A. R. Hatanaka

Reference ranges of atrioventricular valve areas by means of four-dimensional ultrasonography using spatiotemporal image correlation in the rendering mode.

This study aims to determine reference curves for fetal atrioventricular valve areas by means of three‐dimensional ultrasound using the spatiotemporal image correlation (STIC) software.

Reference Range for Fetal Interventricular Septum Area by Means of Four-Dimensional Ultrasonography Using Spatiotemporal Image Correlation

Objective: To determine reference range for fetal interventricular septum area by means of 3-dimensional ultrasonography (3DUS) using the spatiotemporal image correlation (STIC) method. Methods: A prospective, cross-sectional study was conducted on 328 normal pregnant women between the 18th and 33rd gestational weeks. To obtain the interventricular septum area, a virtual plane was used, with the green line (region of interest) adjacent to the external margin of the septum, which was manually delimited. To evaluate the correlation of the septum area with the gestational age, different regression modes were evaluated. The intraclass correlation coefficient was used to evaluate the interobserver reproducibility. Results: The interventricular septum area showed correlation with the gestational age (r = 0.81). The mean increased from 0.47 ± 0.10 cm2 in the 18th week to 2.42 ± 1.13 cm2 in the 33rd week of gestation. The mathematical equation that best represented this correlation was provided by linear regression: interventricular septum area = 0.0511 × gestational age (R2 = 0.095). The interobserver reproducibility was good, with bias of 0.01 cm2, precision of 0.07 cm2 and absolute limits of agreement of -0.14 and +0.15 cm2. Conclusions: Reference range for fetal interventricular septum area were determined by means of 3DUS using STIC in the rendering mode and were shown to be reproducible.

Amniotic fluid “sludge” is an independent risk factor for preterm delivery

Abstract Objective: To determine the prevalence and the clinical significance of amniotic fluid “sludge” (AFS) in asymptomatic patients at low and high risk for spontaneous preterm delivery. Method: A prospective cohort study was conducted on 195 singleton pregnancies at low or high risk for preterm birth (PTB) between the 16th and 26th weeks. Cervical length (CL) <25 mm and the presence of AFS were evaluated. The risk for preterm delivery before 28, 32, 35 and 37 weeks were determined according to the presence of AFS, CL < 25 mm and history of high risk for PTB. Stepwise logistic regression was performed to compare variables. Results: AFS was an independent risk factor for PTB < 35 weeks (OR: 3.08, 95% CI: 1.13–8.34, p = 0.027) but not for PTB < 28, 32 and 37 weeks. CL < 25 mm was an independent risk factor for PTB < 28, 32 and 35 but not for PTB < 37 weeks. High risk for PTB was not found as an independent risk factor for PTB. Conclusion: AFS is an independent risk factor for PTB before 35 weeks.

Reference intervals for fetal ear length between 19 and 24 weeks of pregnancy on 3-dimensional sonography.

The purpose of this study was to establish reference intervals for fetal ear length using 3‐dimensional sonography in the rendering mode.

Prenatal Diagnosis of Penoscrotal Hypospadia in Third Trimester by Two- and Three-Dimensional Ultrasonography: A Case Report

Hypospadia is an abnormal development of the corpus spongiosum, that involves cavernosa urethra, as a result of an inadequate fusion of the urethral folds. The incidence ranges from 0.2 to 4.1 per 1,000 live births. Among the markers of hypospadia, isolated ventral or lateral curvature of the penis associated with shortening are the most important markers and, in severe cases, can result in the classic “tulip sign.” The diagnosis of hypospadia is uncommon unless there is a routine of detailed analysis of fetal genitalia morphology. The prenatal diagnosis is of great importance for genetic counseling and allows better planning of postnatal treatment. The three-dimensional ultrasonography (3DUS) in rendering mode enables better comprehension of the pathology by parents, facilitating postnatal planning. We report a case of penoscrotal hypospadia diagnosed at 33 weeks of gestation, suspected due to the absence of testicles in the scrotum and difficulty of penis visualization. We emphasize the findings of 3DUS and its importance in the pathology compression by parents.

OC10.04: Analysis of fetal ear rotation by three-dimensional rendering mode using a novel method: the ear angle - preliminary results

R. Deshpande1,2, D. Anblagan4, N. W. Jones1,2, N. Raine-Fenning1, G. Bugg2, P. Mansell3, P. Gowland4, L. Leach3 1School of Clinical Sciences, Division of Human Development, University of Nottingham, Nottingham, United Kingdom; 2Deparment of Obstetrics & Gynecology, Queens Medical Centre, Nottingham, United Kingdom; 3School of Biomedical Sciences, University of Nottingham, Nottingham, United Kingdom; 4Sir Peter Mansfield MRI Centre, University of Nottingham, Nottingham, United Kingdom

P01.05: Relationship between fetal thymus size and cervical length in the second trimester of pregnancy and the risk of preterm birth

Objectives: Fetal adrenal gland receives rising awareness as a predictor of spontaneous preterm birth. Previous studies focused on cross-sectional assessments. We first aimed for longitudinally analysis and evaluated trajectories for term and preterm born neonates separately. Methods: Analyses were based on data from a population-based low-risk prospective pregnancy cohort. For this analyses, complete adrenal gland measurements had to be available, which we assessed at 24, 29 and 36 wks (n= 298 for analyses regarding total adrenal gland, n= 227 for adrenal mark). Median (25th, 75th percentile) values were calculated for adrenal gland volume corrected for estimated fetal weight and the ratio of adrenal mark width/total adrenal width (w/W). Continuous Friedman test was used for differences across pregnancy, Mann-Whitney-U test for comparisons between term and preterm. Results: Absolute adrenal volume increased with gestational age (p<0.0001). Regarding the ratio w/W, we observed a decrease over the course of pregnancy (p<0.0001). When stratifying our study sample into term and preterm born neonates, we only considered those neonates with complete data at all three time points. Hence, for those preterm neonates an ultrasound measurement was available at 36 wks and birth occurred shortly afterwards. While we observed similar trajectories regarding total adrenal gland volume (pfor difference ≥0.2), ratio w/W trajectories for term and preterm neonates differed particularly at 29 wks (pfor difference =0.3, 0.007, and 0.08 at 24, 29, and 36 wks, respectively). Compared to term born neonates, preterm ones had a lower ratio at 24, 29 and a higher at 36 wks, with a median increase from 0.43 to 0.49. Conclusions: Our study adds important longitudinal data on the fetal adrenal gland and supports the hypothesis that the adrenal mark enlarges prior to preterm birth and that this occurs already in the second trimester.

P08.17: Assessment of cervical artery indices using transvaginal ultrasound: preliminary results

newborn, umbilical artery power Doppler with zero or reverse enddiastolic blood flow (blood flow class IIIa/IIIb) or changes in venous duct blood flow. We collected data about pregnancy, prenatal ultrasound examinations and result of pregnancy. Results: 20 pregnancies were included. All women underwent caesarian section. Indication was severe maternal complication, worsening of power Doppler or deterioration of the fetus. 4 children died in postnatal period, 3 have some birth defects. Mean time of first ultrasound was 29+2g.w.11 fetuses had zero flow and 6 had reverse enddiastolic blood flow in umbilical artery. Mean estimated body weight was on 4.1th centile, mean pulsatile index in umbilical artery 2.39 (SD0.32) and cerebroplacental ratio 0.65 (SD0.18). Mean gestation week at delivery 29+5g.w, fetal body weight 891 g, Apgar score at 5th min 8, 10th min 9, arterial pH7.25 (SD1.69) and venous pH7.3 (SD1.63). Conclusions: Management of perinatal care of early onset IUGR with signs of blood flow redistribution is based on values of pulsatile index of umbilical artery, medial cerebral artery, venous duct and its pattern. Extreme or severe prematurity and maternal hypertensive complication are important factors. Supported by the grant from the Ministry of Health of the Czech Republic IGA NT 11004-3/2010, NT 12225-4/2011.

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.

P08.21: Analysis of the fetal ear position by three dimensional rendering mode using a novel method: the ear index—preliminary results

Objectives: To stablish normal ranges of Ear Index (EI) between 18 and 24 weeks of pregnancy, using three dimensional (3D) rendered mode sonography. Methods: This cross-sectional study involved 143 pregnant women with gestational age (GA) between 18 and 24 weeks. Voluson 730 Expert equipped with transabdominal transducer was used. Mean maternal age was 33.2 years (SD 10.2), 68 fetus were female and 75 male. A two dimensional coronal view of the ear was performed to make 3D reconstruction. Using rendered mode, a dotted line was traced through the comissure of the eye dividing the ear in two parts. The superior measurement divided by inferior was considered the EI (fig1). For analysis, Pearson Coefficient (r) was calculated. Results: No significant correlation between GA and EI was determined (r = 0.001), however, between 18 to 24 weeks, it could be considered a normal EI from 0.23 to 1.02. Percentiles of EI are shown in Table1. Conclusions: There is no correlation between GA and EI, but acceptable normal values could be observed within a normal range between 18 to 24 weeks (0.23 to 1.02). These values could be important as a new marker for chromosomal abnormalities. Further studies are needed for more conclusive data.