A. Amadio

OC058: Septate uterus: correlation of three‐dimensional power Doppler sonography of the septum with histology of septal tissue after hysteroscopic metroplasty

were recorded upon infant discharge or death. An anomalous fetus was considered detected if an abnormality of the relevant organ system was identified. BMI was based on weight at first prenatal visit and categorized as normal, overweight or class I-, II-, or IIIobesity using NIH criteria. Statistical analyses were performed using Mantel-Haenszel chi-square test. Results: There were 10,112 standard and 1023 targeted US examinations, and abnormalities were verified in 181 infants (1.6%). There was a significant decrease in the standard US detection of anomalous fetuses with increasing BMI, P = 0.03. When standard and targeted US were combined, a significant decrease in anomaly detection with increasing BMI was also observed, P = 0.04.

OC259: Low malignant potential ovarian tumors: role of sonographic diagnostic criteria

removed – there were no cases of malignancy. In a study of 55,278 pregnancy terminations, there were 2 cases of malignancy. We have prospectively evaluated 3000 consecutive women who presented to the Early Pregnancy Unit. The prevalence of ovarian cysts was 5.3%. These women were managed expectantly and followed until resolution of the ovarian cyst occurred, intervention was required or the pregnancy concluded. 72.2% resolved spontaneously, 23.6% persisted and 4.2% required intervention – there were no cases of malignancy. Only 0.13% (1.3/1000) of all women in this longitudinal study required acute intervention. We concluded that examining the ovaries in the first trimester is of no value. Expectant management is advocated, at least until the pregnancy is beyond 14 weeks’ gestation. If symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with sonographic guided cyst aspiration. Adnexal masses can be accurately classified according to TVS. However in the few cases when the nature of the cyst is in question, one must balance the risks to the pregnancy from intervention versus the risk of malignancy.

P48.02: Sonographic diagnosis of bladder endometriosis

the pregnancy after multidisciplinary consultation including genetic counseling. At 38 weeks gestational age, the patient delivered a 2956 g male neonate with Apgar scores of 6–9 at 5 and 10 minutes, respectively. In the neonatal physical examinations found penis length of few mm with left cryptorchidism. Neonatal testosterone concentration was 3 ng/mL. HCG treatment was started and circumcision was delayed. This case is unique in the very early diagnosis of severe micropenis.

OC19.04: Sonographic evaluation of posterior deep pelvic endometriosis: endovaginal-, transrectal- and vaginosonography to assess the extension of the disease: Oral communication abstracts

‘‘If only we could see what is really going on in there’’ has been one of reproductive biology’s great wishes. Ultrasonography has provided us with a tool for visualizing many aspects of human reproduction that we could only dream about a few short years ago. One of the most useful aspects of ovarian imaging would be the ability to predict the probability of conception based upon a simple, noninvasive examination. Although this wish is not currently available, it might not be as far from practical application as we might think. The current focus of attention in ovarian imaging in infertility therapy is directed at three distinct areas of inquiry. They are 1) assessment of the ‘‘ovarian reserve’’, 2) prediction of the ovarian response to exogenous superstimulation and 3) correlation of follicle imaging characteristics and oocyte quality. There is no consensus on a test for ovarian reserve that might allow an accurate prediction of the remaining reproductive lifespan for individual women. The methods now vary from the assessment of age and various hormone levels on a standardized day of the menstrual cycle, response to different hormonal challenge tests and estimates of ovarian volume and antral follicle counts. A difficulty with the imaging based portions of these assessments are that the number of antral follicles in the ovaries varies dramatically over the menstrual cycle, we do not yet know how to determine prospectively the ovarian follicular wave pattern that a women may express and that there does yet appear to be a standardized means of determining the number of follicles in different diameter categories. Currently accepted estimates of the number of follicles detectable with ultrasonography for estimation of ovarian reserve range from 8 to 12; however, recent data from detailed studies may be interpreted to mean that 18 to 32 follicles may be anticipated on Day 3.

OC11.04: Three dimensional evaluation of adenomyosis: correlation of sonographic findings to histology

Methods: Observational cohort study of 804 patients. Two consecutive cohorts of 402 women undergoing SIS or GIS at the department Bleeding Clinic were included. Patients characteristics, ultrasound features, technical failure rates and final diagnosis (based on endometrial sampling, hysteroscopy and/or surgery) were compared. Pathology was defined as hyperplasia, polyps, intracavity myomas and carcinoma. Results: Mean age was 50.7 years (SD 12) and 50.2 years (SD 11.6) in the SIS and GIS group (NS). In the SIS group 12.7% were nulliparous and 53% premenopausal versus 17.4% and 57.2% in the GIS group (NS). Technical failure rate was 5.0% for SIS versus 1.9% for GIS (difference between proportions 0.03; CI [0.0054-0.0588]). Failure due to inadequate distension was 1.5% versus 0.3% for SIS and GIS (difference between proportions 0.01; CI [−0.02 0.03]). Pathology was diagnosed in 180 (49%) patients of the SIS group versus 147 (40.2%) of the GIS group (difference between proportions 0.09; CI [0.02-0.16]). The LR+ and LR− of a lesion during contrast sonography was 4.03 and 0.28 for SIS and 3.9 and 0.19 for GIS, respectively (NS). The sensitivity was 77.8% and 85.0%, respectively (NS). The negative predictive value was 79.1% for SIS and 88.6% for GIS (difference between proportions 0.095; CI [0.02-0.17]). Conclusions: The technical failure rate, partly due to unstable filling of the uterine cavity and transcervical backflow, was less for GIS. The diagnostic accuracy of GIS was comparable with SIS. We conclude that GIS is a feasible and accurate alternative for SIS in the evaluation of periand postmenopausal women with abnormal bleeding.

OC023: Sonographic evaluation of deep pelvic endometriosis: Endovaginal‐, transrectal‐ and vaginosonography to assess the extension of the disease

S. Guerriero1, L. Savelli2, F. P. G. Leone3, A. A. Lissoni4, A. C. Testa5, T. Bourne6, L. Valentin7, D. Timmerman8, C. Van Holsbeke9 1Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Italy, 2Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Bologna, Italy, 3DSC L. Sacco, Università di Milano, Milan, Italy, 4Clinica Ostetrica e Ginecologica, Ospedale S. Gerardo, Università di Milano Bicocca, Monza, Italy, 5Instituto di Clinica Ostetrica e Ginecologica, Universita Cattolica del Sacro Cuore, Rome, Italy, 6Department of Obstetrics and Gynecology, St George’s Hospital, London, United Kingdom, 7Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Malmö, Sweden, 8University Hospitals Leuven, Leuven, Belgium, 9Ziekenhuis Oost-Limburg, Genk, Belgium

OC148: Adenomyosis: sonographic findings before and after insertion of levonorgestrel intrauterine system

correlation between lung volumes, MG, LBC, birth weight and delivery week was investigated. Results: The lung volume was different between preterm and term fetuses (104.8 ± 42.8 and 140.6 ± 27.3, P = 0.016). It also increased longitudinally throughout gestation between 26 and 40 weeks (from 31.7 to 221.9). MG was not statistically significantly different between groups (20.3 ± 18.6 in preterm fetuses and 18.4 ± 21.2 in term fetuses, P = 0.39). Lung area was lower in preterm fetuses than in term fetuses (29.1 ± 7.03 and 46.5 ± 8.8, P = 0.02). LBC was lower in preterm fetuses than in term fetuses (59 000 ± 51 000 and 121 000 ± 89 000, P = 0.012). Lung volume had a strong and significant positive correlation with gestational week (r = 0.431, P = 0.02) and 5-min Apgar score (r = 0.570, P = 0.002). Conclusions: Fetal lung volume measurement with VOCAL may be a reliable technique in the assessment of fetal lung maturity.

OC28: Effects of medical therapy on deep endometriosis: a sonographic study

Objectives: To describe the clinical and sonographic features of abdominal wall endometriotic nodules. Methods: Fifteen women (mean age 36 (range, 30–48)) years, with pathologically proven endometriosis of the abdominal wall were retrospectively recruited during the period between 2001 and 2007. Indications for ultrasound examination were: pain (10 cases, 67%), a palpable mass (seven cases, 47%) and suspicion of umbilical hernia (four cases, 27%). Results: In four cases (27%) the nodule was located on the scar of a previous Cesarean section while in nine (60%) cases it was located at the level of the umbilicus; of these, six patients had a history of laparoscopic surgery for endometriosis. In two women (13%) the nodule was found in the right inguinal canal. Five patients (33%) were asymptomatic, while in 10 cases (67%) cyclic or continuous spontaneous pain was reported. Associated symptoms suggestive of endometriosis were found: dysmenorrhoea in eight (53%) patients, dyspareunia in four (27%) and infertility in five (33%). Sonographically, in all patients the endometriotic nodules appeared as solid hypoechoic masses. Content was inhomogeneous in nine (60%) women; in all cases ill defined margins were found. Pressure exerted with the sonographic probe above the nodule gave pain and helped in the localization. Mean lesion diameter was 20 (± 12) mm. The nodule was located above the abdominal wall fascia muscularis in eight cases (53%), below the fascia in two (13%) while in five cases the nodule extended grossly through it. Doppler examination was performed in eight patients: in all cases scarce vascularization of the nodule was found. Conclusions: Hypoechoic nodules of the abdominal wall circumscribed by a hyperechoic rim should raise the suspicion of abdominal wall endometriosis even in patients with no history of endometriosis nor previous laparotomy or laparoscopic surgery. Pushing against the nodule with the ultrasound probe can strengthen such diagnostic suspicion thanks to the pain induced.

OP11.07: Transvaginal sonographic mapping of pelvic adhesions in women with chronic pelvic pain

Objectives: To compare the efficacy of multi-step hysterosalpingo contrast sonographic (HyCoSy)-based triage for the assessment of tubal patency with X-ray hysterosalpingography (HSG) and laparoscopy (LPS) in an outpatient office infertility program. Methods: Infertile patients are routinely examined by HyCoSy during the proliferative phase to asses tubal patency. The first step was based on a 2D-HyCoSy using saline mixed with air. If tubal patency was doubtful, patients underwent a 2D-HyCoSy using Sonovue (Bracco Diagnostics, Inc.) as contrast media and Contrast-Tuned Imaging. In doubtful cases this second procedure was performed during the same examination with the same catheter (8Fr–Nelaton). These cases underwent as confirmative test either HSG or LPS. Sensitivity and specificity of this multi-step HyCoSy compared to HSG and LPS was calculated by statistical analysis. Results: In 68 patients tubal patency was assessed at saline–air HyCoSy (69%). We report the results of this multi-step HyCoSy in the remaining 30 doubtful cases (59 tubes) compared to HSG (34 tubes)–LPS (25 tubes) (Table). The six discordant occluded tubes proved patent at LPS, similarly the one discordant patent at HyCoSy was found occluded at LPS. Therefore sensitivity and specificity of contrast-HyCoSy when compared to HSG were both 100%. Sensitivity and specificity at LPS were 87% and 60%, respectively.

OP11.05: Three-dimensional sonographic evaluation of septate uterus after hysteroscopic metroplasty: correlation with pregnancy outcome

Objectives: Polycystic ovary syndrome (PCOS) is the most frequently encountered form of endocrinopathy in women, occurring in 4–7% of the population. Thus, it is important to assess the ultrasound morphology of the ovaries in patients with clinical presentation of anovulation together with the cardinal features of hyperandrogenism. We aimed to study the prevalence of PCOS morphology in a cohort of patients clinically presented with oligoanovulation and/or androgen excess. Methods: Two hundred and twenty-seven women between the ages of 17 and 41 were referred to our reproductive infertility clinic with symptoms of oligo-anovulation and/or androgen excess for endocrine evaluation. All the patients underwent clinical, endocrine and ultrasound investigations. The ultrasound criteria included at least one of the following: either 12 or more follicles measuring 2–9 mm in diameter, or increased ovarian volume (> 10 cm3). Results: PCOS was diagnosed in 165 patients, hyperprolactinemia in 25 patients, thyroid abnormality in 22 patients and non-classical adrenal hyperplasia (NCAH) in 15 patients. No significant difference was found in patients’ age. The patients with PCOS were found to have a significantly higher body mass index (BMI), compared to patients with hyperprolactinemia (P = 0.047), but not with thyroid abnormality or NCAH. Diagnostic rates of PCOS were found in150 (90.9%) of the patients with PCOS, 16 (64.0%) of the patients with hyperprolactinemia, 20 (90.9%) of the patients with thyroid abnormality and 10 (66.7%) of the patients with NCAH. Conclusions: PCOS morphology is common in patients with endocrinopathies who present with ovarian dysfunction and androgen excess. For them, PCO ultrasonic morphology is not sufficient for the diagnosis of PCOS. In order to establish the diagnosis of PCOS, it is important to exclude other diagnoses that may replicate symptoms of PCOS. Appropriate treatment should only be started following complete medical evaluation.