45 Efficacy of Second Trimester Selective Termination (ST) for Fetal Abnormalities: International...

Volume 168 Number I, Part 2

45 EFFICACY OF SECOND TRIMESTER SELECTIVE TERMINATION (ST) FOR FETAL ABNORMALITIES: INTERNATIONAL COLLABORATIVE EXPERIENCE AMONG THE WORLD'S LARGEST CENTERS. ~ JD Goldberg. 'f Dum~7,X RJ Wapner. L lynch, BS Dock,x MS Golbus, M Dommergues,x W Holzgreve, MP.Johnson,x RL Berkowitz. Depts Ob/Gyn: WSU, Detroit; UG-San Francisco; Maternite Port Royal, Paris; Jefferson, Philadelphia; Mt Sinai, New York; MOnster, FRG. OBJECTIVE: To build the most powerful database possible to counsel patients about ST for fetal abnormalities, since no one center has sufficient data to assess much more than crude loss rates. STUDY DESIGN: 157 completed cases of ST from 6 centers in ~ countries were combined (145 twins, 9 triplets, 3 quads). Variables included indications. methods (KGI. exsanguination. air embolus). week of procedure. pregnancies lost ($,24 wks), gestational age (GA) at delivery, and neonatal outcome. RESULTS: Indications for ST were: 84 chromosomal. 67 structural. 6 Mendelian. ST was technically successful in 100% of cases. 181157 (11%) miscarried before 24 weeks, but 0131 when done at $,16 weeks and 18/126 (14%) thereafter. Air embolization had a higher loss rate. (11/138 (8%) by KGI & 7/16 (44%) by air; (X2~106 p<.OOOI).

GA at pellyery (weeks) ~ LQnu:. ~.~ ~ .··lli lmaI.

$,16 0 O· 1 (3%) 10 (32%)20 (65"/.)31 17+ 18 (14%) 7 (6%) 16 (13%) 26 (21%) S9 (47%) 126

Complications: 12 PROM, 3 IUGR, 2 NND, and one wrong fetus. There were no differences in loss rates, GA at delivery by indication. 3 monozygotic twins were also reported all with pregnancy losses. There were no coagulopathies or resuhant damage to survivors. CONCLUSIONS: 1) ST in experienced hands for a dizygotic, abnormal twin is safe and effective when done with KG!. 83% of viable deliveries were after 33 weeks, and only 5% at 25-28 weeks. 2) GA at procedure correlated positively with loss rate and Inversely with GA at delivery, stressing the need for early diagnosis in multifetal pregnancies. 3) Coagulopathy tests are unnecessary.

46 FETAL CBRaIlSaIAL RISF; II Pl'l'IEI'l'S III'lII ELEVA'rED LEVElS OF 1IA'lEIIIAL SERIII ALPIIH'E'rOPIlOrEII AID DIIAL OL'rRADlGIIAPIIIC EnIIIIAnlE. L. BaIner, B. iihiteheadI , W. McMannI , E. FabriI , P. Browne. Dept. of Gyn/Cio and Medical Genetics, Elory Univ., Atlanta, GA. 00JECrIVES: The purpose of this study was to assess the risk for fetal CbrOIOSOIal. abnonalities in patients with elevated aaternal serua alpha-fetoprotein (IISAFP) and a noraal ultrasonoqraphic eluination. S'l'UDY DESIGI: All patients with an elevated MSAFP, defined as > 2.50 lultiples of the ledian (D), evaluated at our lab are included in this study. Fetuses with abnonal karyotypes were identified and correlations tade with ultrasound findings and MSAFP values. RESOL'l'S: 17,429 patients had MSAFP evaluations. There were 326 patients (1.9%) with an elevated MSAFP. seven abnoraal fetal karyotypes were identified in the 281 singleton pregnancies (2.5%). Three had structural abnoraali ties detected on ultrasound. Four fetuses (57%) had no sonoqraphic abnoraalities seen. The risk of finding an abnoraal karyotype in this group was 4/281 or 14/1000. IlSAFP values for all seven fetuses were ~ 3.00 101. <XIICLlISI~: Patients with an elevated MSAFP and a nonal ultrasonoqraphic evaluation relain at risk for delivering a fetus with a cbrolOSOEl abnonality. All abnoraal karyotypes were detected in pregnancies with MSAFP values ~ 3.0 D. This infonation is useful in counselling patients undecided on alDiocentesis.

spa Abstracts 307

47 ONE YEAR EXPERIENCE WITH A STATE-WIDE EXPANDED MSAFP SCREENING PROGRAM. K.D .. Wenstrom, R.A. Williamson" S.S. Grant'. Dept. OB/GYN, Univ.

oflowa, Iowa City, IA.

48

OBJECTIVE: To examine our one year experience with a state­wide expanded MSAFP (MSAFP, Estriol, HCG) screening

program. STUDY DESIGN: The results of 13,525 screening tests performed from July I, 1991 to June 30, 1992 were reviewed. Amniocentesis and aneuploidy detection rates were compared to a previous year's (1989-90) experience using only MSAFP for Down Syndrome (OS)

detection. RESULTS: Positive screening tests (OS risk L 11190) occurred in 528/13,525 (3.9%); 412/528 (78%) patients accepted

amniocentesis. Ten aneuploidies were identified: 8 trisomy-2l, I trisomy-18 and I trisomy-13. An additional 22 screening tests were positive for the Trisomy 18 pattern (All 3. markers low); I Trisomy 18 fetus was identified. The overall detection rate was 1139 amniocenteses performed; for trisomy 21 it was 1152. In a previous year using MSAFP alone, 3.6% had positive screening tests (OS risk L 270); the detection rate for all aneuploidies was 1157 amniocentesis performed and for trisomy-21 was 1I114. The expanded MSAFP test was well accepted by clinicians, with 36 %

of gravid state residents undergoing screening. CONCLUSION: The expanded MSAFP test is a good screening tool and is superior to MSAFP alone. It allows improved detection of aneuploidies, and appears to detect aneuploidies other than

trisomy 21.

PATERNAL DRINKING MAY AFFECT INTRAUTERINE GROWTH. RJ Sokol, SS Martier,' JW Ager,' EL Abel,' S Jacobson,' J Jacobson: Depts .0b/Gyn & Psych & the Fetal Alc Res Cent, Wayne State U/Hutzel Hosp, Detroit. MI. OBJECTIVE: There is limited, but provocative evidence for effects of paternal teratogen exposure, including alcohol, in animal & human studies. Our purpose in this study was to attempt to detect an effect, if any. of paternal preconceptional drinking, as reported by the mother, on intrauterine growth in a rigorous multivariate statistical setting. STUDY DESIGN: 3001 consecutive African American antenatal gravidas. prospectively screened in a core city antenatal clinic for substance use & followed through delivery over a 5 year period were queried fa drinking of the baby's father. For this study, the dependent variable was birth weight percentile (BW%I, residualized using multiple regression for maternal demographic characteristics, history of low birth weight, smoking & alcohol intake among pregnancies in which fathers were reported to be light drinkers or abstinent (F I8 , 1718) = 29.41, R2 = 12%}. Paternal demographics, reported alcohol & cigarette use & infant sex were then evaluated as independent variables against residualized BW%. RESULTS: Of 8 independent variables, 3. father's height & frequency of drinking & infant sex, were found to be significant determinants of infant BW%, adjusted for maternal characteristics, smoking & drinking IF".29971=25.28, R2=2.5%, p<.OOOII. Based on the sizes of the standardized regression coefficients, the effect of paternal drinking in decreasing BW% was about 1/2 the effect of maternal drinking. Drinking at the 90th percentile, Le .. nearly daily, compared with abstinence, was associated with a 4 percentile reduction in BW% (44.2 to 40.2). At 40 weeks' gestation, this represents a 45 gram reduction in birth weight. CONCLUSIONS: PRECONCEPTIONAL PATERNAL ALCOHOL INTAKE MAY IMPACT INTRAUTERINE GROWTH. THIS PROVOCATIVE FINDING WARRANTS FURTHER STUDIES IN ANIMAL MODELS &. HUMANS. WITH MORE DIRECT ASSESSMENT OF PATERNAL DRINKING TO ASSURE APPROPRIATE APPORTIONMENT OF ALCOHOL VARIANCE BETWEEN PARENTS &. EVALUATING ADDITIONAL ALCOHOL-RELATED OUTCOMES. IF THE CURRENT FINDING CAN BE CONFIRMED. STRATEGIES FOR THE PREVENTION OF ALCOHOL-RELATED BIRTH DEFECTS WILL NEED TO BE SUBSTANTIAllY BROADENED TO INCLUDE MEN IN THE REPRODUCTIVE AGE RANGE.