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566 THE GENDER DOES MATTER EYAL SHEINER1, AMALIA LEVY2, MIRIAMKATZ1, RELI HERSHKOVITZ1, ELAD LERON1, MOSHE MAZOR1, 1SorokaUniversity Medical Center, Ob/Gyn, Beer-Sheva, Israel 2Ben-Gurion Univer-sity of the Negev, Epidemiology and Health Services Evaluation, Beer-Sheva,Israel

OBJECTIVE: To investigate complications and outcomes of pregnancies ofmale versus female fetuses.

STUDY DESIGN: A population-based study comparing all singletondeliveries between the years 1988 and 1999 was performed. A comparison wasdone between pregnancies of male vs female neonates. Patients with a previouscesarean section (CS) were excluded from the study. Statistical analyses, usingthe Mantel-Haenszel technique, and multiple logistic regression models wereperformed to control for confounders.

RESULTS: During the study period there were 55,891 deliveries of malesand 53,104 deliveries of female neonates. Patients carrying male fetuses hadhigher rates of gestational diabetes mellitus (OR = 1.1; 95% CI 1.01-1.12;P = 0.012), fetal macrosomia (OR = 2.0; 95% CI 1.8-2.1; P < 0.001), failure toprogress during the 1st and 2nd stages of labor (OR = 1.2; 95% CI 1.1-1.3; P <0.001 and OR = 1.4; 95% CI 1.3-1.5; P < 0.001; respectively), cord prolapse(OR = 1.3; 95%CI 1.1-1.6; P = 0.014), nuchal cord (OR = 1.2; 95%CI 1.1-1.2; P< 0.001), and true knots of cord (OR = 1.5; 95% CI 1.3-1.7; P < 0.001). Higherrates of cesarean sections (CS) were found amongmales as compared to females(8.7% vs 7.9%, OR = 1.1; 95% CI 1.06-1.16; P < 0.001). Using 3 multivariatelogistic regressionmodels, controlling for birth weight and gestational age,malegender was significantly associated with non-reassuring FHRpatterns (OR = 1.5;95%CI 1.4-1.6; P < 0.001), low Apgar scores at 5minutes (OR = 1.5; 95%CI 1.3-1.8; P < 0.001), and CS (OR = 1.2; 95% CI 1.2-1.3; P < 0.001). Controlling forpossible confounders like gestational diabetes, cord prolapse, failed induction,non-progressive labor, fetal macrosomia, nuchal cord, and true knots of cord,using theMantel-Haenszel technique, did not change the significant associationbetween male gender and CS.

CONCLUSION: Male gender is an independent risk factor for adversepregnancy outcome.

December 2003Am J Obstet Gynecol

S214 SMFM Abstracts

WHAT IS THE ACCURACY OF PRENATAL ULTRASOUND DIAGNOSIS INFETAL CYSTIC KIDNEY DISEASE? JULIO MATEUS1, SILVIA NARNE1,STUART WEINER1, JORGE TOLOSA1, ALEXA HERMAN1, BABU CHEKU1,BRUCE FILMER2, ERNESTO FIGUEROA2, VINCENZO BERGHELLA1,1Thomas Jefferson University, Department of Obstetrics and Gynecology,Philadelphia, PA 2Alfred I. du Pont Hospital for Children, Division ofPediatric Urology, Wilmington, DE

OBJECTIVE: To assess the concordance between prenatal sonographicdiagnosis and prognosis for fetal cystic kidney disease (FCKD) and definitiveurologic postnatal or pathologic diagnosis.

STUDY DESIGN: Cases of FCKD diagnosed in utero by ultrasound at ourinstitution and subsequently evaluated by a urologist at Dupont Children’sHospital or by a pathologist from 1991 to 2002 were retrospectively reviewed.Ultrasound diagnosis was established based on standard classification. Prenataland postnatal prognosis was defined as good, fair, and poor. In pregnancyterminations, only diagnostic accuracy, and not prognosis, was considered.

RESULTS: 28 cases were identified: 11 (39.3%)multicystic dysplastic kidneydisease (MCDKD), 4 (14.3%) autosomal recessive polycystic kidney disease(ARPKD), 3 (11.7%) unilateral MCKD with contralateral urinary malformation,4 (14.2%) cystic kidneys with obstructive uropathy, and 6 (14.3%) cystic kidneysassociated with structural abnormalities and genetic syndromes. 12 (42.9%) hadsimilar bilateral pathology, 5 (17.9%) had unilateral cystic disease withcontralateral urologic malformation, and 11 (39.3%) were unilateral.Oligohydramnios in 5 cases and bilateral cystic disease in 6 were associated100% and 83.3%with fetal loss. The accuracy of prenatal diagnosis confirmed byautopsy report in 10 cases and postnatal urologic diagnosis in 16 was 78%.Misdiagnoses were due to hyperechogenicity of MCDKD interpreted asARPCKD in 2 cases and complex urologic malformations in 4. The prognosisestablished by the perinatologist was concordant in 19 cases (90.4%) with theurologic postnatal diagnosis. Fetal survival rate was 57.1%.

CONCLUSION: The in utero diagnosis and clinical prognosis of FCKDmade by the perinatologist had high accuracy and concordance with the post-natal diagnosis and prognosis made by pediatric urologists. Collaborationbetween pediatric urologists and perinatologists should be further developed tobenefit the affected family.

DOES ANTENATAL MATERNAL ADMINISTRATION OF PHENO-BARBITAL PREVENT EXCHANGE TRANSFUSION IN NEONATES WITHALLOIMMUNE HEMOLYTIC DISEASE? THOMAS TREVETT JR1, KARENDORMAN1, GEORGINE LAMVU2, KENNETH MOISE1, 1University of NorthCarolina at Chapel Hill, Obstetrics/Gynecology, Chapel Hill, NC 2Universityof North Carolina, Chapel Hill, Gynecology, Chapel Hill, NC

OBJECTIVE: Neonatal alloimmune hemolytic disease is associated withkernicterus due to the inefficiency of the neonatal liver to conjugate bilirubin.Neonatal exchange transfusions (EXT) are performed to prevent kernicterus.We hypothesized that administration of phenobarbital (PB) to women with fetalred cell alloimmunization who required serial intrauterine transfusions (IUT)in the week prior to delivery would induce neonatal hepatic maturity andprevent the need for exchange transfusion.

STUDY DESIGN: Cases of alloimmune hemolytic disease of the fetustreated with PUBS/IUT from January 1992 to June 2003 were reviewed.Variables studied were gestational age and hematocrit at first IUT, number oftotal IUTs, delivery hematocrit and bilirubin, peak neonatal bilirubin, hours ofphototherapy, need for exchange transfusion, and maternal PB administration.Multivariable regression analysis was performed to evaluate the impact ofmaternal phenobarbital administration on the need for EXT. Relative risks and95% confidence intervals were calculated.

RESULTS: 106 patients met study criteria. The mean ( ± SD) gestationalage and hematocrit at time of first transfusion were 25.9 ( ± 3.4) wks and 21.3%( ± 8.1), respectively. The median number of IUTs was 3 (range: 1-8 ). 24% ofthe neonates underwent EXT. The use of antenatal PB significantly decreasedthe need for EXT, 9% vs 38% (P = 0.01). After controlling for confoundingvariables, there was an 84% reduction in the need for EXT with exposure toantenatal PB (RR: 0.16, 95% CI: 0.04-0.70).

CONCLUSION: Maternal administration of phenobarbital late in gestationsignificantly reduces the need for neonatal exchange transfusions in hemolyticdisease of the newborn. A prospective randomized trial should be undertaken toconfirm these results.

567 FETAL INTERVENTION MAY BENEFIT FETUSES WITH SEVERE RIGHT-SIDED CDH KUOJEN TSAO1, BENJAMIN WEI2, ROBERT BALL3, DIANAFARMER4, KERILYN NOBUHARA5, MICHAEL HARRISON6, HANMINLEE7, 1University of California, San Francisco, Fetal Treatment Center, SanFrancisco, CA 2Harvard Medical School, Boston, MA 3University ofCalifornia, San Francisco, Obstetrics, Gynecology & Reproductive Sciences,San Francisco, CA 4University of California, San Francisco, Surgery, OB GYN& Pediatrics, San Francisco, CA 5University of California, San Francisco,Surgery and Pediatrics, San Francisco, CA 6University of California, SanFrancisco, Surgery & Pediatrics, San Francisco, CA 7University of California,San Francisco, Surgery, Pediatrics, & OB/GYN, San Francisco, CA

OBJECTIVE: Because most congenital diaphragmatic hernias (CDH) areunilateral and predominantly left-sided, current literature involving fetaltherapy has been limited to left-sided defects. While right-sided defectscomprise < 10% of prenatally diagnosed CDH, their prognosis with or withoutfetal intervention remains unclear. We have reviewed our experience with themanagement of fetuses with right-sided CDH.

STUDY DESIGN: We retrospectively reviewed all CDH cases referred to ourinstitution and evaluated prenatal evaluation, surgical intervention, and post-natal care for all fetuses with right-sided CDH. Fetuses who underwentintervention were compared to fetuses expectantly managed. Statistical analysiswas performed with chi-square and Student’s t-test.

RESULTS: From January 1994 toMay 2002, 187 fetuses prenatally diagnosedwith CDH were identified; 12 (6.4%) were identified with right-sided CDH. Twoof the 12 fetuses were terminated, five with average LHR of 1.0 were expectantlymanaged, and five fetuses with average LHR of 0.6 underwent fetal trachealocclusion. Mean gestational age (GA) of fetal intervention was 26 weeks. MeanGA at delivery was 38 weeks for the expectantly managed group versus 31 weeksfor the fetal intervention group. No fetus who underwent fetal interventionrequired ECMO, while 3 of 5 expectantly managed neonates required ECMO.Two of five fetuses (40%) expectantly managed survived to discharge, while fourof five fetuses (80%) who underwent intervention survived to discharge.

CONCLUSION: Despite the relatively small group of fetuses with right-sided CDH, overall survival with fetal intervention was comparable to left-sidedCDH. Based on prenatal prognostic factors such as LHR, fetuses in the fetalintervention group would have an equally poor prognosis compared to thoseexpectantly managed. Thus, fetuses with severe right-sided CDH with otherwisedismal prognosis may benefit from fetal tracheal occlusion.