Carlos Tadashi Yoshizaki

Fetal nasal bone length: reference range and clinical application in ultrasound screening for trisomy 21

Fetuses with trisomy 21 typically present with subtle facial abnormalities, including a hypoplastic nasal bone. The aim of this study was to provide a reference range for the length of the fetal nasal bone and to test its value in second‐trimester ultrasound screening for trisomy 21.

Renal Volumes Measured by 3-Dimensional Sonography in Healthy Fetuses From 20 to 40 Weeks

The purpose of this study was to establish reference values for fetal kidney volumes as a function of gestational age, estimated by 3‐dimensional sonography using the Virtual Organ Computer‐Aided Analysis (VOCAL) technique (GE Healthcare, Kretztechnik, Zipf, Austria).

Prediction of successful labor induction using transvaginal sonographic cervical measurements

To predict the success of labor induction by sonographic cervical measurements, maternal/obstetrical factors, and the Bishops score.

Rastreamento Antenatal da Síndrome de Down Utilizando Parâmetros Ultra-sonográficos

Purpose: to appraise the value of ultrasonographic parameters for the diagnosis of fetal Down syndrome (T21), in order to permit its use in routine clinical practice. Methods: this is a prospective cohort study using various ultrasonographic parameters for the prediction of T21. A total of 1662 scans were evaluated in the cohort study and 289 examinations were analyzed as a differential sample to test the normality curve from October 1993 to November 2000. The statistical analysis was based on the calculation of intra- and interobserver variations, the construction of normality curves for the studied parameters, as well as their validity tests, and the calculation of sensitivity, specificity, relative risk, likelyhood ratio and posttest predictive values. Results: among 1662 cases, 22 fetuses (1.32%) with T21 were identified. The normality curves were built for nucal fold thickness, femur/foot ratio and nasal bone length. Renal pelvis had a semiquantitative distribution and the proposed cutoff level was 4.0 mm. Sensitivity, specificity, false positive rate, relative risk and likelyhood ratio for nucal fold measurements above the 95th percentile were 54.5%, 95.2%, 4.9%, 20.2 and 11, respectively. For nasal bone measurements below the 5th percentile, 59.0%, 90.1%, 9.0%, 13.4 and 6.5. For femur/foot ratio below the 5th percentile, 45.5%, 84.4%, 15.6%, 3.7 and 2,6. For renal pelvis greater than 4.0 mm, 36.4%, 89.2%, 10.9%, 4.5 and 3.4. For absent fifth finger middle phalanx, 22.7%, 98.1%, 1.9%, 13.2 and 11.9. For the presence of major malformations, 31.8%, 98.7%, 1.3%, 27.2 and 24,8. After calculating the probability rates and the incidence of T21 in different maternal ages, a table for posttest risk using ultrasonographic parameters was set up. Conclusions: normality curves and indices for the assessment of risk for fetal Down syndrome on a population basis were established by the utilization of different maternal ages and by multiplying factors proposed by the authors. It was not possible to establish a normality curve for renal pelvis measurements, because of their semiquantitative distribution.

P27.05: Quantification of renal vascularity by 3D-power Doppler ultrasonography in normal fetuses

using the VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program which is integrated into the Voluson E8 ultrasound system. The intrauterine content was sent for microscopic examination. The findings were compared with corresponding volumes and findings from women with uncomplicated postpartum periods from a previous study. Results: In 17 of the 20 cases placental remnants were verified by the microscopic examination. Five of these women had a uterine volume that exceeded the largest interquartile volume observed in women with a normal puerperium and in 4 the volume exceeded the largest volume observed in the normal puerperium. The other 12 women had normal uterine volumes. Fifteen of the 17 women with placental remnants had a uterine cavity volume that exceeded the interquartile volume observed in women with a normal puerperium and in 13 the volume exceeded the largest volume observed in the normal puerperium. In all 9 cases examined 42 days or more after delivery the uterine cavity volume exceeded the largest volume observed in the normal puerperium. In all examined women an echogenic mass was seen in the uterine cavity. Conclusions: The uterine and especially the uterine cavity volumes are often larger in women with placental remnants compared to women with an uneventful postpartum course. This knowledge can be of help when placental remnants are to be verified or ruled out. A finding of an echogenic mass in the cavity has a strong correlation with the presence of placental remnants.

P27.10: Nomograms of fetal kidney volumes measured by three‐dimensional ultrasonography

the humerus. Two slice extraction methods were used: parallel to the acquisition plane and perpendicular to the humerus. The cross-sectional adipose tissue area was then manually traced and the overall fractional adipose tissue volume was calculated after interpolation between cross-sections for each method. Fractional adipose tissue volumes obtained via both slice extraction methods were compared using Bland-Altman plots. Results: Perpendicular slice extraction resulted in smaller fractional adipose tissue volumes in 70% of scans. The mean difference in fractional adipose tissue volume was much larger for the more angled scans (0.51 cm3) than for the near horizontal scans (0.17 cm3). The most angled humerus (24.7◦) also resulted in the largest difference in adipose tissue areas (2.42 cm3). Conclusions: In most cases, parallel slice extraction to the acquisition plane significantly overestimates cross-sectional adipose tissue areas and hence fractional adipose tissue volumes. The larger the humerus angle, the greater the difference between both methods. Therefore, perpendicular slice extraction is a preferential method for more accurate volumetric measurements.

OC25.03: Early versus ‘classical’ fetoscopic tracheal occlusion for extremely severe isolated congenital diaphragmatic hernia

of the following steps: Percutaneous intraamniotic access and gas insufflation, fetal posturing, fetal cardiac access. In addition, pacing wire insertion and fixation were attempted in 13 fetuses, insertion of a pacemaker dummy was attempted in 5 fetuses. Results: Percutaneous intraamniotic access, gas insufflation, fetal posturing and fetal cardiac access were achieved during all studies. Pacing wire insertion and fixation were successfully performed in 11 of the 13 attempts; insertion of a pacemaker dummy was achieved in 4 of the 5 attempts. 16 fetuses survived the procedure without complications. Conclusions: Minimally-invasive fetoscopic pacemaker and lead insertion can successfully be achieve in fetal sheep. The impending availability of miniature pacemakers enables now soon the clinical introduction of minimally-invasive fetal cardiac pacing in fetuses with life-threatening cardiac failure from therapy-refractory complete heart block.