CONCLUSION: Idiopathic IUGR fetuses represent a heterogeneous group.When all the parameters became abnormal, perinatal morbidity and mortalityincreased. Waiting for abnormal, non-reassuring fetal testing might be too lateto save the fetus. Multivessel Doppler assessment should be integrated in theevaluation of IUGR fetuses.

453 TEMPORAL ANTENATAL TESTING ALTERATIONS IN SEVERE IUGR FETUSESERICH COSMI1, EDMUND FUNAI2, VINCENZO BERGHELLA3, GIANCARLO MARI4,1University of Padua, Obstetrics and Gynecology, Padua, Italy, 2Yale Univer-sity, Obstetrics and Gynecology, New Haven, Connecticut, 3Thomas JeffersonUniversity, Obstetrics and Gynecology, Philadelphia, Pennsylvania, 4WayneState University, Obstetrics & Gynecology, Detroit, Michigan

OBJECTIVE: To assess the longitudinal changes of Doppler velocimetry,FHR tracing and BPP in severe IUGR fetuses.

STUDY DESIGN: A prospective longitudinal study of 252 IUGR fetuses. Inall fetuses a daily FHR tracing, Doppler velocimetry twice weekly has beenperformed to assess the umbilical artery (UA), middle cerebral artery (MCA),ductus venosus (DV) and umbilical vein (UV) blood flow. The BPP andamniotic fluid index were evaluated twice weekly. Delivery of fetuses has beenperformed in the moment of NST alterations or a biophysical profile ! 4.

RESULTS: Among 252 fetuses enrolled in the study only 69 fetuses showedall Doppler velocimetry abnormalities before timing cesarean section. Gesta-tional age at time of admission ranged from 19 to 39 weeks of gestation.Doppler velocimetry abnormalities were tested with the Kaplan-Meier test andBreslow test. There was a statistical significant difference between Dopplervelocimetry alterations in fetal vessels and time 0 (cesarean section delivery).

CONCLUSION: Severe IUGR fetuses show a specific temporal sequenceantenatal testing alterations consisting of Doppler velocimetry alterations,while FHR tracing become abnormal too late, and are the last changes seen inIUGR fetuses as well as the BPP.

454 PRENATAL DETECTION OF CRITICAL CARDIAC DEFECTS: SECULAR TRENDS ANDASSOCIATION WITH POSTOPERATIVE SURVIVAL BETTINA CUNEO1, SUNTHORN

SMFM Abstracts S133

451 LAMELLAR BODY COUNT INCREASES AS GESTATIONAL AGE PROGRESSESJORGE CARRILLO1, MASAMI YAMAMOTO1, RUBEN BUCHELI1, ALVARO INSUNZA1,1Hospital Padre Hurtado, U. del Desarrollo, Clinica Alemana, Santiago, Chile

OBJECTIVE: Lamellar bodies are structures produced by pneumocyte IIcells in the lung alveoli for providing the lung’s surfactant system. Our aim wasto investigate the increment in fetal lamellar body counts (LBC) as thegestation progresses.

STUDY DESIGN: LBC of 435 consecutive samples of centrifuged amnioticfluid in pregnant women with certified gestational age were measured in theplatelet channel of an automated hematological cell counter. Amniotic fluidwas obtained after signed informed consent by ultrasound-guided amniocen-tesis (AMCT). Graphic depiction of the LBC was contrasted with thecorresponding gestational age.

Figure 1

RESULTS: Mean gestational age at recollection of amniotic fluid was 33.8G2.8 weeks (range 28-38). Figure 1 displays the plot of all LBC. Figure 2 shows thebox plot of the mean (C/�SD) for each gestational age. 50th percentile of LBCwas 3,000 at 30 weeks (n=25), 4,000 at 31 weeks (n=31), 10,000 at 32 weeks(n=50), 22,000 at 33 weeks (n=72), 34,500 at 34 weeks (n=46), and 48,500 at35 weeks (n=38), The traditionally accepted cut-off value of 30,000/mL for fetallung maturity was interestingly related with the values obtained between 33 and34 weeks gestation. It is also noteworthy that two cases at 28 weeks (#433 and#423), one case (#404) at 29 weeks and other case (#356) at 31 weeks, had a sig-nificantly higher count of lamellar bodies than expected; in all these cases theAMCT was performed because of suspected intra-amniotic infection.

Figure 2

CONCLUSION: The LBC increases as the gestation advances, with an exponen-tial increase after 32 weeks and a progressive smoothing after 35 weeks gestation.

452 DOPPLER,NST,ANDBIOPHYSICALPROFILECHANGES IN IDIOPATHIC IUGRFETUSES -A LONGITUDINAL MULTICENTER STUDY ERICH COSMI1, VINCENZO BERGHELLA2,EDMUND FUNAI3, GIANCARLO MARI4, 1University of Padua, Gynecological Scienceand Human Reproduction, Section of Maternal Fetal Medicine, Padua, Italy,2Thomas JeffersonUniversity,Obstetrics andGynecology, Philadelphia, Pennsyl-vania, 3Yale University, Obstetrics and Gynecology, New Haven, Connecticut,4Wayne State University, Obstetrics & Gynecology, Detroit, Michigan

OBJECTIVE: To describe the temporal sequence of umbilical artery, middlecerebral artery, umbilical vein, and ductus venosus Doppler flow patterns andamniotic fluid index changes in idiopathic IUGR fetuses.

STUDY DESIGN: A cohort prospective study of 252 IUGR fetuses withabnormal umbilical artery (UA) pulsatility index (PI), with no maternalcomplications from the time of diagnosis to delivery. IUGR was defined as:estimated fetal weight and/or abdominal circumference !10th percentile, UAPI velocimetry outside the reference range, and absence of fetal anomalies. Inall cases, delivery was performed due to an abnormal biophysical profile (BPP)score (! 4) or non-reassuring non-stress-test (NST). Doppler studies, NST,and BPP, were initially performed every four days; they were repeated on adaily basis when patients were admitted to the hospital. ANOVA, Chi Squareor Fisher’s exact test, and a stepwise multiple regression were utilized forstatistical analysis. A p! 0.05 was considered significant.

RESULTS: Two IUGR groups were identified. Group A (n = 69) includedfetuses in whom all parameters became abnormal before an abnormal BPP orabnormal NST. Group B (n=183) included fetuses in whom one or moreparameters were normal at the time of cesarean delivery. For the fetuses of theGroup A, gestational age at the time of recruitment ranged from 24 to 30 weeks(median: 26.4 weeks), whereas it ranged from 24 to 30.4weeks (median: 28 weeks)in Group B. Gestational age at delivery was between 26 and 32 weeks (Group A,median: 29.6 weeks; Group B, median: 28.4 weeks). Sixty-six perinatal deathsoccurred: 46.3% in Group A, and 25.3% in Group B (p! 0.05). The compositeperinatal morbidity was higher in Group A than in Group B fetuses (p! 0.05).

MUANGMINGSUK1, STEPHEN NEUBERGER2, MARK GRANT3, MICHEL ILBAWI1, 1TheHeart Institute for Children, Oak Lawn, Illinois, 2Division of Pediatric Cardiol-ogy, ParkRidge, Illinois, 3School of Public Health, Epidemiology and Biostatis-tics, Chicago, Illinois

OBJECTIVE: Most critical cardiac defects (CCD)dthose requiring surgicalor catheter intervention before one month of lifedare detectable by fetalechocardiography. The purpose of this study was to examine secular trends inprenatal detection of CCD and the association with postoperative survival.

STUDY DESIGN: A retrospective cohort study was conducted including 688infants ! 1 month of age diagnosed with CCD before (n=190) or after(n=498) birth between 1996 and 2005. Infants underwent catheter (n=20) orsurgical intervention at a single institution. CCD were categorized as singleventricles (SV, n= 218), outflow tract defects (OTD, n=408), or other defects(n=62). Surgery included palliation by the Norwood procedure (n=172);systemic to pulmonary artery shunt (n=159); arterial switch, valvotomy,repair (n=290); and other procedures (n=47). Multivariate logistic regressionmodels were fitted evaluating the association of prenatal detection, procedureand diagnostic category to mortality.

RESULTS: Over time, the proportion diagnosed before birth increased anaverage of 3.5% per year from 12.1% to 44.1% (fitted values, p ! .001 trend);the mortality rate was unchanged (p = .76 trend). Overall, 28% of infants withCCD were diagnosed prenatally including 38% of all SV and 22% of OTD.Infants diagnosed prenatally had higher crude postoperative mortality ratesthan those diagnosed postnatally (crude OR 1.8; 95% CI 1.2-2.7, p = .007).Controlling for diagnosis and surgical procedure, the association betweenprenatal diagnosed and mortality (OR 1.5, 95% CI .95 to 2.4, p = .08)diminished in magnitude became statistically insignificant.

CONCLUSION:While crudepostoperativemortalitywas higher among infantsdiagnosed prenatally with CCD, these results suggest such infants have moresevere disease and undergo higher risk procedures than those diagnosed postna-tally.Additionalprospective study identifyingother importantprognostic factorsfor mortality might assist improving postoperative survival among these infants.