C. De Gasperi

Reliability of the first-trimester cardiac scan by ultrasound-trained obstetricians with high-frequency transabdominal probes in fetuses with increased nuchal translucency.

To examine prospectively the reliability of ultrasound‐trained obstetricians performing a first‐trimester fetal cardiac scan with high‐frequency transabdominal probes, by confirming normal or abnormal heart anatomy, in pregnancies referred for increased nuchal translucency thickness (NT).

Spatial velocity profile changes along the cord in normal human fetuses: can these affect Doppler measurements of venous umbilical blood flow?

Several studies have assumed a parabolic velocity profile through the umbilical vein (UV) to derive the mean spatial velocity that is indispensable for flow rate calculations. However, the structure and arrangement of the umbilical cord suggest that velocity profiles may vary. The aim of this study was to evaluate UV spatial flow velocity profiles at different sites along the umbilical cord.

OC219: Changes in distribution of cardiac output in human macrosomic fetuses

Methods: 36 fetuses with HLHS, from two cardiology referral centers. Results: Mean gestational age of the first exam was 28,5 weeks. 27 fetuses were referred because of abnormal 4-chamber view. 18 mothers were from high-risk group. There was positive family history in 7 cases. Foramen ovale was small with dominantly left to right shunt in all cases, restrictive in 25, atretic in 2 fetuses. In 3 cases big hypokinetic left ventricle progressed into HLHS toward the end of pregnancy. Karyotype was evaluated in 25 fetuses (69%) and was normal in 21 (84%). There was Turner syndrome in 1, Patau syndrome in 1 and deletion of the chromosome 11 in 1 case. In 3 fetuses signs of heart failure increased, 1 died in utero. In 1 fetus severe arrhythmia with heart failure resolved during pregnancy. Two neonates died just after delivery. Four mothers decided to terminate the pregnancy (2 of them had previously children with HLHS). Six mothers decided to withhold treatment in neonates. 14 newborns were operated on in two cardiac surgery centers. In 7 of them classical Norwood procedure was performed, all of them died. During last 1,5 years modified Norwood was performed in 7 neonates: 1 in the first center and he died, 6 in the second center, of which 5 survived. One who died had to be transferred between two towns. Comparison between classical and modified Norwood procedure showed statistically significant difference in survival. Conclusions: 1. Majority of fetuses with HLHS was referred due to abnormal 4-chamber view, but half of all were from high-risk group. 2. HLHS can change in utero-from big hypokinetic ventricle toward hypoplastic one. 3. Tricuspid insufficiency is dangerous sign for the future of fetuses with HLHS. 4. Results of modified Norwood procedure were better than classical Norwood, so it can change the policy for fetuses with HLHS.

OC26.07: Doppler evaluation in fetuses with right ventricular prevalence: a contribution to the diagnosis of coarctation of aorta

CCO ml/min 413 ± 281 1052 ± 388 461 ± 337 1226 ± 591 QLV ml/min (% of CCO) 185 ± 140 (44%) 443 ± 177 (42%) 267 ± 197* (58%) 746 ± 494** (60%) QRV (% of CCO) 234 ± 147 (56%) 608 ± 227 (57%) 194 ± 150 (42%) 480 ± 172* (39%) QDA (% of CCO) 159 ± 107 (38%) 335 ± 171 (31%) 130 ± 91 (28%) 327 ± 176 (26%) QFO (% of CCO) 104 ± 141 (38%) 170 ± 145 (31%) 130 ± 91 (28%) 327 ± 76** (26%) Qlungs (% of CCO) 74 ± 42 (18%) 272 ± 94 (26%) 136 ± 120* (29%) 418 ± 472 (29%)

OP04.10: Role of cardiac output redistribution in maintaining cardiac function in fetuses with isolated congenital heart diseases (CHD)

post-processing, isovolumetric and ejection periods were measured according to valve status. 4D-MPI results were compared to conventional Mod-MPI. Results: 30 healthy fetuses were examined to establish normal range of values for 4D-MPI at 24–32 weeks. MPI measured in both methods remained relatively stable during pregnancy. In 13 cases of evolving cardiac compromise (agenesis of ductus venosus with extrahepatic connection-4, cardiomyopathy-2, SVT-2, diaphragmatic hernia-1, fetal anemia [before treatment]-2, pulmonary-venous shunt-1, CMV infection-1), conventional Mod-MPI and 4D-MPI showed similar results. The difference between them did not exceed ±0.05 (clinically insignificant). Conclusions: 4D-MPI is useful for direct evaluation of fetuses with suspected cardiac compromise, and provided results comparable to those obtained with conventional Mod-MPI. 4D-MPI may form part of the 3D/4DUS exam performed on these fetuses.

OP18.08: Evidence of changes in the third-trimester cardiac outputs of fetuses with increased nuchal translucency

Objectives: To measure right and left cardiac output in fetuses with enlarged NT and normal karyotype in the second and third trimesters and to verify whether hemodynamic changes could occur in these fetuses in comparison to fetuses with normal NT. Methods: Echocardiography (Aloka SSD alpha10) was performed in 40 fetuses with NT ≥ 95th percentile, normal cardiac and extracardiac anatomy and normal karyotype (Group A) at 20–22 and 30–32 weeks of gestational age (GA). Diameters of the aorta (Ao) and pulmonary artery (Pa), time averaged maximum velocities in Ao and Pa, immediately downstream from the valves, were obtained in order to measure left (LCO) and right cardiac output (RCO). RCO/LCO ratios and combined CO (RCO + LCO) (CCO) were calculated and compared to reference values obtained in 42 normal fetuses with normal NT at comparable weeks (Group B). Results: Mean GA at birth and mean neonatal weight in Group A were 40 weeks and 3430 g, in Group B 39 weeks and 3195 g. No significant differences were found between cardiac output of Group B and Group A at 20 weeks, whereas the Table shows the high statistical differences between cardiac output in Group A and B at 30–32 weeks, with a strong positive correlation with nuchal enlargement.

OC95: Feasibility of the first level transabdominal screening for cardiac defects at the time of NT measurements using a new high‐definition blood flow imaging mode

Objectives: To investigate the cardiac defects (CHD) found in association with an increased nuchal translucency (NT). Methods: Patients referred from January 1998 until February 2007 with an NT ≥ 95th percentile at 11–14 weeks and where a cardiac defect was found were included. Chromosome analysis, fetal echocardiography and postnatal echocardiography were performed. After pregnancy termination a postmortem examination was performed when possible. Results: CHD were identified in 63 fetuses (major CHD in 50; 79%). The median NT was 4.8 (range, 2.6−13) mm. Group 1 included 36 fetuses (57%) with a normal karyotype. Median NT was 5.2 (range, 2.8−9) mm. Twenty-four (66.7%) had major CHD. CHD included VSD (10), HLHS (four), TGV (three), AVSD (three), PA + VSD/TOF (two), PS (two), uncertain cardiac diagnosis with hydrops (two), aortic arch abnormalities (two), PDA (two), DORV (one), ASD (one), tricuspid atresia (one), aortic incompetence (one), mitral valve abnormality (one) and persistent right umbilical vein (one). Group 2 included seven fetuses (11%) with a genetic disorder including: 18p deletion (two), 22q11 deletion (two), Coffin–Siris (one) and Holt–Oram (one). CHD found included HLHS, TGV, truncus arteriosus, VSD (two), ASD and DORV. Group 3 included 20 fetuses (32%) with abnormal numeric karyotype including 10 trisomy 21, six trisomy 18, two XO, one trisomy 13 and one trisomy 9. Median NT was 4.7 (range, 2.6−13) mm. Nineteen had major CHD. CHD found with trisomy 21 included AVSD (six), inlet VSD (two) and RV non-compaction (one). In fetuses with trisomy 18, VSD (two), polyvalvular disease (two), HLHS (one) and aortic arch abnormality (one) were found. Both fetuses with XO had HLHS. PA + VSD was found with trisomy 13 and truncus arteriosus in trisomy 9. Conclusions: Various CHD are associated with an increased NT. Conotruncal defects, branchial arch derivative defects, left and right obstructive lesions and shunts were seen. Anomalous pulmonary venous drainage and cor triatriatum were not seen; thus abnormal targeted growth is not the mechanism linking CHD and an increased NT.

OP05.08: Quantitative umbilical venous flow in twin–twin transfusion syndrome (TTTS): intertwin differences and modifications after therapeutic procedures

Objective: To compare the transfer of technetium-99m labelled red blood cells (99mTc RBCs) in monochorionic (MC) placentas, MC placentas after laser coagulation of the vascular anastomoses for TTTS and fused dichorionic (DC) placentas. Methods: Placental perfusion study with 99mTc O Rh – RBCs in 5 MC, 5 lasered MC and 5 fused DC placentas. The arteries of twin 1 were injected with 20–30.10 × 9 99mTc RBCs diluted in 100 mL NaCl, whereas the vessels of twin 2 were rinsed with 200 mL NaCl. The % of transferred 99mTc RBCs was calculated by dividing the radioactivity measured in the rinsing solution of twin 2 by the initial radioactivity injected in twin 1. Afterwards, each placenta was injected with dyed barium sulphate to document the angioarchitecture. Results: GA at birth was similar in the 3 groups. None of the lasered MC and fused DC placentas had visible anastomoses, whereas all 5 MC placentas had visible anastomoses-1 had only small arteriovenous (AV)-venoarterial anastomoses (VA) without an arterioarterial (AA) anastomosis, 4 had an AA with AV/VA. The % of transferred 99mTc RBCs in lasered MC placentas (0, range: 0–000012) was similar to fused DC placentas (0, range: 0–001760) (NS), but significantly lower than in MC placentas (8.5, range: 1–66) (p < 0.01). In MC placentas, the larger the AA, the higher the % of transferred 99mTc RBCs. Conclusion: In MC placentas successfully separated by laser coagulation of the vascular anastomoses, the transfer of 99mTc RBCs was not significant and similar to fused DC twin placentas. Therefore, laser seems to functionally separate the 2 fetal circulations.

P06.06: Vesicocentesis in the first and second trimesters of gestation for treatment of fetal megacystis

Objective: Fetal megacystis in the first and second trimesters of pregnancy is an indication for diagnostic vesicocentesis. Our goal is to assess the effectiveness of early vesicocentesis as a treatment option of megacystis. Materials and Methods: From 1995 to 2005, 18 pregnancies were identified with early fetal megacystis. Fetal biometry, morphology, amniotic fluid, bladder size and volume were evaluated. Karyotype was available in 6 cases (6/18 = 33%). Vesicocentesis was performed in 8 fetuses (8/18 = 44%). Fetal urine biochemical markers were determined after each vesicocentesis. Results: Megacystis was never isolated: 6 cases (6/18 = 33%) demonstrated oligohydramnios or anhydramnios, 5 fetuses (5/18 = 28%) presented renal dysplasia, 4 had renal hyperechogenicity (4/18 = 22%), 3 had mild pyelectasis (3/18 = 17%), 1 ureteral dilatation (1/18 = 5.5%) and 1 a polymalformative syndrome with sacrococcigeal mielomeningocele (1/18 = 5.5%). Any case had chromosomal abnormalities. In 3 fetuses (3/8 = 37.5%) biochemical markers indicated a good fetal kidney function, in the remaining 5 fetuses (5/8 = 62.5%) a poor renal prognosis was suggested. In 2 cases (2/8 = 25%) pregnancy proceeded with normal amniotic fluid volume and a normal-sized urinary bladder with normal dynamics. In 3 cases (3/8 = 37.5%) megacystis recurred and a second vesicocentesis was performed. In the remaining 3 cases (3/8 = 37.5%): 2 terminations of pregnancy were performed and 1 spontaneous abortion occurred. Conclusions: Fetal vesicocentesis in the first trimester of gestation is a useful treatment option in case of megacystis. Fetal vesicocentesis is a minimally invasive procedure that can be life-saving if performed in early pregnancy.

OC143: Use of transabdominal high‐frequency transducers in first‐trimester scan

Introduction: Reproductive ageing was defined in 2001 by the Stages of Reproductive, Ageing Workshop (STRAW). STRAW Stage + 2 begins five years after menopause. Obective: To describe the prevalence of bio physically abnormal ovaries as judged by transvaginal ovarian ultrasonographic (US) examination in STRAW Stage + 2. Methods: We recruited 512 asymptomatic post menopausal women. Each woman was still eligible if they had one ovary, or post menopausal hysterectomy, or hormone therapy provided they could identify the year of their menopause. Each woman undertook US with a specialist of the RANZCOG with a Certificate of Obstetrical and Gynaecological Ultrasound (COGU). Individuals were seen six weeks after their US. Those with an abnormal US had a retest by an independent COGU investigator blinded to the results of the first US test. Results: Median age was 60.0 years. 447 subjects had both ovaries identified. One ovary only was seen in a further 47 (9.2%) women. 18 individuals (3.4%) had neither ovary identified. In 71 (13.9%) women, some comment was made about the ovary, paraovarian area or uterine tubal area at the US test. 46 (8.9%) subjects had normal ovaries on the US test but had possible uterine abnormalities. Conclusions: (1) One or both ovaries were identified by vaginal US testing in 96% of women at STRAW Stage + 2. (2) Prevalence of biophysically abnormal ovaries as judged by US testing is less than 13.9%. (3) Approximately 10% of women show a uterine abnormality.