F. De Musso

Fetal head–symphysis distance: a simple and reliable ultrasound index of fetal head station in labor

To assess the reproducibility of measurement of a new sonographic index of fetal head station in labor, the fetal head–symphysis distance (HSD), using three‐dimensional ultrasound, and its correlation with digital assessment of fetal head descent and with the angle of progression (AoP).

Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery

To compare longitudinal changes in angle of progression (AoP) and midline angle (MLA) during the active second stage of labor according to the mode of delivery.

Brainstem-vermis and brainstem-tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis

To evaluate the role of the brainstem–vermis (BV) and brainstem–tentorium (BT) angles in the differential diagnosis of upward rotation of the fetal cerebellar vermis.

P08.03: Post‐partum evaluation of maternal cardiac function in a cohort of severe pre‐eclamptic women

All fetuses were singletons and were followed-up to delivery to determine whether they had SGA complications. In total, 109 appropriate-for-gestational-age (AGA) fetuses and 21 fetuses with SGA were included. After analysis, 3D PD indices were calculated: Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index (VFI). These indices were compared among the study groups. Results: Our results showed 3D power Doppler indices (VI, FI, and VFI) of fetal upper arm can differentiate SGA fetuses from AGA fetuses well. The study showed that 3D power Doppler indices (VI, FI, and VFI) were significantly lower in the SGA group compared to controls. Conclusions: It appears that 3D PD US assessment of the fetal upper arm reveals significant differences in all indices studied (VI, FI and VFI) between fetuses with SGA and without SGA. Fetal upper arm assessed by 3D PD US can be applied to detect SGA prenatally. We believe those assessments using 3D PD US is a useful test in detecting fetuses with SGA.

OP18.05: Fetal head‐symphysis distance: a simple and reliable ultrasound parameter for the intrapartum assessment of the fetal head descent

(ITU) during the active second stage according to the mode of delivery. Methods: A 3DUS ITU volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 minutes thereafter (T2, T3, etc.). Following delivery, all 3DUS volumes were analysed and both AoP and MLA were measured. Both parameters were then compared between women who underwent spontaneous vaginal delivery (SVD, Group A) and those who underwent operative delivery (Group B). ROC curves were subsequently constructed for both parameters at different scan intervals to estimate their accuracy to predict SVD. Results: Among 71 women included in the study, 58 women underwent SVD, 8 were delivered by vacuum extraction and 5 underwent cesarean delivery. When compared with group B, group A had a significantly wider AoP only at T1 (140.9 ± 20.2◦ vs. 122.9 ± 16.7◦, P = 0.01) and T2 (149.7 ± 20.7◦ vs. 126.9 ± 17.5◦, P = 0.006). The ROC curves revealed an AUC ± SE of 0.731 ± 0.077 at T1 and of 0.785 ± 0.080 at T2. On the other hand, MLA was narrower in Group A only at T3 (21.2 ± 11.7◦ vs. 40.8 ± 27.9◦, P = 0.043), T4 (18.2 ± 15.0◦ vs. 47.4 ± 29.6◦, P = 0.020) and T5 (18.25 ± 6.0◦ vs. 34.7 ± 4.2◦, P = 0.034). ROC curves yielded an AUC at T3 of 0.750 ± 0.044, at T4 of 0.880 ± 0.089 and T5 of 1.000 ± 0.000. On stepwise forward multiple logistic regressions both AoP and MLA were associated with the spontaneous vaginal delivery (OR (exponential beta) 1.047 and 0.983 respectively)). Conclusions: Ultrasonographic assessment of fetal head descent in the second stage may play a role in the prediction of the mode of delivery.

T09-O-02 The impairment of sexual function stresses menopausal less than premenopausal women

Objective Menopause requires psychological and physical adjustments, due to the occurring dramatic hormonal changes. Sexuality is one of the aspects that undergoes the most profound modifications. Preliminary data suggest that sometimes postmenopausal women do not regard sexual changes as being problematic often readjusting their life and relationship according to their new physical status. This underlines the evaluation of personal distress in the diagnosis of sexual dysfunction in particular in menopause. The aim of our study was to evaluate sexual function and the way women feel comparing postmenopausal and pre-menopausal women. Design and Method The Female Sexual Index Function (FSIF) and the Female Sexual Distress Scale (FSDS) were completed by 74 menopausal and 100 premenopausal women. Results Resultsare reported in postmenopausal versus premenopausal women as median + SD: • age: 56.0+4.2 versus 27.6+4.3 years; • FSFI total score: 20.2+3.5 versus 28.7+6.9 (p=0.000); • FSFI score • (p=0.000); • FSDS score >15 in women with FSFI >26.5: 17/51 • (33.3%) versus 16/24 (66.7%) (p=0.007); • sexual dysfunctional women 17/74 (23%) versus 16 /100 • (p= 0.25). Conclusions Although in menopause there is a higher incidence of potential sexual problems, personal distress caused by these problems is lower among menopausal as compared to premenopausal women. This data further supports the importance of incorporating personal distress evaluation in the diagnosis of sexual dysfunction.

OP14.08: Prenatal diagnosis of Dandy‐Walker malformation and Blake's pouch cyst at 15–18 weeks

magna were assessed. The diagnostic value and image quality was evaluated. In all cases brain anatomy was verified by postnatal neurosonography, fetal/postnatal MRI or by autopsy. Results: Abnormal appearance of the posterior fossa was consistent with complete absence of the cerebellar vermis (Dandy-Walker malformation) in 8 fetuses, vermian hypoplasia in 3 fetuses and Blake’s pouch cyst (BPC) in 5 fetuses. Axial transcerebellar view in all fetuses with posterior brain anomalies at 11+0–13+6 weeks’ showed non-specific enlargement of the posterior fossa. Mid-sagittal view in fetuses with Dandy-Walker malformation demonstrated the absence of border between 4th ventricle and cisterna magna. In contrast in fetuses with BPC normal size of cisterna magna, enlargement of the 4th ventricle with an intact border between these two structures was noted in mid-sagittal view. Conclusions: Assessment of the fetal posterior fossa is possible in 1st trimester of pregnancy by 3-D sonography. A mid-sagittal view retrieved from 3D volume data set of the fetal head demonstrates a good display of the diagnostic landmarks of fetal posterior fossa with appropriate quality of images. By standardizing the approach to image acquisition and display 3D-sonography may potentially improve our understanding of normal fetal brain development and help to increase the detection rate of fetal posterior brain abnormalities in early pregnancy.

OC11.02: Late development of the normal cerebellar vermis: is it really an obstacle to the early diagnosis of Dandy-Walker malformation?

loss occurred in 10.4% and 1.6% of children with 1st and 2nd trimester infection, respectively. One child with deafness treated with cochlear implant and one child diagnosed with mild CP, (attributed to prematurity) both after 1st trimester infection. Three children, after 2ed trimester infection, diagnosed with hypotonia (2) and mild developmental delay (1). Nineteen patients had abnormal sonographic findings (4 with normal MRI, and 10 with subtle MRI findings). Of those, 3 (15.7%) had damage to the auditory system. Two other fetuses had very abnormal US findings (refuse TOP) and they suffered severe neurologic damage. In all cases infection occurred during the 1st trimester. None of the children infected during the third trimester were affected. Conclusions: The outcome of congenital primary CMV infection with normal prenatal US and MRI is favorable. The prognostic value of subtle MRI findings is probably limited and as an isolated finding it probably does not justify termination of pregnancies.

OP18.07: Head progression in fetuses with persistent occiput posterior position at delivery: longitudinal assessment by 3D ultrasound in the second stage

Results: Of all 206 women, 9 had a cesarean for fetal distress and were excluded. The remaining 197 had a mean age of 28.6 (15–41). Most were nulliparas (n = 112; 56.9%). Mean gestational age was 40.8 (37–41). Major indications for labor induction were postdates pregnancy (n = 163; 82.7%), gestational diabetes (n = 29; 14.7%) and pre-eclampsia (n = 5; 2.6%). Cesarean section was performed in 31 cases (15.7%). Mean birthweight was 3485 g (2390–4650). ROC curves indicated that the best cut-off of cervical lenght for predicting Cesarean delivery was > 30 mm (sensitivity 68%, specificity 55%, positive predictive value (PV) 22%, negative PV 90%) and for Bishop score was < 5 (sensitivity 84%, specificity 48%, positive PV 23%, negative PV 94%). On univariate analysis nulliparity, cervical length > 30 mm and Bishop score < 5 were all significantly associated with Cesarean delivery (P values of 0.001; 0.023; 0.001 respectively). When patients were selected according to parity, there was found a significant association of Bishop score and cervical length with Cesarean delivery for nulliparas, but not for multiparas. Bishop score < 5 had 83% sensitivity, 39% specificity, 31% positive PV and 88% negative PV for Cesarean delivery (P = 0.027). Cervical length > 30 had 67% sensitivity, 58% specificity, 54% positive PV and 84% negative PV for Cesarean delivery (P = 0.034). Conclusions: Our results suggest that Bishop score and cervical length provide a significant contribution in the prediction of labor induction in postterm pregnancies.

P18.03: The fetal head-symphysis distance correlates well with fetal head perineum distance on three-dimensional intrapartum ultrasound

Objectives: To evaluate the predictive value of maternal weight, Bishop score, and sonographically measured cervical length at 37 weeks’ gestation for predicting the risk of intrapartum Cesarean delivery in parous women with prior vaginal delivery. Methods: This prospective observational study recruited parous women with singleton pregnancies with previous vaginal delivery at 37 weeks’ gestation. Transvaginal ultrasound for measurement of the cervical length was performed and the Bishop score was determined by digital examination. The data collected at enrollment included maternal weight, height and age. A regression model was constructed with control for known intraand post-partum confounders. Results: Five hundred twenty women were analyzed; 6 women (1.2%) underwent Cesarean delivery in labor. Based on univariate analysis, the maternal weight at 37 weeks was significantly associated with the risk for intrapartum cesarean delivery in parous women, whereas cervical length, Bishop score, maternal age and height at 37 weeks, epidural anesthesia, labor induction, and birth weight were not associated. Multiple logistic regression demonstrated that only maternal weight at 37 weeks provided a significant contribution in predicting intrapartum cesarean delivery. To predict cesarean delivery in labor, the best cut-off value of maternal weight was 72.4 kg, with a sensitivity of 83.3% and a specificity of 79.8%. Conclusions: Maternal weight at 37 weeks’ gestation independently predicted the risk of intrapartum Cesarean delivery in parous women with prior vaginal delivery. However, the sonographic measurement of the cervical length and Bishop score were not predictive of Cesarean delivery.