G. Oggè

Prenatal screening for congenital heart disease with four-chamber and outflow-tract views: a multicenter study

Congenital heart diseases (CHD) are the most common congenital anomalies, and most cases occur in the low‐risk population. Prenatal ultrasound screening based on visualization of the four‐chamber view has had disappointing results in detecting these anomalies thus far. The aim of this study was to evaluate the diagnostic accuracy of ultrasound screening based on the combination of the four‐chamber and outflow‐tract views.

Thymic volume in healthy, small for gestational age and growth restricted fetuses

The aim of this study was to verify the hypothesis that a difference in thymic size exists between small for gestational age (SGA) fetuses, likely constitutional, and intrauterine growth restricted (IUGR) fetuses because of placental causes.

Bedside diagnosis of two major clinical phenotypes of hypertensive disorders of pregnancy

To investigate the hypothesis that fetal abdominal circumference (AC) and uterine artery (UtA) Doppler pulsatility index (PI) could be used to select two homogeneous subgroups of women affected by hypertensive disorders of pregnancy (HDP), characterized by the coexistence of maternal hypertension with and without intrauterine growth restriction (IUGR).

An effective and feasible approach to prevention of primary cytomegalovirus infection in pregnancy

In the absence of a cytomegalovirus (CMV) vaccine, other strategies for prevention of primary infection in pregnancy should be considered. Behavioural interventions have been reported to significantly decrease seroconversion rate among seronegative pregnant women. We report here on a recently completed controlled study in which seronegative women at high risk of infection because of close contacts with children <36 months, were identified and informed about risky and protective behaviours. Informed women seroconverted at a significantly lower rate than non-informed women.

OC70: Mild ventricolomegaly: should the cut-off be lowered to 9.5 mm?

Objectives: Persisting pregnancy of unknown location (PPUL) remains a controversial clinical problem with no consensus on diagnosis or management. Biochemically, these behave like ectopic pregnancies (EP) or sick intrauterine pregnancies (IUPs). Many clinicians perform laparoscopy with dilatation and curettage (D&C) to exclude these and subsequently treat with systemic methotrexate (MTX). The aim of this study was to define this challenging group of PULs and to achieve guidelines for the management of PPUL. Methods: This retrospective analysis included pregnancies in the interval 2001–2006. All women who had PUL on transvaginal scan (TVS) were followed up with serial human chorionic gonadotrophin (hCG) levels and TVS until the eventual outcome of the pregnancy was established. Conventional PUL outcomes included failing PUL, IUP and EP. Where the location of pregnancy was never visualized on TVS, and when hCG levels reached a plateau on three or more consecutive measurements, the diagnosis of PPUL was made. All PPUL cases were collected retrospectively from the Early Pregnancy Unit database and management was analyzed. Results: Some 3050 PUL were studied; 42 (1.3%) of these were diagnosed as PPUL. At initial presentation, the median gestational age was 42 (range, 17–73) days and median initial hCG was 180 (range, 39–1491) IU/mL. Management included laparoscopy in 5/42(12%) women to exclude EP, and two had D&C. No EPs were found at the time of laparoscopy and no chorionic villi discovered at D&C. All 42 women received systemic MTX, with two women requiring two doses. There were no adverse outcomes. Conclusions: PPUL is a diagnosis of exclusion. We define this entity as gestations where the site of pregnancy is never localized on TVS and serum hCG levels plateau on three or more occasions. In the worst-case scenario PPUL can represent ultrasonically missed EPs, but there is little place for laparoscopy or D&C. According to our data, MTX without surgical intervention is the preferred method of treatment.

OC39: Small-for-gestational age and fetal growth restricted very low birth weight neonates have different postnatal weight growth curves

Objectives: To evaluate the incidence and practical significance of short femur length as an isolated finding at mid-trimester sonography in women who have had Down syndrome screening by the integrated test. Methods: This was a retrospective cohort study of 1262 women booked for antenatal care and delivery at University College London Hospital. All women had integrated testing in late first trimester and a detailed anomaly scan in mid-trimester. Isolated short femur (SF) was characterized as femur length < 5th centile with otherwise normal biometry without any anomalies. All scan reports, screening results and neonatal data were analyzed statistically using SPSS version 11.0 software. Results: Some 5.1% of patients had a short femur and 4.7% had isolated SF. Pregnancies with isolated SF were significantly associated with low PAPP-A levels (P = 0.001). Women with an isolated SF fetus delivered babies with a significantly lower birth weight (P = 0.008) and had a higher rate of SGA (P = 0.004) and LBW (P = 0.04) babies compared to controls. Isolated SF was not associated with gestational hypertension, preterm delivery or low Apgar score. Conclusions: This study demonstrates that short femur, even as an isolated finding at mid-trimester, is associated with fetal growth restriction. The measurement of femur length is part of the routine scan done at 18–22 weeks. We believe that a finding of SF in midtrimester, on the background of a normal Down syndrome screening test and anomaly scan, should be regarded as a predictor for SGA and that these patients warrant frequent antenatal monitoring and serial fetal growth scans in pregnancy.

OP08.10: Use of prenatal growth velocity charts to detect small‐for‐gestational age fetuses

Objectives: To compare the distribution of routine fetal biometry as assessed by midwives and medical staff at 20–24 weeks and 30–34 weeks in an unselected population. Methods: Standard measurements of biparietal diameter and head circumference, abdominal circumference, and femur length were performed by four midwives and ten physicians at between 20 and 24 weeks and at 30 to 34 weeks as part of routine ultrasound examination during a 26-month period. All measurements were transformed into Z-scores calculated according to different prediction equations. The reference for each type of measurement that best fits our practice was previously determined: Snijders and Nicolaides (1994) for abdominal circumference, Chitty et al. (1994) for head circumference and femur length and the French College of Echocardiography (2006) for biparietal diameter were chosen. Mean and SD of Z-score distributions were compared at 20–24 weeks and at 30–34 weeks between the group of measurements performed by the midwives and physicians respectively. Student’s t-test and a Fisher test were used to compare mean values to and SD values respectively. Results: A total of 1566 ultrasound examinations were included in the midwife group at 20–24 weeks, versus 1631 examinations in the physician group whereas 1710 examinations were included at 30–34 weeks in the midwife group versus 1578 examinations in the physician group. We found that mean values for the midwives were significantly closer to 0 (P < 0.05) as compared to the physicians’ results. On the other hand, the midwives’ SD values were significantly lower and smaller than 1 as compared to the doctors’ SD values. Conclusions: Midwives seem to normalize biometry values more than physicians. Such normalization may hamper the sensitivity of routine ultrasound screening for abnormal fetal growth.

OC162: Assessment of brain vascularization and blood flow in human fetus using quantitative three-dimensional power Doppler sonography

Objectives: New three-dimensional (3D) ultrasound technologies allow the assessment of the overall vascularization within a given volume of tissue. We applied 3D ultrasound to the study of fetal brain with two aims: to evaluate the brain perfusion in normal fetuses, and to detect the presence of eventual vascular dominance in fetal brain by comparing left to right hemisphere vascularization. Methods: We studied 65 normal fetuses of gestational age ranging from 21 to 40 weeks using 3D real-time ultrasound equipment that supports volume contrast imaging technology (Voluson 730 Expert, General Electric). The vascularization index (VI), the flow index (FI) and the vascularization–flow index (VFI) are calculated by a built-in software. These indices were derived from spherical volumes acquired in specifical anatomical regions, obtained from a transverse section of the fetal head at the level of the thalami and cavum septi pellucidi. We calculated the regression of VI, FI and VFI values of the overall vascularization, and the median VI, FI and VFI values of the right and left hemispheres. Results: VI, FI and VFI values of overall brain perfusion showed a slight, but not significant increase from 21 to 40 weeks of gestational age. Median VI (left vs. right, 2.20 (range, 0.02–14.32) vs. 1.04 (range, 0.01–12.71), P = 0.014), median FI (left vs. right, 21.68 (range, 18.18–41.36) vs. 18.25 (range, 16.43–39.40), P = 0.030) and median VFI (left vs. right, 0.66 (range, 0.06–5.38) vs. 0.33 (range, 0.04–4.32), P = 0.023) obtained by sampling the left hemispheres were significantly higher than the values obtained by sampling the right hemispheres. Conclusions: We suggest that quantitative three-dimensional power Doppler sonography can be used to study the in-utero development of the fetal brain vascular network. Moreover, we could demonstrate the presence of a vascular dominance of the left hemisphere in the fetal brain.