Updates from the 27th Annual Society of Maternal-Fetal Medicine Conference

Greigh Hirata, MDThe 27th annual meeting of the SMFM was recently held in San Francisco on 2/5-10, 2007. Here are some of the highlights that may be helpful to your practice.

During the Plenary sessions, several abstracts were presented with interesting findings.

The NICHD MFMU Network studied the use of 17-Hydroxprogesterone caproate for the prevention of preterm birth in twins and failed demonstrate any benefit. 661 women with twin gestations were randomized to either placebo or 250 mg of 17P in 14 different centers. The primary outcome of delivery before 32 weeks was 17% in the 17P group and 14% in the placebo group, not statistically significant. These results seem to conflict with earlier studies demonstrating benefit in reducing the risk for recurrence of preterm birth. Possible explanations for the lack of benefit include inadequate dosage of the 17P or differences in the mechanism behind preterm births of twins.

In another study from the same group, a 4 year follow up was conducted on 278 of the infants exposed to 17P in utero. The authors reported no increase risk for adverse health outcomes in the surviving children.

A group from Australian reported the demographic trends on the detection rate and invasive prenatal testing utilization before and after the implementation of a first trimester combined Down syndrome screening. There was a significant increase in the rate of utilization for first trimester combine screening from 0.4% in 2000 to 44% in 2004 while the invasive testing rate decreased the number of invasive prenatal tests to detect one aneuploidy efficiency of testing increase without adversely affecting the over-all detection rate for Down syndrome.

The post-graduate course on the prediction and prevention of recurrent adverse obstetrical outcome covered complications such as growth restriction, preterm birth, pre-eclampsia, stillbirth and adverse perinatal outcomes. The presentation by Lorraine Dugoff, MD on the management of markers of adverse obstetrical outcome reviewed the literature of the predictive strengths of maternal serum markers.

In the first trimester, low levels of PAPP-A (<0.3 MOM) was associated with fetal loss, SGA, preterm birth and hypertensive disorders of pregnancy. There is a suggestion that low dose aspirin may be of benefit. Abnormally low levels of hCG is only associated with fetal loss.

In the second trimester, abnormal quad markers (aFP > 2.0 MOM, hCG > 2.0 MOM, and Inhibin A > 2.0 MOM) was associated with adverse perinatal outcomes. Treatment considerations recommend by Dr. Dugoff include low dose aspirin, Doppler studies of the uterine artery at 20-24 weeks, close surveillance for IUGR and pre-eclampsia and antenatal testing for cases with IUGR or pre-eclampsia.

These are some of the highlights of the meeting. I am planning to continue updating the information from the meeting during the course of the year through this newsletter.

Please call our offices if there are any additional topics of interest. We will do our best to keep you updated on the recent trends in Perinatal Medicine.

obstetrical outcome reviewed the literature of the predictive strengths of maternal serum markers.

In the first trimester, low levels of PAPP-A (<0.3 MOM) was associated with fetal loss, SGA, preterm birth and hypertensive disorders of pregnancy. There is a suggestion that low dose aspirin may be of benefit. Abnormally low levels of hCG is only associated with fetal loss.

In the second trimester, abnormal quad markers (aFP > 2.0 MOM, hCG > 2.0 MOM, and Inhibin A > 2.0 MOM) was associated with adverse perinatal outcomes. Treatment considerations recommend by Dr. Dugoff include low dose aspirin, Doppler studies of the uterine artery at 20-24 weeks, close surveillance for IUGR and pre-eclampsia and antenatal testing for cases with IUGR or pre-eclampsia.

These are some of the highlights of the meeting. I am planning to continue updating the information from the meeting during the course of the year through this newsletter.

Please call our offices if there are any additional topics of interest. We will do our best to keep you updated on the recent trends in Perinatal Medicine.

Do you have a question? E-mail us at info@hawaiifdip.com or go to the contact page to submit your inquiry. We will get back to you as soon as we can.

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