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Average accuracy results

AmplitudeDifference (bpm)

CorrectCategory (%)

Paper Ruler Paper Ruler..........................................................................................................................................................................................

Experts -1.1 � 2.8* .3 � 4.4 76 � 12 71 � 9..........................................................................................................................................................................................

Non-experts .7 � 4.1 1.1 � 5.1 73 � 10 75 � 10..........................................................................................................................................................................................

698 Fetal demise and prior non-stress testingn pregnancies affected by diabetess. other indications for testing

Lisa Gray1, Temitope Oshodi2, Eva K.ressman1, Loralei L. Thornburg1

1University of Rochester, Rochester, NY, 2University of Rochesterchool of Medicine and Dentistry, Rochester, NY

OBJECTIVE: To evaluate the use of antenatal surveillance by non-stressesting (NST) among patients with diabetes compared to other indi-ations and subsequent intrauterine fetal demise (IUFD).

STUDY DESIGN: Retrospective cohort review of all non-anomalousIUFD beyond 32 weeks gestation delivered from 1998 and 2009 at asingle institution. All non-diabetic patients with indications for NSTwere compared to those with known diabetes. Adequate fetal surveil-lance was defined as a reactive NST or a non-reactive NST with a BPP� 8/10 within 7 days.RESULTS: Of 26 patients with IUFD and indicated testing, only 11

atients (42%) had adequate surveillance within 7 days. Primary in-ication for NST among 13 non-diabetics included chronic hyperten-ion (4), hypertensive disorders of pregnancy (2), growth restriction2), prior IUFD (1), post dates (1), abruption (1) and other (2). Thereas no difference in rates of adequate fetal surveillance in diabetic

7/13, 53%) versus non-diabetic patients (4/13, 30%), p�0.4, how-ver, 100% of diabetic patients had a least one NST prior to IUFD,ompared to 46% (6/13) of non-diabetic patients (p�0.01). Amonghose patients undergoing at least one NST, 67% (4/6) of non-diabeticnd 53% (7/13) of diabetic patients had adequate surveillancep�0.99). Median time from NST to diagnosis was 6 days amongiabetic and 9 days among non-diabetic patients. Power was limited,ith an 80% power to detect differences in adequate surveillance ofore than 50% between groups at the current sample size.

CONCLUSIONS: Adequate fetal surveillance was not predictive of de-ise in 53% of diabetic patients and 30% of non-diabetic patients.espite the presence of indications, most patients with IUFD under-ent inadequate fetal surveillance, regardless of diabetic status. Moreiabetics received at least some fetal surveillance than those patientsith other indications, which may indicate a need for provider edu-

ation. Identifying and resolving barriers to antenatal testing in highisk populations is clearly needed.

699 Perinatal outcome in pregnancies complicated bysolated oligohydramnios prior to 37 weeks of gestation

Nir Melamed1, Eran Hadar1, Avi Ben-Haroush2, Josephardo1, Rony Chen1, Moshe Hod1, Yariv Yogev1

1Helen Schneider Hospital for Women, Petach Tikva,2Helen Schneider Hospital for Women, Sackler Faculty

f Medicine, Tel Aviv University, Petach TikvaOBJECTIVE: Optimal management in cases of isolated oligohydram-

ios is a matter of controversy, moreover, data is limited regardingsolated oligohydramnios� 37 weeks of gestation. Thus, we aimed toompare pregnancy outcome in cases of isolated oligohydramnios atreterm with that of low-risk pregnancies with normal amount ofmniotic fluid.

STUDY DESIGN: A retrospective cohort study. The study group in-luded all singleton pregnancies with isolated oligohydramnios (AFI

5 cm) prior to 37�0 weeks of gestation (n�108). Control group:ow-risk pregnancies with normal amount of amniotic fluid matched

y gestational age and parity in a 3:1 ratio (n�324). w

Supplem

RESULTS: 1) The mean gestational age at diagnosis was 34.9�2.0 weeks.) When compared to controls, pregnancies in the study group wereharacterized by a higher overall rate of preterm delivery (26.9% vs. 12.3,�0.001), most of which was iatrogenic (82.8%), a higher rate of labor

nduction (50.0% vs. 9.6%, p�0.001), and a higher rate of CS (47.2%s.16.9%, p�0.001). 3) Neonates in the study group were characterizedy a lower birthweight (2762�371 vs. 3056�539, p�0.001), higher ratef transient tachypnea of the newborn (8.3% vs. 2.2%, p�0.003), andere admitted more often to NICU (11.1% vs. 4.9%, p�0.02). Impor-

antly, these differences were eliminated when analysis was limited to theubgroup of pregnancies with isolated oligohydramnios that were man-ged conservatively and delivered spontaneously at term. 4) There was noifference between study and control groups in the rate of new onset ofreeclampsia (1.9% vs. 2.2%, p�0.8) and new onset of fetal growth re-triction (7.4% vs. 6.2%, p�0.7). 5) In 9 of the women in the isolatedligohydramnios (8.3%) the level of amniotic fluid was found to be nor-alized on subsequent examinations.

CONCLUSIONS: A significant proportion of adverse maternal and neo-atal outcome in cases of isolated oligohydramnios prior to 37 weeksf gestation appears to be related to iatrogenic prematurity, despite

ack of evidence that conservative management increases the risk ofdverse pregnancy outcome.

700 The accuracy of sonographic fetal weight estimationn cases of breech presentation-how accurate we are?

Nir Melamed1, Yariv Yogev1, Avi Ben-Haroush2,euven Mashiach1, Israel Meizner1, Joseph Pardo1

1Helen Schneider Hospital for Women, Petach Tikva,2Helen Schneider Hospital for Women, Sackler Faculty

f Medicine, Tel Aviv University, Petach TikvaOBJECTIVE: To determine the accuracy of sonographic estimated fetal

eight (EFW) for fetuses in breech presentation and to compare it tohat of fetuses in the vertex presentation

STUDY DESIGN: A total of 3,174 sonographic EFW performed within 3ays prior to delivery. Fetal weight was estimated by 8 different sono-raphic models based on different combinations of the following: ab-ominal circumference (AC), femur length (FL), biparietal diameterBPD) and head circumference (HC). The EFW was than comparedith the actual birthweight.

RESULTS: 1) Overall 3,174 fetuses were included, of them, 165 (5.2%)ere in breech presentation. 2) The systematic error for fetuses in breechresentation was not significantly different from zero for all models tested-1.0-1.5%), and was significantly lower than the systematic error foretuses in vertex presentation (-0.3-3.3%, p�0.05). 3) These presenta-ion-related differences in the systematic error were eliminated when

odels that incorporated HC rather than BPD were employed. 3) Theandom error for fetuses in breech presentation was significantly highers. vertex presentation (9.4-13.6% vs. 7.5-8.6%, p�0.05) and was loweror models that incorporated 3-4 biometric indices (9.4-9.5%) vs.modelshat incorporatedonly1-2biometric indices (9.8-13.6%,p�0.05).4)Theraction of weight estimation within 10% of birthweight was significantlyower for fetuses in breech vs. vertex presentation when models that areased on only 1-2 biometric indices were used (51.9-72.1% vs. 61.1-9.2%), although no such differences were observed when models thatncorporate 3-4 indices were used (77.0-77.6% vs. 78.3-81.2%, p�0.3).). These presentation-related differences in the systematic and randomrror were independent of birthweight, gestational age at delivery, andetal head shape.

CONCLUSIONS: EFW appears to be less accurate for fetuses in breechhan in vertex presentation, mainly due to higher random error,hich overrides the decreased systematic error observed in these

ases. Differences may be minimized by using sonographic models

hich incorporate 3-4 biometric indices.

ent to JANUARY 2011 American Journal of Obstetrics & Gynecology S277