A. R. Caetano

P16.16: Fetal growth restriction: obstetrics and neonatal outcomes

Results: For renal volumes, a high correlation between 2 and 3D measurements, and between 3D measurements on the left and right side was observed. Bladder volume assessment correlated well between the sono AVC and VOCAL technique. Urine production gradually increased with gestational age with a large interfetal difference late in gestation. Fetal venous and arterial doppler flow measurements in the left and right kidney did not differ significantly; the PSV increases gradually with gestational age. The PI for renal veins remains almost constant. There was a good correlation between renal volume, fetal urine production and PSV of the renal artery. Conclusions: Reference curves for renal volume, fetal urine production and renal Dopplers flow measurements in normal pregnancies are provided. These will serve as potential predictors for renal function in fetuses with renal and urinary tract pathology.

OP17.08: Assessment of fetal brain volume by tridimensional ultrasound in fetal growth restriction

Objectives: Our purpose was to evaluate the brain volume in fetal growth restriction (FGR) by 3D ultrasound (3DUS) and to compare these values with those from adequate for gestational age (AGA) fetuses. Methods: This was a longitudinal prospective study involving 18 pregnancies complicated by FGR (fetal weight < P10), with 9 under the third percentile of weight, 9 between the third and tenth percentile and 10 controls, from 30 to 34 weeks of gestation, all of them with normal umbilical Doppler. The assessments of the fetal brain volume were carried out using XI VOCAL (Virtual Organ Computer-aided AnaLysis) in the biparietal diameter plane. Volumes were estimated and differences between FGR and AGA fetuses were calculated. Results: Brain volumes were satisfactorily obtained in all fetuses. The average brain volume was 224.901 cm3 in < P3 group, 252,698 cm3 in FGR between P3 and P10 and 292,153 cm3 in AGA fetus. The brain volume was significantly smaller in FGR< P3 (P = 0.000547) and in FGR between P3 and P10 (0, 007464) than controls. Comparing the two FGR groups, the volume was significantly smaller in < P3 group (0, 04438). Conclusions: Fetuses with growth restriction have smaller brain volume than AGA fetus even without brain sparring effect. These findings are important since recent studies show that the size of the head circumference is the main risk factor for neurological adverse outcome in fetal growth restriction, associated with psychomotor and cognitive retardation, school delay and behavioral disorders in childhood and adult life.

OP07.07: Ventricular volumetry, heart stoke volume, cardiac output and ejection fraction obtained by STIC: comparison between fetal sex

Objectives: The ductus arteriosus (DA) emerged from the pulmonary trunk and connects with the descending aorta. The normal Doppler evaluation depends on gestational age and the pulsatility index (PI) must be greater than 1.9. Anatomical and functional problems can occur as aneurysm of DA and DA with restrictive flow. DA anatomical changes can be caused by changes in blood flow and / or morphology of DA especially in the last trimester. Methods: Description of cases: 10 cases of anatomical changes of DA in fetuses with gestational age (GA) ranging from 28 to 37 weeks: 2 aneurysms DA (diameters of 5 and 8 mm) and 8 with morphological alteration with elongated, tortuous duct but with normal diameter with no points of constriction. Doppler flow changes was present with systolic velocity > 155 cm/s IP ranging from 1.7 to 2.5. Predominance of right heart chambers and tricuspid regurgitation was presented in 3 fetuses. ControI examinations were performed weekly or every two weeks. Results: Four women were found on routine obstetric ultrasound and three with suspected restrictive DA in previous fetal echo. One patient presented an excessive intake of grape juice, no use of drugs NSAIDs. All newborns born at term without significant symptoms and evolved with spontaneous closure of the DA. Conclusions: Changes of morphology in DA can be identified in the third trimester mainly because in this period the arteries and cardiac output pressures are greater and the proliferation of the intima occurs in DA preparing for postnatal closure. Evaluation with Doppler mainly using the PI help in the differential diagnosis of restrictive ductus arteriosus.

OP30.10: Left heart ejection fraction assessed by 4D ultrasound using STIC: observation of 265 normal fetuses

Objectives: The aim of this study was to obtain left ejection fraction (LEF) from fetal heart using four-dimensional ultrasound (4DUS) and spatio-temporal image correlation (STIC) in late middle pregnancy. Methods: 4D volumes of the fetal heart were acquired by sonography using a convex transabdominal transducer (RAB 4–8-MHz probe, Voluson 730 Expert, GE Medical Systems, Milwaukee, WI, USA) and the offline analysis was performed using 4DView software. Ventricular volumes were measured using STIC in 265 normal singleton pregnancies at 20 to 34+6 weeks’ gestation. By Virtual Organ Computer-aided AnaLysis (VOCAL) technique, left ventricular volume were obtained after a 30 degrees rotation around a fixed axis extending from the apex of the heart to the point that divides symmetrically mitral valve. The inner contour of left ventricle was drawn manually and the 4D volumes in end systole (ESV) and end diastole (EDV) were estimated. Stroke volume (SV) is calculated by formula SV = EDV−ESV and finally EF is obtain by the ratio between SV and EDV, by formula: EF = SV/EDV. Results: Based on frequency distribution of LEF according to gestational age, we built nomograms for 5, 10, 50, 90 and 95 centiles (Table 1). Linear regression equation provided the best fit for EF (Figure 2); LEF = 0.904 − 0.007. GA (r = 0.075, P < 0.001). Conclusions: Despite advancing gestational age, LEF remained stared stable.

P28.12: Intrauterine spontaneus rupture of a sacrococcygeal teratoma diagnosed by amniocentesis

was also present. The thired patient was reffered at 15 weeks. Fetus had normal face and head, but also marked pipelike scoliosis, short limbs and malformed lower extremities, ventral defect which included liver and bowels. It was not possible to confirm the presence of fetal kidneys, and also olygohidramnion was present. The short umbilical cord was also present. The fourth and most complex case was referred to our office at 20 weeks as twin pregnancy with one anomalous fetus. The anomalous monochorionic twin was acardiac, associated with holoprosencephaly, cystic hygroma, facial edema, marked scoliosis, gastroschisis. This twin had short ubmilical cord. 3D surface and 3D maximum rendering showed conjoined upper and lower extremities in one stalk for upper and one for lower limbs. This pregnancy was continuted until 33 weeks and delivered by cesarean section due to premature rupture of membranes. Fetal kariotyping in all cases showed normal kariotype. Conclusions: 3D and 3D multislice ultrasound gave significant information about types of anomalies in FBSA. Analysis of the fetuses in different 3D modes and in 3D multislice technique had important role in establishing the diagnosis of fetal body stalk anomaly.

OP33.03: Ultrasound evaluation of bowel complication in fetuses with gastroschisis

aimed to explore quantifiable sonographic approaches to evaluate uterine involution after vaginal birth. Methods: Eighty-one women who vaginally delivered a singleton at term were recruited. Weekly uterine examinations were performed until 7 weeks after the delivery. Uterine volumes were assessed manually, followed by twoand three-dimensional sonographies. Doppler studies of uterine and arcuate arteries were also carried out. Results: Analysis was achieved in 71 women with uncomplicated postpartum course and complete follow ups. Longitudinal normogram of uterine volumes was created from 497 observations. It demonstrated a steady involution from week 1 to 7 after the delivery. The volume measured by two and three-dimensional sonographies are well correlated (r > 0.7), but not with the manual estimation (r < 0.3). Continuous thinning of endometrial stripes and gradual elevation of uterine artery resistance indices were not correlated with the uterine volume (r < 0.1, and < 0.2, respectively). Resistance indices of the intramural arcuate artery were unchanged for the whole postpartum course. Involution was not affected by parity (r < 0.2). Conclusions: In contrast with traditional belief, the involution process may not be completed yet at 7 weeks after delivery. Uterine involution normogram might facilitate the diagnosis of postpartum uterine complications. Broader applications are expected with the normogram created from two-dimensional data. Additional predictive claims could be achieved with endometrial stripe and uterine artery Doppler indices, since their sequential changes are independent to that of uterine volume.

OP12.03: Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC

Objectives: To evaluate the significance of changes in umbilical artery (UA) and middle cerebral artery (MCA) pulsatility index (PI) in fetuses with congenital heart disease (CHD) of septal defect. Methods: Umbilical artery (UA) and middle cerebral artery (MCA) pulsatility index (PI) were retrospectively analyzed in 82 fetuses with CHD, including 25 cases of ECD, 51 cases of VSD and 6 cases of ASD. The control group comprised 660 healthy gestational agematched fetuses. Individual PI measurements were converted into Z-scores for statistical analysis. Results: When compared to controls, fetuses with ECD, VSD and all CHD had an increased UA-PI (P < 0.05), but fetuses with ASD have no significant difference (P > 0.05). There was no significant difference in the MCA-PI between fetuses with ECD, VSD, ASD, all CHD and controls (P > 0.05). Conclusions: Fetuses with CHD of septal defect might have an increased UA-PI, without remarkable change in MCA-PI.