Correlation of Cardiovascular Profile Score and fetal outcome in patients with congenital heart defects

Abstract

PATIENTS WITH CONGENITAL HEART DEFECTS ALEKSANDRA ROCZEK, JAMES HUHTA, JOSE HERNANDEZ-ROBLES, University of South Florida, Pediatrics and Obstetrics, St. Petersburg, Florida OBJECTIVE: Fetuses with congenital heart defects (CHD) have a higher perinatal mortality rate than normals. Monitoring the severity of the fetal condition is vital for appointment of a suitable treatment as well as preparation of favorable time and environment for delivery. The aim of this study was to assess if the Cardiovascular Profile Score (CV Score) correlates with the corresponding fetal outcome. STUDY DESIGN: We have examined 662 pregnancies that underwent prenatal fetal echocardiographic examination. Of these, 256 (38.7%) had a diagnosis of congenital heart defect. The CV Score results on the last examination before delivery or intrauterine death were evaluated in fetuses with CHD. Fetal and neonatal outcome was followed, including gestational age at time of delivery, birth weight (BW) and perinatal survival, and, compared to its corresponding last fetal echocardiogram study’s score. RESULTS: Of the 256 CHD fetuses, 125 died in the perinatal period for an overall mortality of 48.8%. Of these 8 (3%) died in utero and 117 (97%) were born alive. Sixty eight (26.5%) had a CV score below 10 (mean 7.9, max. possible score 10/10) during the last examination before delivery or intrauterine death (mean gestational age 36.5 wks at birth). Mean BW was 2633g. In comparison, the non-CHD group’s (n = 406) mortality was 3.9% with 28 (7%) cases of intrauterine fetal demise. We found 2% mortality with a perfect score of 10/10 (n = 546) then it increased markedly to 20% at %9 (n = 69); 36% at %8 (n = 28); 62% %7 (n=13) and 80% when the score was 6 or less (n = 15). CONCLUSION: A Cardiovascular Profile Score less than 10/10 in fetuses with congenital heart defects indicates the need for closer cardiovascular status monitoring. A Cardivascular Profile Score below 7 predicts poor fetal prognosis and warrants intervention. 636 MYOMETRIAL THICKNESS ACCORDING TO UTERINE SITE, GESTATIONAL AGE AND PRIOR CESAREAN DELIVERY CELESTE DURNWALD, BRIAN MERCER, MetroHealth Medical Center at CWRU School of Medicine, Obstetrics and Gynecology, Maternal Fetal Medicine, Cleveland, Ohio OBJECTIVE: To identify differences in myometrial thickness (MT) based on site of uterine measurement and whether MT changes with advancing gestation. STUDY DESIGN: In this prospective cross-sectional study, MT was evaluated by ultrasound in women with viable singleton pregnancies. Women with suspected abruption, accreta, previa, fibroids, uterine and fetal anomalies, abnormal fluid volume, labor were excluded. MT was measured at the fundus, anterior wall (AW), posterior wall (PW), right and left side walls, lower uterine segment (LUS) and under the placenta. The cohort was divided to determine differences in MT at each site in each trimester (TRI). Differences in MT between sites were assessed. RESULTS: 175 women underwent ultrasound by a single observer. There were 25 1st, 100 2nd, and 50 3rd TRI scans at mean(sd) gestations of 11.0 (1.9), 21.5 (3.6) and 34.1 (3.0)wks,respectively. Women were 37% Black, 72% government insured, 39% nulliparous. 23 (13%) women had a prior cesarean. MT (mean [SD]) of each uterine site across 3 TRI is shown in Table I (*P ! .05 cf fundal MT). For all sites, MT was less in 2nd than 1st TRI (P ! .0001 each). This was most evident for fundal and LUS MT (35% less each). There was no difference in MTs between 2nd and 3rd TRI. Fundal, AW and LUS MTs were greater in parous women (P ! .05 each). With anterior placentas, AW MT was less (6.6 vs 7.4 mm, P = .008). This was not found with posterior or fundal placentas. The LUS MT in 2nd and 3rd TRI was not less with prior cesarean (5.8 vs 5.7 and 5.0 vs 5.4mm, P= .76 and .58, respectively). CONCLUSION: MT is less in 2nd and 3rd TRI than in 1st TRI. Fundal MT is less than other upper segment MT in 2nd and 3rd TRI. LUS MT is not less with prior cesarean.