G. Bogana

P26.01: Fetal cardiovascular functional parameters across gestation

ossified metacarpals with two digits with ossified phalanges in both hands. X-ray of the feet demonstrated a claw-like deformity in both and no ossified metatarsals were identified. To our knowledge this is the first report on diagnosis of SHFM in first trimester. In agreement with others, the observation of a more severe phenotype in the offspring of a mildly affected parent suggests anticipation. First trimester diagnosis of SHFM is feasible and may provide the couple with early knowledge of recurrence and severity.

OP02.02: The global myocardial performance (Tei) Index in fetuses of mothers with well controlled gestational diabetes mellitus

fetuses and 1040 fetuses with Down syndrome were included in the analysis. Data Extraction: Articles were independently selected, reviewed, and abstracted by 2 reviewers. For each study, the positive likelihood ratio (LR), negative LR, sensitivity, and specificity were calculated. Overall estimates of pooled positive LR, negative LR, sensitivity, specificity, and pooled odds ratio with 95% confidence intervals were calculated for absent nasal bone. Data Synthesis: When the absence of nasal bone was observed in the first trimester, the odds of Down syndrome increased 48-fold (positive LR, 48; 95% CI 29–79). When the nasal bone was seen, the risk of a fetus having Down syndrome was halved (negative LR, 0.44; 95%CI 0.33–0.59). The pooled estimates of sensitivity for detecting fetuses with Down syndrome was 65% (95% CI 61%–69%) and specificity was 99% (95% CI 98%–99%). The diagnostic odds ratio for absent nasal bone was 112 (95% CI 66–187). Conclusions: The absence of nasal bone when observed in the first trimester is a useful tool in distinguishing Down syndrome fetuses. The overall sensitivity of absent nasal bone allows us to use it as a practical marker for Down syndrome.

OP02.11: Comparison of cardiovascular functional parameters and Doppler flow waveforms in fetuses with two‐vessel cord versus three‐vessel cord at 20–23 weeks gestational age

−3.47 for those without coarctation. Difference between means in the two groups was −0.18 (95%CI = −1.56 to 1.2). In sagittal views, mean Z-scores were −2.97 and −3.45 for those with and without coarctation, respectively. Difference between the means was 0.49 (95%CI = −0.95 to 1.93). Conclusions: In this small case series of prenatally suspected coarctation of the aorta, the use of aortic isthmus Z-scores did not allow prompt identification of affected fetuses.

P26.12: Self-medicated acetaminophen and ibuprofen in the third trimester of pregnancy can cause constriction of the fetal ductus arteriosus (DA): A report of 2 cases

Objective: For many years, disproportion of ventricles and great arteries has been the main ultrasonographic finding to suspect and diagnose coarctation of the aorta prenatally. This is associated with low positive predictive value. We report the use of three-dimensional ultrasound (3D-US) in 2 fetuses with suspected coarctation and highlight the role of 3D-US in these cases. Materials and methods: We used the combination of twodimensional (2D-US) and 3D-US to assess the aortic isthmus in 2 fetuses with suspected coarctation of the aorta (CoA) at 23 and 32 weeks of gestation. Bidirectional high definition flow (HDF) was used to examine the aortic isthmus area directly during standard 2D imaging and 3D volume acquisition. Results: Using 2D-US, the aortic isthmus was seen well on transverse views in both cases but not on longitudinal views. 3D-US allowed good visualisation of the isthmal area in all views. Both fetuses showed a discrete isthmal narrowing prenatally (coarctation ‘‘shelf?). Both newborn babies had coarctation requiring surgical treatment. Conclusion: 3D-US improves visualisation of the isthmus part of the aorta and the presence of the shelf when it exists. We suggest that this technique is of additional value in fetuses suspected to have coarctation of the aorta. This may improve the accuracy of prenatal diagnosis of coarctation.

P37.10: Growth discordance and abnormal Doppler flow in a monochorionic triamniotic triplet pregnancy: A case report

ultrasound early in gestation. Differential diagnosis is important because of avoiding unnecessary termination. We report here an epigastric heteropagus conjoined female twins case which was characterized by a completely formed fetus with an omphalocele and an adjacent second body consisting with a pelvis and two lower extremities. There was not a bowel or bony connections and there was a thin vascular pedicle between twins. The diagnosis was made with three dimensional ultrasonography at 18 weeks of gestation.

P26.02: Evaluation of cardiac structure and function in fetuses with isolated gastroschisis

ossified metacarpals with two digits with ossified phalanges in both hands. X-ray of the feet demonstrated a claw-like deformity in both and no ossified metatarsals were identified. To our knowledge this is the first report on diagnosis of SHFM in first trimester. In agreement with others, the observation of a more severe phenotype in the offspring of a mildly affected parent suggests anticipation. First trimester diagnosis of SHFM is feasible and may provide the couple with early knowledge of recurrence and severity.

OP21.06: Sizes of fetal cardiovascular structures across gestation

We sought to define growth parameters of normal fetal heart structures throughout gestation from our database of 2246 normal comprehensive fetal echocardiograms (FECHO). Methods In a retrospective cross sectional study, we evaluated the FECHO results of 2246 normal fetuses. Fetuses had been studied for reasons of family history of congenital heart disease or possible exposure to teratogenic medications, advanced maternal age without karyotyping, suspected abnormalities or difficulty in obtaining complete heart views. None of this group had structural or functional heart disease or arrhythmias. All measurements were performed on a Voluson 730 by one sonographer between 2006 and 2008. Standard cardiovascular diameter measurements were performed on frozen magnified, high resolution images. Valves were measured in long axis at the annulus during diastole with 2 leafets in the image. Systolic and diastolic ventricular measurements were made by follow-the-line methods. These included: ductus venosus size (DV), aorta annulus size (AoV), pulmonary valve annulus size (PV), tricuspid annulus size (TV), mitral annulus size (MV), superior vena cava (SVC) and inferior vena cava (IVC) at the diaphragm sizes, as well as the M-mode measurements including interventricular septum at diastole (IVSD), left ventricular posterior wall dimension at diastole (LVPWD), interventricular septum at systole (IVSS), left ventricular posterior wall dimension at systole (LVPWS) across gestation. Results

OP14.15: The effects of the maternal hyperoxygenation test on twin pregnancies with one intrauterine growth restricted (IUGR) fetus

Objectives: To compare the effects of maternal hyperoxygenation on the Doppler waveforms in twin pregnancies where one fetus has IUGR and absent or reversed end diastolic flow (ARED) in room air. Methods: Women with monochorionic diamniotic twin pregnancies with one IUGR fetus with ARED in room air between 2006 and 2008 who were hospitalized after 24 weeks gestation for close surveillance and bed rest were included in the study. All fetuses had structurally normal hearts. None had evidence of twin-twin transfusion syndrome. Measurements of Doppler flow pattern in middle cerebral artery (MCA), free loop of umbilical artery (FLUA) and ductus venosus (DV) were made in room air and then after breathing 60% oxygen by face mask for twenty minutes. Results: Seven twin pregnancies were included. The normal cotwin in each case had normal Doppler waveforms in room air and oxygen. All seven IUGR fetuses had ARED in room air and dilated DV size. In five patients, the FLUA normalized (PI < 1.75) after breathing 60% oxygen (mean PI = 3.21 in room air versus mean PI = 1.65 in oxygen). These five patients who had positive change with oxygen delivered an average of 5 weeks (range 3–14 weeks) after hospitalization. The other two patients who had no change in FLUA with oxygen and had abnormal MCA and DV in room air were delivered for obstetric indications within one day of the test. Conclusions: Maternal hyperoxygenation may be associated with normalization of the FLUA in fetuses with ARED after 24 weeks of gestation. A positive maternal hyperoxygenation test can select IUGR fetuses who have an abnormal FLUA in room air with a better prognosis and may be useful in postponing delivery in these fetuses with ARED.

OP21.09: Global myocardial performance index (Tei index) is a sensitive parameter of cardiovascular dysfunction in fetuses with supraventicular tachycardia (SVT)

Myocardial performance is diminished in persistent SVT and will lead to hydrops fetalis (HDF). This study sought to determine which methods of fetal echocardiography are best for evaluating treatment and outcome in these fetuses. Methods: Ten infants with HDF due to SVT were included in this study. No fetus has structural heart disease. Serial cardiovascular function was estimated from CC/TC ratio, left ventricular shortening fraction, tricuspid E and A velocities and E/A ratio, mitral E, A velocities and E/A ratio and Doppler flow patterns in the free loop of the umbilical cord, MCA, ductus arteriosus and ductus venosus (DV) as well as maximal velocities and time velocity integrals into the ascending aorta and main pulmonary artery. The Tei index was calculated as the sum of the isovolumetric contraction time (ICT) and the isovolumetric relaxation time (IRT) divided by the ejection time using the ‘‘clicks’’ method. These parameters were compared to age matched normal fetuses from our data base. Changes in the gross measurements of third space effusions were considered demonstrable of improvement of fetal cardiovascular status. Results: The most sensitive indicator of change in fetal function was the Tei index followed by CC/TC ratio. Tei index is the first cardiovascular parameter which gets normalised in these fetuses responding to the treatment. There was no significant change over time with E/A ratios, LV shortening fraction or peripheral arterial Doppler values. DV A wave reversal normalized with cessation of SVT with normal PI values. DV size went from greater than the 95% to normal with cessation of SVT. Conclusions: The Tei index easily performed from 14 weeks through term. It is a useful and likely the most sensitive method of evaluating global myocardial performance in followup of fetuses with HDF especially due to SVT.