E. Di Naro

Single and multiple umbilical cord cysts in early gestation: two different entities

To investigate the prevalence of single and multiple umbilical cord cysts in the first trimester and to assess whether there is a difference in the pregnancy outcome between them.

Prenatal diagnosis and postnatal outcome of cardiac rhabdomyomas

Abstract Aims: To evaluate the sonographic appearance of suspected fetal cardiac rhabdomyomas and their evolution until delivery and in the postnatal period. Methods: The study group consisted of 6 patients at 23–37 weeks of gestation referred to our Ultrasonic Unit, between March 1992 and December 1998, for suspected fetal cardiac rhabdomyomas. Results: The cardiac tumors were single in three cases and multiple in the other cases. The size ranged from 11 to 47 mm. In two cases the tumors arose from the right ventricle, in one case from the interventricular septum and in three cases from the left ventricle. Five infants are alive and in satisfactory hemodynamic compensation, but three of them developed tuberous sclerosis. In two infants a regression in the maximum diameter of the tumor masses has been observed. One child underwent surgical treatment at the age of six months and the baby died after surgery. Conclusions: Two-dimensional and Doppler echocardiography are useful non invasive methods to diagnose fetal cardiac rhabdomyomas and to monitor their influence on the fetal cardiac function. However they do not allow us to recognize which fetuses presenting with features compatible with rhabdomyomas will develop tuberous sclerosis.

Large cross‐sectional area of the umbilical cord as a predictor of fetal macrosomia

To determine whether a large cross‐sectional area of the umbilical cord is a predictor of fetal macrosomia.

Ductus venosus blood flow velocity characteristics of fetuses with single umbilical artery

Sonographic Doppler evaluation of the fetal ductus venosus has been proved to be useful in the evaluation of fetal cardiac function. The aim of this study was to investigate the ductus venosus blood flow profile in fetuses with single umbilical artery and to correlate it with the umbilical cord morphology.

P12.11: Discordant sonographic umbilical cord coiling pattern in twins with twin‐to‐twin transfusion syndrome

of amnioinfusion was 658 ± 220 cc. The mean pre-op MVP was significantly different between the SP and NSP groups (8.7 ± 0.6 vs. 11.0 ± 0.2 cm, p < 0.05). The mean gestational age (GA) was not different (20.3 ± 1.9 vs. 19.7 ± 6.5 weeks). There was no correlation between MVP and GA (r = .03, p = .72). There was no difference in Stage (p = .08), with 11/16 (68%) SP patients being Stage III or IV. Conclusion: An SP is present in 12% of patients with TTTS, despite polyhydramnios. Amnioinfusion is required for SLPCV in patients with SP to disclose all anastomotic vessels. As a corollary, therapeutic amniocenteses prior to laser surgery may result in iatrogenic development of SP, requiring intraoperative amnioinfusion.

P12.10: Incidence of sonographic lean and large umbilical cords in twin pregnancies

of amnioinfusion was 658 ± 220 cc. The mean pre-op MVP was significantly different between the SP and NSP groups (8.7 ± 0.6 vs. 11.0 ± 0.2 cm, p < 0.05). The mean gestational age (GA) was not different (20.3 ± 1.9 vs. 19.7 ± 6.5 weeks). There was no correlation between MVP and GA (r = .03, p = .72). There was no difference in Stage (p = .08), with 11/16 (68%) SP patients being Stage III or IV. Conclusion: An SP is present in 12% of patients with TTTS, despite polyhydramnios. Amnioinfusion is required for SLPCV in patients with SP to disclose all anastomotic vessels. As a corollary, therapeutic amniocenteses prior to laser surgery may result in iatrogenic development of SP, requiring intraoperative amnioinfusion.

P05.26: Prognostic factors for survival in fetuses with reverse end‐diastolic flow on Doppler umbilical artery velocimetry

Objective: to evaluate the morbidity and mortality rate of IUGR fetuses correlated to Doppler velocimetry, FHR tracing, BPP and AFI. Methods: a multicenter prospective study of 246 fetuses with ultrasound diagnosis of IUGR. Among them 186 met the study entry criteria. The study group underwent Doppler velocimetry study of UA, MCA, DV and UV twice weekly, BPP and AFI twice weekly and FHR tracing daily. IUGR fetuses were divided into two groups: Group 1 IUGR fetuses with Doppler velocimetry abnormality; Group 2 with normal Doppler velocimetry. In Group 1 the type and time passing from Doppler alteration to birth were documented. Apgar score, pH at birth, need of intubation, RDS, IVH, PVL, days of NICU hospitalization were available and related to neonatal outcome. Results: Gestational age at time of admission ranged from 16.1 to 40 weeks. One hundred IUGR fetuses showed Doppler velocimetry alteration while sixty-eight fetuses did not show Doppler alteration (Group 2). In Group 1 morbidity and mortality rate were significantly correlated with the type of Doppler velocimetry abnormality and with time passing from the latter finding and delivery being higher in fetuses with AEDF, RF in UA with a time > 72 hours from the Doppler abnormality and delivery. Conclusions: Doppler velocimetry should be performed in IUGR fetuses as its findings help to reduce morbidity and mortality rate. There is a significant correlation between the type of alteration and time passing from alteration to birth.

P210: Sonographic ‘jelly like’ placenta and pregnancy outcome

lean mass (MAFM and MALM, scm), the mid-thigh fat mass and lean mass (MTFM and MTLM, scm), the abdominal fat mass (AFM, mm) and the subscapular fat mass (SSFM, mm). The Mann-Withney U-test and the Student t test were used to compare the two groups. Results: The abdominal circumference and the humerus were statistically lower among the GR fetuses. Most of the SCTT values were different in the two groups; particularly the SSFM (3.6 ± 1.1 vs 2.6 ± 0.7 mm; p = 0.011), the AFM (5.1 ± 0.7 vs 4 ± 1 mm; p = 0.01), the MAFM (3.5 ± 0.9 vs 2.2 ± 0.8 scm; p < 0.01) and MALM (2.1 ± 0.4 vs 1.7 ± 0.5 scm; p = 0.029) were statistically higher in fetuses with a normal development respect to the GR fetuses. Conclusions: We observed that, at mid-gestation, the whole set of SCTT, excluding the MTFM, is reduced among fetuses later developing an intrauterine growth restriction. Moreover we also found that the MALM was lower in GR fetuses, testifying that fat free mass and not only fat mass is involved in the incorrect fetal development. Therefore, the evaluation of SCTT allows us to understand that the whole fetal body compartments are involved in a ‘‘intrauterine dismantlement’’ that, if not recognized by time, might lead the fetus to death.

P058: Incidence of uncoiled umbilical cords in trisomy 21 fetuses at 10–15 weeks of gestation

Objective: To determine the accuracy of first trimester sonography in identifying fetal gender. Materials and methods: This study was carried out prospectively in 250 singleton pregnancies who underwent sonography at 11–14 weeks of gestation (confirmed by CRL or BPD). Fetal genitalia was examined in a midsagittal plane and if the angle of genital tubercle to horizontal line through the lumbosacral skin surface was greater than 30′ the gender was assigned as male and when the genital tubercle was parallel or convergent less than 30′, female. The results were checked after birth. Results: In 22 (8.2%) patients fetal sex was not determined. Genital tubercle was identified in 228 (91.2%) patients. Sex determination was correct in 207 (90.8%) and wrong in 21 (9.2%) of cases. The accuracy of sex determination increase with gestational age from 82.7% at 11 weeks, to 90.9% at 12 weeks, 94.7% at 13 weeks and 94.1% at 14 weeks. Most common mistake was to assign male fetuses as female. Conclusion: Sex determination by sonography at first trimester has an important role in case of X-linked anomalies to avoid invasive procedures in female fetuses. The accuracy of correctly identifying fetal gender by sonography at first trimester was 90.8%.

OC205: Sonographic atypical vascular coiling of the umbilical cord: incidence and clinical significance

Introduction: Cerebral hypoxic and ischaemic changes have been implicated in the aetiology of the characteristic seizures that signify the end-progression of pre-eclampsia. Until recently, neuronal dysfunction secondary to ischaemic causes or functional impairment has been difficult to study in adult humans due to the relative inaccessibility of the cerebral circulation. Doppler ultrasound now provides a means of assessing the normalcy of blood flow velocity, and has demonstrated consistency in the evaluation of severe vascular stenosis 1. Differences in systemic peripheral resistance between normotensive and preeclamptic pregnant women have also been demonstrated using calibrated carotid pulse tracings 2. Objective: To measure peak Carotid blood volume flow in a group of prospective mothers at high-risk of pregnancy hypertension and preeclampsia following uterine artery Doppler screening. Methods: Carotid artery velocimetric and blood volume flow profiles were evaluated using standardised techniques in 31 pregnant women at 24–28 weeks gestation. Results: Blood volume flow measurement showed a 75% sensitivity for elevated blood pressure in later pregnancy, 60% sensitivity for the development of preeclampsia and 100% sensitivity for preterm preeclampsia. Conclusion: The measurement of blood volume flow in the Carotid circulation in high-risk pregnant women merits further investigation as a second-tier screening test for pregnancy hypertension and preeclampsia.