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Objective To compare prenatal findings, associated genetic anomalies and postnatal outcome in fetuses with tetralogy of Fallot (TOF) with normal cardiac axis (CAx) and those with abnormal CAx. Methods In this retrospective cohort study, 85 cases diagnosed with TOF by prenatal ultrasound at our clinic between 2005 and 2015 were reviewed. Follow-up ultrasound and postnatal outcome were available for 68 cases. One case complicated with absent pulmonary valve syndrome and a further seven cases diagnosed postnatally with anomalies other than TOF were excluded from the study. The remaining 60 cases of postnatally confirmed TOF were divided according to CAx into two groups: those with normal CAx (n = 33) and those with abnormal CAx (n = 27). CAx was defined as the angle between the interventricular septum and midline of the fetal thorax at the level of the four-chamber view. CAx > 65° or

Objectives The 2012 Eunice Kennedy Shriver National Institute of Child Health fetal imaging consensus suggested that fetal anatomy ultrasound in obese pregnancies be performed at 20 to 22 weeks, with follow-up in 2 to 4 weeks if anatomy is incomplete. It was postulated that imaging in early gestation may improve visualization, although no prospective trials had been done to date. Methods We performed a prospective longitudinal blinded trial comparing an early gestation ultrasound (13 + 0 to 15 + 6 weeks) with the traditional second-trimester ultrasound for completion of the fetal anatomy survey in obese patients. Inclusion criteria included singleton gestation, body mass index (BMI) more than 30, less than 16 + 0 weeks' gestation, and no karyotype abnormality; exclusion criteria included age younger than 18 years, more than 16 weeks' gestation at time of consent, and BMI less than 30. Participants received a transvaginal and/or transabdominal sonogram for fetal anatomic survey at 13 + 0 to 15 + 6 weeks' gestation (US1). Images from US1 were blinded to physicians and sonographers performing subsequent examinations. All participants underwent the traditional transabdominal sonogram at 18 to 24 weeks (US2). If US2 failed to complete the anatomic survey, a repeat transabdominal sonogram (2-US2) was performed 2 to 4 weeks later. Results A total of 152 pregnancies met the criteria. Anatomy completion rate was 57.2% for US1 and 62.5% for US2, which was not statistically significant, even when stratified by BMI. Excluding the philtrum, the US1 performed better than US2 for class III obesity (65.5% versus 45.5% [P = .035]). Combination of US1 + US2 yielded a higher completion rate than US2 + 2-US2 (94.1% versus 83.6% [P = .0023]). Conclusions In the setting of maternal obesity, the addition of an ultrasound in early gestation may be of highest benefit for patients with class III obesity (BMI > 40 kg/m2).

Objective This study aims to compare completion rates and reproducibility of myocardial performance index (MPI) using conventional spectral Doppler versus tissue Doppler in an unselected high-risk third trimester population.Study Design This was a prospective cross-sectional study of high-risk pregnancies at ≥28 + 0 weeks’ gestation. Conventional spectral and tissue Doppler MPI of the left ventricle (LV) and right ventricle (RV) was attempted on all patients.Results Seventy-nine pregnancies were evaluated. LV tissue Doppler MPI was completed more frequently than LV conventional spectral Doppler MPI (63/79, 79.7% vs. 45/79, 55.7%), p-value Conclusion Tissue Doppler had statistically higher completion rates than conventional spectral Doppler, including the obese subgroup, with evidence of strong reproducibility in the third trimester.

The 2012 Eunice Kennedy Shriver National Institute of Child Health fetal imaging consensus suggested that fetal anatomy ultrasound in obese pregnancies be performed at 20 to 22 weeks, with follow-up in 2 to 4 weeks if anatomy is incomplete. It was postulated that imaging in early gestation may improve visualization, although no prospective trials had been done to date.We performed a prospective longitudinal blinded trial comparing an early gestation ultrasound (13 + 0 to 15 + 6 weeks) with the traditional second-trimester ultrasound for completion of the fetal anatomy survey in obese patients. Inclusion criteria included singleton gestation, body mass index (BMI) more than 30, less than 16 + 0 weeks' gestation, and no karyotype abnormality; exclusion criteria included age younger than 18 years, more than 16 weeks' gestation at time of consent, and BMI less than 30. Participants received a transvaginal and/or transabdominal sonogram for fetal anatomic survey at 13 + 0 to 15 + 6 weeks' gestation (US1). Images from US1 were blinded to physicians and sonographers performing subsequent examinations. All participants underwent the traditional transabdominal sonogram at 18 to 24 weeks (US2). If US2 failed to complete the anatomic survey, a repeat transabdominal sonogram (2-US2) was performed 2 to 4 weeks later.A total of 152 pregnancies met the criteria. Anatomy completion rate was 57.2% for US1 and 62.5% for US2, which was not statistically significant, even when stratified by BMI. Excluding the philtrum, the US1 performed better than US2 for class III obesity (65.5% versus 45.5% [P = .035]). Combination of US1 + US2 yielded a higher completion rate than US2 + 2-US2 (94.1% versus 83.6% [P = .0023]).In the setting of maternal obesity, the addition of an ultrasound in early gestation may be of highest benefit for patients with class III obesity (BMI 40 kg/m

Fetal biometry has been used routinely in the second trimester for the past 40 years for the evaluation of gestational age, fetal weight and fetal anomalies. Its importance in the first trimester is even greater, as it allows for more accurate pregnancy dating, earlier detection of fetal anomalies and multiple gestations, and identifies pregnancies at increased risk for aneuploidy. The gestational sac and yolk sac are early pregnancy structures that can offer information related to the health of the pregnancy. The crown-rump length measurement in the first trimester is the most accurate predictor for pregnancy dating. Nuchal translucency measurement has become integral in the evaluation of increased aneuploidy risk, and is routinely offered with serum markers as a screening option. Evaluation of the nasal bone is useful as a secondary marker in screening for aneuploidy, especially with regard to trisomy 21. Other biometric measurements routinely used later in pregnancy may be utilized in the first trimester in certain scenarios. Fetal biometry in the first trimester is an important tool for evaluation of the health of a pregnancy. Clinicians should be aware of normal and abnormal development to enhance their counseling and management of normal and complicated pregnancies.

772 Maternal death in the maternal-fetal medicine unit cesarean registry Lea Porche, Ibrahim Hammad, Malgorzata Mlynarczyk, James Hill, Bonnie Dattel, Suneet Chauhan Eastern Virginia Medical School, Obstetrics and Gynecology, Norfolk, VA OBJECTIVE: The primary purpose was to describe maternal death (MD) in the Maternal-Fetal Medicine Units (MFMU) Network Cesarean Registry; secondary purposes compared MD between African American (AA) vs. Caucasian (C); and MD vs. 24 hours after delivery. STUDY DESIGN: This is a secondary analysis of prospectively collected data for MFMU. Medical problems included asthma, cardiac, renal or connective tissue disease, chronic hypertension (HTN), or pregestational diabetes. Obstetric complications included abruption, gestational HTN, preeclampsia, eclampsia, HELLP, chorioamnionitis, or placenta accreta. Fisher exact test with approximation of Woolf or odd ratio (OR) with 95% confidence intervals (CI) was used. RESULTS: Of 73,257 births, there were 37 MD (50/100,000 births). All were singletons, 8% were 20 years old, 38% were nulliparous, and 41% were obese (body mass index 30 kg/m). Modes of delivery were: 57% primary cesarean, 35% repeat, and 8% trial of labor after cesarean. While 68% had no prior medical problems, 46% had no obstetric complications. The 3 leading initiating events for MM were hypertensive disease (32%), infection (16%) and cesarean delivery (16%); the 3 leading causes of death were cardiopulmonary arrest (43%), amniotic fluid embolism (13%) and intracranial hemorrhage (11%). The perinatal mortality was 81/1000 births. Maternal mortality rate among AA (79) was higher than C (44) but similar (OR 0.55; 95%CI 0.25, 1.20). Other factors did not differ significantly. Almost half of maternal deaths (49%) were 24 hours of delivery. Comparison of those who died vs. 24 hours of birth differed significantly for ethnicity (p 0.009) and ICU admission (28% vs. 63%, respectively; OR 0.16; 95% CI 0.04, 0.69). Other factors were not significantly different. CONCLUSION: Despite the small sample size, this prospectively collected database provides reliable data on the rate as well as causes of maternal death related to cesarean delivery in the US. Futures studies that include data from non-tertiary centers are needed.