C. M. Verwoerd-Dikkeboom

Reliability of three‐dimensional sonographic measurements in early pregnancy using virtual reality

To establish the reliability of three‐dimensional (3D) ultrasound measurements in early pregnancy using a virtual reality system (the Barco I‐Space).

Early pregnancy volume measurements: validation of ultrasound techniques and new perspectives

Objective  To investigate accuracy and reliability of four different ultrasound‐related volume‐measuring methods.

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.

Embryonic delay in growth and development related to confined placental trisomy 16 mosaicism, diagnosed by I-Space Virtual Reality

OBJECTIVE To demonstrate the use of a novel three-dimensional (3D) virtual reality (VR) system in the visualization of first trimester growth and development in a case of confined placental trisomy 16 mosaicism (CPM+16). DESIGN Case report. SETTING Prospective study on first trimester growth using a 3D VR system. PATIENT(S) A 34-year-old gravida 1, para 0 was seen weekly in the first trimester for 3D ultrasound examinations. INTERVENTION(S) Chorionic villus sampling was performed because of an enlarged nuchal translucency (NT) measurement and low pregnancy-associated plasma protein-A levels, followed by amniocentesis. RESULT(S) Amniocentesis revealed a CPM+16. On two-dimensional (2D) and 3D ultrasound no structural anomalies were found with normal fetal Dopplers. Growth remained below the 2.3 percentile. At 37 weeks, a female child of 2010 g (<2.5 percentile) was born. After birth, growth climbed to the 50th percentile in the first 2 months. CONCLUSION(S) The I-Space VR system provided information about phenotypes not obtainable by standard 2D ultrasound. In this case, the delay in growth and development could be observed very early in pregnancy. Since first trimester screening programs are still improving and becoming even more important, systems such as the I-Space open a new era for in vivo studies on the physiologic and pathologic processes involved in embryogenesis.

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.

OC16.07: First trimester embryonic growth charts derived from virtual reality measurements

Objective: The aim of this study was to evaluate real-time three dimensional (3D) determined volumes of the yolk sac and fetal body, including the limbs, in first trimester pregnancies using a virtual reality (VR) application, and to analyse relations with gestational age (GA) and crown-rump length (CRL). Methods: We analyzed 180 3D first trimester ultrasound scans of 42 spontaneous and IVF/ICSI pregnancies. Only scans with high quality images were included and transferred to a Barco ISpace VR system and visualized as 3D ‘holograms’ with V-Scope volume rendering software. An implemented segmentation algorithm calculated the yolk sac volume (YSV) and fetal volume (FV) semiautomatically (A). The logarithmically transformed outcomes were analyzed using repeated measurements ANOVA. Interobserver agreement was established by calculating intraclass correlation coefficients (ICC). Results: In total 118 YSV and 88 FV were measured with GA between 5 + 5 and 12 + 6 weeks. YSV ranged from 33 mm3 to 424 mm3 and FV ranged from 14 mm3 to 29877 mm3. Reference charts were constructed according to GA and CRL (B). ANOVA calculations showed that when the CRL doubles, the mean FV increases 6.5 fold and when the GA doubles the mean FV increases approximately 500 fold (p<0.001). Furthermore, it was found that for each day, the YSV increases on average by 4% and when the CRL doubles, the YSV increases with 67% (p<0.001). Interobserver agreement was excellent with an ICC of 0.99. Conclusions: We constructed reference charts for growth of YSV and FV in the first trimester using a VR system. This approach allows us to obtain information about the size of the fetus using all dimensions. These new data can be used to differentiate between normal and abnormal human development.

OC16.05: First trimester human yolk sac and fetal volumetry in virtual reality

Objective: The aim of this study was to evaluate real-time three dimensional (3D) determined volumes of the yolk sac and fetal body, including the limbs, in first trimester pregnancies using a virtual reality (VR) application, and to analyse relations with gestational age (GA) and crown-rump length (CRL). Methods: We analyzed 180 3D first trimester ultrasound scans of 42 spontaneous and IVF/ICSI pregnancies. Only scans with high quality images were included and transferred to a Barco ISpace VR system and visualized as 3D ‘holograms’ with V-Scope volume rendering software. An implemented segmentation algorithm calculated the yolk sac volume (YSV) and fetal volume (FV) semiautomatically (A). The logarithmically transformed outcomes were analyzed using repeated measurements ANOVA. Interobserver agreement was established by calculating intraclass correlation coefficients (ICC). Results: In total 118 YSV and 88 FV were measured with GA between 5 + 5 and 12 + 6 weeks. YSV ranged from 33 mm3 to 424 mm3 and FV ranged from 14 mm3 to 29877 mm3. Reference charts were constructed according to GA and CRL (B). ANOVA calculations showed that when the CRL doubles, the mean FV increases 6.5 fold and when the GA doubles the mean FV increases approximately 500 fold (p<0.001). Furthermore, it was found that for each day, the YSV increases on average by 4% and when the CRL doubles, the YSV increases with 67% (p<0.001). Interobserver agreement was excellent with an ICC of 0.99. Conclusions: We constructed reference charts for growth of YSV and FV in the first trimester using a VR system. This approach allows us to obtain information about the size of the fetus using all dimensions. These new data can be used to differentiate between normal and abnormal human development.

OC16.06: Early pregnancy gestational sac volume measurements in virtual reality

Objective: The aim of this study was to evaluate real-time three dimensional (3D) determined volumes of the yolk sac and fetal body, including the limbs, in first trimester pregnancies using a virtual reality (VR) application, and to analyse relations with gestational age (GA) and crown-rump length (CRL). Methods: We analyzed 180 3D first trimester ultrasound scans of 42 spontaneous and IVF/ICSI pregnancies. Only scans with high quality images were included and transferred to a Barco ISpace VR system and visualized as 3D ‘holograms’ with V-Scope volume rendering software. An implemented segmentation algorithm calculated the yolk sac volume (YSV) and fetal volume (FV) semiautomatically (A). The logarithmically transformed outcomes were analyzed using repeated measurements ANOVA. Interobserver agreement was established by calculating intraclass correlation coefficients (ICC). Results: In total 118 YSV and 88 FV were measured with GA between 5 + 5 and 12 + 6 weeks. YSV ranged from 33 mm3 to 424 mm3 and FV ranged from 14 mm3 to 29877 mm3. Reference charts were constructed according to GA and CRL (B). ANOVA calculations showed that when the CRL doubles, the mean FV increases 6.5 fold and when the GA doubles the mean FV increases approximately 500 fold (p<0.001). Furthermore, it was found that for each day, the YSV increases on average by 4% and when the CRL doubles, the YSV increases with 67% (p<0.001). Interobserver agreement was excellent with an ICC of 0.99. Conclusions: We constructed reference charts for growth of YSV and FV in the first trimester using a VR system. This approach allows us to obtain information about the size of the fetus using all dimensions. These new data can be used to differentiate between normal and abnormal human development.

P09.06: First-trimester umbilical cord and vitelline duct measurements using virtual reality

Methods and Results: Retrospective case note analysis of ultrasound and MRI diagnosed morbidly adherent placenta praevias were obtained. In the first case, an elective Cesarean section was done for major degree placenta praevia, antenatal diagnosis of morbidly adherent placenta praevia was not made. Patient had a Cesarean hysterectomy, ureteric stenting and repair of the urinary bladder. All other cases had antenatal diagnoses of morbidly adherent placenta praevias made. Colour Doppler ultrasound scan had a 100% sensitivity. In five out of six cases MRI confirmed morbidly adherent placenta praevia giving a sensitivity of 83%. Three out of seven cases (3/7) have had Cesarean hysterectomies. In four out of seven cases, uterus was preserved. Surgical haemostatic procedures undertaken include; interventional radiological procedures, bilateral internal iliac artery occlusion and B-lynch suture. Complications of internal iliac artery occlusion includes one patient suffering from popliteal arterial occlusion and subsequent vascular surgery. Conclusion: Six out of seven cases reported were antenatally diagnosed as having morbidly adherent placenta praevias by colour Doppler ultrasound and MRI. Detailed management and care plans were outlined in each case and patients and their families were briefed about the care pathways. These six cases will highlight the necessity of multidisciplinary involvement with high quality diagnostic modalities by colour Doppler ultrasound and MRI. This will have an impact on reduced maternal mortality and morbidity in this very complex and challenging clinical situation in Obstetric surgery.

OC14.08: Virtual embryoscopy for detection of structural congenital abnormalities

EDD-U. Among pregnant women with a BMI ≥ 30 kg/m2, the risk of postponed EDD was significantly increased compared to women with BMI 20-24.9 kg/m2. In women with a BMI ≥ 30 kg/m2 the EDD was more often postponed ≥ 14 days (OR 1.51; 95% confidence interval [CI] 1.46–1.56) or 7–13 days (OR 1.38; 95% CI 1.35–1.41). Similar risk was observed among women with BMI 25–29.9 kg/m2, but was less pronounced. Conclusions: High maternal BMI increases the risk for postponing date of delivery at mid-trimester ultrasound examination. The estimation of gestational age in obese women as shorter than according to the LMP, might be due to erroneous sonographic measurements.