D. Rosenak

Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode

Quantification of fetal heart ventricle volume can aid in the evaluation of functional and anatomical aspects of congenital heart disease. The aim of this study was to establish nomograms for ventricular volume using three‐dimensional (3D) inversion mode ultrasonography with the spatio‐temporal image correlation (STIC) modality and to calculate ejection fraction and stroke volume.

Added value of three-/four-dimensional ultrasound in offline analysis and diagnosis of congenital heart disease.

Many published studies have shown that application of three‐dimensional (3D) and real‐time 3D (4D) ultrasound modalities can improve certain aspects of fetal echocardiography, but have left open the question of whether these modalities improved the accuracy of prenatal detection of anatomical fetal cardiovascular malformations. We aimed to determine whether 3D/4D ultrasound improved diagnostic ability in cases of congenital heart disease (CHD).

Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique

Intrapartum damage to the anal sphincter is an important factor in fecal incontinence. Recognized lacerations occur in 0.36–8.4% of vaginal deliveries, and occult sphincter damage in up to 35% of primiparous women. We examined the role of three‐dimensional transperineal ultrasound (3DTUS) in the evaluation of the anal sphincter in primiparous women after vaginal delivery and after surgical repair of third‐degree intrapartum tears by the overlapping technique.

Fetal heart ventricular mass obtained by STIC acquisition combined with inversion mode and VOCAL

Estimation of fetal heart ventricular mass is important for fetal cardiac evaluation in cases of structural or functional cardiac disorders or extracardiac factors. It may be used with other cardiac parameters to ascertain the severity and prognosis of such disorders, or the nature and timing of intervention. We applied a novel technique combining spatiotemporal image correlation (STIC) with three‐dimensional inversion mode and Virtual Organ Computer‐aided AnaLysis (VOCAL™) for fetal cardiac mass assessment in healthy fetuses in the second and third trimesters.

OP08.10: 3D/4D ultrasound for fetal cardiac ventricle mass measurement in the second half of gestation in normal and anomalous cases

magnification and rotation functions and a right-left set was done using the spine as a reference point in plane A. The software senses and reconstructs views using spatial relationships. A seven plane tomographic ultrasound imaging (TUI) display is then added. The data was then analysed to determine whether the target diagnostic planes were correctly identified in one or more of the seven TUI plane. Results: Necessary planes were observed in 93% of patients studied. Conclusions: 3D scans permit accurate display modes for evaluation of the fetal heart. This holds great potential for reducing operator dependency and enhancing the utility of ultrasound in normal and diseased fetal hearts.

OP33.09: Does 3D/4DUS improve diagnostic accuracy in congenital heart malformations?

performed in Plane A (the reference plane: 4-chamber view) alone or in the three orthogonal planes A, B and C. We assessed the location of the reference point placed in plane A at the crux of the heart or in the descending aorta. For all combinations of standardizations and reference point locations tomographic ultrasound imaging (TUI) was set to display seven images of AoA. Data were analyzed to determine the ability of the automated software to display the AoA plane in each volume. Image quality was also analyzed. Results: The automated software displayed, at least one TUI plane, target AoA view in more than 90% of volumes (table). In most, cases quality of retrieved images was good and excellent. The best results were achieved when standardization was made in three orthogonal planes and the reference point placed in the aorta. The difference however was not statistically significant. The software performed equally well at each gestational age between 18 and 23 weeks. Conclusion: The developed formula demonstrates an excellent display of the AoA view with appropriate quality of images in most cases. This should help improve the detection of congenital AoA anomalies in future.

OC041: A new direct technique for fetal cardiac function evaluation: 4D‐MPI with STIC acquisition

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.

OP08.15: Fetal myocardium: Compressible or noncompressible?

Background: Controversy exists regarding whether myocardium compresses during contraction. Some studies have shown that during systole the muscle compresses when fluid and blood exit from the muscle during contraction. This theory has not been tested in the fetal heart. Objectives: To examine whether fetal myocardium during systole is of lesser or equal volume to that of diastole, and to compare these measures in newborn myocardium, employing 4D-STIC and inversion mode. Methods: STIC volumes were acquired and analyzed with VOCAL and inversion mode. Right and left heart end-diastolic and endsystolic myocardial (MV) and ventricular volumes were determined. Proportional change between end-diastolic and end-systolic MV was calculated, as were stroke volume (SV) and ejection fraction (EF) for the right and left ventricles. For comparison, echocardiography was performed on 10 normal term newborns and children using 4D-STIC, but limiting acquisition and analysis to the left ventricle. Results: 30 fetuses at GA 20–37 wks were examined. The Total Volume Change (ventricle+myocardium) between end-diastole and end-systole ranged from 0.5–5.38 cm3 in the left ventricle and 0.25–4.89 cm3 in the right, while the SV ranged from 0.13–2.64 cm3 in left ventricle and 0.15–2.16 cm3 in the right at these GAs. SV values therefore are smaller than the total volume change in systole, i.e. SV does not account for all volume change following cardiac contraction. This difference is the compression of the myocardium. MV compressed between end-diastole and endsystole by 8–19% in the right ventricle and 5–25% in the left. In newborns and children left heart MV compression between enddiastole and end-systole was 0–8%. EF was relatively constant at ∼60%. Conclusions: Fetal myocardial volume in the second half of gestation compresses by approximately 20% during systole. To the best of our knowledge this is the first study to demonstrate the compressibility of fetal myocardium.

OP23.07: Rate and possible risk factors for levator ani muscle trauma in primiparae after term vaginal birth

patients. Tape was placed opposite the proximal, middle, or distal urethra in 4/55 (8%); 39/55 (70%); and 12/55 (22%) respectively. Distance between tape and urethra was 0.21–1.45 cm (mean 0.65). Sonographic levator ani defect was observed in 40/55 (73%) women: bilateral defect in 17 (41%), right in eight (20%) and left in 15 (38%). Tape was symmetrical in 46/55 (84%) women. These results are compared with ICI-Q scoring of urinary incontinence. Conclusions: 3DTUS is a feasible method of pelvic floor evaluation and may prove to be a useful adjunct tool in TVT follow-up. This population showed a high rate of levator ani defects.

OP04.31: B-flow modality combined with STIC in the evaluation of malalignment of the great vessels

was induced shortly before term. Fetal well-being during labor was controlled by fetal pulse oxymetry (FPO) in all of the cases delivered vaginally. Pregnancy is terminated by Cesarean section only for obstetrical indications or an impossibility to use intrapartal FPO (breech position). C) Two babies have a pacemaker since the newborn’s period. These babies have had a FHR less than 60 bpm. The other 5 babies are still followed up (26–36 weeks). Conclusion: AVB III without structural anomalies are usually present in mothers with autoimmune disease. Prevention is often impossible because women are asymptomatic at the time of diagnosis of the AVB III. Vaginal delivery is preferable but FPO monitoring is recommended during labor. If FHR is lower than 60 bpm babies will probably need a pacemaker early in their life. A multidisciplinary approach is necessary.