A. Ebrashy

13–14‐week fetal anatomy scan: a 5‐year prospective study

To assess the potential value of an early (first‐trimester) ultrasound examination in depicting fetal anomalies by transabdominal (TAS) and transvaginal (TVS) sonography, to compare it with the traditional mid‐trimester anomaly ultrasound examination and to evaluate the degree of patient acceptance of early sonography by the transvaginal route.

OP19.08: Effect of prophylactic progesterone on incidence of preterm labour in spontaneous twin pregnancy, randomized controlled study

L. E. Romine1, M. Hwang5, N. Trivedi2, J. Wan4, Y. LaCoursiere2, P. Do4, K. Benirschke3, D. Schrimmer2, D. H. Pretorius1 1Radiology, University of California, San Diego, CA, USA; 2Reproductive Medicine, University of California, San Diego, CA, USA; 3Pathology, University of California, San Diego, CA, USA; 4School of Medicine, University of California, San Diego, CA, USA; 5School of Medicine, Vanderbilt University, Nashville, TN, USA

OC163: Transvaginal ultrasound guided needle aspiration in the management of patients with simple ovarian cysts

Objectives: To determine fetal and neonatal outcome in referrals with isolated abdominal fetal calcifications. Methods: We report 24 cases of prenatally diagnosis isolated abdominal calcifications referred to our centre over the period 1997–2007. The management included detailed fetal ultrasound imaging, maternal TORCH analysis, parental and fetal cystic fibrosis mutations analysis, fetal karyotype, and infectious investigations in amniotic fluid. Neonatal examination and postnatal ultrasound findings were collected and follow-up was obtained. Results: In 16 cases, abdominal calcifications were limited to one single organ (7 into the liver, 1 into the bowel, 1 into the spleen, 6 cases close to stomach and 1 behind the liver). In 2 cases, TORCH screening was abnormal (1 case of CMV and 1 toxoplasmosis) and in 1 case ureplasma urealyticum was found in amniotic fluid. Calcifications size remained stable during pregnancy for all cases excepted one with spontaneous antenatal resolution. In 8 cases, multiple abdominal calcifications were present. CMV infection was found in 2 cases and in 1 case Ureaplasma urealyticum was found in amniotic fluid. Postnatal outcome was complicated by neonatal peritonitis for one newborn and by chorioamnionitis ureaplasma for another one. For the others, postnatal outcome was uneventful and abdominal isolated calcifications were confirmed in postnatal US examination. No abnormal karyotype and no genetic abnormality of parental and fetal CF screen was evidenced. Conclusions: Abdominal isolated calcifications are frequently found at the 2nd trimester US. Our experience shows that when they are isolated to one single organ, neonatal outcome is uneventful but when they are present in multiple localisations, there is an increased risk of neonatal complications, as meconial peritonitis or chorioamniotitis. The prenatal management should include maternal TORCH screen and US Follow-up and amniotic fluid sampling should be discussed

P04.12: Current status of prenatal diagnosis of beta‐thalassemia in Egyptian patients: a preliminary report

Objectives: Beta-thalassemia is the commonest genetic disorder in Egypt with an estimated carrier rate of 9–10%. The aim of the study was to look at the common mutations found in our population and the impact of prenatal diagnosis on parents attitudes. Methods: Prospective analysis of cases referred for prenatal diagnosis of thalassemia at Fetal Medicine Unit, Cairo University from 2007 till 2010. Families with previous affected child had molecular assessment of their mutations as well as in the affected siblings. In future pregnancies they would be referred for invasive testing at 11–12 weeks where chorionic villous samples (CVS) were obtained or amniocentesis samples were taken for those who show at later gestations. All cases would first undergo a detailed first trimester scan including assessment of risk for chromosome abnormalities using Medison Accuvix XQ machine (Korea). Samples were analyzed for point mutations using PCR reversed hybridization techniques, in cases with absence of mutant primers direct automated DNA sequencing is performed to located the uncharacterized DNA mutation. Patients with anomalies or high risk for chromosome abnormalities are counselled for fetal karyotype accordingly. Results: Forty one cases were sampled of which 28 cases were CVS and 13 were amniocentesis. Commonest mutations seen were IVS 110, IVS 1-6, IVS 1-1. Other mutations found were IVS 2-1, IVS 2848, IVS 2-745, Codon 5, 30, 39, 27, 87, some were uncharacterized. 13 cases were affected, 5 were normal and 23 cases were carriers. Nearly half of the affected cases were homozygous and other half were compound heterozygous. No miscarriages due to procedures occurred and 1 CVS case was repeated due to inadequate sample. Conclusions: Premarital counselling and couple screening is available but under-utilized. The availability of prenatal diagnosis service changed the current attitude of couples. The hope for bone marrow transplantation seems promising from normal siblings in carrier families.

OP05.02: 3D multislice analysis of ultrasound volumes for the prenatal diagnosis of central nervous system fetal malformations

holoprosencephaly was ruled out in a case of severe hydrocephaly with agenesis of corpus callosum, a definitive diagnosis of bilateral open lip schizencephaly was made and a case with suspected intraventricular hemorrhage was ruled out, although it missed an arachnoid cyst shown by US. Conclusion: Our preliminary results suggest that neurosonography performed by dedicated sonologists using both 2D/3D transabdominal and transvaginal sonography provides equal results to MRI in the diagnosis of most fetal brain anomalies. MRI supplied important clinically useful information in selected cases of brain anomalies. Therefore, both diagnostic tools can and probably should be used to complement each other.

OP30.02: The role of 3D ultrasound extended imaging in the evaluation of uterine myomas prior to surgical management

OP30.01 Interobserver agreement on reporting uterine intracavity lesions at gel infusion sonography (GIS) T. Van den Bosch1, J. Luts2, T. Bourne3,1, T. Bignardi4, G. Condous4, E. Epstein5, F. Leone6, A. Testa7, L. I. Valentin8, S. Van Huffel2, D. Van Schoubroeck1, D. Timmerman1 1Obstetrics & Gynecology, University Hospitals K.U. Leuven, Leuven, Belgium; 2Electrical Engineering, ESAT-SCD, K.U. Leuven, Leuven, Belgium; 3Obstetrics and Gynaecology, Imperial College London, Hammersmith Campus, London, United Kingdom; 4Acute Gynaecology, Early Pregnancy Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Sydney, NSW, Australia; 5Obstetrics & Gynecology, Lund University Hospital, Lund, Sweden; 6Obstetrics & Gynecology, Clinical Science Institute L. Sacco, University of Milan, Milan, Italy; 7Obstetrics & Gynecology, Universita del Sacro Cuore, Rome, Italy; 8Obstetrics & Gynecology, Malmo University Hospital, Lund University, Malmo, Sweden

OC15.02: 3D sonohysterography versus 3D ultrasound examination of the coronal plane of the uterus in infertile women with suspected uterine cavity lesions or anomalies

EDD-U. Among pregnant women with a BMI ≥ 30 kg/m2, the risk of postponed EDD was significantly increased compared to women with BMI 20-24.9 kg/m2. In women with a BMI ≥ 30 kg/m2 the EDD was more often postponed ≥ 14 days (OR 1.51; 95% confidence interval [CI] 1.46–1.56) or 7–13 days (OR 1.38; 95% CI 1.35–1.41). Similar risk was observed among women with BMI 25–29.9 kg/m2, but was less pronounced. Conclusions: High maternal BMI increases the risk for postponing date of delivery at mid-trimester ultrasound examination. The estimation of gestational age in obese women as shorter than according to the LMP, might be due to erroneous sonographic measurements.

OP09.04: Early fetal trans‐abdominal and trans‐vaginal anatomy scans. Will they substitute the mid‐trimester anomaly scan?

after the onset of the last menstrual period were eligible for further analysis. For each gestational age (GA) we calculated mean CRL and standard deviation. For the purpose of the comparison with results obtained by Robinson and Fleming a non-linear regression analysis was performed in order to obtain the curve of best-fit together with two standard deviations. Original measurements were further analyse to determine dating curve for GA relative to CRL. Actual GA data were then compared with predicted GAs at corresponding CRL values of Robinson and Fleming, resp. Drumm dating curves. Results: The best-fit curve for relation of CRL to GA was achieved by a quadratic function y = −0.0232x2 + 5,1802x − 214,5414 (SD = 6.81, R2 = 0.2994). Dating curve for GAs relative to CRL was determined GA (days) = −0.0005CRL2 + 0,6264CRL − 69.9803 (SD = 3.34, R2 = 0.2949). Comparing actual GAs for our CRL values with predicted GAs from Robinson and Fleming at corresponding CRLs, mean diferrence were −1.32 ± 3.91 days. Similar comparison with the data of Drumm revealed mean difference 0.67 ± 4.17 days. Robinson CRL curve, resp. Drumm CRL curve underestimated GA by 7.6, resp. 6.9 days for CRL of 40 mm, and overestimated by 4.8, resp. 8.2 days for CRL of 90 mm. Conclusions: Dating curve based on 6221 CRL measurements was more gradual than those of Robinson and Drumm. For CRL of 40 mm Robinson CRL curve, resp. Drumm CRL curve underestimated the GA by 7.6, resp. 6.9 days, and for CRL of 90 mm overestimated by 4.8, resp. 8.2 days. The difference is on the verge of significancy.

OP17.11: Evaluation of ultrasonographic characteristics of malignancy in ovarian tumors

Primary ovarian fibrosarcoma is one of the rarest ovarian tumors. It is an aggressive malignant condition and there are no clinical guidelines for the management of patients. In the published reports, these ovarian malignancies present a great heterogeneity of clinical and pathological features, and no specific sonographic features have been reported. We present two cases of primary ovarian fibrosarcoma referred to our tertiary center in Rome. These two cases are unique in several aspects: i) both patients did not complain of any particular symptom and the diagnosis was made at a routine ultrasound scan; in the vast majority of previously reported cases, the patients were symptomatic, with abdominal and pelvic pain or progressive abdominal enlargement ii) the malignant nature of the ovarian tumor was suspected at the preoperative sonographic examination: in both cases a monolateral inhomogeneous roundish solid ovarian mass, with irregular borders and the largest diameter of 110 and 80 mm, respectively, was diagnosed. A small amount of free fluid in the pouch of Douglas was detected in both cases. At color Doppler examination, a main vessel penetrating into the mass (‘‘lead vessel’’) was observed in one case (color score = 3), whereas only a few vascular spots were detected (color score = 2) in the other case. In both cases an aggressive strategy was applied, and after radical surgery, the patients underwent six courses of adjuvant chemotherapy with Adriamicin and Ifosfamide. Both patients are now free of disease and the survival period of 50 months, for the first patient, is one of the longest reported in the literature. In both cases the ovarian fibrosarcomas showed an inhomogeneous solid morphology with irregular borders. These sonographic features, together with the absence of regular stripes, allowed us to exclude the hypothesis of ovarian fibromas. However, no specific sonographic features to discriminate fibrosarcomas from ovarian carcinomas, were identified.

OC060: Comparison of 2D transvaginal sonohysterography and 3D ultrasound evaluation of the uterine cavity in infertile women

Objectives: To evaluate the relationship between uterine arteries blood flow and endometrial and subendometrial volume and vascularity using three-dimensional (3D) power Doppler untrasonography in patients with recurrent miscarriage (RM). Methods: 40 women with unexplained RM were included in the study. All patients underwent an accurate screening in order to exclude all the etiological RM factors. Three-D ultrasound examination with power Doppler was performed in all cases in the midluteal phase of the cycle by Voluson 730 pro GE machine. Twenty patients showed increased resistance to uterine arteries blood flow whereas in 20 cases normal resistances were found. Endometrial and subendometrial volume, vascularization index (VI), flow index (VI) and vascularization flow index (VFI) were calculated using the VOCAL (Virtual Organ Computer-aided AnaLysis) software. Results: Endometrial and subendometrial volume and VI were found significantly lower in patients with increased resistance to uterine arteries blood flow. No statistically significant correlations between uterine arteries PI, endometrial and subendometrial FI and VFI were observed. Nonetheless, patients with increased resistances to uterine arteries blood flow showed lower 3D vascularization indices. Conclusions: 3D power Doppler ultrasonography study of uterine perfusion seems to reflect the actual blood flow to the subendometrium and endometrium. This technique represents a unique tool to examine the blood supply towards the endometrial and subendometrial regions providing the opportunity to identify women with RM in which appropriate therapeutic protocols may effectively improve the possibility for successfully pregnancy.