1233. Accuracy of Prenatal Assessment of Asymmetrical Interventricular Septal Hypertrophy in Diabetic Mother Compared with Post Natal Outcome
Authors* Denotes Presenting Author
Hoda Darwish *;
Kasr Alainy Cairo University
New Giza University
was to assess the accuracy of prenatal assessment of interventricular septum (IVS) thickness, right myocardial wall thickness (RMWT), and left myocardial wall thickness (LMWT) by two-dimensional (2D) ultrasound across the 2 participant groups; diabetic and non-diabetic pregnant women for the prediction of perinatal mortality and postnatal diagnosis of hypertrophic cardiomyopathy (HCM) among diabetic pregnant women
Materials and Methods:
240 pregnant women between 28 - 37 weeks of gestation were enrolled in our prospective case-control study from May 2019 to January 2020 in our hospital. 120 were diabetic and 120 were non-diabetic singleton pregnant women. The 2D ultrasound was done once for all the participants at the time of recruitment. IVS, RMWT, LMWT and IVS/LMWT ratio were measured in four-chamber view of fetal heart.
The results of fasting glucose tolerance test (GTT-F) and a 2-h oral glucose tolerance test (2HR- GTT) of all our study 240 participants were recorded. Neonatal assessment of 120 neonates of diabetic mothers including postnatal echocardiography was done within 3- 5 days after delivery. Postnatal results were compared with the prenatal predictive results.
The mean interventricular septum thickness in fetuses of pre-gestational diabetic mothers was 5.09 ± 0.96 mm, compared to 3.58 ± 0.32 mm in fetuses of gestational diabetic mothers and 2.02± 0.88 in the fetuses of the control group. The mean right myocardial wall thickness was 5.15 ± 0.86, 4.26 ± 0.47 and 3.36 ± 0.68 mm in fetuses of pre-gestational diabetic, gestational diabetic and control groups respectively.
While, the mean left wall myocardial thickness was 5.36 ± 0.54 mm in fetuses of pre gestational diabetic mothers compared to 4.67 ± 0.35 mm in fetuses of gestational diabetic mothers and 3.77 ± 0.52 in fetuses of the control group.
Of the included 120 neonates of diabetic mothers, 12 (10%) were stillborn, 103 (85.8%) had a five-minute Apgar score = 7, and 5 (4.2 %) had a five-minute Apgar score = 3. The five neonates with severe neonatal distress had a low ejection fraction (EF) (<50%) , 3 (2.5%) of them died after admission to neonatal intensive care unit within less than one week after delivery due to HCM while the other 2 neonates (1.6 %) survived. Another two (1.6 %) neonates died from severe respiratory distress syndrome within 3 days after delivery.
Optimum cut off point of IVS was (0.39 cm) for prenatal IVS thickness was predictive of neonatal distress due to HCM with a sensitivity of 92%, specificity of 78%, and diagnostic accuracy of 82%. In our study a cutoff value of 1.16 for the ratio of IVS thickness to LMWT had a sensitivity of 80% and a specificity of 71% and diagnostic accuracy of 74% for the prediction of neonatal distress due to HCM.
Our study showed that IVS, RMW, and LMW thicknesses were higher in fetuses of diabetes mother than those of fetuses of non-diabetic mother.
We conclude that prenatal IVS thickness of = 0.39 cm or an IVS/LMWT ratio of = 1.16 seems to be predictive of hypertrophic cardiomy-opathy (HCM and is associated with perinatal mortality