A. Kenanidis

OC282: Amniotic fluid isoprostane levels in fetuses with cystic hygroma

included sensitivities, false-positive rates and receiver–operating characteristic (ROC) curves. Results: Of 576 pregnancies studied from 1995 to 2006, 145 (25.2%) were affected. At 12–13 weeks’ gestation, fetal cardiomegaly predicted the affected pregnancies significantly better than placentomegaly (area under ROC curve, 0.949 vs. 0.687, P < 0.05). The sensitivity for prediction of the affected pregnancies was 90.6% for fetal cardiomegaly (CTR ≥ 0.5), 69.8% for placentomegaly (PT > 18 mm) and 65.1% for combined testing. The corresponding false-positive rate was 6.8%, 50.3% and 2.8% respectively. At 14–15 weeks’ gestation, the sensitivity for prediction of affected pregnancies was 93.8% for fetal cardiomegaly, 93.8% for placentomegaly and 87.5% for combined testing. The corresponding false-positive rate was 16.7%, 76.9% and 17.7% respectively. MCAPSV was not predictive in early second trimester. However, at 18–19 weeks’ gestation, MCAPSV (at a cut-off 1.5 multiples of the median) predicted affected pregnancies significantly better than fetal cardiomegaly (area under ROC curve, 0.959 vs. 0.788, P < 0.05). The sensitivity for the prediction of affected pregnancies was 100.0% for fetal cardiomegaly and 57.1% for high MCAPSV while the corresponding false-positive rate was 46.2% and 0% respectively. Conclusions: The best ultrasonographic predictor of affected pregnancies at 12–13 weeks’ and 18–19 weeks’ gestation was fetal CTR and MCAPSV respectively.

P08.05: Intrauterine oxidative stress and Doppler flussimetry in fetuses with IUGR

notch and clinical risk factors were present in 41.9% and 11% of women respectively. There were statistically significant differences between Doppler indices from pregnancies with or without subsequent PE or associated complications: mean PI 1.75 vs 2.04 (P = 0.002, t-Student test) and mean RI 0.75 vs 0.79 (P = 0.000, t-Student test). A multivariate logistic regression produced a two parameter model (including the mean PI and the presence of clinical risk factors) with the best sensitivity (46.27%) and specificity (80.99%) for the prediction of PE and its associated complications. Conclusion: There are differences in uterine Doppler blood flow indices at 11–14 weeks in pregnancies with or without subsequent PE and /or associated complications. The combination of mean PI with the presence of clinical risk factors at this gestational age show the best sensitivity and specificity for the prediction of PE and its associated complications in our population.

P050: Anatomical and functional embryo-fetal survey using 2D and 3D-4D ultrasound scan in the first trimester

Objective: To determine the feasibility of correctly identifying fetal gender from 11 to 13 weeks of gestation. Methods: Fetal gender assessment by ultrasound was prospectively carried out in 425 singleton pregnancies at 11–13 weeks of gestation (confirmed by crown-rump length or biparietal diameter) immediately before chorionic villus sampling for karyotyping. A total of 425 women underwent a detailed assessment of fetal anatomy at 11–13 weeks of gestation by means of transabdominal and transvaginal sonography. Fetal gender was identified in transverse and sagittal planes, and was confirmed by chorionic villus sampling. Results: The accuracy of sex determination increased with gestation from 91.7% at 11 weeks, to 97.2% at 12 weeks and 100% at 13 weeks. Male fetus were wrongly assigned as female in 5.5% of cases in 11 weeks, 2.4% at 12 weeks and 0% at 13 weeks. The accuracy of correctly identifying fetal gender increased with gestational age. Conclusion: Whilst the accuracy of sonographic determination of fetal gender at 11–13 weeks is good, our decision on invasive testing for sex-linked conditions should be undertaken.

P50.14: Massive omphalocele: management and outcome: a case report

feet and at this moment the hypothesis of congenital arthrogryposis was placed. At 18 weeks the scan showed the fetus in the same position but with marked hypomobility and flexion of limbs. The hypothesis of fetal akinesia sequence was placed and after discussion, the couple decided for termination of pregnancy. Fetopathological examination showed a 200 g male fetus, with nuchal and neck edema, flexion contractures of limbs, marked scoliosis of all vertebral column extension, rocker-bottom feet and multiple pterygia of great joints, leading to diagnosis of lethal multiple pterygium. This case report demonstrates the importance of the first trimester scan in the diagnosis of early fetal syndromes.

P15.05: The use of 3‐4D ultrasound improves the diagnosis of spinal dysraphism

Objectives: To assess the feasibility of prenatal diagnosis and the outcome of partial agenesis (PACC) and hypoplasia of corpus callosum (HCC). Methods: PACC/HCC were suspected on fetal multiplanar neurosonography when the corpus callosum appeared caudally shorter and thinner respectively. Follow-up was obtained in all cases. Results: Between 1990–2003, 8 cases of PACC and 3 cases of HCC were identified at a median gestational age of 22 weeks (21–33) (see table). The cavum septi pellucidum was present in 9 cases, in 7 there was mild to severe ventriculomegaly, usually in association with ‘teardrop’ lateral ventricles, and 4 had associated cerebral anomalies (Dandy-Walker complex, emimegalencephaly, microcephaly). Magnetic resonance (MR) was performed in 4/11 cases without adding significant information. Five fetuses were terminated, 7 had multiple anomalies, and 3 are developing normally. Conclusions: PACC can be reliably diagnosed since midgestation. However, multiplanar neurosonography is required. On standard axial planes sonographic findings are similar to complete agenesis but more subtle. In particular the cavum septi pellucidum is usually present. MR did not offer significant advantage over multiplanar neurosonography. HCC was an incidental finding usually in fetuses with multiple anomalies. The outcome of PACC/HCC is similar to complete agenesis of the corpus callosum.

P052: Can a selective use of amniocentesis replace the routine for advanced maternal age?

Objective: To determine the feasibility of correctly identifying fetal gender from 11 to 13 weeks of gestation. Methods: Fetal gender assessment by ultrasound was prospectively carried out in 425 singleton pregnancies at 11–13 weeks of gestation (confirmed by crown-rump length or biparietal diameter) immediately before chorionic villus sampling for karyotyping. A total of 425 women underwent a detailed assessment of fetal anatomy at 11–13 weeks of gestation by means of transabdominal and transvaginal sonography. Fetal gender was identified in transverse and sagittal planes, and was confirmed by chorionic villus sampling. Results: The accuracy of sex determination increased with gestation from 91.7% at 11 weeks, to 97.2% at 12 weeks and 100% at 13 weeks. Male fetus were wrongly assigned as female in 5.5% of cases in 11 weeks, 2.4% at 12 weeks and 0% at 13 weeks. The accuracy of correctly identifying fetal gender increased with gestational age. Conclusion: Whilst the accuracy of sonographic determination of fetal gender at 11–13 weeks is good, our decision on invasive testing for sex-linked conditions should be undertaken.

P040: Nasal bone visualization: A comparison between 3D and 2D ultrasound in the first-early second trimester

Objective: To compare the sonographic findings of the nasal bone in fetuses with trisomy 21 with the pathomorphological findings and to define a standardised measurement of the nasal bone. Methods: 17 first trimester fetuses with trisomy 21 were identified with a median gestational age of 12 weeks (11–14), in women with a median age of 38 years (range 27–47). Transabdominal scan, preceding TA-CVS for karyotyping, included the assessment of the fetal nose. The nasal bone was assessed to be ‘‘hypoplastic’’ or ‘‘absent’’ and length was measured. All pregnancies underwent termination after diagnosis. Serial sagittal sections with HE-staining of formaline fixed tissue was performed. Results: Of the 17 cases, the nasal bone was sonographically present, but with severe hypoplasia in 10, absent in 6, and in the remaining case, not able to be assessed secondary to fetal position. In 16 cases a nasal bone was present, histomorphologically detectable by the evidence of an ossification center. In 1 case the ossification structure was not clearly visualized. Retrospective review of ultrasound images could identify nasal bones in 5 of the 6 cases initially reported as absent on ultrasound examination. These were visible, but less distinct and had decreased echogenicity. Misinterpretation led to the false finding of an ‘‘absent’’ nasal bone while it was present, but ‘‘hypoplastic’’. Conclusion: Sonographic assessment of the fetal nasal bone should not distinguish between ‘‘present’’ and ‘‘absent’’, but should be reported as ‘‘normal’’ or ‘‘hypoplastic’’. For reproducible results it is necessary to standardise the sonographic examination. The sonographic landmarks of the fetal nose are: the nasal bone, the skin above and the cartilaginous tip of the nose.

OC225: Diagnosis of chorionicity at 10–19 weeks by 2D and 3D–4D scan

IUFD. Other losses were related to PPROM prior to 25 weeks. Long term follow up (> 1 yr) shows normal outcomes except in two cases with PPROM 26 and 28 weeks. Iatrogenic PPROM remains thus the leading complication, occurring in about 10%. Selective fetocide may also be contemplated more electively. For instance, some centres practise an active early management for TRAP sequence, because of the technical advantages and the inability to predict outcome early on in gestation. This may however lead to unnecessary treatment of a number of cases. In MC twins discordant for a non-lethal severe structural anomaly or chromosomal defect, the predictable poor quality of life for the abnormal twin may not be acceptable to the parents. Instead of termination of the entire pregnancy, selective feticide may be a more valuable option, given approval of the ethics committee and if no legal constraints apply. In these situations the disadvantages of an invasive procedure without benefit for the normal co-twin but with a clinically relevant risk must be outweighed against the potential but remote benefits parents expect. Once the decision for elective fetocide has been taken, it may be contemplated to perform this procedure later in gestation, to avoid the risks of an early iPPROM, compromising the co-twin, again given ethics committee consultation and only in countries where the law would permit this. Currently, it is not possible to say what the optimal method is for selective feticide in MC pregnancies. Different techniques are applicable at different gestational ages and for different indications. The surgeon should ideally be familiar with several techniques in order to tailor therapy to the individual requirements of each case. Of interest is that bipolar cord coagulation can be used late in pregnancy and is effective in TRAP as well as in MC twins with normal hemodynamics.