C. Ioannou

Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size.

Please cite this paper as: Ioannou C, Talbot K, Ohuma E, Sarris I, Villar J, Conde‐Agudelo A, Papageorghiou A. Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size. BJOG 2012;119:1425–1439.

Pregnancy dating by fetal crown-rump length: a systematic review of charts.

Fetal crown–rump length (CRL) measurement by ultrasound in the first trimester is the standard method for pregnancy dating; however, a multitude of CRL equations to estimate gestational age (GA) are reported in the literature.

A review of fetal volumetry: the need for standardization and definitions in measurement methodology

Volume charts of fetal organs and structures vary considerably among studies. This review identified 42 studies reporting normal volumes, namely for fetal brain (n = 3), cerebellum (n = 4), liver (n = 6), femur (n = 2), lungs (n = 15), kidneys (n = 3) and first‐trimester embryo (n = 9). The differences among median volumes were expressed both in percentage form and as standard deviation scores. Wide discrepancies in reported normal volumes make it extremely difficult to diagnose pathological organ growth reliably. Given its magnitude, this variation is likely to be due to inconsistencies in volumetric methodology, rather than population differences. Complicating factors include the absence of clearly defined anatomical landmarks for measurement; inadequate assessment and reporting of method repeatability; the inherent difficulty in validating fetal measurements in vivo against a reference standard; and a multitude of mutually incompatible three‐dimensional (3D) imaging formats and software measuring tools. An attempt to standardize these factors would improve intra‐ and inter‐researcher agreement concerning reported volumetric measures, would allow generalization of reference data across different populations and different ultrasound systems, and would allow quality assurance in 3D fetal biometry. Failure to ensure a quality control process may hamper the wide use of 3D ultrasound. Copyright

Surface area measurement using rendered three‐dimensional ultrasound imaging: an in‐vitro phantom study

Cranial sutures and fontanelles can be reliably demonstrated using three‐dimensional (3D) ultrasound with rendering. Our objective was to assess the repeatability and validity of fontanelle surface area measurement on rendered 3D images.

A longitudinal study of normal fetal femur volume

Fetal femur volume (FV) is a useful marker of skeletal growth. Our objective was to create a normal FV chart in a cohort of healthy pregnant women and to assess FV repeatability.

OP26.06: Automatic detection of fetal brain structures from ultrasound volumes

parameters and cortical maturation landmarks able to predict postnatal outcome in fetuses with borderline (VMBL) or moderate ventriculomegaly (MDVM). Methods: We retrospectively studied 34 fetuses with F-MRI diagnosis of VMBL or VMMD not resolved during pregnancy. Ultrasound (US) and/or F-MRI monitoring was performed for all fetuses, of which 6 fetuses with adverse postnatal outcome and 28 with favorable postnatal outcome. The sulcation, the superficial cortical gyration and the interopercular (IO) angles were visualized and correlated to the gestational age. The interopercular distance (IOD) antero-posterior (AP) and craniocaudal (CC) were measured and correlated to the normal value of corresponding gestational age. Results: In the group of fetuses with adverse postnatal outcome we observed: 2/6 fetuses with sulcation delay, 3/6 with superficial cortical gyration delay, 6/6 with enlarged IOD AP, 6/6 with increased IOD CC and 3/6 with IO angles delay. In the group of fetuses with favorable postnatal outcome we observed: 1/28 fetuses with sulcation delay, 2/28 with superficial cortical gyration delay, 2/28 with enlarged IOD AP, 1/28 with enlarged IOD CC and 3/28 with IO angles delay. Conclusions: Delayed development of sulcation, superficial cortical gyrarion, IO angles and increased biometric parameters of Sylvian fissure maturation IOD AP and IOD CC suggest a possible association with poor prognosis. F-MRI is able to detect these parameter objectively to provide a more appropriate counseling to pregnant women even at an early stage of pregnancy.

P28.02: Automated fetal biometry image landmark detection for confirming correct image planes: abdominal circumference

dimensional sagital view of the fetal front was performed to make the 3D reconstruction. Only one examiner obtained the anterior bâ by rendered mode. Correlation between gestational age (GA) and bâ was obtained by Pearson’s coefficient (r). Results: There was a weak linear correlation between GA and bâ (r = 0.05), however, between 18 and 24 weeks the bâ has ranged from 15.01 to 47.59 degrees. Percentiles from 5 to 95 are shown in table 1. The mean, median, SD, maximum and minimum values for each gestational age were calculated. Conclusions: Although no clear correlation between gestational age and angle values above the bregma, there are minimum and maximum values within the range 18–24 completed weeks of gestation. Such values may perhaps be adopted during the second trimester scan, seeking for early diagnosis of craniosynostosis. However, further studies are needed for more conclusive data.

OP33.09: The effect of maternal vitamin D concentration on fetal bone

Objectives: The aim of the present study was to explore the possible use of 3D Power Doppler Angiography (3D PDA) using VOCALTM software (GE Healthcare, USA) assessing different fetal cerebral regions in normal and growth restricted fetuses (IUGR). Methods: 77 AGA and 55 IUGR (24–36 ws gestation). IUGR were divided in 3 groups: group 1 (n = 28): Late onset IUGR (>34 ws) with normal bidimensional Doppler flow analysis, group 2 (n = 11): early onset IUGR (<34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), normal middle cerebral artery (MCA) PI and normal ductus venosus (DV) PI, group 3 (n = 16): early onset IUGR (<34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), abnormal MCA PI and pathological DV PI. Two regions of interest (ROI) were defined within the fetal brain. The first ROI (zone 1) is anterior respect the cavum septi pellucidi (CSP). The second ROI (zone 2) is obtained tracing a contour between the temporal bones as wide as the CSP. 3D-PDA vascular indexes (VI = vascularization, FI = flow, VFI = vascularization and flow) were determined in both areas for both AGA and IUGR fetuses by one operator. Results: VFI values demonstrated increased blood flow in frontal zone compared to control group (AGA) in ‘‘early onset IUGR’’ (in both groups 2–3 with and without abnormal 2D MCA findings). VI and VFI values demonstrated increased blood flow in frontal zone and decreased blood flow in temporal zone compared to control group (AGA) in ‘‘late onset IUGR’’ with preferential increment in bloody supply to the frontal region to protect general cognitive functions. Conclusions: 3DPDA analysis could be considered a valid method to identify earlier vascular redistribution in IUGR fetuses comparing to 2D velocimetry. 3DPDA could become an additional parameter to adjust the monitoring intervals in the evaluation of high risk fetuses.

P16.09: Intra‐inter observer variability of BPD outer‐to‐outer and outer‐ to‐inner methods

Number of Cases 79 (18%) 5 (1%) 44 (10%) 319 (71%) Gestation at Delivery (wks) Median Interquartile Range 38+2 36+6–39 38+5 38+4–40+2 38+4 37+4–39+2 38+5 38+2–39+2 Birthweight at Delivery (g) Median Interquartile Range 225

P29.13: A simple method for calculation of the fetal femur volume in 3D ultrasound

C. Ioannou1, I. Sarris1, M. Yaqub2, R. Napolitano1, H. Nicholl3, J. A. Noble2, M. K. Javaid4, A. T. Papageorghiou1,5 1Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, United Kingdom; 2Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom; 3Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom; 4Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; 5Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom