B. Meurer

Angiogenic growth factors in maternal and fetal serum in pregnancies complicated by intrauterine growth restriction

The present study was performed to compare serum concentrations of maternal and fetal angiogenic growth factors in IUGR (intrauterine growth restriction) and normal pregnancy at the time of delivery. VEGF (vascular endothelial growth factor), PlGF (placental growth factor), sFlt-1 (soluble fms-like tyrosine kinase 1), sKDR (soluble kinase domain receptor) and bFGF (basic fibroblast growth factor) were measured by ELISA in serum from a maternal peripheral vein, the umbilical vein and the umbilical arteries in 15 women with pregnancies complicated by IUGR and 16 controls (women with normal pregnancies). In IUGR, sFlt-1 was increased, and PlGF and sKDR were decreased, in both maternal serum and serum from the umbilical vein. Additionally, bFGF was increased in serum from the umbilical vein of women with pregnancies complicated by IUGR. No significant differences in growth factor concentrations between the groups were found in serum from the umbilical artery. In both groups, levels of VEGF were higher and levels of sFlt-1 were lower in serum from the umbilical vein and umbilical artery compared with maternal serum. PlGF levels were found to be lower in serum from the umbilical vein compared with maternal serum in both groups, whereas PlGF levels in serum from the umbilical artery were significantly lower only in the control group. These findings suggest an imbalance of angiogenic and anti-angiogenic factors in IUGR, with formation of an anti-angiogenic state in maternal and, to a lesser extent, umbilical vein blood. The placenta appears to play a central role in the release of sFlt-1 into maternal and umbilical blood. Umbilical artery blood was unaffected in IUGR, indicating that the fetus does not contribute to changes in angiogenic growth factor concentrations.

Weight estimation by three‐dimensional ultrasound imaging in the small fetus

To improve birth weight estimation in fetuses weighing ⩽ 1600 g at birth by deriving a new formula including measurements obtained using three‐dimensional (3D) sonography.

Macrosomia: a new formula for optimized fetal weight estimation

To develop and test a specific formula for estimating weight in the macrosomic fetus.

Increased Accuracy of Fetal Weight Estimation with a Gender-Specific Weight Formula

Objective: To test whether Schild’s sex-specific formula for estimating fetal weight is more accurate than commonly used regression formulae. Methods: The gender-specific formula and 10 widely used equations were evaluated in a group of 989 pregnancies. Each fetus underwent ultrasound examination with complete biometric parameters within 7 days before delivery. Results: Over the whole weight range and in the subgroup of newborns with a birth weight between 2,500 and 3,999 g, the sex-specific weight formula from Schild demonstrated the best level of accuracy. For infants with a birth weight of less than 2,500 g as well as for macrosomic newborns, the gender-specific formula did not improve fetal weight estimation. Conclusion: In pregnancies where fetal gender is known, Schild’s regression formula should be used when fetal weight lies within the range of 2,500–3,999 g.

Fetal Adrenal Haemorrhage – Two-Dimensional and Three-Dimensional Imaging

A case of prenatal adrenal haemorrhage first detected by 2-dimensional and 3-dimensional sonography at 27 weeks’ gestation is reported. Ultrasound examination showed a large cystic mass (32 × 27 × 27 mm) in the right suprarenal region of the fetus. Two weeks later, the mass had slightly increased in size demonstrating hyperechoic areas within the cyst. Further serial ultrasound examinations revealed a progressive organisation of the cystic mass associated with a moderate reduction in size. The diagnosis of adrenal haemorrhage was confirmed by postnatal follow-up sonograms as the mass decreased in size from 28 × 21 × 21 mm on day 1 to 23 × 18 × 17 mm on day 42. Course and sonographic signs were typical for adrenal haemorrhage and the neonate was therefore managed without surgical exploration. The child is developing normally at 6 months of age.

OC16.01: Correlation between second trimester 3D‐placental volumetry and vascularization, cytokines in the amniotic fluid and fetal weight at birth

Objective: The septate uterus is associated with a decreased live birth rate. The mechanisms by which septate uteri cause early pregnancy loss and infertility have not been completely established yet. Evaluation of septate uterus is quite easy by means of transvaginal three-dimensional (3D TVS) ultrasound. The aim of this study was to assess by 3D TVS uterine septum dimensions, volume, morphology and vascularization and to correlate these features to reproductive outcome. Methods: Patients of reproductive age with a septate uterus underwent 3D TVS. On 3D TVS coronal view of the uterus, septal length and width, volume, echostructure and vascularization by means of the Vascularisation Index (VI), were evaluated. The number of pregnancies and the reproductive outcome of each patient were recorded and correlated to the previous mentioned 3D TVS features. Results: Among 65 patients with septate uterus, 19 had a recurrent pregnancy loss, 5 had a preterm delivery, 4 had a term delivery and 36 presented with primary infertility. The width of the septum was significantly larger in patients with recurrent abortion (31.6 + 6.10mm) compared to those with primary infertility (25.6 + 7.12mm). 3D TVS showed that vascularization expressed as VI calculated on septal volume (17.49 ± 8.40%) was significantly higher in patients with term or preterm deliveries Conclusions: 3D TVS allows detection of different types of uterine septa. The different morphology of uterine septa suggests that the pathogenesis of infertility in these patients is multifactorial, and perhaps the reproductive outcome can be correlated to septal width and structure.

OC24.05: Increased concentration of tubular parameters in the amniotic fluid of male fetuses in the 2nd trimester of pregnancy

13.53◦ (95% CI: 13.28◦–13.78◦, 5th–95th percentile: 10.4◦–16.9◦). In 22 fetuses with facial clefts (median gestational age: 23 weeks, range: 19+1–29+6 weeks) the mean MNM was 20.6◦ (95% CI: 18.2◦–23.0◦). In all fetuses (n = 3) with intact alveolar ridge the MNM angle was normal. In 13 fetuses with unilateral interruption of the alveolar ridge the MNM angle was above the 95th percentile in 62% (n = 8) and normal in 38% (n = 5) of the cases. In all (n = 6) fetuses with bilateral interruption of the alveolar ridge the MNM angle was above the 95th percentile. Conclusions: The MNM angle can quantify the amount of maxillary protrusion in fetuses with facial clefts. A MNM angle above the 95th percentile indicates an (at least unilateral) interruption of the alveolar ridge.

OP10.06: First trimester 3D‐placental volumetry is a good predictor of both low and high birth weight

Objective: The extremes of fetal weight are associated with serious perinatal complications and increased morbidity and mortality of the newborn. Early pathological changes in the placenta with reduction of its size and increase in uterine blood flow resistance may be of clinical relevance in intrauterine growth restriction but not in macrosomia. We therefore investigated whether placental volume parameters as assessed by 3D-ultrasound in the first trimester are related to fetal weight at birth. Methods: Inclusion criteria were: singleton pregnancy and gestational age between 11 + 0 and 13 + 6 weeks. Exclusion criteria were: smoking, pre-existing diabetes, fetal anomalies, serious maternal disease and maternal medication affecting fetal growth. In 236 patients fetal biometry with regard to crown-rump-length (CRL), biparietal diameter (BIP) and abdominal circumference (AC) and placental volumetry by 3D-ultrasound were routinely performed. The placental volume (PV) and three different placental ratios (PR1=PV/CRL; PR2=PV/BIP; PR3=PV/AC) were calculated. Fetal birth weight below the 10th (SGA) and above the 90th percentile (macrosomia) served as primary outcome variables. Statistics were based on linear and logistic regression analysis. Results: 8.5% of our newborns were SGA and 11.9% macrosomic. The median of first trimester PV was 59.73 cm3. PV (p=0.001) and PR1-3 (p<0.0001) were significantly correlated with fetal weight at birth. In linear regression analysis highly significant effects on fetal birth weight were shown for all placental volume parameters. PV and placental ratios significantly predicted fetal birth weight below the 10th and above the 90th percentile in a logistic regression model. Conclusions: Different placental volume parameters in the first trimester show a strong correlation with fetal birth weight. 3Dplacental volumetry appears to be a useful technique in the early identification of pregnancies at risk for being SGA and macrosomic at birth.

OP08.11: Placental volume measurement by 3D ultrasound in the first trimester and prediction of fetal growth restriction

Objectives: To compare the distribution of routine fetal biometry as assessed by midwives and medical staff at 20–24 weeks and 30–34 weeks in an unselected population. Methods: Standard measurements of biparietal diameter and head circumference, abdominal circumference, and femur length were performed by four midwives and ten physicians at between 20 and 24 weeks and at 30 to 34 weeks as part of routine ultrasound examination during a 26-month period. All measurements were transformed into Z-scores calculated according to different prediction equations. The reference for each type of measurement that best fits our practice was previously determined: Snijders and Nicolaides (1994) for abdominal circumference, Chitty et al. (1994) for head circumference and femur length and the French College of Echocardiography (2006) for biparietal diameter were chosen. Mean and SD of Z-score distributions were compared at 20–24 weeks and at 30–34 weeks between the group of measurements performed by the midwives and physicians respectively. Student’s t-test and a Fisher test were used to compare mean values to and SD values respectively. Results: A total of 1566 ultrasound examinations were included in the midwife group at 20–24 weeks, versus 1631 examinations in the physician group whereas 1710 examinations were included at 30–34 weeks in the midwife group versus 1578 examinations in the physician group. We found that mean values for the midwives were significantly closer to 0 (P < 0.05) as compared to the physicians’ results. On the other hand, the midwives’ SD values were significantly lower and smaller than 1 as compared to the doctors’ SD values. Conclusions: Midwives seem to normalize biometry values more than physicians. Such normalization may hamper the sensitivity of routine ultrasound screening for abnormal fetal growth.

OP08.07: New specific ultrasound‐based weight formula for fetuses with abdominal wall defects

Objectives: Fetal weight is generally underestimated for macrosomia and current models are relatively imprecise. This on-going study investigates the effect of combining soft tissue with conventional biometry in this population. Methods: BPD, AC, FDL, fractional arm (AVol) and thigh (TVol) volume measurements were obtained using 3D ultrasound within 4 days of delivery (n = 248). A weight estimation model was based on multiple linear regression (BPD, AC, FDL) and compared to one that replaced FDL with AVol or TVol. New models were prospectively applied in 18 pregnancies with BW > 4000 g. Predicted and observed weights were compared with mean and SD of signed % differences. Normally distributed paired differences were compared using a paired t-test and F-test based on two correlated variances in paired samples. Proportion of subjects with predicted BW within 5 or 10% (inclusive) were compared (McNemar’s test). Results: To date, 18 infants have delivered with a BW of 4452.44 ± 301.96 g. The ‘modified Hadlock’ model was Log BW = 0.0026 (BPD2) +0.0467 (AC) +0.1865 (FDL) −0.0042 (AC × FDL) +1.346. Soft tissue models were: (1) BW = 13.0112 (BPD2)−65.0208 (BPD) +1.4847 (AC2)−26.0729 (AC) −0.2637 (AVol2) +52.5110 (AVol) +269; and (2) BW = 11.1372 (BPD2) −67.2281 (BPD) +1.2175 (AC2) −17.3004 (AC) −0.0490 (TVol2) +25.3052 (TVol) +284.