E. Carreras

P07.07: Predictive value of peak systolic velocity in the middle cerebral artery to detect fetal anemia in red‐cell alloimmunized pregnancies beyond 35 weeks

Results: The colour Doppler derived mean velocity of 59 (SD ± 10.8) mm/s is significantly (P = 0.04) higher than the spectral Doppler derived velocity of 54 (SD ± 9.5) mm/s. Umbilical blood flow derived from the mean flow multiplied by the cross sectional area is 114 ml/min (SD ± 69) and 104 ml/min (SD ± 58), respectively (P = 0.01) (student t test). Conclusion: These preliminary data suggests that colour Doppler derived umbilical venous volume flow is approximately 10% higher than spectral Doppler derived volume flow. This can be explained by less angle dependency of colour Doppler derived velocity.

Brain angiogenic gene‐expression in congenital heart disease

To assess potential differences in the expression of antiangiogenic and angiogenic factors and of genes associated with chronic hypoxia in cerebral tissue of euploid fetuses with congenital heart disease (CHD) vs those without.

OP07.01: Clinical significance of isolated posterior fossa anomalies: Dandy‐Walker variant, megacisterna magna and Blake's pouch cyst

Objective: To determine the outcome of fetuses with a prenatal ultrasound (US) diagnosis of isolated Dandy-Walker variant (DWV), megacisterna magna (MCM) or Blake’s pouch cyst (BPC). Methods: Registers from our scan database diagnosed as isolated posterior fossa (PF) anomaly between 2002 and 2008 were retrospectively collected at Vall d’Hebron Materno Infantil Hospital in Barcelona. Information concerning karyotype, other image studies, pathology findings, perinatal outcome and postnatal evaluation was obtained from medical records. Infant’s development and behaviour was evaluated with the validated tool parent’s evaluation of development status (PEDS). Results: This series included 24 cases over seven years, we sonographically identified 7 fetuses with isolated DWV, 14 with isolated MCM, and 3 with isolated BPC. Mean gestational age at diagnosis was 24 weeks for DWV, 29 weeks for MCM and 20 weeks for BPC. Karyotypes were performed in 4, 8 and 2 fetuses with DWV, MCM and BPC respectively and all were normal. Of DWV cases 4 (57.4%) requested termination of pregnancy (TOP), one was lost after diagnosis, one had an intrauterine fetal demise and one had a healthy neonate. Of MCM cases one opted for TOP and 13 continued, all healthy neonates were born uneventfully, but one has developmental delay at follow-up. All cases of BPC continued pregnancies and finished with healthy babies. PEDS was used to detect possible developmental or behavioural problems in 16 cases with isolated PF anomalies in fetal US. We found one infant (6.2%) in group A-treatment needed; two infants (12.5%) in group B-perform wider evaluation; three infants (18.8%) in group C-close observation, and ten infants (62.5%) in group E-normal. Conclusions: Isolated DWV prognosis is still unclear, even when karyotype is normal, and both, isolated MCM and BPC, are generally associated to normal karyotype and have a high possibility of leading to a normal neonate and good long term prognosis.

Re: ISUOG Practice Guidelines: role of ultrasound in twin pregnancy.

We wish to express our disagreement with some of the statements relating to preterm birth in the recently published ISUOG Practice Guidelines on the role of ultrasound in twin pregnancy1. Firstly, cervical length (CL) measurement is the best predictor of preterm birth (PTB) < 35 weeks’ gestation in asymptomatic twin pregnancy, as stated previously2,3. However, since the majority of twins are delivered before 37 weeks, CL is not a good predictor for delivery at this gestational age; as in singletons, CL is not a good predictor of PTB at 34–37 weeks. However, for symptomatic women, it is a good predictor for PTB within 48 h to 7 days after assessment2.

Future Uses of Three/Four Dimensional Power Doppler Signal in Fetal Medicine

Three-dimensional Ultrasound (3DUS) has grown quickly and constantly over the last fifteen years. However, some of its best clinical uses remain to be defined. The threedimensional Power Doppler (PD) is based on the ability to register the signal amplitude of the ultrasound wave, which allows us to depict most moving particles in a given Region of Interest (ROI). It is also based on the three-dimensional US principles, that permit the collection of signals from such particles in a given Volume of Interest (VOI) The inclusion of a time sequencing protocol or a Space-Time Image correlation (STIC) algorithm, developed and made available to last generation US machines, adds the additional possibility of following the signal evolution during a pre-established lap. At first, this promising tool was used to evaluate vascularisation and perfusion in a series of foetal organs, finding neither adequate accuracy nor repeatability. Nowadays, its use in Foetal Medicine is restricted to certain foetal conditions, although new research is on-going and further uses for this technology are being unveiled.

OP30.08: Fetal cardiac function by tissue Doppler imaging in fetuses with and without congenital heart disease

achieve > 250 fps. For each acquisition, 15s of non compressed data were stored in cine-loop format and analyzed offline. Aortic valve closure was marked from aortic flow and the onset of each cardiac cycle was manually indicated in the 2D images. Sample volume and area length were standardized at the minimum size. Two observers measured peak systolic left ventricular strain and strain-rate. Results: Strain and strain-rate measurements were feasible in 93% of the acquisitions. Mean time spent for 2D strain was 9 min with intraclass agreement coefficient of 0.89 (95% CI 0.76–0.95) and 0.89 (95% CI 0.78–0.94) for strain and strain-rate respectively. Agreement between observers using 2D strain showed a mean difference of 0 with 95% limits of agreement −8.1 to +8.1 for strain and 0 (−1.2 to 1.1) for strain-rate. Mean time for TDI was 14 min with an intraclass agreement of 0.65 (95% CI 0.41–0.83) and 0.63 (95% CI 0.36–0.82) for strain and strain-rate respectively. Agreement between observers using TDI showed a mean difference of 3.2 (−14 to 21) for strain and 0.1 (−5.6 to 5.8) for strain-rate. Conclusions: Evaluation of strain and strain-rate of the fetal heart is feasible by 2D strain or TDI and has reproducibility similar to previous data in adults.

OP01.05: Prenatal diagnosis and treatment planning of conotruncal anomalies: fetal echocardiographic features, associated anomalies and outcome

Objectives: To investigate the value of two-dimensional combined with STIC technique to localize the VSD in fetus. Methods: From June 2010 to October 2010, 378 pregnant women were included in our study. GE Voluson E8 was used. The definition of the types of VSD: perimembrane type, isolated membrane type, subseptal valve type, subcrista type, intracrist type, and muscular type. The subseptal valve type and the inlet muscular type were confirmed in four-chamber view. Membrane type, perimembrane type, outlet muscular type were confirmed in left ventricle outlet view. Results: 27 ventricular septal defects were diagnosed by two dimensional echocardiography combined with STIC. The typy and located ventricular septal defect compared with autopsy and echocardiography after birth. The coincidence 92.5%. Conclusions: The type of ventricular septal defect can be diagnosed by two dimensional and STIC echocardiography.

OP01.01: The functional single ventricle heart in the fetus: accuracy of prenatal diagnosis and outcome

Objectives: The purpose of this study was to determine the diagnostic accuracy of fetal Echocardiography in evaluating anatomic details of the functional single ventricle heart and the outcome of fetuses diagnosed with this anomaly. Methods: This is a retrospective study of 128 fetuses with single ventricle of our database (from January 2004 to March 2011): Double inlet single ventricle (DISV) (n = 16), tricuspid valve atresia (TA) (n = 18), Mitral valve atresia and hypoplastic left heart syndrome (HLHS) (n = 75), hypoplastic right-heart syndrome (HRHS) (n = 16) and heteroataxy syndrome with common auriculoventricular valve (HS) (n = 3). The results of fetal echocardiography were compared with the diagnoses at postnatal echocardiography or anatomopatologic findings. Postnatal surgical outcome of survival patients was reviewed. Results: We had 81 terminations of pregnancy (TOP) (63.1%: 50% DISV; 50% TA; 69% HLHS; 50% HRHS and 100% HS) and 2 intrauterine fetal death. Anatomical findings were correlated in 91% of cases. In 7 morphology of the predominant ventricle was not identified. Diagnostic accuracy was present in visceral situs, presence of pulmonary or aortic outflow tract obstruction and presence of obstructed pulmonary venous outflow (sensitivity 100%). However, the ability to predict a ductal dependent pulmonary circulation was poor (sensitivity 63%). Of the 45 newborns, intervention was elected in 40 (88%), nonintervention in 5, and 9 died after intervention (6 after Norwood procedure). Of the cohort of operated newborns 71% are presently alive after various stages of intervention. Conclusions: Accurate diagnosis of the fetal single ventricle heart is possible, and outcome is improving. The rate of TOP is high in single ventricle anomalies. Caution must be taken in judging ventricular morphology and in predicting ductal dependent pulmonary circulation.

OC20.05: Fetal cardiac function by tissue Doppler imaging in women with preeclampsia and/or intrauterine growth restriction

of the uncertainty of the occurrence of PE. Whereas the risk for an individual with DAP < 70 mmHg and normal retinal perfusion had a risk for PE of 6.8%, those with DAP > 70 mmHg and retinal hyperperfusion had a risk for PE of 45%. Conclusion: Women with impaired placentation who develop preeclampsia have retinal hyperfusion present at first trimester. The study of this maternal haemodynamic state improves the prediction of PE by stratifying its risk.

P25.06: Structural congenital heart disease in twins, report from a large cohort of twin pregnancies

nor functional cardiac anomalies were taken into account for this purpose. Results: A total of 57 (3.8%) cases of sCHD were found in the entire population, the incidence of sCHD was 3.25% in DC, 4.35% in MC and in TTTS cases was about 8%. 34 (59.6%) of cases underwent selective feticide because of either associated anomalies or severity of CHD. 7 (12.3%) died spontaneously in-utero and 16 were followed until birth, 75% of which was preterm (mean gestational age 29 +/− 2 weeks). 4 (25%) of cases were severe pulmonary stenosis (all of them in previous TTTS cases), two of which underwent pulmonary valvuloplasty at 4th and 7th day of life. 4 (25%) presented anomalous vein drainage systemic (3) and pulmonary (1). 3 (18.7%) fulfilled criteria for Fallot tetralogy. 3 (18.7%) had aortic coarctation. 2 (12.5%) presented cono-truncal anomalies (TGA and truncus). Neonatal intensive care stay was very long (mean of 74 +/− 23 days) because of prematurity and surgical interventions. Conclusions: sCHD have a higher incidence among twins, in TTTS the incidence of pulmonary stenosis is even higher than in other twins. Cardiac thorough screening is mandatory in all TP, particularly in MC.