D. Pedraza

P31.01: Postnatal follow-up of a case with proximal focal femur deficiency

Objectives: To determine the characteristics of fetal bladder filling and emptying in the 2nd and 3rd trimester. Methods: Fetal bladder’s volume was measured by 3D volume acquisition at intervals during routine 2nd (T2) and 3rd (T3) trimester ultrasounds in 129 patients. Measurements were obtained by using the 3D mode on Voluson E730 with a rotation angle of 15 degrees. The midline plane was that with the bladder and 2 umbilical arteries visible, with a rapid sweep of 70 degrees. We assessed the speed of bladder filling (Vf) and emptying (Ve), the maximal (Vmax) and minimal (Vmin) bladder volume as well as the time of filling (Tf) and emptying (Te) corresponding to the time necessary to obtain a maximal and minimal volume respectively. Multiple pregnancies, fetal structural or chromosomal anomalies were excluded. Results: Out of 129 patients, only 75 with good quality acquisitions, were recruited. 39 were 2nd trimester (24 male and 15 female) and 36 were 3rd trimester (22 male and 14 female). The mean Vf was 0.052 cm3/min (SD = 0.046) in T2 and 0.611 cm3/min (SD = 0.693) in T3. The mean Ve was 0.095 cm3/min (SD = 0.113) in T2 and 1.231 cm3/min (SD = 1.71) in T3. The mean Vmax was 1.10 cm3 (SD = 2.2) in T2 and 16.11 cm3 (SD = 4.31) in T3. The mean Vmin was 0.24 cm3 (SD = 0.16) in T2 and 4.65 cm3 (SD = 3.05) in T3. The mean Tf was 12.5 min (SD = 6.51) in T2 and 20.57 min (SD = 15.39) in T3. Conclusions: Dynamic fetal bladder assessment in the 2nd and 3rd trimester is still unexplored. Our study allowed us to establish a profile of normal fetal bladder filling and voiding, in male and female fetuses. This profile will help explore lower urinary tract obstructive pathologies and bladder dysfunction in other extraurinary pathologies. . . Further number is needed to confirm these results.

P09.14: Report of first two cases of TRAP treated with US guided bipolar forceps cord coagulation in Chile

Bronchogenic cysts develop from abnormal budding of the ventricular diverticulum of the foregut resulting in focal cystic duplication of the tracheobronchal tree.They may present single or, rarely, as multiple lesions. Dimension of bronchogenic cysts vary from a few milimeters to greater 5 cm. Wall of the cysts contain fibrous tissue and small amounts of cartilage and the content of the cysts may be watery or viscid. Pneumocystis jiroveci (old P. carinii) is now considered a fungus based on nucelic acid and biochemical analysis; nevertheless, on the basis of morphologic and biologic characteristics it’s included in the atlas of medical parasitology. P.j. is one of the most common infections in immunosuppressed patients with AIDS. Other impairments of cellular immunity such as primary immunodeficiency, steroid treatment, organ transplantation and cancers predispose to P.j. infection which usually infiltrates diffuse but also atypical presentations can occur: nodules, cavitation, consolidation, pneumatocoele and pneumothorax. Clusters of P.j. are demonstrated in the alveolar space of lung biopsy tissue. We met 20 w. fetus of 19 y.o. healthy pregnant patient with unremarkable history with a single cyst 2.5 cm. This cyst was located in middle part of the left lung. Aspiration was done under ultrasound control, 9 ml of pure limpid liquor was aspirated. When we drew a needle out empted cyst’s cavity a little of fetal blood was admixed. Aspirated liquor contaminated by fetal blood was sent to cytological examination. Cytological expert conclusions were surprised – in sediment a lot of pneumocites were found. Of course, we can’t be sure about exact source of P.j., cystic liquor or fetal blood because contamination. Unfortunately we have no another additional data so far as the family decided to terminate pregnancy and forbad any further investigations. Nevertheless we publish these incomplete data because it’s very unusual and first prenatal P.j. findings from fetal lung tissue

P13.16: Can we trust in 3D brain volumes? Internal validation of DBP, FOD, cisterna magna and TCD measurements

B. van der Knoop1, J. I. de Vries1, F. Slaghekke2, S. J. Steggerda3, J. I. Verbeke4, L. S. de Vries5, L. R. Pistorius6 1Obstetrics and Gynaecology, VU University Medical Center Amsterdam, Amsterdam, Netherlands; 2Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands; 3Neonatology, Leiden University Medical Center, Leiden, Netherlands; 4Radiology, VU University Medical Center, Leiden, Netherlands; 5Neonatology and Child Neurology, University Medical Center Utrecht, Utrecht, Netherlands; 6Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands

OP03.10: Inter and intra‐observer reproducibility in the standard evaluation of fetal central nervous system using 3D ultrasound

Objectives: Assess the development of fetal cerebral fissures through three-dimensional (3D) ultrasonography. Methods: This cross-sectional study included 80 normal pregnancies between 21 and 34 weeks. The distances between the Sylvian, parietooccipital, hippocampus and calcarine fissures and the internal surface of the fetal skull were measured. For the evaluation of the first three fissures, an axial three-dimensional scan was obtained (at the level of the lateral ventricles). To obtain the calcarine fissure measurement, a coronal scan was used (as the level of the occipital lobes). First degree regressions were performed to assess the correlation between fissure measurements and gestational age, using the determination coefficient (R2) for adjustments. The 5th, 10th, 35th, 50th, 75th, 90th e 95th percentiles for each fissure measurement were calculated. Pearson’s correlation coefficient (r) was used to assess the correlation between fissure measurements and the biparietal diameter (BPD) and head circumference (HC). Results: All fissure measurements were linearly correlated with gestational age (Sylvian R2 = 0.57; parietooccipital R2 = 0.73; hippocampus R2 = 0.37 and calcarine R2 = 0.38). Mean fissure measurement ranged from 7.0 to 14.0 mm, 15.9 to 28.7 mm, 15.4 to 25.4 mm and 15.7 to 24.8 mm for the Sylvian, parietooccipital, hippocampus and calcarine fissures, respectively. The Sylvian and parietooccipital fissure measurements had the highest correlations with the BPD (r = 0.80 and 0.78, respectively) and HC (r = 0.73 and 0.82, respectively). Conclusions: The objective development of fetal cerebral fissures assessed through 3D-ultrasonography is positively correlated with gestational age.

OC16.10: Reliability study of bladder volume measurement with 3D VOCAL

Objective: To evaluate the correlation between fetal renal volume (FRV), determined by three-dimensional ultrasonography (3DUS), and two-dimensional biometric parameters. Methods: A longitudinal prospective study was conducted on 57 women between 24 and 34 weeks of a healthy pregnancy. The volumes of both fetal kidneys were measured with 3DUS using the VOCAL (Virtual Organ Computer-aided AnaLysis) method with a 300 rotation angle. Correlation between FRV and biometric parameters biparietal diameter (BPD), cranial circumference (CC), femoral length (FL), abdominal circumference (AC) and estimated fetal weight (EFW) was evaluated using polynomial regressions, with adjustments made by the coefficient of determination (R2). Results: FRV was highly correlated with all fetal biometric parameters and all equations were of the linear type: FRV= 0,27 × BPD − 11,57 (R2= 0,70); FRV= 0,07 × CC − 12,36 (R2= 0,74); FRV= 0,31 × FL − 8,99 (R2= 0,69); FRV= 0,063 × AC − 73,22 (R2= 0,67); FRV= 0,004 × EFW + 2,76 (R2= 0,61). Conclusions: FRV assessed by 3DUS using the VOCAL method was highly correlated with two-dimensional biometric parameters.

OP18.07: Characteristic discordance of umbilical vein flow (UVF) in twin-twin transfusion syndrome (TTTS) is absent in normal twins

Methods: This was an observational study of 75 consecutive monochorionic twin pregnancies complicated with amniotic fluid discordance (AFD) which did not meet the criteria for TTTS (polyhydramnios and oligohydramnios) at initial presentation. AFD was defined as mniotic fluid volume of both fetus did not meet oligohydramnios and polyhydramnios (2cm < MVP ≤ 3cm, 7cm ≤ MVP < 8cm). Fetoscopic surgery was applied for TTTS progressing before 26 weeks’ gestation. The population was subdivided into two groups (normal Doppler: ND, abnormal Doppler: AD) by presence of abnormal Doppler studies of umbilical artery or ductus venosus in either twins. Results: Forty six of 75 cases (61%) showed presence of abnormal Doppler blood flow. Twenty seven of 46 cases (59%) progressed to severe TTTS and 8 cases of those (30%) progressed to TTTS after 26 weeks’ gestational age. Survival rate without neurological problem of cases progressed to TTTS after 26 wks 63% (ND) was 24% (AD). And survival rate without neurological problem in cases without progression to TTTS was 88% (ND) and 47% (AD). Cases with abnormal Doppler study in either twins showed poor prognosis. Conclusions: Our data suggest that amniotic fluid discordance in monochorionic diamniotic twin pregnancies in combination with abnormal Doppler study represents an extremely high-risk constellation for adverse pregnancy outcome. Fetoscopic laser coagulation of vascular anastomoses can be considered as a therapeutic option for this group.

OC043: Seeking the optimal number of shots for proper fetal diuresis measurement by 3D vocal technique

Objectives: Diagnosis of cleft lip and palate remain a challenge with 2-D ultrasound particularly when clefting involves only the secondary palate. The utility of 3-D ultrasonography (3DUS) has enhanced our ability to detect clefts of the secondary palate. We report our experience with a modification of the flipped face technique to aid in the diagnosis of clefting of the secondary palate. Methods: Ninety-two volumes of fetal faces were evaluated. Of these, 36 volumes were acquired prospectively. The remaining 52 volumes had previously been acquired and included 8 with clefting of the secondary palate. Volumes were obtained using the Voluson 730 Expert (GE) and the IU22 (Phillips) and reviewed by four blinded readers on personal computer workstations. Volumes were manipulated so that an upright profile was visualized. The palate was then rendered utilizing a thin, curved render box. Statistical analysis was performed using Fisher’s exact test for categorical data. Intraclass correlations were computed to assess inter-rater agreement. Results: The mean gestational age of image acquisition was 22 + 5 weeks. Image quality of the secondary palate was obtained and rated as adequate by at least two reviewers in 34% (31/92) of volumes. The sensitivity of cleft detection ranged from 33–63% and the specificity ranged from 84–95%. The low sensitivity was mainly due to artifact/shadowing. The interrater reliability was 0.62 (95% CI 0.47,0.76). After review of the data, an additional 10 fetuses were studied and the secondary palates successfully visualized. These volumes were acquired slightly obliquely from the inferior aspect of the maxilla, pointing upward. Conclusions: 3DUS can be utilized to diagnose clefts of the secondary palate. However, this evaluation is limited by plane of acquisition and artifacts from shadowing of adjoining structures. Pseudoclefts can be created and optimal imaging cannot be obtained in all fetuses.