G. De Felice

Impact of Dienogest on Endometriomas Transvaginal Ultrasound Features and Symptoms.

Intervention: Laparoscopic ovarian cystectomy was performed by stripping technique. The endometrioma wall was histologically examined and specimens were categorised into 2 groups based on semiquantitative scale of follicle loss from 0 to 4. Group 1 and 2 included grade 0, 1, 2 and 3, 4 respectively (Group 1: low follicle loss; Group 2: high follicle loss). Measurements and Main Results: 170 patients were included. Mean age of patients was 32.4 0.5 years. The frequency (95% confidence interval) of sever ovarian damage following surgery (grade 4) was 8.8% (7–21%). From one-way ANOVA model, a statistically significant effect on the grade of follicle loss was determined only by pre-operative cyst dimension as measured by transvaginal sonography (p= 0.011). No significant correlation was found with surgeon’s experience, ASRM disease stage, lesion localization, history of previous ovarian surgeries, number of previous pelvic surgeries or preoperative medical therapy. When dividing patients on the basis of the grade of follicle loss, a statistically significantly larger mean cyst diameter was found in group 2 (38.44 17.39 mm vs 31.99 15.59 mm in Group 1, p= 0.029). The LSD post-hoc analysis indicated a more evident effect of endometriomaze in Grade 4 follicle loss patients, when compared with all the other groups. Conclusion: Uninteded ovarian damage, occurring after endometrioma surgery, is not a rare event. Increased cyst diameter is significantly associated with the loss of normal ovarian parenchyma.

OC03.05: Three‐dimensional ultrasound characterization of uterine junctional zone in patients with recurrent miscarriage: a new diagnostic tool?

established: failed PUL, intrauterine pregnancy (IUP) or ectopic pregnancy (EP). Univariate analysis was performed in order to establish the significant variables for the different PUL outcomes (ANOVA F-test and Fisher’s exact test). Results: 152/2067 (7.35%) women were initially classified as a PUL. 142/152 (93.4%) women were included in the final analysis. Final PUL outcomes were: 71.1% (101/142) failed PUL, 20.4% (29/142) IUP and 8.45% (12/142) EP. Endometrial symmetry data was available for 95.1% (135/142) women with a PUL at the initial TVS. Off-line analysis of 3-D TVS images showed a symmetric endometrial cavity for 55.2% (16/29) IUPs, 88.3% (83/94) failed PULs, and 91.7% (11/12) EPs. There was a significant association between endometrial symmetry (symmetric vs. asymmetric) and 3-category PUL outcome (P = 0.00017). Conclusions: The use of 3-D TVS in the evaluation of uterine cavity symmetry may be useful in the prediction of PUL outcome at the primary scan. In particular, the presence of an asymmetrical endometrial cavity seems to be most commonly associated with PULs that subsequently develop into intrauterine pregnancies.

OP11.02: Uterine junctional zone (JZ) in infertile and fertile patients with and without pelvic endometriosis: a three-dimensional transvaginal ultrasound (3TVS) study

Methods: A web-based survey of fellows and trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Results: Three hundred and sixty-six (28%) responses included about 50% of Fetal Medicine and Obstetric Ultrasound subspecialists. Just over /4 (76.1%) of practices report or receive reports as a systolic:diastolic ratio (SD), just under 1/3 (31.6%) as pulsatility index (PI) and over 1/3 (36.4%) as resistance index (RI) with 22% declining to nominate a preferred umbilical artery Doppler index. 57% did not know the reference source used in their practice and more than 30% cited unpublished, local reference ranges. Many respondents were well aware of the limitations of umbilical artery Doppler. Survey participants requested 1. consistency 2. gestational age specific reference ranges 3. guidance in interpretation. Conclusions: Regarding Doppler indices, SD remains popular. RI advocates note its straightforward interpretation. PI is favoured by subspecialists, those following international research and those using ratios (e.g. cerebro-placental ratio). Until one index becomes universal, co-reporting of all indices is prudent. Concerning reference chart choice, local, unpublished charts remain popular: their concordance requires investigation. Generally, ideal reference chart are 1. Drawn from a representative population 2. not drawn from a referred population (biased toward abnormality) 3. not subject to retrospective exclusions (biased to ‘‘super-normality’’) 4. Developed using valid statistics, especially to estimate extreme values 5. Use optimal information about gestation 6. Use a good sample size. Ideally usable charts should be subject to peer review and publication, ASUM and RANZCOG endorsement, be readily accessible on ultrasound machines, reporting packages, smart phone applications and the world wide web

OP11.07: Three dimensional sonographic assessment of septate uterus: correlation between morphlogy, volume and vascularity of the septum and reproductive outcome: Short Oral Presentation (OP) Abstracts

BF, and in the distal part (spill around ovaries) in 80% when using GS and 93% when using BF. When using air and saline, contrast flow was detected in the proximal part of 88% and 90% of the 230 tubes when using GS and BF, respectively; in the medial part in 52% and 64%, and in the distal part in 68% and 85%. Conclusions: BF imaging improved the visualization of both contrast media in all parts of the Fallopian tubes. BF imaging with air-saline was good for assessing tubal patency. Sonovue may be needed just in cases where air-saline flow visualized by BF does not provide conclusive results about tubal patency.