www.AJOG.org Ultrasound, Fetus, Genetics Poster Session I

STUDY DESIGN: We performed a prospective observational study onwomen who were scheduled for induction of labor at >39 weeksgestation. At admission, participants underwent cervical exam todetermine Bishop Score and transvaginal ultrasound to measurecervical length and attenuation. The exam and ultrasound mea-surements were repeated 12 hours after initiation of cervicalripening. Clinical outcomes and demographic data were collected.Comparisons were performed using Sigma Stat.RESULTS: Forty-four women agreed to participation. Mean attenu-ation at admission was 1.13 dB/cm-MHz (� 0.44). Mean attenuation12 hours into cervical ripening was 0.88 dB/cm-MHz (� 0.43).Ultrasound attenuation of the cervix decreased significantly withcervical ripening (Paired t-test p¼0.001). Cervix consistency onBishop Score was not found to correlate with attenuation (PearsonProduct Moment Correlation). Bishop Score and transvaginal cer-vical length also changed significantly over this interval (p<0.001).Attenuation, Bishop Score, and transvaginal cervical length failed topredict mode of delivery.CONCLUSION: Remodeling of cervix tissue during cervical ripeningcan be objectively demonstrated by attenuation measurement. Whilea correlation between consistency and attenuation was not demon-strated, this may reflect the subjectivity in assessment of tissueconsistency by digital exam among different examiners. Furtherstudies are warranted to determine if attenuation may be useful inthe assessment of preterm birth risk and cervix preparedness forlabor induction.

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Association between fetal gender, fetal growth andperinatal outcome, a nationwide cohort studyBart Jan Voskamp1, Myrthe Peelen1, Ben Willem Mol1,Eva Pajrkt1, Wessel Ganzevoort1, Brenda Kazemier11Academic Medical Center, Obstetrics and Gynecology, Amsterdam,Netherlands

OBJECTIVE: To assess whether fetal gender, after adjustment for fetalgrowth, is an independent predictor of fetal death, neonatal deathand neonatal morbidity.STUDY DESIGN: We performed a prospective cohort study using theNetherlands Perinatal Registry. The study population comprised allCaucasian women who delivered a singleton baby between 25+0 and42+6 weeks gestation (1999 to 2007). Fetuses with structural orchromosomal abnormalities were excluded. The Dutch referencecurves stratified by sex and parity were used. Primary outcomes werefetal death, neonatal death (from the onset of labour until 28 daysafter birth), perinatal death (fetal death+neonatal death) and acomposite measure of neonatal morbidity, including IRDS, sepsis,NEC, meconium aspiration, and intracranial hemorrhage. Outcomeswere expressed by birthweight percentile separate for 3 strata ofgestational age at delivery. Multivariable logistic regression analyseswere performed to assess the association between fetal gender andoutcomes.RESULTS: We studied 1,299,244 pregnancies. Fetal death (0.46% vs0.45%), neonatal death (0.18% vs. 0.15%), and composite neonatalmorbidity (1.34% vs. 1.00%) occurred more often in males than infemales. After adjustment for differences in gestational age at de-livery and birthweight percentile, perinatal death did not differ be-tween males and females (OR 1.02, 95%CI 0.98-1.07). However, itappeared that males were less likely to suffer fetal death (Odds Ratio(OR) 0.93, 95% Confidence Interval (CI) 0.88-0.99), but more likelyto suffer neonatal death (OR 1.13, 95%CI 1.03-1.23), compared tofemales. Composite morbidity was more likely to occur in males(OR 1.28, 95%CI 1.24-1.33).

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CONCLUSION: After correction for birthweight percentile and gesta-tional age at delivery, females are at increased risk of fetal death,whereas males are at increased risk of neonatal death and compositeneonatal morbidity. Male gender does not predict perinatal death.

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Association between fetal gender and abnormal fetalgrowthBart Jan Voskamp1, Brenda Kazemier1, Myrthe JCS Peelen1,Ben Willem Mol1, Eva Pajkrt1, Wessel Ganzevoort11Academic Medical Center, Obstetrics and Gynecology, Amsterdam,Netherlands

OBJECTIVE: Previous research has suggested an association betweenfetal gender and abnormal fetal growth. However, adjustment forbirthweight ratio and gestational age at delivery has not been per-formed before. Our objective was to assess whether fetal gender is anindependent predictor of abnormal fetal growth.STUDY DESIGN: We performed a prospective cohort study using theNetherlands Perinatal Registry. The study population comprised allCaucasian women who delivered a singleton between 25+0 and 42+6weeks gestation (1999 to 2007). Fetuses with structural or chro-mosomal abnormalities were excluded. Birthweight ratio was definedas the observed birthweight divided by the median birthweight foreach gestational age. The Dutch reference curves stratified by sex andparity were used. Outcomes were expressed by birthweight ratiosseparate for 4 strata of gestational age at delivery. Primary outcomeswere small for gestational age (SGA) (birthweight ratio �0.85) andlarge for gestational age (LGA) (birthweight ratio �1.2).

We assessed the relation between prematurity and SGA risk.Logistic regression analyses were performed to compare the relationbetween fetal growth of males and females in the different gestationalage strata. A graph was constructed to gain insight in the associationbetween fetal gender, gestational age at delivery and fetal growth.RESULTS: We studied 1,299,244 pregnancies. Prematurity wasstrongly associated with SGA, both in males and females. SGAoccurred in 37.8% (25-28wks), 25.7% (29-32wks), 17.0% (33-36wks) and 9.7% (37-42wks) of births respectively. Males were notmore likely to be SGA compared to females (Odds Ratio (OR) 1.01,95% confidence interval (CI) 0.99-1.02). However, in the pretermperiod (29-32wks and 33-36wks), males were less likely than femalesto be LGA (OR 0.83, 95%CI 0.74-0.92; and OR 0.83, 95%CI 0.79-0.88 respectively).CONCLUSION:Male fetuses are not at increased risk of being SGA, andpreterm females are more often LGA than males.

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Poster Session I Ultrasound, Fetus, Genetics www.AJOG.org

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Prenatal genital measurements as an indicator ofneonatal genital development and exposure to endocrinedisputing compoundsLori Cruze1, Ramsey Unal1, James Kiger2, Jeffrey Korte3,Louis Guillette1, Roger Newman11Medical University of South Carolina, Obstetrics and Gynecology,Charleston, SC, 2Medical University of South Carolina, Neonatology,Charleston, SC, 3Medical University of South Carolina, Public HealthSciences, Charleston, SC

OBJECTIVE: Alterations in neonatal genital measurements have beenassociated with maternal exposure to endocrine disrupting com-pounds (EDC). Our objective is to determine whether ultrasonicgenital measurements obtained in utero can be an early indicator of:1) neonatal genital measurements, and 2) gestational exposure totwo commonly encountered EDCs in humans: phthalates andbisphenol A (BPA).STUDY DESIGN: At 18-22 weeks of pregnancy, penis length (PL) andwidth (PW) were measured (N¼115) by ultrasound and a penilevolume (PV) calculated. After birth, PL, PW, anogenital (AGD) andanoscrotal (ASD) distances were measured on the same newborns.Maternal urine samples were collected at multiple points duringpregnancy to quantify exposure to BPA and phthalate metabolites.RESULTS: We found a significant correlation (p¼0.04) between fetalPL measured at 18-22 weeks and neonatal PL measured shortly afterbirth. Birth weight (BW) was correlated with neonatal measures ofPW (p¼0.0002), AGD (p<0.0001), and ASD (p¼0.04). Thesemeasures were BW normalized to generate a penis width (PWI),anogenital (AGI), and anoscrotal (ASI) index. Correlations werefound between fetal PL and neonatal ASI (p¼0.01) and AGI(p¼0.04), and between fetal PW and neonatal AGI (p¼0.03). Inaddition, fetal PV was correlated with both neonatal ASI (p¼0.02)and AGI (p¼0.009).CONCLUSION: Animal and initial human studies have shown thatphthalate and BPA exposure may have significant developmentaleffects and life-long reproductive implications. Ultrasonic measuresof PL and PW at 18-22 weeks’ gestation correlate significantly withneonatal genital measurements known to be altered by exposureto EDCs. By correlating these measurements with maternal levelsof contaminants we will gain insight into the effects of prenatalEDC exposure on reproductive development. Prenatal genital mea-surements could be useful as an early indicator of altered neonatalgenital development.

S114 American Journal of Obstetrics & Gynecology Supplement to JANUARY

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Ultrasound estimates of fetal lung volume: what is thebest predictor of perinatal outcomes in congenitaldiaphragmatic hernia?Amanda Trudell1, Tasnim Najaf2, Geetika Khanna3, Alison Cahill1,Methodius Tuuli1, George Macones1, Anthony Odibo11Washington University in St. Louis, Obstetrics & Gynecology, St. Louis, MO,2Washington University in St. Louis, Pediatrics Newborn Medicine, St. Louis,MO, 3Washington University in St. Louis, Radiology, St. Louis, MO

OBJECTIVE: To compare four ultrasound estimates of fetal lung vol-ume (FLV) for the prediction of perinatal death and extracorporealmembrane oxygenation (ECMO) use in fetuses with congenitaldiaphragmatic hernia (CDH).STUDY DESIGN: This was a retrospective cohort study of all prenatallydiagnosed CDH cases seen in one institution (1998 -2013). Lung tohead ratio (LHR), observed to expected LHR (O:E LHR), quanti-tative lung index (QLI), and observed to expected contralaterallung area (O:E CLA) were calculated from 2-D US measurements ofthe contralateral lung area. We reviewed prenatal and postnatalrecords for the outcomes of perinatal mortality and the use ofECMO. Univariable analysis was used to determine significantassociations between measures of lung volume and outcomes.Receiver operating characteristic (ROC) curves were developed andthe areas under the ROC curves (AUC) were compared using non-parametric statistics.RESULTS: Among 86 cases of CDH diagnosed prenatally, the peri-natal mortality rate was 51% (N¼44) and 35% (N¼30) requiredECMO. All four measures were poor predicators of perinatal mor-tality and ECMO use (Table/Figure); however, the LHR was superiorto O:E LHR (AUC 0.63 vs. 0.52, P < 0.01) and QLI (AUC 0.63 vs.0.54, P¼0.05) for predicting perinatal mortality. The predictiveability of the four measures for ECMO use were not significantlydifferent (AUC: 0.75, 0.78, 0.78, 0.75, P¼0.57), respectively.CONCLUSION: Overall, ultrasound estimates of FLV perform poorly aspredictors of perinatal outcomes. The LHR is the best predictor ofperinatal mortality among the ultrasound estimates of FLV exam-ined. Further investigation should focus on identifying better pre-dictors of perinatal outcomes in these anomalous fetuses.

ROC curve comparison of FLV estimates for theprediction of perinatal death

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