C. Heien

Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term

To evaluate whether engagement of the fetal head or cervical length in women with premature rupture of membranes (PROM) at term, are associated with time from PROM to delivery or need for operative delivery.

Ultrasound assessment of fetal head–perineum distance before induction of labor

To evaluate fetal head–perineum distance measured by ultrasound imaging as a predictive factor for induction of labor, and to compare this distance with maternal factors, the Bishop score and ultrasound measurements of cervical length, cervical angle and occiput position.

Can ultrasound measurements replace digitally assessed elements of the Bishop score

Objective. To compare elements of the Bishop score and corresponding sonographic measurements before induction of labor, and assess how predictive factors can be used in a clinical setting. Design. Prospective comparative clinical study. Setting. Secondary referral center, university hospital. Population. A total of 275 women scheduled for induction of labor. Methods. Fetal head descent to the perineum was assessed with transperineal ultrasound. Cervical length, posterior angle, and dilatation were evaluated with transvaginal ultrasound followed by Bishop score without knowledge of the ultrasound measurements. Results. Univariable regression analyses of successful induction were significant for digital assessment of cervical dilatation, ultrasound measured fetal head–perineum distance ≤40 mm, ultrasound measured cervical length ≤25 mm, and ultrasound measured posterior cervical angle >90 degrees. After adjusting for maternal factors in a multivariable model, estimates were significant for previous vaginal birth (OR 5.3; 95% CI 2.1–13.9, p<0.01), but borderline for maternal height (OR 1.1; 95% CI 1.0–1.2, p = 0.01) and ultrasound measured posterior cervical angle >90 degrees (OR 2.6; 95% CI 1.1–6.1, p = 0.03). A scoring model combining ultrasound measured fetal head–perineum distance, cervical length, cervical posterior angle and digitally assessed cervical dilatation, discriminated successful and failed induction at 71% (95% CI 61–80%, p<0.01) area under the receiver–operating characteristics curve. Conclusion. Digital assessment of fetal head descent, cervical length and position can possibly be replaced with ultrasound measurements. Dilatation is best evaluated with digital assessment. Combination of these four factors can predict success of labor induction.

Routine Use of Color Doppler in Fetal Heart Scanning in a Low-Risk Population

Objectives. To investigate the detection rate of major fetal heart defects in a low-risk population implementing routine use of color Doppler. Material and Methods. In a prospective observational study, all women undergoing fetal heart scanning (including 6781 routine examinations in the second trimester) during a three-year period were included. First a gray-scale scanning was performed including assessment of the four-chamber view and the great vessels. Thereafter three cross-sectional planes through the fetal thorax were assessed with color Doppler. Results. Thirty-nine fetuses had major heart defects, and 26 (67%) were prenatally detected. In 9/26 (35%) of cases the main ultrasound finding was related to the use of color Doppler. The survival rate of live born children was 91%. Conclusions. Routine use of color Doppler in fetal heart scanning in a low-risk population may be helpful in the detection of major heart defects; however, still severe malformations were missed prenatally.

Umbilical vein vasomotion detected in vivo by serial three‐dimensional pixelwise spatially angle‐corrected volume flow measurements

To explore changes in volume flow in the umbilical vein in healthy second‐trimester fetuses.

OC191: Ultrasound measurements of fetal head‐engagement and cervical length as predictive factors of labor outcome in women with induced labor

of fetal head position. An error rate of around 50% for vaginal examination was nearly constant during the first 50 examinations. It decreased subsequently, to stabilize at a low level from the 73rd patient. Errors of ± 180◦ were the most frequent. With regard to the vaginal examination, the learning curve of ultrasound stabilized earlier, after the 23rd patient. The most frequent errors with ultrasound were the absence of conclusion, particularly at the beginning of training, followed by errors of ± 45◦. Conclusions: Learning was easier and accuracy was higher in the determination of fetal head position in labor with transabdominal sonography than with digital examination. This should encourage physicians to introduce ‘clinical ultrasound’ into their practice.

OP35.06: Detection of major fetal heart defects with routine use of colour Doppler

Objectives: Rhabdomyoma is the most common type of cardiac tumor in fetuses and is often associated with tuberous sclerosis complex (TSC) with neurologic sequelae. The purpose of this study is to investigate short-term and long-term outcome of fetal cardiac rhabdomyoma. Methods: We analyzed the clinical characteristics of 23 cases prenatally diagnosed with cardiac rhabomyomas on fetal echocardiography at Asan Medical Center between January 1998 and December 2009. We performed postnatal workup including brain magnetic resonance imaging (MRI), echocardiography, abdominal ultrasonography and molecular genetic analysis to confirm the presence of cardiac rhabdomyomas associated with or without TSC. Results: Among 23 cases, 17 cases (74%) had available outcome and 6 cases (26%) were lost to follow-up. 1) The survival rate was 100% (17/17). 2) Among 17 cases, while spontaneous tumor regression occurred in 11 cases (65%), no change in tumor size and number was observed in the remaining 6 cases (35%). 3) There was no evidence of long-term cardiac dysfunction due to remnant rhabdomyomas, regardless of tumor size. 4) TSC was revealed in 9 patients (53%), of whom four (44%) showed neurodevelopmental morbidities. 5) Among 4 patients with neurologic impairment, three (75%) had TSC gene (TSC1/TSC2) mutation. 6) Seven (78%) of 9 TSC cases were non-familial. Conclusions: The overall outcome of isolated cardiac rhabdomyomas was favorable. We suggest that systematic evaluation of TSC be performed even in cases of cardiac rhabdomyomas without family history of TSC. Molecular diagnosis of TSC1 and TSC 2 might be helpful in predicting short-term and long-term neurodevelopmental outcome.

OC140: Ultrasound measurements or Bishop score before induction of labor?

Objectives: 1) To determine the incidence of cord entanglement during early gestation using three dimensional (3D US) sonography. 2) To establish relationship between fetal and umbilical cord lengths, as a suggested pathophysiology for the cord entanglement incidence throughout pregnancy. Material and Methods: A prospective consecutive study was designed and 3D US was performed. Two hundred and thirty seven singleton pregnancies between 13–16 weeks were included. Cord entanglement was defined when one or more of the following was detected: cord around neck, hand, leg, thorax, abdomen shoulder, pelvis. Floating free cord through all its length in the amniotic fluid was defined as normal position cord. Results: Abnormal cord position was observed in 149 (62.9%) patients. Of those: 42.9.0% around neck, 15.4% legs, 12.7% hands, 4.8% -abdomen, 24.2% -other body parts (thorax, shoulder and pelvis). Incidence of total cord entanglement was similar between 13–16 weeks gestation. A decreasing ratio between cord length and CRL (according to literature) was calculated throughout pregnancy. Conclusions: A high incidence of early second trimester cord entanglement was found. This may be explained by the high calculated ratio between cord and fetal lengths during early pregnancy. Cord entanglement should be considered a part of normal early fetal movements and development.

The Bishop score components correlated to sonographic measurements prior to induction of labor

Objective: The Bishop score remains the gold standard for assessing favourability for induction of labor, but it is a subjective evaluation with limitations. The aims of this prospective study were to relate the components of the Bishop score to corresponding sonographic measurements and to assess predictive values for a successful labor induction. Methods: In 275 women the fetal head-perineum distance was measured through a transverse transperineal scan, and the cervical length, posterior cervical angle and cervical dilatation through a transvaginal scan. The Bishop score was assessed without knowledge of ultrasound measurements immediately after the scans. Correlation analyses were done, and receiver-operating characteristics (ROC) curves were used for evaluation of the probability of a successful vaginal delivery. Results: By sonographic assessment the cervix was closed in 219 (80%) of the women compared to 58 (21%) by digital assessment. Spearman\s correlation coefficient for digital and ultrasound assessment of cervical length was 0.54 (p<0.01), fetal head decent 0.23 (p<0.01) and cervical position/angle 0.03. The predictive value for a vaginal delivery after induction of labor for Bishop score and ultrasound measurements is presented in figure 1. The best predictive factors for a vaginal delivery were digital assessment of cervical dilatation with 61%; 95% CI 51–71% (p=0.03) under the ROC curve area, and a combination of ultrasound measured fetal head-perineum distance, cervical length and cervical angle with 67%; 95% CI 56–77% (p<0.01) under the curve area. Conclusion: The correlation between ultrasound and digital assessments is weak. None of the factors used alone are good predictors of labor outcome. Combinations of factors improve the prediction.

P04.25: An easy way to determine fetal heart laterality

Objective: Fetuses with problems, for example growth restriction, diabetic mothers or complex heart disease may change the hemodynamics of ventricular chambers come to alter chamber size, shape, contractility, filling properties, stroke volume (SV,mL) and ejection fraction (EF,%). However normal ranges have been varied, the purpose of this study is to report the mean ranges of cross-sectional and M-mode echocardiographic measurements and to compare with each methods. Methods: This was a prospective study of 62 normal fetuses (Gestational age 20 ∼ 38 weeks) referred for a routine sonographic examination. Two operators using a 2 ∼ 6 MHZ sector probe (Accuvix XQ,MEDISON,co.,LTD.Korea) performed all measurements. The cross-sectional formula employed was the method of discs, which divides the ventricles into 20 equal-thickness discs. (Simpson method). The other method was Teichholz formula. All volumetric data by M-mode echocardiography were computed. Results: We collected normal ranges for the left and right enddiastolic ventricular dimension (EDD) and ejection fraction. M-mode measurements: The mean LVEDD was 9.1 ± 0.45 mm, LV SV 1.09 ± 0.92 mL, LV EF 63.38 ± 16.07%, RVEDD 1.08 ± 1.67 mm and RV EF 60.42 ± 19.12%. Simpson method measured the LV EF was 56.62 ± 17.67%, RV EF was 58.51 ± 19.55%. As gestational age, there was no significant difference between M mode and crosssectional echocardiography. Also there was not a difference of the ventricular function which it follow gestational age. Conclusion: This is the initial research which shows ranges for fetal ventricular ejection fraction and quantify them in fetus by the noninvasive echocardiography. In the future, we apply this method in the fetuses who have a problem and reveal an interrelation between prenatal and postnatal ventricular function. It will be helpful to decide a treatment time and predict their prognosis.