C. Brezinka

Evaluation of volume vascularization index and flow index: a phantom study

Three‐dimensional (3D) power Doppler ultrasonography provides indices to quantify moving blood within a volume of interest (e.g. ovary, endometrium, tumor or placenta). The purpose of this study was to determine the influence of ultrasound instrument settings on vascularization index (VI) and flow index (FI) at different flow velocities, using a specially built flow phantom with a small tube diameter.

Ductus venosus flow velocity waveforms in relation to fetal behavioural states

Objectives To establish the reproducibility of flow velocity waveforms in the human ductus venosus and to assess the influence of fetal behavioural states on these waveforms in normal term fetuses.

Using virtual reality for evaluation of fetal ambiguous genitalia

The utility of a virtual reality system was examined in the visualization of three‐dimensional (3D) ultrasound images of fetal ambiguous genitalia.

A virtual reality rendition of a fetal meningomyelocele at 32 weeks of gestation

Using a virtual reality system to render images obtained with three-dimensional (3D) ultrasound a fetal lumbosacral meningomyelocele (L3–S2) is shown here at 32 weeks’ gestation (Figure 1). The defect was originally observed in a 24-year-old primigravida during a routine sonogram at 22 weeks (Figure 2). After extensive counseling the patient decided not to have an amniocentesis and to continue with the pregnancy. In this image the meningomyelocele is seen from a coronal view with the sac partially ‘cut open’. The slitlike dark structure in the center is the actual midline defect of the osseous structure of the spine. The spinal nerve roots can be observed running from the vertebral column towards the inside wall of the meningomyelocele where they adhere to the neural placode (Figure 3). The neural placode is the flat plate of dysplastic neural tissue, which is elevated to the dome of the meningomyelocele by the pressure of cerebrospinal fluid. The image, originally obtained during a 3D ultrasound examination, is seen hovering in space in front of the investigator, giving the impression of a 3D structure with a diameter of approximately 80 × 80 × 60 cm. The image can be moved, resized and turned around in space with the help of a hand-held joystick. The joystick also allows a part of the volume to be ‘cut away’.

Unusual Manifestation of Acute Hepatic Porphyria in Pregnancy

A 22-year-old para I/gravida II developed psychiatric symptoms at 8 weeks of gestation. Subsequently neurological symptoms with seizures developed leading to a status epilepticus with continuing seizures at week 14. Anticonvulsive therapy had little effect in alleviating the seizures and the condition of the patient rapidly deteriorated. A sudden reddening of her urine lead to the diagnosis of acute hepatic porphyria confirmed by laboratory tests. After extensive discussion with the patient’s family it was decided to terminate the pregnancy at week 16. Within hours after pregnancy termination the seizures stopped and the patient recovered without any neurological deficits. Acute hepatic porphyria can be triggered by pregnancy and usually presents with gastrointestinal symptoms and personality changes. In its rare neurological manifestation it can lead to untreatable convulsions which leave no option but to terminate the pregnancy.

OP09.16: A new approach for evaluation of fetal ambiguous genitalia: using 3D images in virtual reality

Objective: This study examines the role of virtual reality in the visualization of 3D data volume sets of ambiguous genitalia as acquired by 3D ultrasound. Methods: In 2005 in three patients referred to our department for prenatal ultrasound assessment ambiguous genitalia were diagnosed. Postpartum diagnosis was one case of Russell-Silver syndrome, one case of an XY-female with normal labia majora and an enlarged clitoris and a case with an unusual type of cloacal malformation with an enlarged clitoris, prominent preputium and single urogenital sinus. Prenatally, patients were examined by 2D and 3D ultrasound and subsequently the images obtained at 3D ultrasound were visualized in the Barco I-Space virtual reality system. Results: In these cases, prenatal diagnosis was impossible with 2D ultrasound. 3D ultrasound provided an impression of ambiguity, however this was incorrect in two cases. In the I-Space, a better impression of genital ambiguity was established. Particularly the bi-ocular depth perception provided by the I-space was useful when faced with the task of differentiating a micropenis from an enlarged clitoris. Conclusions: The presence of ambiguous genitalia in a baby post partum presents a major diagnostic dilemma that few clinicians would attempt on a purely visual basis without resorting to palpation and physical examination. Prenatal ultrasound of such a condition can at best only alert to a condition that will need further examinations post partum, thus unfortunately raising parents’ anxiety level. A 3D virtual reality technique that improves depth perception can improve visualisation of difficult anatomical structures such as ambiguous genitalia.

OP09.01: Evaluation of the vascularization index; a flow phantom study

Wharton’s jelly and total cord area, however, increased linearly with gestation. No difference was found between sonographic measurements of umbilical cord in normal and diabetic pregnancies. Umbilical parameters are increased above 90 percentile only in few diabetic pregnancies (umbilical cord area in 10 cases, umbilical vein area in 13 cases and Wharton’s jelly area in 11 cases). Five of six cases with decreasing umbilical vein and artery area were SGA fetuses. No statistical significant differences were seen between normal and LGAfetuses. Statistically significant correlations between birth weight and placenta weight and sonographic parameters of umbilical cord were detected in both control and in diabetic pregnancies. Conclusion: No differences were seen between sonographic estimation of umbilical cord, vein, arteries and Wharton’s jelly area in normal and diabetic pregnancy.

OP09.04: Improving 3D ultrasound interpretation of fetal anatomy using a virtual reality system

Objective: Three-dimensional (3D) ultrasound imaging has greatly improved evaluation of organ circulation and might contribute new information on maternal and fetal blood supply. The aim of this study was to evaluate the relationship between 3D flow index (FI) and flow velocity in a human vessel and in a flow phantom. Study Design: A 1 cm long strip of the uterine artery was recorded in 3D power Doppler (3D-PD) mode in a cross-sectional study of 170 normal singleton pregnancies between 26 and 42 weeks of gestation. A fixed ultrasound system installation was used during the examination. Vessel volume and FI were calculated by the VOCALTM software integrated in the ultrasound unit. Reproducibility of the measurements was tested. The method was also tested on a commercially available flow phantom. Results: Reproducibility measurements gave satisfactory results. In normal pregnancy, the uterine artery FI decreased slightly with gestation. The vessel volume increased with gestational age. A poor correlation was found between the FI and velocity in the flow phantom. Conclusion: 3D power Doppler imaging can give impressive anatomical pictures of organ vascular tree. However, the new flow indices are poorly related to flow velocity or volume of flow.

OC102: Longitudinal observation of the human yolk sac, yolk sac and fetoplacental hemodynamics: preliminary results

Methods: This cohort study included 3,348 singleton pregnancies between 22 and 26 weeks. The primary outcome was early onset (≤ 34 weeks) and/or severe PE. Secondary outcomes included: PE, SGA without PE, and composite neonatal morbidity. Data were analyzed using contingency tables, ROC curve and multivariate logistic regression. Results: 1) The prevalence of PE, severe PE, and early onset PE was 3.4% (113/3,296), 1.0% (33/3,296), and 0.8% (25/3,174), respectively; 2) abnormal UADV and a maternal plasma PlGF < 280 pg/ml were independent risk factors for PE, and SGA without PE; 3) a combination of abnormal UADV and maternal plasma PlGF < 280 pg/ml was associated with a dramatically increased risk for early onset PE, severe PE, PE, and SGA [early onset PE: OR 44.5 (95% CI:18.8–105.4); severe PE: OR 37.4 (95% CI: 17.6–79.1); PE: OR 8.6 (95% CI: 5.3–13.7); SGA: OR 2.7 (95% CI: 1.7–4.3)]; 4) among patients with abnormal UADV the measurement of maternal plasma PlGF improved the prediction of PE as determined by the ROC curve (early onset PE: area under the curve: 0.80; p < 0.001, and severe PE: area under the curve: 0.77; p < 0.001); 5) of importance, 89% (16/18) of patients who developed early onset PE and 88% (21/24) of those who developed severe PE had plasma PlGF < 280 pg/ml. Conclusions: The combination of abnormal UADV and low maternal plasma PlGF concentration in the second trimester is associated with a dramatically increased risk for the development of early onset and/or severe PE.

OP02.40: Congenital isolated talipes equinovarus; comparison of outcome between prenatal detection and detection only at birth

Achondroplasia n << 3rd n FB Short macrocephaly Acromesomelic n < 3rd n mild FB Short skull shape, narrow chest, bowed humerus Kneist n or 5th ≤ 5th n flat, mild micrognathia N short chest, talipes, bowed long bones SEDC < 5th << 3rd micrognathia N short chest Stickler 5th 5th n flat N OI IV n n n n N mild femoral bowing Brachytelephalangelic CDP 5th < 5th stippled DNB Camptodactly, stippled carpals stippled epiphyses Conradi Hunerman < 5th < 5th stippled DNB N stippled epiphyses