Transabdominal and transcervical chorionic villus sampling models to teach maternal-fetal medicine fellows.

OBJECTIVE: Many fellowship programs in maternal-fetal medicine (MFM) lack sufficient exposure and training in chorionic villus sampling (CVS). We describe a novel training model of transabdominal and transcervical CVS. METHODS: A porcine heart simulated a 12-week human uterus with a cervical canal created at the apex of the heart. A piglet was placed within a water-filled condom, which was placed inside the "uterus." A second water-filled condom simulated a maternal bladder. Fresh human placenta was placed between the condom and uterine wall. A zipper-sealed freezer bag with ultrasonic gel simulated an abdominal wall. Transabdominal ultrasound was utilized with this model to perform CVS. RESULTS: The design involved four MFM specialists and three fellows. Twenty-three faculty MFM specialists and eight MFM fellows endorsed the fidelity of both models. One hundred percent of attendees of a procedural workshop agreed that these models could be used to teach proper technique to fellows and faculty. CONCLUSION: We report a novel training model for transabdominal and transcervical CVS to teach proper technique in a nonclinical setting.

Ultrasound findings in trisomy 22.

We sought to identify the characteristic sonographic findings of fetal trisomy 22 by performing a retrospective review of nine cases of fetal trisomy 22. All cases of chromosomal mosaicism were excluded, as were first-trimester losses. Indications for sonography, gestational age, and sonographically detected fetal anomalies were analyzed. The majority of patients were referred for advanced maternal age or abnormal ultrasound findings on screening exam. Oligohydramnios was the most common sonographic finding, present in 55% of affected fetuses. Intrauterine growth restriction and increased nuchal thickness were slightly less frequent.

Sonographic findings in trisomy 9.

OBJECTIVE: The purpose of this study was to identify the most common prenatal sonographic findings in fetuses with complete trisomy 9. METHODS: A retrospective review of all cases of trisomy 9 at 5 participating institutions over a 15-year interval was conducted. Indications for referral and sonographic findings in each case were reviewed to identify characteristic fetal structural anomalies. RESULTS: Six cases of trisomy 9 are presented. Most patients were referred for abnormal sonographic findings on screening examinations (66%) or advanced maternal age (33%). Fetal heart defects and central nervous system malformations were the most frequent sonographic anomalies seen. CONCLUSIONS: Sonographic findings in trisomy 9 are similar to those found in other autosomal trisomies. Because trisomy 9 is uniformly lethal and is not included as part of the standard prenatal aneuploidy screening by fluorescence in situ hybridization analysis, clinicians should be cautious in counseling patients with structurally abnormal fetuses until the full karyotype is available.

Modifiable risk factors for growth restriction in twin pregnancies.

OBJECTIVE: This study was undertaken to evaluate modifiable risk factors for adverse fetal growth in twin pregnancies. STUDY DESIGN: A large cohort study from a database of women with twin gestations identified at risk for preterm labor was performed. Examining each infant's birth weight and gestational age at delivery, infants were classified as being average (AGA), large (LGA), or small (SGA) for gestational age, using the Alexander reference curve. Clinical and demographic factors were compared between patients delivering at least 1 SGA infant and AGA pairs using Pearson's chi2 Student t test statistics and logistic regression. RESULTS: There were 11,827 twin pregnancies evaluated. Risk factors associated with SGA deliveries included tobacco abuse, poor weight gain, lean prepregnancy body mass index, African American race, and nonmarried. The logistic regression identified tobacco abuse as the single greatest risk for poor fetal growth, (odds ratio [OR] 1.95; 95% CI [1.68, 2.27]). Weight gain of less than one-half lb/wk also increased SGA risk (OR 1.35; 95% CI [1.16, 1.68]), whereas weight gain greater than 1 lb/wk decreased SGA risk (OR 0.77; 95% CI [0.68, 0.86]). CONCLUSION: Tobacco abuse and weight gain are the modifiable risk factors, which require intervention during a twin pregnancy. Patients should be encouraged to stop tobacco abuse and gain a minimum of one-half lb/wk in the later half of pregnancy to minimize the risk for growth restriction.