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For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

Objective Assessment of adrenal function in a sick neonate remains a challenge in spite of major advances in neonatal care. We used 2D ultrasound of adrenal glands to assess maturity of adrenal glands in extremely preterm infants and sick term and near term infants. Study design We collected demographics details of 99 mother-infants pairs (24-41 weeks) and obtained 2D ultrasound scans of adrenal glands in first week of life to measure adrenal volume, fetal zone size, and adrenal to kidney ratios. Relationship between adrenal measurements, antenatal factors, and postnatal outcomes were studied. Results We reported normative adrenal gland volume data during gestation from 80 appropriate for gestational age (AGA) infants. In a binary analysis, adrenal size was significantly related to gender, race, intrauterine growth restriction (IUGR), maternal chorioamnionitis, and maternal hypertension. Linear regression analysis showed that fetal zone is significantly related to not only gestational age but also chorioamnionitis and later development of intraventricular hemorrhage (IVH). Adrenal volume likewise is also related to gestational age, preeclampsia, and IVH. Conclusions Antenatal maternal factors and uterine environment affects adrenal growth and development thus postnatal high resolution 2D US scan of adrenal glands can provide useful information to predict outcomes. This information can complement hormone and adrenocorticotrophic hormone (ACTH) stimulation assays.

Objective The purpose of this study was to review antenatal sonographic findings in children born with persistent cloaca. Methods Infants (n =145) with persistent cloaca followed at a center for colorectal congenital anomalies were identified by a retrospective chart review. Fifty female infants with a persistent cloaca met inclusion criteria and had prenatal records and imaging studies available for review. Sonographic data were retrospectively abstracted from charts. Results Anomalies were detected in 27 of 50 cases (54%). A correct antenatal diagnosis of persistent cloaca occurred in 3 of 50 (6%). Common findings misinterpreted on antenatal sonography include urinary tract anomalies, dilated bowel, and a cystic pelvic mass (representing hydrocolpos). Conclusions Antenatal diagnosis of persistent cloaca is difficult. Persistent cloaca should be considered in the differential diagnosis if urinary tract malformations, dilated bowel loops, or cystic pelvic masses are visualized by prenatal diagnosis.

Objectives The purpose of this study was to determine if prenatal exercise alters the maternal and fetal heart responses during labor and delivery. We hypothesized that fetuses of exercising mothers would exhibit a lower baseline heart rate (HR), increased HR variability (HRV), and no differences in fetal heart accelerations and decelerations. Design This study employed a cross‐sectional design. Methods The Modifiable Physical Activity Questionnaire was used for group classification. Exercising women were those participating in 30 minutes of moderate‐to‐vigorous exercise at least 3×/week throughout the entire pregnancy. Women achieving a lower dose of exercise were classified as non‐exercisers. Cardiotocography recordings during the first hour of labor and delivery assessed fetal baseline HR, HRV, accelerations, decelerations, and contractions. ANCOVA analyses were performed to assess group differences in these outcomes and were adjusted for maternal body mass index. Results Thirty‐one women were included in the analyses. No group mean differences were found for maternal and fetal characteristics, except for maternal age (EX: mean (SD) 28.5 (±4.6y) vs NON‐EX: 24.1 (±1.2y)). After controlling for body mass index, no statistical differences in maternal HR response (β = 3.9, SE = 5.0, 95%CI −6.4‐14.2) or fetal HR response (β = 3.9, SE = 2.5, 95%CI −1.2‐9.11), accelerations and decelerations (β= −0.03, SE = 0.4, 95%CI −0.9‐0.8; β= −0.10, SE = 0.4, 95%CI −0.8‐0.9, respectively), or HRV (β = 0.6, SE = 1.7, 95%CI −2.8‐4.0) were observed. Conclusions Based on the findings of this study, we found no evidence that maternal exercise during pregnancy was associated with maternal or fetal HR response during labor and delivery. These data suggest maternal exercise may not elicit positive or negative effects on maternal and fetal cardiovascular responses to the physiological stress of labor and delivery.

Objective: To define the MRI findings of congenital high airway obstructionsequence (CHAOS) in a series of fetuses.Materials and Methods: Prenatal fetal MR images were reviewed in sevenfetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings werereviewed. The MRI parameters evaluated included the appearance of the lungsand diaphragm, presence or absence of hydrops, amount of amniotic fluid, airwayappearance, predicted level of airway obstruction, and any additional findings orsuspected genetic syndromes. Results: All the fetuses viewed (7 of 7) demonstrated the following MRI find-ings: dilated airway below the level of obstruction, increased lung signal, marked-ly increased lung volumes with flattened or inverted hemidiaphragms, massiveascites, centrally positioned and compressed heart, as well as placentomegaly.Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRIidentified the level of obstruction as laryngeal in five cases and tracheal in twocases. In four of the patients, surgery or autopsy confirmed the MRI predictedlevel of obstruction. Associated abnormalities were found in 4 of 7 (genetic syn-dromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungswith inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumoth-oraces and tracheotomy. Two fetuses were terminated and one fetus demised inutero. Four fetuses were delivered via ex utero intrapartum treatment procedure.Conclusion: MRI shows a consistent pattern of abnormalities in fetuses withCHAOS, accurately identifies the level of airway obstruction, and helps differenti-ate from other lung abnormalities such as bilateral congenital pulmonary airwaymalformation by demonstrating an abnormally dilated airway distal to the obstruc-tion. ongenital high airway obstruction sequence (CHAOS) is a rare, life-threatening condition characterized by complete or near complete intrin-sic obstruction of the fetal airway. CHAOS has been considered analmost invariably fatal condition (1) which often goes incorrectly diagnosed untilautopsy. However, advances in prenatal imaging, earlier diagnosis in utero, in uterosurgical treatment, and delivery via ex utero intrapartum treatment (EXIT) totracheostomy may contribute to improving the outcome of this condition (1-7). Withthe exception of case reports (2, 8-10), there is little in the literature describing theMRI findings of CHAOS. We present the MRI findings in a series of seven fetuses withprenatal diagnosis of CHAOS. To our knowledge, this is the largest described series ofpatients with CHAOS and the first article focusing on the description of MRI findings.Carolina V. A. Guimaraes, MD

Background/Purpose Anecdotal reports suggest that maternal steroids may arrest the growth of congenital pulmonary airway malformations (CPAMs), preventing or reversing hydrops. We reviewed our experience with CPAMs to determine the fetal response to steroid therapy. Methods This study is a retrospective review of all fetal CPAMs from 2004 to 2008. Fetuses with high-risk CPAMs that received at least one course of steroids were identified. Fetal magnetic resonance imaging and ultrasound data were used to classify the CPAMs, identify hydrops fetalis and follow the fetuses poststeroid dosing. Results Forty-four fetuses with CPAM were identified. Fifteen patients were found to have received at least one course of steroids. Thirteen were hydropic and 2 were nonhydropic. Seven of the 13 hydropic fetuses (54%) showed an initial response to steroid administration, whereas the 2 nonhydropic high-risk fetuses progressed to birth without developing hydrops. Seven of the 15 patients, however, resulted in fetal demise or early postnatal death, giving a survival rate of 53%. Conclusions High-risk CPAMs have a variable response to steroids. This variable response demonstrates the need for a placebo-controlled randomized study to more accurately determine the effect of steroids on hydrops and CPAM growth rates. Repeated steroid courses may not be helpful, and progression in CPAM volume to head circumference ratio (CVR) or hydrops should prompt open fetal surgery to prevent irreversible fetal insult.

Background Mirror syndrome is a rare entity characterized by maternal disease mimicking fetal hydrops. In mirror syndrome, there is maternal hypertension, edema, and often proteinuria in association with fetal hydrops. The causal link between mirror syndrome and hydrops fetalis remains elusive. Case This is a case report of a pregnant woman who developed mirror syndrome associated with fetal hydrops. A fetal pelvic mass resulted in bladder outlet obstruction, subsequent bladder rupture, and massive urinary ascites. The resultant massive ascites caused thoracic and cardiac compression and subsequent hydrops fetalis. Placement of a peritoneal-amniotic shunt resolved the fetal hydrops and maternal mirror syndrome. Conclusion In utero treatment of hydropic fetus can result in the cure of maternal mirror syndrome.

Objectives To examine cardiac structural and functional changes in twin–twin transfusion syndrome (TTTS), relative to Quintero stage, as a means of evaluating the spectrum of cardiomyopathy in TTTS. Methods This was a cross-sectional, retrospective study of 42 consecutive cases of TTTS referred to a single fetal therapy center. Quintero stages were assigned by standard criteria. Presence of ventricular hypertrophy, cardiomegaly, atrioventricular valve regurgitation (AVVR), ventricular systolic dysfunction and right ventricular outflow tract obstruction on fetal echocardiography were noted. The Doppler myocardial performance index (MPI), an index of global ventricular function, was calculated for both ventricles in subjects with adequate Doppler data. We compared cardiac changes across Quintero stages. Results There was no cardiomyopathy observed in donor twins. The majority of subjects presented at Quintero Stage I (n = 14), II (n = 14) or III (n = 11), with fewer at Stages IV (n = 2) or V (n = 1). As early as Quintero Stages I and II, a significant proportion of recipient twins had ventricular hypertrophy (17/28, 61%), AVVR (6/28, 21%) or quantitative abnormalities in either right (12/24, 50%) or left (14/24, 58%) ventricular function. Increasing prevalence of biventricular systolic dysfunction and cardiomegaly accompanied advancing Quintero stage. Conclusions Changes in cardiac structure and function not reflected in Quintero staging occur in recipient twins early in the evolution of TTTS. Incorporation of cardiac findings into assessment of TTTS severity may prove useful in stratification of risk and treatment selection. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

Objective: The purpose of this study was to describe subsequent pregnancy outcome in women with a history of hemolysis, elevated liver enzymes, and low platelet count syndrome for which delivery occurred at ≤ 28 weeks of gestation during the index pregnancy. Study Design: A descriptive report of women with previous hemolysis, elevated liver enzymes, and low platelet count syndrome who were delivered between August 1984 and July 1998 at the E.H. Crump Women's Hospital (Memphis, Tenn) and between March 1994 and July 1998 at the Central Baptist Hospital (Lexington, Ky). To have adequate time to study subsequent pregnancy outcome, only patients who were delivered >2 years before the analysis were included. Medical records of the index pregnancy and subsequent outcomes were available for review. Results: Adequate follow-up data were available in 69 patients; the median duration of follow-up was 5 years (range: 2-14 years). There were 76 subsequent pregnancies among 48 women, of which 62 pregnancies (82%) progressed beyond 20 weeks of gestation. Preeclampsia developed in 34 of 62 subsequent pregnancies (55%). Recurrent hemolysis, elevated liver enzymes, and low platelet count syndrome developed in 4 of these pregnancies (6%), and abruptio placentae developed in 3 of these pregnancies (5%). There were no cases of eclampsia in our population. Delivery before 37 weeks of gestation occurred in 33 of the cases (53%), and 17 of the newborn infants (27%) were small for gestational age ( Conclusion: Patients with a history of hemolysis, elevated liver enzymes, and low platelet count syndrome at ≤ 28 weeks of gestation during the index pregnancy are at increased risk for obstetric complications in subsequent pregnancies. Overall, however, the rate of recurrent hemolysis, elevated liver enzymes, and low platelet count syndrome is only 6%. (Am J Obstet Gynecol 2003;188:1504-8.)

Background The extent of the benefits of exercise training during pregnancy on maternal, fetal, and neonatal health outcomes has not been sufficiently addressed. While aerobic exercise training has been determined as safe and efficacious throughout pregnancy, the effects of other training modes on fetal health and development as well as any continued benefits for the neonate, especially with regards to cardiovascular development and function, is largely unknown. In the ENHANCED by Mom study we aim to determine the effects of different modes of exercise training (aerobic, circuit, and resistance) throughout pregnancy on childhood health by controlling individual exercise programs and assessing the effects of each on fetal and neonatal health adaptations. Methods/Design ENHANCED by mom is a cross sectional comparison study utilizing 3 intervention groups in comparison to a control group. Participants will complete three 5 min warmup + 45 min sessions weekly from 16 weeks to 36 weeks gestation of aerobic, resistance, or circuit training, in comparison to non-exercising controls. Maternal physical measurements will occur every 4 weeks throughout the intervention period. Fetal morphometric and heart measurements will occur at 34 weeks gestation. Neonatal measurements will be acquired at birth and at 1 month, 6 months, and 12 months. Discussion A better understanding on the effects of exercise training during pregnancy on fetal and neonatal health could have a profound impact on the prevention and development of chronic diseases such as obesity, hypertension, and diabetes.

Current research supports the health benefits of exercise during pregnancy for mother and baby. However, scant research has focused on how maternal exercise during pregnancy influences fetal heart response during labor and delivery. The purpose of this study was to compare the effects of exercise throughout pregnancy on fetal heart response to the stress of labor and delivery. We hypothesized that during labor and delivery there would be lower baseline fetal heart rate (HR), increased fetal heart rate variability (HRV), and no differences in fetal accelerations and decelerations in fetuses exposed to maternal exercise relative to controls. The Modifiable Physical Activity questionnaire was used to classify controls and exercisers. Based on routine fetal HR recordings, we measured fetal baseline HR, HRV, accelerations, and decelerations and birth measures. Group differences were tested using t-tests. There were no differences found between the mother’s age, gestational age, gravida and parity. No statistic...

Our purpose was to determine whether the onset of the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in women ator =28.0 weeks' gestation is associated with an increased risk of adverse maternal and perinatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age.Sixty-four patients with either the HELLP syndrome (n = 32) or severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted ator =28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test.There were no significant differences between the 2 groups regarding African-American race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%; P.05). There were no significant differences between the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No significant differences were found between the 2 groups with respect to neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity.Except for the need for transfusion of blood products in women with the HELLP syndrome, onset ator =28.0 weeks' gestation is not associated with an increased risk of adverse maternal or neonatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age.

Objective The purpose of this study is to assess the incidence of clinically significant neonatal abstinence syndrome (NAS) based on maternal antenatal methadone dosing in women with a history of narcotic dependence. Study design A retrospective review of 174 pregnant women on methadone maintenance was performed. Data were stratified based on maternal methadone dose at delivery: low (0–50 mg/day, n = 59), medium (51–100 mg/day, n = 63), and high (>100 mg/day, n = 52). NAS was defined by Finnegan as score greater than 7 on two occasions. Outcome measures were rate and severity of NAS, birth weight, preterm birth rate, and neonatal morbidities and mortality. Results The rates of NAS (40.7% vs. 52.4% vs. 40.8%, p > .05), birth weight, and neonatal morbidities were similar regardless of the maternal methadone dose. Although there was a trend toward earlier delivery, the rate of preterm birth among the three groups (low dose, 17%; medium dose, 19%; high dose, 27%; p > .05) was not statistically significant. Conclusion Higher maintenance dosing of methadone is not associated with increased rate or severity of NAS or other adverse perinatal outcomes. Concerns about NAS should not restrict the methadone dosing during pregnancy. Methadone dosing should not be restricted to lower dosing during pregnancy.

The aim was to evaluate the incidence and perinatal outcomes of TTTS complicated with placental insufficiency (PI/TTTS).This was a retrospective study of all TTTS with PI. PI is defined as estimated fetal weight10% with elevated head circumference/abdominal circumference ratio and weight discordance20%.Fifty-two out of 270 (19%) pregnancies met criteria. Forty-nine (94.2%) donor twins were diagnosed with PI/TTTS. Fifteen were treated with amnioreduction, 26 with selective fetoscopic laser photocoagulation, 4 with donor intrafetal radiofrequency ablation (RFA), and 7 had expectant management. There was a high incidence of abnormal Dopplers and abnormal placental cord insertion in the donor twin (58% marginal, 35% membranous) with a mean estimated fetoscopic donor placental share of 26.1 +/- 14.3%. There was a significant decrease in the overall donor survival rate of 61% (4 RFA selected donors were excluded) as compared to overall recipient survival rate of 85%, respectively (P = .009). There was no significant difference in donor or recipient survival rate among the treatment groups (P = .058).Placental insufficiency impacts the survival of the affected twins in the setting of TTTS. Studies are needed for appropriate treatment in TTTS with placental insufficiency.

(2002). Can heparin prevent adverse pregnancy outcome? The Journal of Maternal-Fetal & Neonatal Medicine: Vol. 12, No. 1, pp. 1-8.

This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood platelet count (50,000 cells/microL vsor =50,000 cells/microL), and peak serum levels of aspartate aminotransferase and lactate dehydrogenase. Maternal outcome variables analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and death. Statistical analysis was performed with the Student t test, the chi(2) test, and logistic regression analysis.A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% ator =28 weeks' gestation to 3% at32 weeks' gestation (P.05) and was higher among African American patients than among white patients (12% vs 3%; P.05). Logistic regression analysis showed an independent relationship between eclampsia and race (P.05). Incidence of abruptio placentae was higher among women with previous preeclampsia than among women without this clinical history (26% vs 5%; P.05). Disseminated intravascular coagulopathy was significantly associated with abruptio placentae (P.0001) and acute renal failure (P.0001). A nadir platelet count of50, 000/microL, a peak serum aspartate aminotransferase level of150 U/L, and a peak serum lactate dehydrogenase level of1400 U/L were not independent risk factors for adverse outcome.Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome.

We present a case of twin gestation complicated by severe depression and psychotic behavior; the mother was treated with electroconvulsive therapy (ECT). She had received multiple medications for treatment of her depression earlier during the first part of the pregnancy. However, frequent use of ECT later in the course of pregnancy did not result in adverse fetal outcome as is evident from normal fetal surveillance tests. We conclude that, when indicated, ECT during pregnancy improves maternal condition and does not adversely affect fetal well-being.

Objective This study evaluated the acute effects of selective fetoscopic laser photocoagulation (SFLP) on recipient cardiovascular function in a twin-twin transfusion syndrome (TTTS) pregnancy. Study Design This was a retrospective chart review of echocardiographic data in TTTS including right (RV) and left (LV) ventricular Doppler myocardial performance index (MPI); LV and RV end diastolic wall thickness; and umbilical artery (UA), vein (UV), and ductus venosus (DV) Dopplers. The primary outcome measures were improved MPI defined as greater than 10% interval decrease in left and/or right MPI. Data were analyzed by Student t test and Fisher's exact test. Results Sixty-five patients met inclusion criteria. SFLP results in a significant improvement in UV and DV Doppler and an increase in both RV and LV wall thickness. A 10% or greater improvement in recipient LV MPI after SFLP is associated with improved recipient survival as compared with unimproved LV MPI (100% vs 86.1%, P = .05). Conclusion Improved recipient myocardial performance index after SFLP is associated with improvement in recipient survival.

Objective The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS). Study Design This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients. Results There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) ( P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) ( P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) ( P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) ( P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) ( P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality ( P = .055, OR 3.025/point) by logistic regression analysis. Conclusion The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.

Objective The objective of the study was to review perinatal outcomes in pregnancies treated with intrafetal radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence. Study Design Perinatal outcome data from a quaternary care referral center were abstracted from a chart review of pregnancies with TRAP sequence treated in the midtrimester with umbilical cord RFA of the perfused twin. Results Twenty-one pregnancies with TRAP sequence were evaluated. Two women had a pump twin demise prior to therapy, 1 with trisomy 21 declined treatment. Four of 20 were treated successfully with RFA but remain undelivered, and 1 was treated with fetoscopic cord coagulation. Twelve of 13 pump twins treated with RFA (94%) survived to 30 days of life. Mean preoperative cardiac combined cardiac output was 588 mL/kg and pump/twin ratio was 0.7 (range 0.4 to 1.1). The effect of RFA on postoperative cardiac output was variable (6-85%). The average gestational age at birth was 37 weeks (range 26-39 weeks). Conclusion Primary therapy with RFA is a successful modality for pregnancies complicated by TRAP sequence.

FROM THOSE WITH GESTATIONAL HYPERTENSION AT FIRST PRENATAL VISIT? STEPHANIE DEIS, CHRISTOPHE MASSON, GILLES KAYEM, ROMAN ROUZIER, JOELLE GOUR, JEFFREY LIVINGSTON, BASSAM HADDAD, University Paris 12 Creteil, Obstetrics and Gynecology, Creteil, France, University of Cincinnati, Obstetrics & Gynecology, Cincinnati, Ohio OBJECTIVE: To compare maternal characteristics at first prenatal visit between women who developed PE to those who developed GHT. STUDY DESIGN: In a prospective population-based study that included 4632 consecutive healthy singleton pregnancies, maternal characteristics of women who developed hypertensive diseases were analyzed. Statistical analysis were performed by Student t-test and chi-square test.Multivariable logistic regression analysis was performed for variables that had p ! .1 in univariate analysis. RESULTS: 96 (2%) had PE and 59 (1.2%) had GHT. No differences were found between PE and GHT regarding the following variables obtained at the first visit: maternal age, ethnicity, previous hypertension in pregnancy, previous early pregnancy loss, new partner, tobacco use, and diastolic blood pressure. There were statistical differences between the 2 groups in mean systolic blood pressure (SBP, 124 G 18 vs 130 G 13 mmHg, p=.02), body mass index (BMI, 23 G 3 vs 26 G 6, p=.001), BMI O30 (6 vs 25%, p=.002), and nulliparity (56 vs 29%, p=.05). Multivariable logistic regression analysis showed that BMI or BMI O30 were independently decreased in women that developed PE when compared to those having GHT (see Table). Moreover, nulliparity tended to be increased in women that developed PE. CONCLUSION: Maternal characteristics are similar in women who developed PE or GHT except for body mass index.