C. Blank

OC22.04: Ultrasound-based strain mapping for contraction frequency in the non-pregnant uterus

Methods: A retrospective cohort study of women who underwent a laparoscopic myomectomy at University College London Hospital between December 2014 and November 2017 was carried out. Ultrasound images and operation notes were reviewed. The size and minimum distance of the fibroid from the endometrial cavity in a 2-dimensional longitudinal plane were determined from ultrasound images (negative distance was scored when the fibroid protruded into the cavity). Endometrial cavity breaches at the time of surgery were identified from the operation notes. Women who did not have a preoperative ultrasound and those who had more than two fibroids removed were excluded. Results: 74 women who had laparoscopic myomectomy and a preoperative ultrasound were identified. The median age was 36.0 (IQR 33 – 39.8) and the median fibroid diameter was 68.2mm (IQR 47.7 – 80.6). 10/74 (13.5%, 95% CI 5.7 – 21.3) had a breach of the endometrial cavity. Women who suffered a breach had a fibroid that was close to or within the endometrial cavity (distance from cavity -9.9 vs. 8.9mm, p=0.001, degree of protrusion 17% vs. 0.0% and intracavitary surface area 1463mm2 vs. 0.0). A logistic regression model with cavity breach as independent variable and ultrasonic variables as predictors selected minimum distance from cavity as the best predictor of cavity breach (OR 0.79, 95% CI 0.73 – 0.92). 10/19 (52.6%, 95% CI 30.2 – 15.1) of women with a submucosal component to their fibroid did not have a cavity breach. No women with a fibroid further than 5.2mm from the cavity had a breach identified at surgery. Conclusions: Identifying patients who are at increased risk of endometrial cavity breach based on ultrasound facilitates appropriate preoperative counselling regarding the risk of intrauterine adhesions and the need for Caesarean section.

Primum non nocere: earlier cessation of glucose monitoring is possible

Newborns are at relatively high risk for developing hypoglycaemia in the first 24xa0h after birth. Well-known risk factors are prematurity, small for gestational age (SGA) or large for gestational age (LGA), and maternal pre-existent or gestational diabetes mellitus. Prolonged hypoglycaemia is associated with poor neurodevelopmental outcomes; hence, prevention through proper monitoring and treatment is important. Given the ongoing debate concerning frequency and duration of screening for neonatal hypoglycaemia, therefore, we investigated the frequency and duration of glucose monitoring safe to discover neonatal hypoglycaemia in different risk groups. Data of newborns at risk for hypoglycaemia were retrospectively collected and analysed. Blood glucose concentrations were measured 1, 3, 6, 12, and 24xa0h after birth. Moderate hypoglycaemia was defined as a blood glucose concentration of <u20092.2xa0mM and severe hypoglycaemia as a concentration of <u20091.5xa0mM. Of 1570 newborns, 762 (48.5%) had at least one episode of hypoglycaemia in the first 24xa0h after birth; 30.6% of them had severe hypoglycaemia (all in the first 9xa0h after birth). Only three SGA and two LGA newborns had a first moderate asymptomatic hypoglycaemic episode beyond 12xa0h after birth. The incidence of hypoglycaemia increased with accumulation of multiple risk factors.Conclusion: Safety of limiting the monitoring to 12xa0h still has to be carefully evaluated in the presence of SGA or LGA newborns; however, our results suggest that 12xa0h is enough for late preterm newborns (>u200934xa0weeks) and maternal diabetes.What is Known:• Newborns are at relatively high risk for developing hypoglycaemia and such hypoglycaemia is associated with adverse neurodevelopmental outcomes.• Proper glucose monitoring and prompt treatment in case of neonatal hypoglycaemia are necessary.What is New:• Glucose monitoring 12 h after birth is proficient for most newborns at risk.• Maternal diabetes leads to the highest risk of early neonatal hypoglycaemia and newborns with more than one risk factor are at increased risk of hypoglycaemia.

Ex-vivo phantom for evaluation of ultrasound speckle tracking in the uterus

Uterine peristaltic movement plays an important role for the success of embryo implantation. This is especially relevant in the context of assisted reproductive technology. Unfortunately, the lack of tools for quantitative analysis limits our understanding of the uterine contractility. Recently, strain analysis by ultrasound speckle tracking has gained attention for the assessment of the uterine contractility. However, the absence of a ground truth hampers the optimization of this technology. This work proposes the first phantom based on a human ex-vivo uterus able to generate controlled tissue motion by sinusoidal (0,05 Hz), linear displacement of a syringe piston, injecting 3-mL water through a balloon catheter inserted into the uterine cavity. This way, controlled, realistic peristaltic movement was generated while maintaining original speckle characteristics. Uterine motion analysis was obtained by US speckle tracking on acquired B-mode imaging data using two block matching techniques, normalized cross-correlation (NCC) and sum of absolute differences (SAD). The proposed phantom based on a human ex-vivo uterus showed its value to assess US speckle tracking techniques providing a realistic ground truth that is fully controlled.

P26.02: Objective assessment of uterine peristalsis outside pregnancy by high-order texture analysis of ultrasound images

the mean uterine wall thickness was 8.05 (SD 2.29) mm and 8.05 (SD 2.24); the mean interostial line was 37.99 (SD 8.33) and 38.00 (SD 8.39); the mean internal midline indentation was 17.06 (SD 9.76) mm and 17.10 (SD 9.80); and the mean external indentation was 7.20 (SD 5.37) and 7.07 (SD 5.21).The Intra-class correlation coefficients were 0.99 for the interostial line, uterine wall thickness, and the external indentation and 1 for internal midline indentation (p<0.05). Conclusions: Three-dimensional ultrasound uterine measurements described in the ESHRE-ESGE consensus and the Thessaloniki ESHRE-ESGE consensus showed a good level of inter-observer reproducibility.

EP31.03: Ultrasound-based strain mapping for quantitative characterisation of uterine activity outside pregnancy

Objectives: To compare transvaginal ultrasound with water contrast (TVUWC) with computed tomography-based virtual colonoscopy (CTC) in the detection of bowel stenosis grade in patients affected by deep infiltrating endometriosis (DIE). Methods: IDEA criteria were used to assess DIE ultrasonographic stadiation. Patients suspected to have a rectosigmoidal localisation at the TVU (performed with a GE Voluson E8) underwent TVUWC and CTC to estimate and quantify bowel stenosis grade by percentage. Both the examination were performed and reported by high qualified sonographers and radiologists, experienced in instrumental detection and stadiation of DIE. Results: 28 patients were recruited. The two techniques showed a good concordance: CTC detected 8 (34,8%) bowel stenosis > 50%; 7 (30.4%) of them were either detected by the TVUWC examination. Stenosis < 50% was reported in 15 (65.2%) and 16 (69.6%) cases by CTC and TVUWC respectively, with a diagnostic accuracy of 85.7%. Related to CTC, TVUWC showed a sensitivity of 75% and a specificity of 90%; positive predictive value was 75% while the negative one was 90%. Conclusions: Our preliminary data suggest a strong concordance between TVUWC and CTC in the detection and estimation of bowel stenosis in patient affected by recto-sigmoidal DIE. We expected to apply TVUWC as a valid first line technique, alternative to CTC in addressing patient to surgery, in consideration of its simpler execution, lower costs and risks for the patient. More data are worth to be studied related to the histological data (gold standard).