G. Haddad

EP10.15: A new sign to demonstrate the presence of a cleft palate: the rolling stone sign!

Objectives: It’s easy to prove hard palate integrity with the posterior wall visualisation but difficult to demonstrate a cleft because of bony shadows. This technique is a new reliable sign, also easy to obtain, with precise landmarks. Methods: We begin with a scan of an axial view, the Inter Orbital Distance plan. Then we do an angulation of the probe in caudal direction without sliding on the skin. We normally obtain on this new frontal view a hyperechogenic line corresponding to the hard palate posterior wall. This method has been applied at every fetal scan after 18 weeks of gestation since 2002. It allows us to be sure of the hard palate integrity but can’t affirm a cleft palate. Indeed, the visualisation of the echogenic line can be missed due to the maxillary bony shadows. Generally when we can’t get the hyperechogenic line it’s impossible to see any structure behind the maxillary. In one case instead of this complete absence we observed a hyperechogenic structure perpendicular to the waited posterior wall with soft tissue moving around, interpreted as nasal septum. We concluded to the presence of a cleft palate, confirmed with others scan as sagittal views and after birth. We studied 1000 patients without posterior wall visualisation, with the method described above. Results: Performing this scan is as easy as getting the posterior wall so its feasibility allows to be used in all cases, without spending too much time. In most cases we could get the posterior wall, thanks to a better pathway between maxillary and mandible and be sure of hard palate integrity. In 12 cases we could find this hyperechogenic line perpendicular to the researched posterior wall, with soft tissue moving around. All these cases presented a proved cleft hard palate. We had no false negative or positive exam. Conclusions: This sign complete a positive sign of normal hard palate avoiding pitfalls due to bony shadows and seems to be a reliable positive sign of hard palate cleft. It’s feasibility allows us to think it can be researched in all cases when the posterior wall can’t be visualised.

OC04.01: Lost of lambda's posterior cerebral falx: a new sign of spina bifida

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.

OP15.10: A new indirect sign of minor atrioventricular septal defects (AVSD): aiastolic disappearance of atrioventricular valves (AVV)

pulmonary vein was further to interatrial septum from the 4-chamber view, connected with left atrium obliquely. The left inferior pulmonary vein was close to descending aorta from 4-chamber view, connected with left atrium vertically. The left inferior pulmonary vein was located to anterior descending aorta from aortic arch view, and formed 90◦ angel with descending aorta. The right superior pulmonary vein was close to apical right atrium and superior vena cava from 4-chamber view, connected with left atrium. The right inferior pulmonary vein was near to spine, parallelled to interatrial septum, connected with left atrium. Conclusions: There is an advantage in visualizing and locating in fetal pulmonary veins by EFI combine with 2 dimensional echocardiography. Pulmonary veins anatomy should be checked during fetal heart examination.

P25.18: Interest of choroid plexus at first trimester in diagnosis of spina bifida

median gestational age was 12+4 (range, 11–14) weeks and the median CRL was 64 (range 45–84) mm. The median for the NT was 1.6 mm (range 0.8–4) mm and for the IT was 1.7 mm (range 1.2–2.8) mm. The IT increased with gestational age from a median of 1.5 mm at 45 mm to a median of 2.2 mm at a CRL of 84 mm. (P > 0.01). The calculated 5th and 95th centile for different CRL is shown in Figure 1. Conclusions: The IT is easily recognizable only if a perfect mid sagital view of the face is assessed. This is important in order to avoid over diagnosis of spinal defects early in gestation. In accordance to Chaoui et al, the IT increases linearly with gestationas seen on our population studied. These reference ranges will be of use in the evaluation of central nervous system defects early in gestation.

P18.03: Epiglottis‐uvula distance: to be sure about soft palate integrity

Results: Chromosomal abnormalities were found in 78 cases. In the first group the flow was abnormal in 53 cases, the overall detection rate, specificity, positive predictive value, negative predictive value and likelihood ratio for aneuploidy were 67.9%, 99.0%, 67.9%, 99% and 66.7 respectively. On basis in the ductus venosus blood flow during atrial contraction as positive marker only A-wave was negative (43 cases) the sensitivity, specificity, the positive and negative predictive values and likelihood ratio were 55.1%, 99.1%, 67.2%, 98.6%, 64.4 respectively. Conclusions: Abnormal ductus venosus blood flow is an useful marker of chromosomal anomalies in the first trimester ultrasound screening. We could improve the predictive for the detection of aneuploidies by considering absent flow during atrial contraction as a positive marker (abnormal).

OP23.09: Did first trimester screening can affirm kidneys agenesis or presence?

Results: 33/43 pregnancies (76.7%) were terminated or had spontaneous fetal death due to only chromosomal abnormalities (n = 3; 6.9%) and additional malformations (n = 30; 76.7%). In the remaining 10 cases classified as ‘isolated’ omphalocele, one showed at 18 weeks a tetralogy of Fallot, another a left diaphragmatic hernia and a third the picture of omphalocele exstrophy complex. Two other fetuses died in utero at 30 and 32 weeks respectively. All these cases had a nuchal translucency within the normal range. The remaining five had a good outcome after neonatal operation. Conclusions: Omphalocele at 11–14 week has more than 84% association with chromosomal or structural anomalies. Survival rate is 11.6% of all detected cases and 71.4% of isolated cases with continuing pregnancy. Despite comprehensive ultrasound 3/10 (30%) of ‘assumed’ isolated omphalocele will show additional malformations and another 2/10 (20%) may die in utero. Counselling at 11–14 weeks is in our experience different to the counselling usually done at 22 weeks.

OP18.07: Isolated cleft lips: interest of ‘Cupid's bow’

Objectives: To evaluate usefulness of sagittal CDUS images for the differential diagnosis of fetal cleft lip (CL) and cleft palate (CP). Methods: We got coronal and axial images of upper lip and maxillary alveolar in 25 fetuses with CL and CP. Existence of defect and malalignment of alveolar was assessed. We assessed existence of hard palate defect on the mid-sagittal image and flow through the defect on CUDS during fetal swallowing. We compared the US findings with postnatal features. We assessed the accuracy of axial and sagittal images in the differential diagnosis of CL and CP. Results: 19 cases had CL and CP. 6 cases had CL without CP. 3 of 6 CL cases had cleft alveolar. Alveolar defect on axial image was detected in 18 of 19 cases with CP and 3 of 6 with CL. Alveolar malalignment was detected in 11 of 19 cases with CP, but in no case with CL. Hard palate defect on the sagittal image was detected in 15 of 19 cases with CP, but in no case with CL. CDUS evaluation of fetal swallowing was possible in 20 of 25 cases. Communicating flow through the palate defect was detected in 14 of 15 cases with CP, but in no case with CL. The accuracy of alveolar defect and malalignment on axial image were 84% and 68%, respectively. Accuracy of hard palate defect and flow on mid-sagittal image were 84% and 95%, respectively. Combined axial and sagittal images correctly diagnosed in all 6 cases with CL and 18 of 19 cases with CP. The accuracy was 96%. Conclusions: Sagittal US evaluation of the fetal hard palate may have additional value in the differential diagnosis of fetal CL and CP.

OP20.09: Is it possible to diagnose fetal kidneys agenesis or to affirm their presence during first trimester screening?

three risks was used to calculate detection and false positive rates by taking the proportions with risks above a given risk threshold. Results: In the study population of 57,119 pregnancies, there were 44 (0.08%) cases with holoprosencephaly, 150 (0.3%) cases with exomphalos and 35 (0.06%) cases with megacystis. Of the fetuses with holoprosencephaly, 29 (65.9%) were chromosomally abnormal. Of those with exomphalos and megacystis the karypype was abnormal in 83 (55.3%) and 11 (31.4%), respectively. Applying a risk cut off of 1 : 100 would detect 96.7%, 96.4% and 100% of the aneuploid fetuses with holoprosencephaly, exomphalos and megacystis for respective false positive rates of 6.7%, 16.4% and 4.2%. Conclusion: In fetuses with holoprosencephaly, exomphalos and megacystis, the combined risk for trisomies can help to distinguish between euploid and aneuploid fetuses. However, in view of the following pregnancy, karyotyping is still recommended.

OC12.05: Foetal esophagus scans screening: the distance between trachea and aorta versus the pouch sign?

Results: Thirteen prenatal cases of non-nuchal vascular-lymphatic malformations were identified and all cases were confirmed postnatally. The presence of a vascular-lymphatic malformation was suspected in the first trimester in five fetuses secondary to an enlarged anterior cystic hygroma. In eight cases the first trimester ultrasound appeared normal but the lesion was noted on a second trimester morphology sonogram. Two ultrasounds noted a lymphangioma of the lower extremity with extension into the abdomen. Six fetuses had lymphatic malformations of the chest wall with involvement of the upper limb. In two cases hemangiolymphangioma was located to the face and neck. Additionally, in 3 patients with bilateral pleural effusion pulmonary lymphangiectasia was diagnosed. One of these cases resulted in hydrops fetalis and a neonatal diagnosis of Hennekam’s syndrome. Pregnancy outcomes included two terminations, one intrauterine fetal demise, and ten live births. These ten neonates underwent multiple surgical interventions. Postoperative complications included sepsis, lymphorhea, and airway obstruction. Only four babies were alive at one year after birth. Conclusions: This represents one of the largest series of prenatal diagnosis of non-nuchal vascular-lymphatic malformations. These lesions are most commonly diagnosed later in pregnancy. Rapid growth of the lesion, large size at the time of presentation, and the development of hydrops fetalis are poor prognostic indicators.

P12.05: Fetal soft palate integrity: epiglottis‐uvula distance, an easy new sign to be sure

Objective: To asses the learning curve for the observed to expected fetal lung area to head circumference ratio (O/E LHR) calculation in fetuses with congenital diaphragmatic hernia (CDH). Methods: Three trainees with the theoretic knowledge, but without prior experience in the O/E LHR measurement were selected. Each trainee and one experienced explorer measured the O/E LHR in the contralateral lung to the side of the hernia by firstly, manual tracing of the lung borders and secondly, by multiplication of the longest diameters in a cohort of 95 consecutive CDH fetuses. The average difference between the three trainees and the expert in the O/E LHR measurement was calculated. A difference below 10% was considered as accurate measurement. The average learning curve was delineated using the cumulative sum analysis (CUSUM). Results: The CUSUM plots demonstrate that the learning curve was surmounted by 77 and 71 cases performed for the area obtained by the manual tracing and multiplication of the longest diameter methods, respectively. Conclusion: The minimum number of scans required for an inexperienced sonographer to become competent in examining the O/E LHR is on average 70.