G. Di Pierro

Intrauterine growth restriction and fetal body composition

To assess the differences in fetal body compartments between fetuses with normal growth and those with reduced intrauterine growth, during the third trimester, through ultrasonographic determination of subcutaneous tissue thickness (SCTT).

Fetal subcutaneous tissue thickness (SCTT) in healthy and gestational diabetic pregnancies

To determine reference values of fetal subcutaneous tissue thickness (SCTT) throughout gestation in a healthy population and to compare them with those from a population of pregnant women with gestational diabetes under standard therapy.

Maternal body composition at term gestation and birth weight: is there a link?

Abstract.To assess the relative influence of maternal body composition at late gestation on birth weight, we examined maternal body composition near term (36.50±2.67 weeks gestation) in a group of 29 women, aged 20–39 years. The women came to the laboratory after an overnight fast. After anthropometric measurements, bioelectrical impedance analysis (BIA) was performed, determining resistance (R) and reactance (Xc), with a Tefal scale at 50 kHz. Fat mass (FM, kg) and fat-free mass (FFM, kg) were determined with the total body water (TBW) equation of Siri. The correlation between BIA parameters and birth weights was examined by linear regression analysis. All subjects delivered between 37 and 41 weeks’ gestation. The mean±SD values of the studied parameters were: Xc=490.00±77.34 Ω, R=55.71±8.71 Ω, FM=24.18±6.51 kg, FFM=45.82±2.65 kg, maternal weight gain=9.51±6.43 kg, birth weight=3.43±0.36 kg. A direct significant correlation was found between FFM, maternal weight gain, and birth weight. It is known that in late pregnancy, maternal weight gain over gestation is linked to birth weight. We observed that FFM was the most important maternal body component associated with the newborn weight at term gestation, and we believe that this finding might be elucidated by fluid retention. In fact, resistance seemed to be inversely related to birth weight and we do not overlook the link between resistance and TBW. The implementation of our study could shed more light on the influence of maternal body composition on birth weight.

OC92: A proposal for a pharmacological treatment for hypertensive pregnancies complicated by severe fetal growth restriction (FGR) with absent end diastolic flow (AEDF) of the umbilical artery

The differential diagnosis of hypertensive disorders in pregnancy is based in clinical, laboratorial and fundoscopic findings. The role of the ophthalmologist in the diagnosis of pre-eclampsia appears to be subjective and limited. Ophthalmic artery Doppler is an objective exam that can improve the diagnosis of hypertension in pregnancy. The study aims to analyze the ophthalmic artery Doppler indices in pregnancies with chronic hypertension and pre-eclampsia. Methods: Cross-sectional study that analysed 30 women with chronic hypertension and 44 preeclamptic women (National High Blood Pressure Education Program 2000 criteria) during the third trimester of pregnancy. Right and left eyes indices means and standard deviation were evaluated to the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic velocity (EDV) and peak ratio (PR). Mann-Whitney test were applied to compare the two groups of hipertensive woman and p-values < 0.05 were considerd statistically significant. Results: The ophthalmic arteries Doppler averages indices in chronic hypertension and pre-eclampsia were respectively RI: 0.74 ± 0.06; 0.63 ± 0.17, PI: 1.68 ± 0.41; 1.12 ± 0.28, PSV: 34.01 ± 10.3; 38.60 ± 9.67, DVF: 9.0 ± 4.12; 14.26 ± 4.74 and PR: 0.64 ± 0.13; 0.82 ± 0.09. The Doppler indices demonstrated ophthalmic artery lower impedance in preeclamptic women compared with chronic hypertension women. All the Doppler indices were accurate in the diferential diagnosis of chronic hypertension and pre-eclampsia demonstrated by p = 0.0001 (RI, PI, EDV, PR) and p = 0.0171 (PSV). The best parameter to establish a cut of point to differentiate chronic hypertension to pre-eclampsia was 0.75 to PR index. Conclusions: The ophthalmic artery Doppler is a new parameter that can be used in the differential diagnosis and classification of hypertensive disorders in pregnancy.

OC53: The effect of low dose aspirin and omega-3 fatty acids on uterine artery Doppler flow velocity in women with impaired uterine perfusion having a history of recurrent abortion

tenaculum. This enables continuous monitoring during cervical dilatation and uterine curettage for surgical treatment of miscarriage. The purpose of this study was to establish the feasibility of evacuation of retained products of conception using this new device to monitor the procedure. Methods: Women diagnosed with miscarriage or retained products of conception on TVS were invited to join the study. The procedure was timed from application until removal of the tenaculum. Views obtained were rated as satisfactory or poor. Success of the procedure was gauged by absence of products of conception, assessed by TVS and transabdominal ultrasound scan (TAS) at the end of the procedure. Operative complications were recorded. Women were followed-up by telephone questionnaire. Results: 43 women were recruited to the study. The procedure was successful in 42/43 (98%) cases. The mean operating time was 7 minutes (range 2 to 23 minutes). There were two minor operative complications. In one case the condom broke, which may have increased the risk of infection, and in a further case the tenaculum caused trauma to the cervix, necessitating hemostatic suture. On follow-up questionnaire the mean duration of bleeding was 4 days (range 1–7 days). There were no cases of post-operative complications necessitating readmission or repeat procedure. Conclusion: This study indicates that TVS-guided ERPC is a successful method for surgical evacuation of the uterus following miscarriage, with a low risk of complications.

P10.18: Ultrasound-determined fetal subcutaneous tissue thickness (SCTT) for a birthweight prediction model: Poster abstracts

Objectives: To construct new reference charts and equations for fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) using a large sample of fetuses examined at 15–40 weeks in France. To compare this new reference with previous ones. Materials and methods: The study data were obtained from a population of pregnancies undergoing ultrasound examination over a continuous one-year period. Exclusion criteria were: known abnormal karyotype or congenital malformation, multiple pregnancies, no first trimester dating based on crown-rump length No exclusion was made on the basis of abnormal biometry or birth weight. For each measurement, separate regression models were fitted to estimate both the mean and standard deviation at each gestational age. Results: Complete biometric measurements were obtained in 19 647 fetuses. New charts and reference equations are presented for BPD, HC, AC and FL. Prediction intervals for the new reference were comparable to those of previous references, whereas there were some difference in the predicted centiles among references. Conclusion: We have presented new French reference charts and equations for fetal biometry. They can be easily used to compute centiles and Z-scores, to control quality of biometric assessment as well as to evaluate their performance as compared to other references.

P10.19: Intrauterine growth restriction and fetal body composition

Objectives: To construct new reference charts and equations for fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) using a large sample of fetuses examined at 15–40 weeks in France. To compare this new reference with previous ones. Materials and methods: The study data were obtained from a population of pregnancies undergoing ultrasound examination over a continuous one-year period. Exclusion criteria were: known abnormal karyotype or congenital malformation, multiple pregnancies, no first trimester dating based on crown-rump length No exclusion was made on the basis of abnormal biometry or birth weight. For each measurement, separate regression models were fitted to estimate both the mean and standard deviation at each gestational age. Results: Complete biometric measurements were obtained in 19 647 fetuses. New charts and reference equations are presented for BPD, HC, AC and FL. Prediction intervals for the new reference were comparable to those of previous references, whereas there were some difference in the predicted centiles among references. Conclusion: We have presented new French reference charts and equations for fetal biometry. They can be easily used to compute centiles and Z-scores, to control quality of biometric assessment as well as to evaluate their performance as compared to other references.

OC067: Hypertension in pregnancy: a need for a clinical classification

were analyzed using a General Linear Model Repeated Measures. There was a statistically significant difference (f = 6.721, p < 0.01) in attitude after the 3DUS however there was no difference between gender. Six questions had statistically significant differences (fetal cramping p < 0.012; fetal personality p < 0.001; baby thinking and feeling p < 0.009; waiting to hold baby p < 0.005; picturing baby appearance p < 0.011 and baby hiccoughs p < 0.006); they were analyzed non-parametrically as 2 related samples however due to a Statistical Type 1 error this was for exploratory analysis only. Line scores showed no significant difference. Conclusions: Evaluation of a Maternal-Fetal Attachment assessment showed parents experience a statistically significant change in attitude regarding their fetus after a 3DUS study. No significant difference was found between parental gender.

P199: Fetal subcutaneous tissue and two independent-parameter-formulas for estimating fetal weight

was 3296 ± 253 (SD) grams. The mean start point was 6.1 ± 2.0 menstrual weeks. Rossavik models fit the AVol trajectories very well (mean R2 = 99.4 ± 0.5). By fixing the k coefficient (mean 2.617), the fit did not change and the variabilities coefficients c and s were reduced. The mean percent deviation between observed and predicted AVol measurements was 0.36 ± 8.5% (n = 72) during the third trimester. Conclusions: IGA standards for fractional arm volume provides a new soft-tissue parameter for characterizing fetal growth. Expected normal growth trajectories and neonatal soft tissue mass can be accurately predicted from growth models specified by fractional arm volume data made before 28.5 menstrual weeks. This parameter may allow earlier detection and improved monitoring of fetuses with soft tissue abnormalities such as IUGR and macrosomia.

P198: Fetal subcutaneous tissue thickness (SCTT) in normal and gestational diabetic pregnancies: reference values and therapy variations

was 3296 ± 253 (SD) grams. The mean start point was 6.1 ± 2.0 menstrual weeks. Rossavik models fit the AVol trajectories very well (mean R2 = 99.4 ± 0.5). By fixing the k coefficient (mean 2.617), the fit did not change and the variabilities coefficients c and s were reduced. The mean percent deviation between observed and predicted AVol measurements was 0.36 ± 8.5% (n = 72) during the third trimester. Conclusions: IGA standards for fractional arm volume provides a new soft-tissue parameter for characterizing fetal growth. Expected normal growth trajectories and neonatal soft tissue mass can be accurately predicted from growth models specified by fractional arm volume data made before 28.5 menstrual weeks. This parameter may allow earlier detection and improved monitoring of fetuses with soft tissue abnormalities such as IUGR and macrosomia.