table · 2020-04-16 · successful treatment of spontaneous heterotopic pregnancy with ongoing...

TABLE OF CONTENTS

Abstract Title Presenter Category Abstract Poster Use of Dextrose Containing Parenteral Solution in Induction of Labor in Nulliparous and Multiparous Patients

Dr. Megan Avesian AWARD 1 2

Inappropriate prophylactic use of antibiotics in gynecologic surgeries in inner city hospital

Dr. Jacquelyn Boyd AWARD 3 4

Severe fetal academia (umbilical cord pH<7) was poorly predicted by three-tiered fetal heart rate interpretation system.

Dr. Katelyn Brendel AWARD 5 6

Rates of Urinary Tract Infections in Patients who Underwent Hysterectomy

Dr. Nicole Faulkner AWARD 7 8

A Comparison of Estimated Blood Loss (EBL) and Quantitative Blood Loss (QBL) as Predictors of Post-Partum Hemoglobin Change

Dr. Sarah O’Nan AWARD 9 10

Weight gain in pregnancy: Does a women’s misconception of pre-pregnancy weight affect actual weight gain in pregnancy?

Dr. Kelly Park AWARD 11 12

Initial prenatal visit vaginosis screening and its association with adverse pregnancy outcomes at Henry Ford Macomb Hospital.

Dr. Sara Pulito AWARD 13 14

Accuracy of estimated fetal weight in third trimester

Dr. Bertha Vasquez AWARD 15 16

The effect of excessive gestational weight gain on neo-natal outcomes in obese women with a normal estimated fetal weight

Dr. Bertha Vasquez AWARD 17 18

Adenocarcinoma insitu of cervix involving the entire endometrial cavity contiguously without invasion

Dr. Kathleen Ackert Open 19 20

Multi-disciplinary successful treatment of a massively enlarged fibroid

Dr. Amira Alkhatib Open 21 22

Successful treatment of spontaneous heterotopic pregnancy with ongoing intrauterine pregnancy

Dr. Katelyn Brendel Open 23 24

A Late Term Misdiagnosis of Congenital Diaphragmatic Hernia

Dr. Ayesha Hussain Open 25 26

CKD in Pregnancy Earlier Utilization of Daily Dialysis and Addressing Anti-angiogenic Factors of Pre-eclampsia, the Better the Outcomes?

Dr. Ayesha Hussain Open 27 28

Pregnancy complicated by Hyperreacto luteinalis (HL), non-immune hydrops fetalis (NIHF)and Ballantyne syndrome

Dr. Bertha Vasquez Open 29 30

Prenatal diagnosis of vein of Galen Aneurysm

Dr. Bertha Vasquez Open 31 32

2020 2020 POSTER PRESENTATION COMPETITION

Category: AWARD

Use of Dextrose Containing Parenteral Solution in Induction of Labor in Nulliparous and Multiparous Patients Author: Avesian, Megan DO

Institution: Henry Ford Macomb Hospital

Co-authors: Dr. Stephen Redding M.D.

FINAL ABSTRACT: Objective: A study in 2017 (DEXTRANS) trial looked at reducing total labor time in nulliparous women undergoing induction of labor (IOL) by comparing a dextrose containing solution to normal saline in induced nulliparous women, with the primary outcome being total time of active labor. The trial found that the average length of labor was decreased in the dextrose group without adverse effects. The purpose of this prospective cohort study is to determine whether using a dextrose containing solution will shorten time to delivery during IOL in both nulliparous and multiparous women in a community hospital setting. Methods: Women admitted for IOL were given D5LR at 125 mL/hr. Exclusion criteria included patients requiring cervical ripening, patients with diabetes, and any patients on magnesium sulfate. The control population included all inductions from the previous year. Data was obtained via chart review. Results: Total labor time was calculated using the time Oxytocin infusion was started until delivery time. The mean labor times and SD were calculated. Mean time in the non-dextrose group compared to the dextrose group: 495 min and 469 min (p=0.477). Mean labor time in multiparous patients receiving dextrose compared to the non-dextrose group: 441 min and 465 min (p= 0.42) In nulliparous patients times in dextrose group and non-dextrose group: 621 min and 654 min (p=0.83). Conclusions: There is evidence that using dextrose may decrease labor time in IOL and could be considered

1


Category: AWARD

Inappropriate Prophylactic Use of Antibiotics in Gynecologic Surgeries in an Inner City Hospital Author: Boyd, Jacquelyn DO

Institution: SSM Health - St. Anthony Hospital

Co-authors: Kristin Kniech, DO, SSM Health - St. Anthony Hospital

FINAL ABSTRACT: As antibiotic resistance is an increasing healthcare issue, promotion of antibiotic stewardship within hospitals has led to research into their proper use. The American College of Obstetricians and Gynecologists (ACOG) has specific recommendations for antimicrobial prophylaxis prior to gynecologic procedures. We hypothesized that patients in an inner-city hospital in Oklahoma City, Oklahoma undergoing gynecologic procedures were receiving prophylactic antibiotics that were otherwise not indicated for their surgery. A retrospective chart review was performed from July, 2017 to June, 2018. 314 surgeries were performed in this time and 169 cases met inclusion criteria as gynecologic procedures with no indication for antimicrobial prophylaxis. Of the 169 included cases, 98 (57.99%) revealed antibiotics were inappropriately given (p<0.5). The most common procedure in which misuse was noted were laparoscopic procedures without entry into the bowel or vagina, composing 61.2% of cases. Cefazolin was the most frequently used medication and was given in 84.7% of the cases. These results reflect the overuse of antibiotics for surgical prophylaxis, which contributes to increasing antibiotic resistance in women undergoing elective gynecologic procedures. Overall, this is hindering the progressive movement towards promotion of antibiotic stewardship. We hope that these study results will limit the misuse of antibiotics in a hospital setting, and specifically in surgical specialties.

3


Category: AWARD

Severe fetal acidemia (umbilical cord arterial pH < 7) was poorly predicted by the three-tiered fetal heart rate interpretation system (Category I, II, and III) Author: Brendel, Katelyn DO

Institution: Einstein Medical Center Philadelphia

Co-authors: Sarah Gan, MD, Chase White, MD, Jay Goldberg, MD, David Jaspan, DO

FINAL ABSTRACT: The purpose of this study was to evaluate EFM during the hour prior to birth in babies born with an umbilical cord arterial pH < 7 for predictors of severe acidemia. A retrospective cohort study was performed on babies with umbilical cord arterial pH < 7. The last hour of EFM was reviewed. Maternal, neonatal, labor and delivery characteristics were compared using the Chi-squared test for independence and the Fisher’s Exact Test. Thirty babies were identified with umbilical cord arterial pH < 7. 27%, 73%, and 0% of FHTs during the last hour of EFM of babies with severe acidemia were Category I, II, and III, respectively. 85% and 54% of the severely acidemic babies had moderate variability and accelerations, respectively. Only 8%, 8%, 19%, and 15% of severely acidemic babies had fetal tachycardia, fetal bradycardia, recurrent variable decelerations or recurrent late decelerations, respectively. Delivery was expedited only in the presence of recurrent late decelerations. The presence of a Category I tracing, moderate variability or accelerations was falsely reassuring such that delivery was less likely to be expedited.

5

2020

2020 POSTER PRESENTATION COMPETITION

Category: AWARD

Accuracy of Estimated Fetal Weight in the Third Trimester Author: Hussain, Ayesha DO Institution: UPMC Pinnacle Harrisburg Co-authors: Bertha Vasquez, Andrea Sebright, Terry Tressler, Claudia Taboada

FINAL ABSTRACT: OBJECTIVE: Determine if fetal growth scans performed at/after 37 weeks gestation can give an accurate EFW to help to guide antenatal management and delivery recommendations. Accepted margin of error between EFW and ABW is 15%. EFW is considered acceptable, for delivery management within 10%. METHODS: Retrospective descriptive qualitative study of 1785 cases where EFW within 3 weeks of delivery was compared with ABW. Significant difference between EFW and ABW was tested by paired t-test. Pearson's correlation used to detect significant linear relationship between EFW and ABW. Difference in error rates among the weight categories and GA categories assessed by chi-square test. p-value < 0.05 considered statistically significant. RESULTS: Error rate of <15% was 81%, 86% and 83% for ABW of <2500 gm, >2500 gm to <4000gm, and >4000gm respectively. Error rate of <10% was 66% for ABW of <2500 gm and >2500 gm to <4000 gm and 65% for ABW of >4000 gm. Error rate of <5% was 41%, 38% and 37% for ABW of <2500 gm, of >2500 to <4000 gm of >4000 gm respectively. Error rates of <15% <10% and <5% for GA of 37 to 40 weeks was 86%, 68% and 38% respectively. Error rate of <15% for GA of <37 weeks was lower compared to the GA in other categories. CONCLUSION: Estimated fetal weight measurements at/after 37 weeks may be considered accurate; error rate is below the acceptable rate of <15%. With increasing gestational age and increased ABW, our EFW are within acceptable error rates.

7

2020


Category: AWARD

A Comparison of Estimate Blood Loss (EBL) and Quantitative Blood Loss as Predictors of Postpartum Hemoglobin Change Author: O'Nan, Sarah DO Institution: Henry Ford Wyandotte Hospital Co-authors: Salvatore Finazzo, DO Henry Ford Wyandotte Hospital

FINAL ABSTRACT: Objective: To determine whether quantitative blood loss is more effective than estimate blood loss in predicting changes in hemoglobin levels associated with cesarean delivery.

Study Design: Data collected included EBL, QBL and lab-measured pre- and post-delivery hemoglobin levels which were compared to blood loss determined by QBL and EBL in patients who had undergone cesarean deliveries. This was a retrospective chart review performed at Henry Ford Wyandotte and Henry Ford Hospital from January - May 2019. Pearson correlation coefficients were calculated for evaluating the relationship between EBL and change in hemoglobin, and QBL and change in hemoglobin. Hemoglobin changes were measured as post-cesarean hemoglobin minus pre-cesarean hemoglobin. Statistical significance was set at p<0.05. Analyses were performed using SAS 9.4.

Results: The two blood loss groups were treated independently. Both QBL and EBL had weak correlations with changes in hemoglobin as shown by the correlation coefficients of r=-0.07 and 0.02, respectively. There was a very weak negative correlation between QBL and hemoglobin change and a weak positive correlation between EBL and hemoglobin change. A Z-test was conducted to measure any difference in magnitude or strength between the two correlations without regard to positive or negative slope direction.

Conclusion: There is insufficient evidence to suggest that one measure of blood loss is superior (more highly correlated) with hemoglobin change.

9

2020


Category: AWARD

Weight Gain in Pregnancy: Does a woman's misconception of pre-pregnancy weight affect actual weight gain in pregnancy? Author: Park, Kelly DO Institution: Rowan SOM Co-authors: Maria Nguyen DO, Xinhua Chen MD, MSCE, Sarah Bechay MS-4

FINAL ABSTRACT: Aims: We examined the relationship between pregnant women’s perception of weight status and awareness of an appropriate gestational weight gain (GWG). The influence of provider counseling on GWG was also evaluated.

Methods: 100 participants were recruited in a community hospital. Participants’ knowledge was assessed by a survey postpartum. Four categories were created with combination of inaccurate and accurate knowledge, with and without provider counseling. The main outcome was GWG defined by the IOM guidelines. Univariate and multivariate analyses were performed by SAS. Covariates included age, parity, education, smoking status, marital status and ethnicity.

Results: The baseline characteristics:: Caucasians 68%, age 29.0±5.2 (yr.), college education 62%, pre-pregnant BMI 28.4±7.9, overweight 23%, obese 36%. 38% of women received provider counseling. 49.5% of the women had excessive GWG. The proportion of excessive GWG was higher in women of inaccurate (52-60%) vs. accurate (42-47%) knowledge with and without counseling but the difference was not significant (p=0.84); Obese women were more likely to be in the inaccurate knowledge group regardless of whether they received counseling or not (55% vs 20%) as compared to the accurate knowledge group (p<0.0001) . The odds ratio adjusted for age, parity and smoking was 4.65 (95% confidence interval 1.89-11.45, p<0.001).

Conclusions: Women who accurately assessed their BMI and received counseling did have lower prevalence of excessive GWG. Inadequate knowledge was associated with more obesity. Our results underscore the importance of larger studies and the need for more education and standardized provider counseling on weight gain to reduce excessive gestational weight gain.

11

2020


Category: AWARD

Initial Prenatal Visit Vaginosis Screening and its association with adberse pregnancy outcomes at Henry Ford Macomb Hospital Author: Pulito, Sara DO Institution: Henry Ford Macomb Hospital Co-authors: Steven Ferrucci, MD

FINAL ABSTRACT: Objective: Bacterial vaginosis is diagnosed in 15-20% of pregnant women and is the most common infection in preterm labor. The purpose of this study is to determine the effect of a vaginosis screen on patients at their initial prenatal appointment on preterm labor, PPROM, PROM and developing chorioamnionitis.

Methods: A retrospective chart review was performed on patients of two physicians at Henry Ford Macomb Hospital. Their charts were reviewed. Data recorded included initial obstetric appointment, gestational age at first visit, and if a vaginosis screen was performed, result, and treatment. Additional data included preterm labor, PPROM (preterm premature rupture of membranes), PROM (premature rupture of membranes), chorioamnionitis, and postpartum endometritis.

Results: 790 patients were included, 475 had no vaginosis screen, 241 of the patients had a screen done with negative results, 48 patients had a screen done with positive results and treated, 26 patients had vaginosis screen done with positive results and no treatment. The rate of preterm labor was higher in the group that had positive vaginosis screen resulted and were treated.

Conclusion: There was no statistically significant difference among vaginosis screen results, and treatment groups in PPROM and PROM and development of chorioamnionitis.

13

2020


Category: AWARD

Predictors of expedited delivery in the presence of severe fetal acidemia (umbilical cord arterial pH < 7) Author: Brendel, Katelyn DO Institution: Einstein Medical Center Philadelphia Co-authors: Sarah Gan, MD Chase White, MD Jay Goldberg, MD David Jaspan, DO

FINAL ABSTRACT: The purpose of this study was to determine which characteristics of EFM in babies with severe acidemia (umbilical cord arterial pH <7) affected whether delivery was expedited or not. A retrospective cohort study was performed on babies with umbilical cord arterial pH <7. Two groups were identified: (1) expedited delivery (either operative vaginal delivery or urgent/emergent cesarean section) and (2) non-expedited delivery (spontaneous vaginal delivery, scheduled or non-urgent cesarean section). Maternal, labor, and neonatal characteristics between the groups were compared using Chi-squared test for independence and the Fisher’s Exact Test. Thirty neonates with umbilical cord pH <7.0 were identified. Of these, 47% were delivered in expedited fashion. There was no statistical difference between groups in average umbilical cord arterial pH or base excess, gestational age, if labor was induced, length of labor, Pitocin usage for labor augmentation, sentinel events, 5 minute Apgar score or neonatal length of stay. Recurrent late decelerations were more likely to be present in the expedited delivery group (31% vs. 0%), while moderate variability (100% vs. 69%), accelerations (77% vs. 31%), and category I tracing (46% vs. 8%) were more common in the non-expedited group.

15

2020


Category: AWARD

The Effect of Excessive Gestational Weight Gain on Neonatal Outcomes in Obese Women with a Normal Estimated Fetal Weight Author: Vasquez, Bertha DO Institution: UPMC Pinnacle Harrisburg MFM Co-authors: Ayesha Hussain Terry Tressler Claudia Taboada Andrea Sebright Yijin Wert Michael Muench

FINAL ABSTRACT: OBJECTIVE:Study effect of excessive gestational weight gain (EGWG) on neonatal outcomes in obese women with normal estimated fetal weight (EFW) delivered at term. METHODS:A multicenter observational retrospective cohort study using electronic chart review of obese women delivered at term from Oct 2016 to Jun 2019 in UPMC Pinnacle hospitals with a fetal growth ultrasound within 3 weeks of delivery with EFW within 2500 to 4500 grams. Obese women with normal EFW were compared on basis of weight gain. EGWG is defined as weight gain of more than 20lbs during pregnancy by the IOM. Neonatal outcomes included NICU admission and APGAR scores. Second analysis was conducted on the same population including fetuses with EFW consistent with macrosomia or fetal growth restriction. RESULTS: Obese women with normal EFW who had EGWG had a significantly higher rate of NICU admissions. Fetal growth patterns had no significant effect on the rate of NICU admissions. Despite a normal EFW, biometric fetal measurements were significantly larger and HC/AC ratio was significantly smaller in obese women who had EGWG. Despite the amount of gestational weight gain, no significant difference in fetal growth patterns or APGAR scores in obese women. No significant difference in age, race or co-morbidities between study groups. CONCLUSION: Obese women with EGWG and a normal EFW within 3 weeks of delivery have an increased risk of a NICU admission. No significant differences in maternal co-morbidities.

17

2020


Category: AWARD

Postoperative Urinary Tract Infection Rates in Patients who Underwent Hysterectomy Author: Faulkner, Nicole DO Institution: Henry Ford Macomb Hospital Co-authors: Dr. Andrew Agosta

FINAL ABSTRACT: Objective: Among patients who underwent hysterectomies, we assessed the rates of postoperative urinary tract infections and whether any associations exist between type of hysterectomy or additional procedures performed (including anterior repair, bladder sling, or cystoscopy) on postoperative UTI rates.

Methods: Retrospective chart review for hysterectomies completed at Henry Ford Macomb Hospital 1/1/2016 to 1/1/2018 (n = 565). EMR was reviewed to determine procedures performed and media utilized for cystoscopy. Postoperative UTIs were defined as those diagnosed and treated within 30 days of surgery.

Results: Primary outcome revealed statistical significance between rates of UTIs among different hysterectomy types. Highest rates of UTIs with total vaginal hysterectomy (TVH) 22.9%. Statistical significance between TVH vs TAH (p = 0.001) and TVH vs RATH (p = 0.001). Secondary outcome analyzed type of distention media used for cystoscopy, statistical significance between omission of cystoscopy and use of D10 (p = 0.014). Lastly, concomitant procedures: bladder injury (p = 0.003), anterior repair (p = 0.001), and bladder sling procedures (p = 0.001) all significantly increased UTI rates.

Conclusions: Among hysterectomies evaluated in this study there was a significant difference in rates of UTIs with the highest rates after TVHs. Increased rates of infection were found when cystoscopy, anterior repair, bladder sling procedure, or bladder injury occurred.

19

2020


Category: OPEN

Multi-disciplinary successful treatment of a massively enlarged prolapsing fibroid Author: Alkhatib, Amira DO Institution: Albert Einstein Healthcare Network Co-authors: Jay Goldberg, MD David Jaspan, DO Shuchi K. Rodgers, MD Paul S. Brady, MD

FINAL ABSTRACT: Introduction: A massively enlarged prolapsing fibroid causing prolonged menses, severe anemia, and pelvic pressure is a therapeutic challenge due to anatomic distortion and surgical risks. Case: A 48-year-old woman presented with daily vaginal bleeding and pelvic pressure for years. She had been transfused for a hemoglobin of 2.4 mg/dl, increasing to 10 mg/dl. Ultrasound and MRI noted a highly vascular, 20 cm fibroid prolapsing through her cervix and severe hydronephrosis. On examination, she had a 25-week sized uterus with a large mass filling her vagina. Vaginal myomectomy was recommended. Due to concern for hemorrhage, pre-operative uterine fibroid embolization (UFE) was recommended. In case surgical hemorrhage still occurred, requiring exploratory laparotomy and hysterectomy, pre-operative ureteral stenting was recommended due to significantly distorted anatomy and risk of ureteral injury. The day following UFE by interventional radiology, she entered the OR. Bilateral ureteral stents were placed by urology with difficulty due to the prolapsing fibroid distorting visualization of the bladder’s ureteral orifices. The vaginal myomectomy was performed on the 20+ cm fibroid using scalpel morcellation, removing the fibroid in multiple pieces. EBL was 50 cc. She was discharged to home. The ureteral stents were later removed. She had an uneventful recovery. Conclusions: Pre-op UFE and vaginal myomectomy with scalpel morcellation successfully and safely treated this patient.

21

2020


Category: OPEN

Successful treatment of a spontaneous abdominal heterotopic pregnancy, with an ongoing intrauterine pregnancy Author: Brendel, Katelyn DO Institution: Einstein Medical Center Philadelphia Co-authors: Katelyn Brendel, DO Laurel Garber, DO Kate Stampler, DO David Jaspan, DO Jay Goldberg, MD

FINAL ABSTRACT: This is a rare case of a live abdominal heterotopic pregnancy at 11 weeks and 6 days, where the intrauterine pregnancy survived after removal of the ectopic. A 33-year-old gravida 1, para 0 at 11 weeks and 1 day by LMP consistent with a 7-week ultrasound presented with sudden onset abdominal pain. Transvaginal ultrasound showed two pregnancies at 11 weeks and 6 days with cardiac activity, one intrauterine and an ectopic of unclear location. MRI noted that the ectopic pregnancy was located superior to the uterus and surrounded by blood products and bowel. Diagnostic laparoscopy visualized abundant clotted blood adhered to the anterior abdominal wall in the pelvis. A laparotomy was then performed, complicated by significant hemorrhage while attempting to remove the ectopic. The ectopic pregnancy was able to be removed and hemorrhage controlled. The intrauterine pregnancy is still viable and ongoing. Heterotopic pregnancy is exceedingly rare. The ectopic pregnancy was missed on the initial ultrasound performed at an outside clinic. Transvaginal ultrasound has low sensitivity and specificity in abdominal pregnancies. In stable patients, MRI is a useful diagnostic modality to assess for placental adherence and aid in surgical planning. About one-third of heterotopic pregnancies treated surgically result in miscarriage of the intrauterine pregnancy. Our patient had a successful procedure for removal of her abdominal ectopic and survival of her highly desired intrauterine pregnancy.

23

2020


Category: OPEN

A Late Term Misdiagnosis of Congenital Diaphragmatic Hernia Author: Hussain, Ayesha DO Institution: UPMC Pinnacle Harrisburg Co-authors: Bertha Vasquez DO Andrea Sebright DO Terry Tressler DO Claudia Taboada DO

FINAL ABSTRACT: Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that allows abdominal viscera to herniate into the chest. CDH is rare, 1-4:10,000 live births. Herniation occurs during a critical period of lung development, resulting in increasing degrees of pulmonary hypoplasia. Affected neonates usually present with respiratory distress that ranges from mild to incompatible with life. Survival has improved with antenatal diagnosis, neonatal care, and surgical management.

There is a wide differential diagnosis for CDH, including pulmonary thoracic lesions and congenital pulmonary airway malformation (CPAM) of the lung.

This case report describes a 22 year old G2P1001 with left‐sided CDH that was misdiagnosed as a CPAM with displacement of heart up until a third trimester transfer from another facility. A preliminary scan revealed similar findings to the outside facility but not only was the left heart shift noted, there was bowel and kidney displacement. After a few scans confirming peristalsis of small bowel in the left chest, MRI was used to officially diagnosis a large left CDH with small bowel and the superior left kidney in the left hemithorax, with no evidence of CPAM.

Patient was transferred to a tertiary facility for continued prenatal care, delivery, and postnatal management of CDH. Making the correct diagnosis to dictate management can be essential for neonatal survival.

25

2020


Category: OPEN

CKD and Pregnancy – Earlier Utilization of Daily Dialysis and Addressing Antiangiogenic Factors of Pre-eclampsia, the Better the Outcomes? Author: Hussain, Ayesha D.O. Institution: UPMC Pinnacle Harrisburg Co-authors: Bertha Vasquez, DO Andrea Sebright, DO Terry Tressler, DO Claudia Taboada, DO

FINAL ABSTRACT: The prevalence of chronic kidney disease (CKD) is rising, and may affect 3% of women in their childbearing years. CKD is a challenge for pregnancy. Preexisting CKD of any stage impacts upon maternal and perinatal outcomes.

Summary: 32 year old G1P0 with IUP at 22w3d presented to MFM office with significant history of CKD Stage 3-4 (with Creatinine 3.01, BUN 42, EGFR <30) and Chronic HTN on 2 antihypertensive medications. Patient’s late presentation was complicated with Preeclampsia with severe features due to elevated liver enzymes, proteinuria, thrombocytopenia, and fetal growth restriction with abnormal umbilical artery Doppler and polyhydramnios

This patient was followed in the hospital with BP monitoring and Rx for control (Labetolol, Procardia XL, Aldomet). Daily dialysis was completed to maintain a BUN in a normal range secondary to finding initial hydramnios for the fetus and suspicion for fetal urea osmotic diuresis. BP patterns worsened during hospital course due to worsening pre-eclampsia with baseline endothelial dysfunction, placental vascular remodeling, and increase in antiangiogenic factors including fms-like tyrosin kinase 1 (sFlt) causing vasoconstriction and endothelial dysfunction. Aldomet worked well with controlling her blood pressures post dialysis, decreasing her risk of delivery that day and possibly decreasing sFLT levels which would in turn decrease the amount of placental and maternal endothelial dysfunction.

27

2020


Category: OPEN

Pregnancy complicated by hyperreactio luteinalis (HL), non-immune hydrops fetalis (NIHF), maternal hyperthyroidism and Ballantyne syndrome: A Case Report Author: Vasquez, Bertha DO Institution: UPMC Pinnacle Harrisburg MFM Co-authors: Ayesha Hussain, Isha Shrimanker, John Mantione, Terry Tressler, Claudia Taboada

FINAL ABSTRACT: Objective:Improve familiarity of HL features to avoid unnecessary surgical intervention, reducing surgical and reproductive morbidity. Methods:Report a case of enlarged bilateral ovarian cysts, hyperthyroidism, NIHF and Ballantyne syndrome in the 2nd trimester. Case Description: Patient presented at 14 weeks gestation with nausea and vomiting with unremarkable history. Ultrasound showed septated cystic hygroma, NIHF, placentomegaly and normal ovaries. NIPS and infection evaluation were ordered; both negative. 17 weeks: surgical intervention recommended due to rapidly enlarging complex left ovarian mass, worsening pain and development of vasomotor symptoms. 18 weeks: multicystic, enlarged right ovary measuring 11x10x8cm developed. hCG at 847,600mIU/mL. Amniocentesis performed; normal male karyotype and microarray. Planned left oophorectomy canceled. Methimazole initiated for new onset hyperthyroidism. 19 weeks: finding of placentomegaly, abnormal UA doppler study, 12x8x7cm left ovary, 11x8x8cm right ovary, hypertension, proteinuria, anemia, and low albumin. Ballantyne syndrome was diagnosed; delivery recommended. Non-viable male infant weighing 545g delivered. Autopsy showed large bilateral cystic hygroma, hydrops and large placenta. 4 weeks PP: normal TSH level. Six weeks PP: right ovarian cyst resolved and left ovarian cyst measured 3 cm. 14 weeks PP: hCG level was at 1.4mIU/mL. Conclusion:Improved familiarity of HL may help reduce surgical and reproductive morbidity.

29

2020


Category: OPEN

Prenatal Diagnosis of Vein of Galen Aneurysm: A Case Report Author: Vasquez, Bertha DO Institution: UPMC Pinnacle Harrisburg MFM Co-authors: Ayesha Hussain Isha Shrimanker Claudia Taboada Terry Tressler

FINAL ABSTRACT: Objective: Improve familiarity of prenatal presentation of VGAM to aid in identification of prenatal prognostic indicators to improve appropriate parental counseling and antenatal management. Methods:Report a case of prenatally diagnosed VGAM at 25 weeks gestation. Case: Fetal ultrasound at 25 weeks revealed a midline brain vascular abnormality suspicious for an arteriovenous malformation versus hemangioma vs VGAM. Evaluation at outside institution showed ultrasound findings significant for hepatomegaly, thickened placenta with placental lakes, elevated cardiac output (CO), dilated heart, and dilated left internal jugular vein, left carotid artery, and superior vena cava. Fetal MRI showed a VGAM at midline superior to the third ventricle and enlargement of the straight, bilateral transverse, and bilateral sigmoid sinuses. Serial ultrasound monitoring for hydrops and assessment of CO was initiated. Delivery at the outside institution was planned. At 33 weeks there was elevated CO, holodiastolic flow reversal in the aortic arch, moderately dilated right atrium, and trivial tricuspid regurgitation. At 36 weeks, patient delivered a male infant with a murmur and cranial bruit and respiratory distress at Harrisburg Hospital. Infant was transferred to the outside institution and subsequently deceased. Conclusion: VGAM is not well understood. Variables suggested as prognostic of poor outcomes have been based on small series or anecdotal descriptions from case reports.

31

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table · 2020-04-16 · successful treatment of spontaneous heterotopic pregnancy with ongoing...

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