Cristina Martínez-Payo

Reproducibility of first trimester three-dimensional placental measurements

OBJECTIVEnThe aim of this study was to assess intra and interobserver reproducibility of placental volume and vascularization during the first trimester of pregnancy studied by three dimensional ultrasonography and angio power Doppler.nnnSTUDY DESIGNnThis is a prospective study in 69 singleton pregnancies. Once the bi-dimensional protocol study was carried out, we performed a 3D-US (three-dimensional ultrasonography) of the placenta by abdominal ultrasonography. The Virtual Organ Computer-Aided Analysis program was used to evaluate the placental volume (PV), the placental quotient (PQ: placental volume/crown-rump length) and the vascular indices (vascularization index VI, flow index FI and vascularization-flow index VFI). The intraobserver and interobserver variability were respectively expressed as an intraclass correlation coefficient (Intra-CC) and interclass correlation coefficient (inter-CC).nnnRESULTSnIntraobserver correlation for PV was excellent with an Intra-CC of 0.97 while an Inter-CC of 0.71 demonstrated less agreement between observers. In the same way, PQ showed better intraobserver than interobserver correlation, with an Intra-CC of 0.97 and an inter-CC of 0.67. The analyzed vascular indices had both excellent intraobserver and interobserver correlation coefficients, with values of 0.98 and 0.96 for VI, 0.93 and 0.89 for FI and 0.97 and 0.95 for VFI, respectively.nnnCONCLUSIONnOur study demonstrate an excellent intra and inter-observer reproducibility for vascular indices and a good reproducibility of the evaluated Doppler indices with intra-CC higher than 0.90. PV and PQ were also reproducible most of all within the same observer. As a conclusion, first trimester tridimensional sonography is a reproducible tool for the systematic study of placental vascularization.

Clinical results after the implementation of cell‐free fetal DNA detection in maternal plasma

Detection of cell‐free fetal DNA in maternal blood is a type of noninvasive prenatal diagnosis test (NIPT), which has already been known for some time but has not yet been introduced in most of public hospitals in Spain. How the implementation of cell‐free fetal DNA (cffDNA) in a contingent protocol has influenced the aneuploidy screening in our hospital is described.

P07.02: Reliability analysis on ductus venosus Doppler flow measurements in the first trimester transvaginally

Objectives: To report on a serial case of ectopic pregnancies managed with ultrasound-guided local infiltration of methotrexate (MTX). Methods: Eleven women with interstitial, cornual or Cesarean section scar unruptured ectopic pregnancies referred to our department for final evaluation and management. Under abdominal or transvaginal ultrasound guidance, careful puncturing and MTX injection locally were performed on each ectopic pregnancy as indicated. Results: Of the 11 ectopic pregnancies, in locality 5 were interstitial, 1 cornual and 5 within the Cesarean section scars. Of them 5 cases were viable ectopic pregnancies. The cornual case was failed of induced abortion. All the initialβ-hCG levels were elevated with the highest up to 74780U/L. 5 cases were successfully cured with one injection, another 5 cases with two injections but 1 case needed 3 injections. No complication was encountered on follow up study. Conclusions: Ectopic pregnancies of various types may be successfully treated through careful local MTX injection without surgical intervention.

P07.01: Intraobserver and interobserver variability of transabdominal Doppler velocimetry measurements of the ductus venosus in the first trimester

Objectives: To report on a serial case of ectopic pregnancies managed with ultrasound-guided local infiltration of methotrexate (MTX). Methods: Eleven women with interstitial, cornual or Cesarean section scar unruptured ectopic pregnancies referred to our department for final evaluation and management. Under abdominal or transvaginal ultrasound guidance, careful puncturing and MTX injection locally were performed on each ectopic pregnancy as indicated. Results: Of the 11 ectopic pregnancies, in locality 5 were interstitial, 1 cornual and 5 within the Cesarean section scars. Of them 5 cases were viable ectopic pregnancies. The cornual case was failed of induced abortion. All the initialβ-hCG levels were elevated with the highest up to 74780U/L. 5 cases were successfully cured with one injection, another 5 cases with two injections but 1 case needed 3 injections. No complication was encountered on follow up study. Conclusions: Ectopic pregnancies of various types may be successfully treated through careful local MTX injection without surgical intervention.

P03.04: Right aortic arch: 7 cases

Objectives: To evaluate the diagnostic accuracy of prenatal screening for congenital heart diseases (CHD) based on the combination of the four-chamber view and the three-vessel view in an unselected population. Methods: A prospective study on 8025 scanned fetuses was performed. All singleton pregnancies scheduled for a routine prenatal ultrasound screening at 20–24 weeks’ gestation and subsequently delivered within our unit were included. Data were recorded regarding visualization of the four-chamber view, the outflow tracts and the three-vessel view. Suspected CHD was confirmed by postmortem or postnatal echocardiography. We obtained the followup data of the newborns and calculated the diagnostic accuracy of the test. Results: Major CHD were identified in 32 cases (4.0‰) of which 26 cases (81.3%) were diagnosed antenatally and 6 postnatally. Four cases were false positive. Twenty-one cases were identified by the four-chamber view and five as a result of the abnormal three-vessel view. The sensitive of the four-chamber view alone was 65.6% (17/32), and the specificity was 99.9%. The sensitivity of the combination of the four-chamber view and the three-vessel view was 81.3% (26/32), and the specificity was 99.9%. Conclusions: The three-vessel view is reliable and easy methods to be used in a routine antenatal clinic, along with the four-chamber view. *This project was funded by Beijing Municipal Science and Technology Commission Foundation grant D0906005000091.

P16.11: Absent ductus venosus in the sonography of the 11–14 weeks

Objectives: To evaluate the clinical conditions associated with absent ductus venosus (DV) in the sonography of the 11–14 weeks. Methods: Retrospective review of 5620 sonographies of screening of the first trimester, realized in a tertiary hospital during the last 4 years (2005–2008), in general population. There was valued the measure of the nuchal translucency, the nasal bone (present/absent), as well as the morphology of the wave of the DV, and the foetal morphology. Results: We have found a whole of 3 cases of ductus venosus absent. The following table shows the finds in every case. Conclusions: In our experience, the find of an absent ductus venosus in the sonography of the 11–14 weeks is strongly associated with a foetus affected by Down syndrome.

P11.09: First-trimester Down syndrome screening: clinical results in patients with risk ≥ 1/270

Conclusion: The policy of performing invasive procedures in all women aged ≥ 35yo did not detect any chromosomal abnormality, in our series, that would not be identified after 1st trimester screening. On the contrary, the much higher false positive rate of the age-alone screening adds just increased collateral damage, high cost/benefit ratio to the national health system, precious time consuming investigations for obstetrician/geneticists.

OP07.08: Evaluation of the number of umbilical cord vessels in the sonography of the 12–14 weeks

Objectives: Determination of the expected day of conception is difficult and controversial. However, assessment of the remaining days of pregnancy would be valuable information for growth monitoring and management at term. We aimed to develop a prediction model of the remaining days of pregnancy based on first-trimester measurements. Methods: Data consisted of ultrasound examinations in pregnancies with an estimated gestational age at delivery of at least 37 weeks and with a normal outcome. Predictions of the median interval in days between ultrasound examination and delivery were computed using crown–rump length (CRL), biparietal diameter (BPD), abdominal circumference (AC) and head circumference (HC) measurements. Both a linear quantile regression and a non-linear quantile regression method were tested. The regression cubic spline approach was used to smooth the median and quantile curves. Results were checked through a cross-validation of the random sample estimates. Results: 3649 ultrasound scans were included in the study with ranges of measurements of 24–115, 10–36.3, 31–107.8 and 28–130 mm for CRL, BPD, AC and HC, respectively. The CRL, BPD or HC based prediction models provided similar results with up to 93.6% of the births within ±14 days of the predicted day of delivery from non-linear models, whereas AC provided slightly worse predictions. Cross-validation analysis confirmed these results. Conclusions: We have developed a simple method for predicting accurately the date of delivery based on first-trimester measurements. It allows simple monitoring of growth and term in pregnancies. It also avoids controversies between doctors and patients about the exact date of conception.