D. Alhamdan

OP06.02: The K-P algorithm: new 1st trimester growth assessment technique. Correlation with earliest recorded embryo length, comparison with Robinson's formula

persistence of vaginal bleeding after evacuation. We demonstrated that ultrasound is essential not only in diagnostic of HM but also in follow up and in definition of the high-risk population. Clinical use of such risk assessment permits individualization of follow-up according to the risk of developing subsequent GTN. Patients at high risk for GTN may undergo a closer monitoring whereas those at low risk may benefit of a smaller amount of visits. The extent to which these findings may allow an anticipated search of new pregnancy in low risk cases, remains to be determined.

OP06.03: A new mathematical model for the prediction of successful expectant management of first trimester miscarriage

persistence of vaginal bleeding after evacuation. We demonstrated that ultrasound is essential not only in diagnostic of HM but also in follow up and in definition of the high-risk population. Clinical use of such risk assessment permits individualization of follow-up according to the risk of developing subsequent GTN. Patients at high risk for GTN may undergo a closer monitoring whereas those at low risk may benefit of a smaller amount of visits. The extent to which these findings may allow an anticipated search of new pregnancy in low risk cases, remains to be determined.

OC07.03: The use of power Doppler colour scoring to predict successful expectant management in women with an incomplete miscarriage

Caucasian population. A mixed-effects analysis was performed to determine the relationship between CRL and GA. After internal validation, the CRL was compared to the expected CRL at a given gestational age according to the Robinson and Hadlock models and was expressed as a z-score. Bland–Altman plots were constructed to compare the new CRL curve with both curves. Results: 3710 normal singleton pregnancies with a known last menstrual period were included, corresponding to 4387 scans. Compared to the CRL curve, Robinson gave a 4 day underestimation of GA at 6 weeks with a difference in CRL of 3.75mm and a 1 day overestimation from 11 to 14 weeks with a difference in CRL of 2mm. Comparison with the Hadlock curve shows a difference in CRL equivalent to an underestimation of 2 days at 6 weeks and a difference of CRL equivalent to an overestimation of 2 days at 14 weeks. At 9 weeks all the curves are similar. Conclusion: The new CRL curve shows significant differences with the Robinson and Hadlock curves at the beginning and the end of the first trimester.

OC10.05: Can we predict pouch of Douglas obliteration using sonovaginography in women with chronic pelvic pain?

on the pain during insertion, in the following 3 days and at 4 to 6 weeks. Methods: A prospective cohort of 331 women in whom a Mirenauf6da was inserted. At the day of insertion they completed a first questionnaire including a pain assessment score from 0 to 10. A second questionnaire was handed to them to record pain experienced in the following 3 days and in the last 14 days before routine followup ultrasound 6 weeks after insertion. At ultrasound the position of the uterus was recorded and the position of the Mirenauf6da was assessed with 2Dand 3D-imaging. The sonographer was blinded as to the answers to the questionnaire. The pain scores were compared to the ultrasound findings. The first 93 3D-volumes were also examined off-line to determine if the arms extended past the confines of the endometrial cavity. This was reported as ‘embedded’ (Benacerraf et al. UOG 2009;34:110–6). Results: The mean (SD) pain-score at insertion was 4.5 (2.6) versus 2.7 (2.7) in the first 3 days and 0.8 (1.7) 4 to 6 weeks after insertion. The uterus was anteflexed in 80% of cases, retroflexed in 17%, stretched in 2.5% and mobile in 0.5%. The localization of the Mirenauf6da stem was recorded as abnormal in 7.1% of cases and the arms were abnormally unfolded in another 3.4%. The right arm was considered embedded in 56.8% and the left arm in 56.3%. The position the uterus and of the LNG-IUS (both of the stem and of the arms) did not influence the pain scores, nor did the fact that the IUD arms were considered embedded on coronal 3D-volume reconstruction. Conclusions: The position of the uterus, the position of the LNG-IUS nor the ultrasound image that the IUS arms were embedded, did influence the pain score at insertion, in the first 3 days or at 4 to 6 weeks after insertion. Pain does not seem to be a reliable predictor of correct position. A routine ultrasound check seems therefore recommended 6 weeks after Mirenauf6da insertion.

OC10.04: Can we predict posterior compartment deep infiltrative endometriosis using sonovaginography in women undergoing laparoscopy for chronic pelvic pain?

on the pain during insertion, in the following 3 days and at 4 to 6 weeks. Methods: A prospective cohort of 331 women in whom a Mirenauf6da was inserted. At the day of insertion they completed a first questionnaire including a pain assessment score from 0 to 10. A second questionnaire was handed to them to record pain experienced in the following 3 days and in the last 14 days before routine followup ultrasound 6 weeks after insertion. At ultrasound the position of the uterus was recorded and the position of the Mirenauf6da was assessed with 2Dand 3D-imaging. The sonographer was blinded as to the answers to the questionnaire. The pain scores were compared to the ultrasound findings. The first 93 3D-volumes were also examined off-line to determine if the arms extended past the confines of the endometrial cavity. This was reported as ‘embedded’ (Benacerraf et al. UOG 2009;34:110–6). Results: The mean (SD) pain-score at insertion was 4.5 (2.6) versus 2.7 (2.7) in the first 3 days and 0.8 (1.7) 4 to 6 weeks after insertion. The uterus was anteflexed in 80% of cases, retroflexed in 17%, stretched in 2.5% and mobile in 0.5%. The localization of the Mirenauf6da stem was recorded as abnormal in 7.1% of cases and the arms were abnormally unfolded in another 3.4%. The right arm was considered embedded in 56.8% and the left arm in 56.3%. The position the uterus and of the LNG-IUS (both of the stem and of the arms) did not influence the pain scores, nor did the fact that the IUD arms were considered embedded on coronal 3D-volume reconstruction. Conclusions: The position of the uterus, the position of the LNG-IUS nor the ultrasound image that the IUS arms were embedded, did influence the pain score at insertion, in the first 3 days or at 4 to 6 weeks after insertion. Pain does not seem to be a reliable predictor of correct position. A routine ultrasound check seems therefore recommended 6 weeks after Mirenauf6da insertion.

P07.09: Estimation of uterine dry weight from pre‐operative 3D uterine volume ultrasound evaluation in women undergoing total laparoscopic hysterectomy (TLH)

layers represented by basal endometrial and was considered normal between 4 and 8 mm. Patients with endometrial abnormal elevated thickness (26 cases) were treated with didrogesteron 30 mg b.d. for 3 days and then 20 mg b.d for another 7 days. In these cases, the preventing treatment was conducted in a discontinuous manner, with 20 mg didrogesteron b.d., ten days, starting with the 15th day of the cycle, for 3 months. Patients with endometrial atrophy (11 cases) were treated with combined oral contraceptive containing 30 μg etinilestradiol and 150 μg levonorgestrel, 2–3 pills b.d. until the bleeding ceased followed by 1 pill b.d. for completing 21 days of therapy. In these cases the preventive treatment was done in the same discontinuous manner, with didrogesteron. Results: In both groups the bleeding ceased after a medium of 3, 6 days of treatment. One patient with endometrial hyperplasia needed after 6 days of treatment uterine haemostatic curettage. Four patients in the first group and one in the second have experienced in the following six months after completing preventive therapy bleeding recurrences. In these cases was applied the same treatment and no relapse was encountered another six months. Conclusions: The endometrial thickness ultrasound evaluation is a valuable criterion for the treatment of juvenile uterine functional bleeding. Hormonal therapy in such cases is highly efficient in bleeding cessation. Prevention of the illness’s receive needs in 16% of cases am additional treatment until maturation of the hypothalamushypophysis-ovarian axe is established.

P02.07: New logistic regression model compared to the type of miscarriage alone for the prediction of successful expectant management of miscarriage

Objectives: We have developed a new logistic regression model for the prediction of successful expectant management of first trimester miscarriage. We aimed to compare its performance to the type of miscarriage alone for the prediction of successful expectant management. Methods: Prospective observational study from November 2006 to December 2009. The new logistic regression model, which was developed on 186 women with successful expectant management of miscarriage, comprised of diagnosis of incomplete miscarriage at primary scan, vaginal bleeding (no/yes without clots/yes with clots) and maternal age. The performance of this model was compared to the type of miscarriage alone i.e. (incomplete miscarriage, empty sac miscarriage or missed miscarriage). The performances of the new logistic regression model and the type of miscarriage were evaluated using receiver operating characteristic (ROC) curves. Results: Complete data from another 126 women with miscarriage were included in the test set. The new logistic regression model gave an area under the ROC curve of 0.803 with an accuracy of 82.5%. Compared to the type of miscarriage alone, gave an area under the ROC curve of 0.725 with an accuracy of 82.5%. The difference between the performance of these models was significant (P-value = 0.0443). Conclusions: We have developed a new mathematical model to predict successful management of first trimester miscarriage. This model outperforms the type of miscarriage alone for the prediction of successful expectant management.

OC05.04: Does symptomatology at presentation correlate with successful expectant management of first trimester miscarriage?

Objectives: To assess the efficacy and safety of surgical evacuation in the management of cervical ectopic pregnancies. Methods: Women with a certain ultrasound diagnosis of cervical pregnancy were offered surgical evacuation under general anaesthetic. Procedures were performed under ultrasound guidance using suction curette. Shirodkar cervical suture was used selectively to secure haemostasis following evacuation of pregnancy. Intravenous ergometrine 500 μg was administered intra-operatively to ensure uterine contraction. The patients were prescribed prophylactic antibiotics and the suture was removed 48–72 hours later in the outpatient clinic. Results: Over a 10 year period 40 women were diagnosed with cervical pregnancy in our Units. Of the 40 cases, 39 (98%, 95% CI 87–100) women presented < 12 weeks’ gestation with either viable pregnancy or retained products of conception and only one (2%, 95% CI 0–13) woman presented > 12 weeks’ gestation with a viable fetus. 26/39 (67%, 95% CI 51–79) women underwent surgical evacuation, whilst the remaining 13/39 (33%, 95% CI 21–49) women were managed conservatively. The median intra-operative blood loss was 250mls (range, 50–2000). 10/26 (38%, 95% CI 22–57) women had Shirodkar cervical suture inserted to arrest intra-operative haemorrhage. 2/26 (8%, 95% CI 2–24) women required blood transfusion. The uterus was successfully preserved in all women. Two (8%, 95% CI 2–23) women required repeat surgical evacuation; one woman had retained products of conception and the other had persistent haematometra. There were no cases of pelvic infection or any other postoperative complications. Conclusions: Surgical evacuation is a safe and effective method in the management of first trimester cervical ectopic pregnancy. The use of Shirodkar suture minimises the need of blood transfusion and the risk of hysterectomy is very low.

OP02.02: The K‐P algorithm: a new 1st trimester growth model, comparison with other formulae and correlations with recorded embryonic lengths

Objectives: The aim was to develop a new model to predict 1st trimester outcomes after a single visit in women classified with an intrauterine pregnancy of uncertain viability (IPUVI) at the primary transvaginal scan (TVS). Methods: Prospective observational study. All pregnant women presenting to the EPU, between Nov 2006 and Jan 2010, underwent a TVS. Data was collected from women with an IPUVI at primary TVS. More than 40 historical, clinical and ultrasonographic (US) end points were recorded for analysis. US measurements included gestational sac (GS) and yolk sac (YS) in 3-planes and crown–rump length (CRL). Women were followed up until the outcome was established: viable or non-viable pregnancy at the end of the 1st trimester. Variables for preliminary model development were determined by stepwise logistic regression. Results: 2048 consecutive pregnant women underwent TVS. 268/2048 (13.1%) were classified with an IPUVI. For 237/268 pregnancies (88.4%) the 1st trimester outcome was known (52.3% viable, 47.7% non-viable). 185 data sets have been used for model fitting. The variables used in the model were maternal age, gestational age in days by LMP, CRL in mm, mean GS size in mm, previous normal vaginal delivery and indication for scan: rescan for previous early intrauterine pregnancy. The predictive ability was measured with an AUC of 0.91, sensitivity for viable 81.1%, specificity 85.3% for the preliminary model. Conclusions: We have developed a new model to predict the likelihood of viability at the end of the 1st trimester in women with an IPUVI. We aim to test this model prospectively to evaluate its performance.

OP02.03: The new ‘21‐day rule’—ultrasound error in CRL estimation, time interval and performance of the new ‘K‐P’ CRL growth formula

Objectives: The aim was to develop a new model to predict 1st trimester outcomes after a single visit in women classified with an intrauterine pregnancy of uncertain viability (IPUVI) at the primary transvaginal scan (TVS). Methods: Prospective observational study. All pregnant women presenting to the EPU, between Nov 2006 and Jan 2010, underwent a TVS. Data was collected from women with an IPUVI at primary TVS. More than 40 historical, clinical and ultrasonographic (US) end points were recorded for analysis. US measurements included gestational sac (GS) and yolk sac (YS) in 3-planes and crown–rump length (CRL). Women were followed up until the outcome was established: viable or non-viable pregnancy at the end of the 1st trimester. Variables for preliminary model development were determined by stepwise logistic regression. Results: 2048 consecutive pregnant women underwent TVS. 268/2048 (13.1%) were classified with an IPUVI. For 237/268 pregnancies (88.4%) the 1st trimester outcome was known (52.3% viable, 47.7% non-viable). 185 data sets have been used for model fitting. The variables used in the model were maternal age, gestational age in days by LMP, CRL in mm, mean GS size in mm, previous normal vaginal delivery and indication for scan: rescan for previous early intrauterine pregnancy. The predictive ability was measured with an AUC of 0.91, sensitivity for viable 81.1%, specificity 85.3% for the preliminary model. Conclusions: We have developed a new model to predict the likelihood of viability at the end of the 1st trimester in women with an IPUVI. We aim to test this model prospectively to evaluate its performance.