G. Ohel

Expectant management of pregnancy-related high-velocity uterine arteriovenous shunt diagnosed after abortion

To assess sonographic and clinical outcome in women with pregnancy‐related uterine arteriovenous malformations (AVMs) diagnosed after abortion.

Prospective randomized comparison between an open and closed vaginal cuff in abdominal hysterectomy.

Objective: To compare an operative and postoperative course of open vaginal cuff hysterectomy and closed vaginal cuff hysterectomy, and to correlate the length of stay, febrile morbidity and the incidence of pelvic fluid collections to the type of surgery. Participants: One‐hundred women scheduled for hysterectomy were prospectively randomized into two groups that underwent either a closed or an open vaginal cuff technique. Results: The open vaginal cuff technique took on average 19% more time than the closed vaginal cuff operation (P<0.05, t‐test). The incidence and size of pelvic fluid collections was significantly higher after the closed vaginal cuff hysterectomy than after the open technique (P<0.01, t‐test). However, the postoperative length of stay, febrile morbidity and the rate of complications were similar. Conclusions: Both techniques of hysterectomy produced a similar postoperative course despite the fact that the closed vaginal cuff technique resulted in a higher incidence of pelvic fluid collections. Therefore considering a shorter operation time for the closed vaginal cuff hysterectomy, this technique seems slightly preferable.

Variations of the origin of renal arteries in the fetus identified on power Doppler and 3D sonography

To investigate anatomic variations of renal arteries (RAs) using 2‐dimensional (2D)/3D power Doppler sonography (PDUS) in normal fetuses and in fetuses with renal anomalies.

Three‐dimensional power Doppler in the evaluation of painful leiomyomas and focal uterine thickening in pregnancy

Objective: To determine the usefulness of 3‐dimensional (3D) power Doppler ultrasound in distinguishing painful leiomyomas from focal myometrial contractions or nonpainful leiomyomas in pregnancy. Methods: A 2D section of the area of interest in the uterine wall was first obtained in 29 patients to determine whether the pain originated from a myoma or a uterine contraction. Then, volume acquisition was activated and Doppler indices (vascularization index, flow index, and vascularization–flow index) were calculated for thickened and normal uterine wall. Results: Of 15 patients found to have uterine myomas, 11 had multiple tumors and 4 had single tumors. In the remaining 14 patients the painful uterine thickening proved to be a focal contraction. Painful segments of uterine thickening were associated with lower Doppler indices. Painful myomas were found to have significantly lower indices than normal uterine wall (P = 0.008, 0.03, and 0.01 for VI, FI, and VFI, respectively, vs. 0.001, 0.003, and 0.01). However, the differences in indices between nonpainful myomas and uterine wall on the one hand, and nonpainful myomas and focal uterine contractions on the other, were not statistically significant. Conclusion: Three‐dimensional power Doppler ultrasound may be a sensitive and reliable tool for distinguishing painful uterine myomas from focal myometrial contractions and nonpainful myomas.

Complication of Laparoscopic Detorsion of Adnexal Mass

Detorsion of an ischemic adnexal mass has recently been advocated for most cases of twisted adnexa. Usually, the affected ovary regains some or all of its vitality and function. However, when the ovary is completely necrotic, it may form an abscess if it contains tissue components that cannot be eliminated by the peritoneal immune system. We report a case of pelvic abscess formation in a detorsed ovary that previously contained an unsuspected dermoid cyst. We call for an extensive inspection of the detorsed ovary before ending the laparoscopic operation, and if it remains necrotic and is suspected of containing a dermoid cyst, it should be removed promptly.

Instability of doppler cerebral blood flow in monochorionic twins

Objective. The purpose of this study was to evaluate Doppler flow velocity changes in cerebral vessels of monochorionic twins with twin‐twin transfusion syndrome (TTTS). Methods. Repeated Doppler umbilical and cerebral blood flow studies were performed in 7 twin pairs with TTTS. Eight monochorionic twin pairs and 11 dichorionic twin pairs served as control groups. The following Doppler parameters were assessed: umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio, delta PI between the umbilical artery and MCA, and peak systolic velocity (PSV) in the MCA. Results. Significant variations in PSV in the MCA and cerebral indices were found in the study group of monochorionic twins with TTTS. Periods of high PSV with low PI in the MCA were followed by lower PSV in the same fetus. Repeated measurements in the comparison groups were stable without significant variations. The delta cerebroplacental ratio was significantly higher in the study group (0.38 versus 0.09 and 0.19 in the comparison groups; P < .02). Conclusions. Significant changes in Doppler flow velocity and indices suggest instability of cerebral blood flow with episodes of “hyperperfusion” in monochorionic twins with TTTS. Further studies are needed to elucidate the relationship of these transient changes to neurologic sequelae in the neonate.

P17.15: A case of Meckel‐Gruber syndrome: the evolution of the sonographic features from 8th to 13th gestational weeks

ultrasound showed the cystic structure to be a vascular anomaly 20 × 16 mm in size. The lesion demonstrated high blood flow and the presumed diagnosis was that of Vein of Galen aneurysm. No other intracranial anomalies were found (with special attention to possible altered brain structure, edema or ventriculomegaly). The only associated finding was slight cardiomegaly, but there were no apparent signs of cardiac overload (normal ventricular function, no A-V regurgitation, and no pericardial effusion). Dopplers were normal. A fetal MRI was performed to confirm the character of the lesion, as well as the otherwise normal brain structure. The findings were consulted with the department of neurosurgery and radiology to plan appropriate management, and the high-risk character of the lesion and uncertain prognosis were explained to the parents. The patient was followed weekly to assess the growth of the lesion, cardiac function, and possible signs of worsening. An elective cesarean section was performed eight weeks after the diagnosis, leading to the delivery of a male infant, 2770 g, showing no signs of cardiopulmonary compromise immediately after birth. The infant soon underwent endovascular embolization with an uncomplicated postoperative course.

P03.07: A case report of the fetal urinary bladder exstrophy: sonographic follow‐up from 12th to 36th gestational weeks

accuracy according to the initial, lower and higher angle was calculated. Cases with wrong fetal assignment were individually analyzed. Results: Overall, 95 cases were included in the analysis. Following online genital angle calculation fetal gender assignment was possible in all but one woman (98.9%) in which the angle fell inside the cut-off (28◦). The assigned gender was correct in 90 of the 95 cases (94.7%). Among the 5 cases with wrong fetal gender assignment 2 cases were < 12 weeks and two cases had an angle calculated from the second volume which fell inside the cut-off (undetermined gender). Using the narrower and higher angle the accuracy of fetal gender determination was 93.7% and 96.8% respectively. Conclusions: 3DUS is a highly accurate tool for fetal gender assignment in the first trimester. A second look may have a role in reducing the margin of error in fetal gender determination. In case of discrepancy the wider angle seems to perform better.

P13.10: Nomograms of fetal posterior fossa measurements in median plane using 3D‐MPR fetal head sonographic imaging

Objectives: Size of posterior fossa (PF) is primary feature in the diagnostic algorithm of PF malformations. This study was designed to provide nomograms of the sonographic parameters of PF morphometry in median plane of fetal head. Methods: Three dimensional sonographic volumes of 348 fetal heads in 15–35 gestational weeks were retrospectively studied using multiplanar display in 4D-View application. All patients had low risk, singleton pregnancy, and delivered healthy babies. All examinations were performed by single sonographer (L.Z.). All sonographic volumes were obtained above fetal vertex by sagittal acquisition using transabdominal or transvaginal probe. Borders of PF were defined from clivus to tentorium and from occipital bone to upper tectal plate margin. The measured parameters were: Posterior Fossa Area (PFA), Posterior Fossa Perimeter (PFP). Measurements were performed in the median head plane, by a single observer (P.C.). Based on these measurements we determined the relationship of these parameters to gestational age. Results: From the 348 examinations that were initially included, 282 were selected according to technical visibility. We found a linear growth pattern of PFA and PFP with r = 0.97 for each parameter. Percentiles were calculated for each parameter according to gestational week. The total feasibility rate of our parameters was 81%. The intra-observer variation was 4.5% ± 2.3% for PFA and 2.1% ± 1.2% for PFP. Conclusions: In this study we found a linear growth pattern of the fetal PFA and PFP and created their percentiles along gestational weeks. Our data may be useful in the diagnosis of the anomalies characterized by abnormal posterior fossa size, like Dandy-Walker malformation, Arnold-Chiari malformation and PF arachnoid cyst.

P05.04: Fetal cystic scalp lesion—dermoid cyst over the anterior fontanel

Congenital dorsal dermal sinuses (CDDS) are posterior, midline, congenital malformations of the spine. They are a form of occult spinal dysraphism characterized by thin, epithelium-lined channels that open on the skin posteriorly as a variety of cutaneous lesions. We describe four cases in which the CDDS tract was detected antenatally in 3 cases with 2D and 3D ultrasound and its presence was suspected in one case of lumbar spinal dysraphism. All cases were evaluated postnatally with MRI, while postnatal CT was performed in selected cases to evaluate the severity and extent of the spinal dysraphism. Discussion on antenatal ultrasound diagnosis, the value of 3D ultrasound for assessing both the sinus tract and bony spinal dysraphism are discussed and correlated with antenatal MRI and postnatal imaging.