Fetal Medicine Specialists Research Articles

Society of Obstetricians and Gynecologists Pakistan Guideline on Second Trimester Anomaly Scan Published in year 2022.

The Guideline on Second trimester anomaly scan has been prepared by the National Maternal Fetal Medicine guidelines committee, approved by the Society of Obstetricians and Gynecologists Pakistan. These guidelines are developed in 2022 and will be reviewed after two years.The current document provides guidance about the importance of second trimester scan to practicing clinicians and sonologists. It will enable them to offer it timely offer to their patient this scan and refer them to the Fetal medicine specialist when indicated. It is unique as the document is modified according to local needs. The Guidelines are developed in 2022 and will be reviewed after two years.

Key messages for obstetricians and fetal medicine specialists from the confidential enquiry into stillbirth and neonatal death in twins

Linked article: There is a comment on this article by Meller et al. Click here to view the Correspondence.

Abstract 11239: Changes in Clinical Outcomes for Patients Enrolled in a Non-Academic Multidisciplinary Cardio-Obstetrics Program

Introduction: Cardiovascular disease (CVD) is the leading cause of maternal death. Maternal mortality has steadily increased in the US. More than 60% of deaths due to CVD are preventable. In 2018, a non-academic multidisciplinary cardio-obstetrics (CVOB) program was formed at a Midwest hospital system. Cardiologists and Maternal Fetal Medicine specialists work together to provide evidence-based care to pregnant women with cardiac risk. To assess program effectiveness, we compared women seen by the CVOB program in 2018/2019 with a sample of pregnant women seen by cardiology in 2016/2017 prior to the program’s inception. Hypothesis: Women seen by the CVOB program will have improved outcomes - measured by gestation at delivery, length of stay (LOS) and readmission rates - over pre-program controls. Methods: A retrospective chart review was conducted of 102 patients who received care from the CVOB program in 2018/2019. These women were matched 1:1 based on mWHO categories with women who were seen by cardiology in 2016/2017. Results: Women who received care in the CVOB program had more cardiology tests during pregnancy relative to pre-program controls (median of 8 tests vs 5; p <0.001). Women in the CVOB program had a longer LOS (median of 3.08 vs 2.55 days; p=0.02). Women in the CVOB program were less likely to have inpatient or ED visits in the 6 months postpartum (24% vs 72%; p <0.001). Gestational age was similar at time of delivery. Conclusions: In a multidisciplinary, non-academic CVOB program; there was a trend towards an increase in LOS after delivery, as well as in increase in ICU utilization. However, there were fewer readmissions or emergency visits in the post-partum period. A multidisciplinary CVOB program is feasible in a non-academic setting. The development of the program led to a decrease in the rates of readmission and ED visits in the postpartum period.

The importance of information and support following a suspected second-trimester anomaly that is later discarded: A qualitative study of women's experiences.

A second-trimester anatomy scan may identify a suspected minor fetal anomaly and/or "soft marker," such as choroid plexus cysts or femoral shortening. Such findings can raise a medical concern, as they could indicate severe fetal disease; however, they are also often transient or a "false alarm." The aim of this study was to explore the experiences of pregnant women, where a medical concern was raised at the second-trimester ultrasound scan and later discarded after follow-up examinations and diagnostic testing. This study consists of qualitative, in-depth interviews with nine women, where a minor anomaly/soft marker was identified at the second-trimester scan and a severe anomaly was later ruled out. Data were analyzed using thematic analysis. The main source of worry was uncertainty about the possible implications for the pregnancy and the baby, particularly concerns about potential termination of pregnancy for a severe fetal condition. The women described four strategies to manage worry and uncertainty during the diagnostic process: (a) seeking additional information to feel more in control, and (b) using social networks to share their concerns. Some women tried to (c) mentally distance themselves from the pregnancy during the diagnostic period, while (d) extra scans could relieve worry and support attachment. The women appreciated when the fetal medicine specialist pointed to normal features in the pregnancy and the baby, as this provided some counterbalance to the sense of uncertainty. In general, the women expressed satisfaction with the information received during the diagnostic process. However, all of them were worried during the diagnostic process, and where this process was prolonged, such worry lingered even after the minor anomaly/soft marker had been discarded. Diagnostic uncertainty cannot be avoided in obstetric ultrasound and the women concerned appreciated being informed about the suspected findings even if it caused increased worry. Expedient diagnostic processes may alleviate worry, but are not always possible. Women in a prolonged diagnostic process may benefit from psychological and social support in parallel with, and even beyond, the obstetric investigation. However, further research is warranted.

Proposed domains for assessing postpartum recovery: a concept elicitation study

To propose postpartum recovery domains. Concept elicitation study. Semi-structured interviews. Ten writing committee members and 50 stakeholder interviews (23 postpartum women, nine general obstetricians, five maternal and fetal medicine specialists, eight nurses and five obstetric anaesthetists). Alternating interviews and focus group meetings until concept saturation was achieved (no new themes discussed in three consecutive interviews). Interviews were digitally recorded and transcribed, and an iterative coding process was used to identify domains. The primary outcome was to identify recovery domains. We also report key symptoms and concerns. Discussion frequency and importance scores (0-100; 0 = not important; 100 = vitally important to recovery) were used to rank domains. Discussion frequency was used to rank factors helping and hindering recovery, and to determine the greatest challenges experienced postpartum. Thirty-four interviews and two focus group meetings were performed. The 13 postpartum recovery domains identified, (ranked highest to lowest) were: psychosocial distress, surgical/medical factors, infant feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance, sexual function and cognition. The most frequently discussed factors facilitating postpartum recovery were: family support, lactation/breastfeeding support and partner support. The most frequently discussed factor hindering recovery was inadequate social support. The most frequent challenges reported were: breastfeeding (week 1), breastfeeding (week 3) and sleep (week 6). We propose 13 domains that comprehensively describe recovery in women delivering in a single centre within the USA. This provides a novel framework to study the postpartum recovery process. We propose 13 postpartum recovery domains that provide a framework to study the recovery process following childbirth.

A Practical Approach to Antibiotic Use in Critically Ill Obstetric Patients.

In recent years, several new antimicrobials have become available that are safer and more effective compared with older agents commonly used in obstetrics. Basic knowledge of these agents is of paramount importance to obstetricians and maternal fetal medicine specialists, as administration of early adequate broad-spectrum empiric antibiotic coverage plays a pivotal role in the management of septic patients. Of particular importance is the critically ill pregnant patient with life-threatening infectious processes in whom poor initial antibiotic selection may result in higher mortality and significant side effects from antibiotics themselves. In this article we aim to provide a guide for clinicians to select an adequate empirical antibiotic regimen for the most common severe infections that may affect pregnant individuals.

How to deal with uncertainty in prenatal genomics: A systematic review of guidelines and policies.

Exome sequencing (ES) enhanced the diagnostic yield of genetic testing, but has also increased the possibility of uncertain findings. Prenatal ES is increasingly being offered after a fetal abnormality is detected through ultrasound. It is important to know how to handle uncertainty in this particularly stressful period. This systematic review aimed to provide a comprehensive overview of guidelines available for addressing uncertainty related to prenatal chromosomal microarray (CMA) and ES. Ten uncertainty types associated with prenatal ES and CMA were identified and defined by an international multidisciplinary team. Medline (all) and Embase were systematically searched. Laboratory scientists, clinical geneticists, psychologists, and a fetal medicine specialist screened the papers and performed the data extraction. Nineteen papers were included. Recommendations generally emphasized the importance of trio analysis, clinical information, data sharing, validation and re‐analysis, protocols, multidisciplinary teams, genetic counselling, whether to limit the possible scope of results, and when to report particular findings. This systematic review helps provide a vocabulary for uncertainties, and a compass to navigate uncertainties. Prenatal CMA and ES guidelines provide a strong starting point for determining how to handle uncertainty. Gaps in guidelines and recommendations were identified and discussed to provide direction for future research and policy making.

Heterogeneity in defining fetal corpus callosal pathology: systematic review.

Fetal anomalies of the corpus callosum (CC) have been reported in the prenatal imaging literature since 1985, and, especially when isolated, pose challenges for both the patient and fetal medicine specialist. The purpose of this study was to review systematically the literature on prenatally diagnosed abnormalities of the CC, focusing on the terminology used to describe abnormalities other than complete agenesis of the CC, and to assess the heterogeneity of the nomenclature and definitions used. This study was conducted in accordance with the PRISMA statement for reporting systematic reviews. A literature search was performed to identify prospective or retrospective case series or cohort studies, published in English, French, Italian, German or Spanish, reporting fetal imaging findings and describing anomalies of the CC. Quality and risk of bias of the studies were evaluated using the Newcastle-Ottawa scale and a modification of the scale developed by Conde-Agudelo et al. for other fetal imaging studies. The data extracted included the number of patients, the number of different anomalies identified, the descriptive names of the anomalies, and, where applicable, the definitions of the anomalies, the number of cases of each type of anomaly and the biometric charts used. Secondary tests used to confirm the diagnosis, as well as the postnatal or post-termination tests used to ascertain the diagnosis, were also recorded. The search identified 998 records, and, after review of titles and abstracts and full review of 45 papers, 27 studies were included initially in the review, of which 24 were included in the final analysis. These 24 studies had a broad range of quality and risk of bias and represented 1135 cases of CC anomalies, of which 49% were complete agenesis and the remainder were described using the term partial agenesis or nine other terms, of which five had more than one definition. In comparison to the postnatal literature, in the prenatal literature there is much greater heterogeneity in the nomenclature and definition of CC anomalies other than complete agenesis. This heterogeneity and lack of standard definitions in the prenatal literature make it difficult to develop large multicenter pooled cohorts of patients who can be followed in order to develop a better understanding of the genetic associations and neurodevelopmental and psychological outcomes of patients with CC anomalies. As this information is important to improve counseling of these patients, a good first step towards this goal would be to develop a simpler categorization of prenatal CC anomalies that matches better the postnatal literature. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Identification and management of fetal anaemia: a practical guide

Key content Fetal anaemia can be caused by alloimmune or infectious red cell destruction, disorders of fetal red cell production, fetal haemorrhage and as a complication of monochorionic multifetal pregnancy. A fetus at risk from maternal alloimmunisation can be detected by maternal serum screening for red cell antibodies and by fetal ultrasonography. Undiagnosed cases may present in routine obstetric practice, so awareness of the identification and initial management of fetal anaemia is important. Pregnancies must be triaged depending on clinical urgency, with input from fetal medicine specialists required. Developments in fetal ultrasound assessment and in fetal therapy have improved outcomes and contemporary research will focus on improving long term outcomes for neonatal survivors. Learning objectives To understand the varied aetiologies and pathophysiology of fetal anaemia and to adopt a system for reaching a diagnosis. To appreciate the different diagnostic tools available, comprising ultrasonography, microbiological testing, noninvasive and invasive tests in fetal medicine units and electronic fetal monitoring in the acute setting. Ethical issues Management involves balancing maternal and fetal risks. Research ethics should be considered in relation to experimental treatments and trials in fetal therapy.

Treatment of Fetal Arrhythmias.

Fetal arrhythmias are mostly benign and transient. However, some of them are associated with structural defects or can cause heart failure, fetal hydrops, and can lead to intrauterine death. The analysis of fetal heart rhythm is based on ultrasound (M-mode and Doppler echocardiography). Irregular rhythm due to atrial ectopic beats is the most common type of fetal arrhythmia and is generally benign. Tachyarrhythmias are diagnosed when the fetal heart rate is persistently above 180 beats per minute (bpm). The most common fetal tachyarrhythmias are paroxysmal supraventricular tachycardia and atrial flutter. Most fetal tachycardias can be terminated or controlled by transplacental or direct administration of anti-arrhythmic drugs. Fetal bradycardia is diagnosed when the fetal heart rate is slower than 110 bpm. Persistent bradycardia outside labor or in the absence of placental pathology is mostly due to atrioventricular (AV) block. Approximately half of fetal heart blocks are in cases with structural heart defects, and AV block in cases with structurally normal heart is often caused by maternal anti-Ro/SSA antibodies. The efficacy of prenatal treatment for fetal AV block is limited. Our review aims to provide a practical guide for the diagnosis and management of common fetal arrythmias, from the joint perspective of the fetal medicine specialist and the cardiologist.

Postmortem Assessment of Isolated Congenital Heart Defects Remains Essential Following Termination of Pregnancy.

To investigate the correlation between prenatal ultrasound (US) and autopsy findings in pregnancies terminated due to isolated congenital heart defects (CHDs), including CHDs associated with heterotaxy syndrome. The material consists of 67 fetuses with prenatally detected isolated CHDs or CHDs associated with heterotaxy syndrome at a tertiary center in Norway between 1985 and 2014. The main CHDs were categorized into subdiagnoses of CHDs in accordance with ICD-10. The US and autopsy findings were categorized according to degree of concordance. Gestational age at termination was 12 + 0-22 + 6 weeks. Hypoplastic left heart syndrome was the most common main diagnosis among the 67 fetuses (32.8%). There was full agreement between US and autopsy findings in 97.4% (222/228) of all subdiagnoses. The discrepant findings in three fetuses had no influence on the decision to terminate the pregnancy. The correlation was high between prenatal US and postmortem findings in fetuses with isolated CHDs. Meticulous assessment of cardiac anatomy is particularly necessary when the decision to terminate relies on isolated CHDs. The trend of earlier termination challenges verification of diagnoses at autopsy. Consequently, the fetus should be examined at a tertiary center with fetal medicine specialists, pediatric cardiologists and perinatal pathologists.

Interrater agreement for sonographic stomach position classification in fetal diaphragmatic hernia across the North American Fetal Therapy Network.

To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in fetal left congenital diaphragmatic hernia (LCDH) among: (i) fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centers within and without the fetal endoscopic tracheal occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal," "anterior left chest," "mid to posterior left chest," or "retro-cardiac" based on the classification published by Basta et al.8 Interrater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER1. Agreement for stomach position between ERs was calculated using kappa statistics. Agreement for stomach position was 69% (39%-85%; n=19) and 54% (23%-92%; n=29) among FETO and non-FETO NAFTNet participants, respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5 of 13 cases (38.5%) and inter-rater agreement was highest for "anterior" stomach position. Interrater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers.

Early Diagnosing of Urinary Tract Anomalies

Nowadays, with advanced diagnostic technology and accessibility of patients to qualified physician, many anatomical anomalies are diagnosed in uterine life, including urinary tract anomalies in prenatal period, however, even with advanced of technology, many of such anomalies continue to be diagnosed later on, in early stage of life or even later when a medical problem arise as a consequence of these anomalies. In Albania, nowadays, high technology and high definition diagnostic imaging machines are available; however, we do face lack of qualified and experienced medical specialist, especially in peripheral regions - city hospitals throughout Albania. Early diagnosing of anomalies like urinary tract ones, are possible to be diagnosed since the end of first trimester of pregnancy by 14 weeks, and later on during the anatomic ultrasound examination or otherwise called morphologic fetal ultrasound at 18 – 22 weeks of pregnancy, if examination carried out by a qualified medical specialist, should clearly visualize fetal urinary tract. However, this fetal problems undiagnosed during pregnancy, there are often diagnosed in postnatal period. In some countries, many ultrasound examinations during pregnancy are performed by ultrasound technicians and interpreted by radiologist or perinatologist, however, generally these examination are performed by fetal medicine specialist, or obstetrician and gynecologists. In Albania these examination are performed only by obstetrician and gynecologist, since qe do not have a fetal medicine center. Any urinary problem during early age, it is appropriate to perform a general abdominal ultrasound examination as fast, reliable and cost-effective examination tool with no side effect. Keywords: Diagnostic, early, urinary, anomalies, medical specialist DOI: 10.7176/ALST/87-02 Publication date: April 30 th 2021

Cardiac Disease in Pregnancy: Hypertrophic Obstructive Cardiomyopathy and Pulmonic Stenosis

The prevalence of cardiovascular disease in pregnancy is increasing, and cardiovascular disease is the leading cause of pregnancy-related death in the United States. 1 Petersen EE Davis NL Goodman D et al. Vital signs: Pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019; 68: 423-429 Crossref PubMed Scopus (382) Google Scholar The physiologic adaptations to pregnancy include an increased heart rate, stroke volume, and substantial expansion in circulatory volume, which may pose significant cardiac stress to patients with cardiac disease. During labor, cardiac output increases further, and maternal expulsive efforts during the second stage of labor, with the decreased preload and increased afterload that accompany the Valsalva maneuver, may provoke decompensation in vulnerable patients. Cardiac output peaks immediately postpartum before the return to baseline over a period of several weeks; the immediate postpartum period also is associated with substantial intravascular fluid shifts. These changes, and the gradual return to baseline physiologic states, also may pose challenges to patients with preexisting cardiac disease. A multidisciplinary approach to the management of cardiac disease in pregnancy is essential, with management guided by input from cardiologists, specialists in maternal fetal medicine, anesthesiologists, and neonatologists. 2 ACOG perioperative ultrasound training in anesthesiology. Obstet Gynecol. 2019; 133: e320-e356 Crossref PubMed Scopus (153) Google Scholar In the case reports described herein, the presentation, management, and outcomes in two patients with significant cardiac disease diagnosed during pregnancy are detailed. The first case involved hypertrophic obstructive cardiomyopathy and the second pulmonic stenosis. These cases illustrate important principles of management of the physiologic stresses of pregnancy, labor, and delivery on patients with significant cardiac disease.

Prenatal ultrasound diagnosis of neural tube defects in the era of intrauterine repair – Eleven years’ experiences

ObjectiveTo modify the current neural tube defect (NTD) classification for fetal medicine specialists, and to investigate the impact of prenatal ultrasound conus medullaris position screening on the detection rate of closed spinal dysraphism and pregnancy outcomes. Materials and methodsThe clinical data of 112 patients prenatally diagnosed with neural tube defects in Taiji clinic from 2008 to 2018 were retrospectively analyzed. All cases were classified following the modified classification. We compared the detection rate before and after introducing the conus medullaris screening and pregnancy outcomes for NTD types. ResultsClosed spinal dysraphism type prevailed in our sample (43.8%). The median gestational age at the time of detection for cranial dysraphism was 13.3 weeks, open spinal dysraphism was 22.0 weeks, and closed spinal dysraphism was 22.6 weeks. All cranial dysraphism (n = 43) and open spinal dysraphism cases (n = 20) had pregnancies terminated. For closed spinal dysraphism Class 1, the live-birth rate was 100.0% in the cases without other anomalies and 33.3% in the cases with other anomalies, respectively (X2 = 17.25, p < 0.001). Similarly, for Class 2, pregnancy continuation rate was 50.0% in cases without other anomalies and 20.0% in cases with other anomalies, yet it failed to reach statistical significance (X2 = 0.9, p = 0.524). ConclusionOur case series may help to improve early screening and prenatal diagnosis of NTDs. Modified classification is adjusted for use in ultrasound fetal care facilities, which could be used for predicting pregnancy outcome. We suggest promoting first-trimester anatomical screening in order to make an earlier diagnosis and therefore provide better prenatal care for open spinal dysraphism cases in the era of intrauterine repair. Our findings imply that the use of fetal conus medullaris position as a marker for closed spinal dysraphism improves the detection rate and would unlikely lead to a higher termination rate.

Genetic Implications in High-Risk Pregnancy and Its Outcome: A 2-Year Study.

The aim of this study is to evaluate high-risk pregnant females' offspring as regard the presence of any medical condition, hereditary disorder, or major anomaly as well as to document parental sociodemographic characteristics and compliance with follow-up schedules of fetal medicine and clinical genetic clinics. This prospective 2-year cohort study of neonates and infants reported the referral indications, investigations, and diagnoses obtained through prenatal and postnatal examinations. It also reported their parental follow-up vigilance. Of the 811 infants of high risk females referred 460 (56.7%) came for assessment. Mean parental consanguinity and endogamy were 67 and 71.3%, respectively. All pregnant mothers underwent first-trimester biochemical testing (plasma protein-A, α-fetoprotein [AFP], human chorionic gonadotropin [hCG]) and serial ultrasound examinations. Seventy mothers needed second-trimester biochemical testing (AFP, hCG, and estriol). Sixty-two mothers underwent amniocentesis where G-banding karyotype, fluorescence in situ hybridization and targeted molecular testing for the specific gene mutation of single gene disorders were conducted according to suspected disorders. High quality fetal ultrasound was performed when brain malformations were suspected, while 16 fetuses required brain MRI examination. Mean age of newborns at first examination was 26.5 days. They were grouped according to the maternal indication for referral. Upon examination, 18 neonates had confirmed congenital malformations/genetic disorders. Five of them were diagnosed prenatally. In four other fetuses with single gene disorder, the molecular diagnosis of their affected siblings was not established prior to this pregnancy; thus, prenatal diagnosis was not possible. The remaining nine cases were diagnosed postnatally. Parental consanguinity and endogamy were increased among high-risk pregnancies. Public awareness about potential adverse effects of consanguineous marriages and the importance of genetic testing are imperative. A structured multidisciplinary team of specialists in fetal medicine, clinical genetics, and neonatology provides good genetic services. Expansion and financial support of these services are urgently required. · A multidisciplinary team provides good genetic services in high-risk pregnancies.. · Parental consanguinity and endogamy are increased among high-risk pregnancies.. · Increased public awareness about genetic testing importance and financial support are imperative..

795 Differences in NIH funding in maternal fetal medicine by gender and rank

The objective of this study is to evaluate the current R01 Equivalent NIH-funded studies holding a "Maternal Fetal Medicine" tag. The goal is to identify the distribution of their principal investigators by profession, gender and rank. This is a cross sectional study that examines the current studies found on the National Institute of Health (NIH) RePORTER website https://projectreporter.nih.gov/reporter.cfm. The projects are examined in September 2020 and include all “Active Projects.” The keyword for the search used is "Maternal Fetal Medicine" and projects included hold an "R01 Equivalent" Activity code. The principal investigators (PIs) of found studies are examined and classified by gender, profession (physician vs non-physician), academic rank (Instructor, Assistant Professor, Associate Professor, Professor), and whether the author is a maternal fetal medicine (MFM) specialist. Through the above mentioned search criteria, 50 studies were identified. 31 (62%) of projects had women PIs whereas 19 (38%) have men PIs. 26 (52%) of studies had PIs who were physicians while 24 (48%) had PIs who were not physicians. Amongst projects with women PIs, 17 (55%) were physicians, and 14 (45%) were not physicians. On the other hand, amongst projects with men PIs, 9 (47%) were physicians, and 10 (53%) were not physicians. Amongst projects with women PIs, 18 (58%) held a professor rank, 7 (23%) held an associate professor rank, and 5 (16%) held an assistant professor rank. On the other hand, amongst projects with men PIs, 14 (74%) held a professor rank, 5 (26%) held an associate professor rank, and none held an assistant professor rank. Only 8 (16%) PIs were identified as maternal fetal medicine specialists and 7 (88%) of MFM PIs were women. Among the active NIH projects with the “Maternal Fetal Medicine” keyword tag , principal investigators were more likely to be women than men. However, men principal investigators were more likely to hold higher academic ranks than their women counterparts. In addition, the minority of principal investigators were maternal fetal specialists.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1121 Comprehensive appraisal of outcomes in singleton pregnancies conceived via in vitro fertilization: US 2016-2018

We set out to better define pregnancy and neonatal outcomes in singleton gestations conceived via in vitro fertilization (IVF). Retrospective analysis of the Centers for Disease Control and Prevention, Natality Live Birth database (2016-2018). All singleton births conceived via IVF comprised the study group while those conceived spontaneously served as controls. Pearson’s chi-square test with Bonferroni adjustment were used to compare baseline characteristics as well as several pregnancy and neonatal outcomes. Multivariate logistic regression was used to adjust outcomes for potential confounders such as maternal age, race/ethnicity, body mass index (BMI), chronic hypertension, pregestational diabetes, and prior preterm birth. Results were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI), and statistical significance was set as P value < 0.05. IVF singleton births comprised 0.84% of the study cohort (83,624 of 9,936,721). Baseline characteristics such as maternal age, BMI, race/ethnicity, pre-gestational diabetes, and smoking varied significantly between the groups (Table 1). IVF pregnancies were associated with several adverse pregnancy and neonatal outcomes including hypertension disorders of pregnancy (aOR 1.73, CI 1.64-1.77), maternal transfusion (aOR 3.12, CI 2.91-3.35), gravid hysterectomy (aOR 2.92, CI 2.47-3.44), maternal ICU admissions (aOR 2.28, CI 2.02-2.56) and preterm deliveries (aOR 1.47, CI 1.44-1.50), as well as adverse neonatal outcomes including low Apgar score (aOR 1.40, CI 1.34-1.47), NICU admission (aOR 1.65, CI 1.61-1.68), prolonged ventilation (aOR 2.18, CI 2.09-2.27), and neonatal seizures (aOR 1.85, CI 1.41-2.42) amongst others (Table 2). We report a significant increase in several adverse pregnancy and neonatal outcomes in singleton pregnancies conceived via IVF compared to those conceived spontaneously. Our data add to the clinical information available regarding pregnancy risks in this population, suggesting that Maternal Fetal Medicine specialist should be involved in the care of patients conceived via IVF.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

568 Non-inferiority of telemedicine vs in-person blood glucose logging among high risk diabetic obstetrical patients

During the COVID19 pandemic, safe distancing required expansion of telemedicine and demonstrated the feasibility of video chat for remote patient encounters. Maternal Fetal Medicine specialists have utilized this technology in conjunction with remote ultrasound for years to provide care to patients outside metropolitan areas. Researchers sought to compare compliance rates for blood glucose log submission among diabetic patients in telemedicine versus in-person visits. Patient compliance with telemedicine has been demonstrated in other areas of medicine, but no previous studies were identified to evaluate diabetic patient compliance when compared to in-person visits. This retrospective cohort study examined patient compliance in weekly blood glucose log submission among diabetic patients followed at Regional Obstetrical Consultants (ROC), an MFM practice in Chattanooga, TN. Inclusion criteria required type 1 or 2 diabetes mellitus or gestational diabetics requiring medications and completed parturition by August 31, 2020. Patients were selected using a randomization algorithm, and data was collected via electronic medical record review. Primary outcome of compliance rate was determined by the number of weeks followed by ROC. Using a non-inferiority trial, the compliance rates for in-person and telemedicine visits were compared. 72 patients were randomized and 57 met inclusion criteria; 28 in-person and 29 telemedicine. The goal blood glucose log submission rate was 60%. Among diabetic patients who attended in-person visits, 50% reached the goal compliance rate, compared to 44.8% of telemedicine attendees. The relative risk of poor compliance in the telemedicine group was 1.10 (95% CI, 0.67-1.81). Telemedicine, however, was non-inferior to in-person visits. Telemedicine has entered the world stage as a safe option for many practitioners and patients. Studies have sought to validate telemedicine and prove noninferiority to in-person visits. We found that telemedicine visits for diabetic obstetric patients were non-inferior when comparing blood glucose submission rates.

A Broader Perspective on the Prenatal Diagnosis of Cornelia de Lange Syndrome: Review of the Literature and Case Presentation.

Cornelia de Lange syndrome (CDLS) is caused by pathogenic variants in genes which are structural or regulatory components of the cohesin complex. The classical Cornelia de Lange (CDLS) phenotype is characterized by distinctive facial features, growth retardation, upper limb reduction defects, hirsutism, and developmental delay. Non-classical phenotypes make this condition heterogeneous. Although CDLS is a heterogeneous clinical and genetic condition, clear diagnostic criteria have been described by specialist consensus. Many of these criteria refer to features that can be seen on prenatal ultrasound. The aim of this paper is twofold: to present the ultrasound findings in fetuses affected by CDLS syndrome; to discuss the recent advances and the limitations in the ultrasound and genetic prenatal diagnosis of CDLS. Our review aims to offer, apart from the data needed to understand the genetics and the prenatal presentation of the disease, a joint perspective of the two specialists involved in the prenatal management of this pathology: the fetal medicine specialist and the geneticist. To better illustrate the data presented, we also include a representative clinical case.