G. Masini

OC07.01: Pre‐conception maternal hemodynamics is associated with subsequent development of pre‐eclampsia (PE) or intrauterine growth restriction (IUGR)

Objectives: Enlargement and abnormal sulcation of the temporal lobes have been described as a hallmark of thanatophoric dysplasia, while less severe abnormalities of the temporal lobes can be seen in achondroplasia or hypochondroplasia. Compared to fetal neurosonography, fetal MRI offers various advantages in the assessment of brain malformations, and may be of value in the prenatal diagnosis of CNS abnormalities in various skeletal dysplasias. The aim of this study was to describe the spectrum of temporal lobe abnormalities in skeletal dysplasias in a perinatal setting, using fetal MRI as well as postnatal in vivo and postmortem brain MRI. Methods: We included 6 cases of thanatophoric dysplasia in which 1,5T or 3T fetal MRI had been performed between GW17 and 23. In 2 of those cases postmortem MRI at 3T and in 3 cases histological analysis with H&E-staining was available and enabled us to correlate postmortem findings with in utero fetal MRI results. In addition we included 1 fetal MRI and 3 postnatal MRI of fetuses with achondroplasia/hypochondroplasia. Results: Enlargement of the temporal lobes with abnormal sulcation was seen in all 6 subjects of thanatophoric dysplasia in fetal MRI and was confirmed in 2 cases with postmortem MRI and in 3 cases at autopsy. Abnormalities in the 4 subjects with achondroplasia/hypochondroplasia included bilateral or unilateral sagittalisation of the parahippocampal sulcus, seen both in fetal MRI as well as in postnatal MRI. Conclusions: Temporal lobe abnormalities of different severities can be an independent marker of the presence of a skeletal dysplasia, as seen both in thanatophoric dysplasia as well as achondroplasia/hypochondroplasia.

OP19.09: Fetal middle cerebral artery Doppler impedance is not related to maternal hemodynamic function: Short oral presentation abstracts

L. Youssef1, J. Miranda2, C. Paules2, F. Crovetto2, F. Figueras2, E. Eixarch2, A. Nadal1, C. Rovira3, F. Crispi2, E. Gratacós2 1Pathology, Hospital Clinic-IDIBAPS, Barcelona, Spain; 2BC Natal, Barcelona, Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clı́nic and Hospital Sant Joan de Deu) and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; 3Pathology, Hospital Sant Joan de Deu, Barcelona, Spain

Association Between Prepregnancy Cardiovascular Function and Subsequent Preeclampsia or Fetal Growth RestrictionNovelty and Significance

Preeclampsia and fetal growth restriction during pregnancy are associated with increased risk of maternal cardiovascular disease later in life. It is unclear whether this association is causal or driven by similar antecedent risk factors. Clarification requires recruitment before conception which is methodologically difficult with high attrition rates and loss of outcome numbers to nonconception/miscarriage. Few prospective studies have, therefore, been adequately powered to address these questions. We recruited 530 healthy women (mean age: 35.0 years) intending to conceive and assessed cardiac output, cardiac index, stroke volume, total peripheral resistance, mean arterial pressure, and heart rate before pregnancy. Participants were followed to completion of subsequent pregnancy with repeat longitudinal assessments. Of 356 spontaneously conceived pregnancies, 15 (4.2%) were affected by preeclampsia and fetal growth restriction. Women who subsequently developed preeclampsia/fetal growth restriction had lower preconception cardiac output (4.9 versus 5.8 L/min; P=0.002) and cardiac index (2.9 versus 3.3 L/min per meter2; P=0.031) while mean arterial pressure (87.1 versus 82.3 mmu2009Hg; P=0.05) and total peripheral resistance (1396.4 versus 1156.1 dynes sec cm−5; P<0.001) were higher. Longitudinal trajectories for cardiac output and total peripheral resistance were similar between affected and healthy pregnancies, but the former group showed a more exaggerated fall in mean arterial pressure in the first trimester, followed by a steeper rise and a steeper fall to postpartum values. Significant relationships were observed between cardiac output, total peripheral resistance, and mean arterial pressure and gestational epoch. We conclude that in healthy women, an altered prepregnancy hemodynamic phenotype is associated with the subsequent development of preeclampsia/fetal growth restriction.

Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function

BACKGROUND: The mechanism underlying fetal‐placental Doppler index changes in preeclampsia and/or fetal growth restriction are unknown, although both are associated with maternal cardiovascular dysfunction. OBJECTIVE: We sought to investigate whether there was a relationship between maternal cardiac output and vascular resistance and fetoplacental Doppler findings in healthy and complicated pregnancy. STUDY DESIGN: Women with healthy pregnancies (n=62), preeclamptic pregnancies (n=13), preeclamptic pregnancies with fetal growth restriction (n=15), or fetal growth restricted pregnancies (n=17) from 24–40 weeks gestation were included. All of them underwent measurement of cardiac output with the use of an inert gas rebreathing technique and derivation of peripheral vascular resistance. Uterine and fetal Doppler indices were recorded; the latter were z scored to account for gestation. Associations were determined by polynomial regression analyses. RESULTS: Mean uterine artery pulsatility index was higher in fetal growth restriction (1.37; P=.026) and preeclampsia+fetal growth restriction (1.63; P=.001) but not preeclampsia (0.92; P=1) compared with control subjects (0.8). There was a negative relationship between uterine pulsatility index and cardiac output (r2=0.101; P=.025) and umbilical pulsatility index z score and cardiac output (r2=0.078; P=.0015), and there were positive associations between uterine pulsatility index and peripheral vascular resistance (r2=0.150; P=.003) and umbilical pulsatility index z score and peripheral vascular resistance (r2= 0.145; P=.001). There was no significant relationship between cardiac output and peripheral vascular resistance with cerebral Doppler indices. CONCLUSION: Uterine artery Doppler change is abnormally elevated in fetal growth restriction with and without preeclampsia, but not in preeclampsia, which may explain the limited sensitivity of uterine artery Doppler changes for all these complications when considered in aggregate. Furthermore, impedance within fetoplacental arterial vessels is at least, in part, associated with maternal cardiovascular function. This relationship may have important implications for fetal surveillance and would inform therapeutic options in those pathologic pregnancy conditions currently, and perhaps erroneously, attributed purely to placental maldevelopment. Uterine and fetal placental Doppler indices are associated significantly with maternal cardiovascular function. The classic description of uterine and fetal Doppler changes being initiated by placental maldevelopment is a less plausible explanation for the pathogenesis of the conditions than that relating to maternal cardiovascular changes.

OP05.04: Cross‐sectional comparison of two techniques for the non‐invasive measurement of cardiac output in and outside pregnancy

imaging) to obtain the fetal uterus in frontal view after rotation of the different axis. Results: During the study period, a total of 29 patients were included after identification of the female fetal external genitals. In 29 fetuses. the volume was acquired by a sagittal posterior view. The volume was assessed for 27 fetuses (93%). For every fetus, the fetal uterus was visualised through a 3D rendered coronal view the Multiplanar-triplan mode and VCI. Conclusions: This study demonstrated the ability to visualised fetal uterus through a 3D rendered coronal view. Based upon the reproducibility of the procedure, we should need to investigate prospectively the intra and inter operator reliability. Due to the potential functional issues associated with such anomalies of the uterus (infertility, hydrometrocolpos) and its association with renal anomalies, there is a clinical value in looking at the fetal pelvis, and thus, to establish a standardised view of the fetal pelvis floor.

OP21.01: Pre-pregnancy exercise stress testing is related to normal physiological adaptation from pre-pregnancy to mid-pregnancy

Objectives: Uterine sarcoma is a rare disease with a poor prognosis, and its preoperative diagnosis is difficult. The author previously presented the finding that a tumour with high tumour-to-subcutaneous fat signal intensity ratio on MRI T2 weighted imaging (TFSIR) and low ADC is highly suspected of sarcoma. However, its sensitivity and specificity are not high enough to diagnose sarcoma. The purpose of this study is to improve the preoperative diagnostic reliability through further investigation of previous and additional cases. Methods: MRI was performed in 6 cases (7 tumours) of uterine sarcoma in the last 3 years (sarcoma group), and in 31 cases of leiomyoma in 2015 (myoma group) at the author’s hospital. TFSIR and ADC were calculated and compared between 2 groups. The cut-off values of these parameters to predict sarcoma were also calculated. Finally, a preoperative prediction method using both of these parameters was considered through the application to the 40 tumours which were examined in 2016. Results: The sarcoma group had significantly higher TFSIR than the leiomyoma group (p<0.01). The minimum cut-off value of TFSIR to diagnose sarcoma was 0.515 (sensitivity: 100%, specificity: 94%). The sarcoma group had significantly lower ADC values than the leiomyoma group (p<0.01). The maximum cut-off value of ADC to diagnose sarcoma was 1.280 (sensitivity: 86%, specificity: 87%). All tumours with both positive TFSIR and ADC were sarcoma (High Suspicion group). All tumours with negative TFSIR were leiomyoma (Low Suspicion group). Tumours with positive TFSIR and negative ADC included both sarcomas and leiomyomas (Intermediate Suspicion group). Among 40 uterine tumours in 2016, two (5.0%) belonged to the High Suspicion group (all sarcoma), three (7.5%) belonged to the Intermediate Suspicion group (all leiomyoma), and the other 35 tumours (87.5%) belonged to the Low Suspicion group (all leiomyoma). Conclusions: Preoperative prediction of uterine sarcoma is possible using both TFSIR and ADC scores on MRI.

EP14.21: Longitudinal comparison of two techniques for non-invasive measurement of cardiac output from pre-conception to postpartum

Objectives: To determine if fetal liver length measured at 14 to 40 weeks gestational age is significantly greater in diabetic Filipino mothers compared to non-diabetic Filipino mothers. Methods: A total of 160 pregnant women with a live singleton pregnancy between 14 to 28 weeks gestational age, seen at the Obstetrics Out-patient Department Unit-Clinical Division of the University of Santo Tomas Hospital, were included in the study. Subjects were classified into non-diabetic (122 subjects) and diabetic (38 subjects). Diabetic subjects (84% were diet-controlled) were further classified into having gestational diabetes (32 subjects) and overt diabetes (6 subjects). All subjects underwent two sonographic measurements of the fetal liver length by a single sonographer, who was blinded as to the glycemic status of the subject. Measurements were analysed using t-test to compare liver lengths between non-diabetic and diabetic subjects. Results: Analysis showed that liver lengths for diabetic subjects were larger compared to non-diabetic subjects, but was only significantly in the overt diabetic group. Conclusions: The fetal liver lengths of overt diabetic Filipino mothers at 14 to 40 weeks gestational age were significantly larger compared to non-diabetics. There was no statistical difference in fetal liver lengths in those with gestational diabetes and those who were non-diabetic.

P05.08: Differences in pre-pregnancy stress response between healthy and PE/FGR pregnancies

Methods: Serum s-Flt-1 and PlGF and their ratio pre-eclamptic index (PEI) were measured in a case-control study of patients that developed PE before or after 34 weeks and unaffected controls. Pre-eclampsia was defined by blood pressure > 140/90mmHg and proteinuria > 300mg/24h. We analysed s-Flt-1 and PlGF (Brahms Kryptor). PEI was calculated for patients before and after 34 weeks of pregnancy. We observed gestational age at delivery (GA), incidence of PE, HELLP syndrome, FGR, SGA, IUFD and perinatal outcomes. Statistical analysis was performed using IBM SPSS Statistics 24. Results: Our study included 339 patients. Average maternal age was 32.9 years, average BMI 24.9, 43% was primigravids and 56% was nulliparous. Patients with subsequent adverse outcomes (n=87) had significantly higher sFlt-1, lower PlGF and higher PEI than women without adverse outcomes (n=252), p<0.001. PEI ratio correlated with prematurity. GA was significantly lower in the PE group: 34.7 vs 39.5 weeks, p<0.001. We calculated a cut-off for PEI ratio (>300) with good sensitivity and specificity for prediction of early PE. This cut-off shows good prediction value (AUC 0.86) for measurements by Brahms Kryptor. Conclusions: Our study shows that previously published PEI cut-off levels did not improve pre-eclampsia detection when measuring sFlt-1/PlGF ratio with Brahms Kryptor in our setting. We propose cut-off (PEI > 300) that shows high diagnostic accuracy for early PE. Further analysis is needed.