center, Neonatology, Nashville, TN; 3Vanderbilt University, Obstetrics & Gynecology, Nashville, TN; 4Vanderbilt University Medical Center, O b / G y n , Nashville, TN; 5Vanderbilt University Medical Centel, Surgery, Nashville, TN; 6Vanderbilt University Medical Centex, Pediatric Surgery, Nashville, TN

OBJECTIVE: In t rau ter ine repai r of spina bifida using s tandard laparoscopic technique has not been successful. The purpose of this study was to develop a surgical protocol fbr intrauterine repair of spina bifida using a robotic endoscopic operat ing system.

STUDY DESIGN: A spina bifida-like lesion was created in six midgestation fetal lambs (75-85 days). A laparotmny was per tbrmed, the p regnan t uterus exposed, and a camera and two 12-ram operat ing ports placed through the uter ine wall using ni t rous oxide anmiodis tent ion. The DaVinci robot ic operat ing system (Intuitive Surgical, Mountain View, CA) was engaged, and the surgically-created dysraphism was repai red using s tandard neurosurgica l technique. The ports were removed, aumiodis ten t ion was released, the l apa ro tomy was closed, a n d the sheep were recovered. The animals were sacrificed on postoperative day ten iu order to assess the adequacy of lesion closure.

RESULTS: Total operat ing time was approximately 90 minutes. The time f rom por t p l acemeut to lesion closure was approximate ly 30 minutes. All lesions were closed satisfactorily. One case was complicated by the intra- operative collapse of the amniou.

CONCLUSION: Use of a robotic endoscopic operat ing system to close a surgically-created spina bifida-like lesion in an animal model was efficient and ettective. The advantages of such an approach to the intrauterine repair of spina bifida in humans is tha t all p regnanc ies could potential ly deliver vaginally at term. The technology is currently liutited by the large diameter of ports required.