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1233. Accuracy of Prenatal Assessment of Asymmetrical Interventricular Septal Hypertrophy in Diabetic Mother Compared with Post Natal Outcome
Authors * Denotes Presenting Author
  1. Hoda Darwish *; Dallah Hospital
  2. Mohamed Habash; Kasr Alainy Cairo University
  3. Waleed Habash; New Giza University
Objective:
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.

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.

Conclusion:
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