G. Rencoret

Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during first trimester of pregnancy.

To develop a predictive model for pre‐eclampsia using clinical, biochemical and ultrasound markers during the first trimester of pregnancy.

Screening for trisomy 21 during the routine second-trimester ultrasound examination in an unselected Chilean population

To evaluate the performance of a detailed ultrasound examination during the second trimester as a screening test for Down syndrome in an unselected Chilean population.

Is there a role for cervical assessment and uterine artery Doppler in the first trimester of pregnancy as a screening test for spontaneous preterm delivery

To evaluate the role of cervical length (CL) and uterine artery pulsatility index (UtA‐PI) at 11 + 0 to 13 + 6 weeks as predictors of spontaneous preterm delivery (sPTD) in a Chilean population.

P25.16: Intracranial translucency (IT) reference range for Chilean population at the 11–13 + 6 weeks scan

fluid (CSF) into amniotic cavity leading to caudal brain displacement. Conversely, ACM is absent in closed spinal dysraphism (CSD). In first trimester fetuses with OSD may have absence of IT due to caudal displacement of brain resulting in compression of the fourth ventricle. We report a case of fetus with normal IT in the first trimester and with the development of ACM in the second trimester. 31 year old primigravida presented for first trimester screening in 13 weeks. NT was 5.1 mm (3.18 MoM) and there was small omphalocoele and fetal edema. CVS was performed with karyotype 46,XY. In 16 weeks we diagnosed ACM (lemon and banana signs, atrial width 8 mm), omphalocoele, contractures of upper extremities and clenched hands. However, no spinal defect was localized. Because of strong suspicion to Edwards syndrome, we opted for iterative invasive testing. Amniocentesis was performed with karyotype 46,XY and normal AF-AFP of 16.4 IU/l (1.72 MoM). After counseling partners elected for termination of pregnancy. Anomalies noted at autopsy included CSD in sacral region, omphalocoele, contractures of extremities with fibrous bands, ventricular septal defect, facial dysmorphism. We retrospectively reviewed first-trimester images and 3D volumes and found normal IT and fourth ventricle. The possible explanation of inconsistent combination of ACM and normal IT in our case is that leakage in the first trimester was probably not sufficient enough for caudal brain displacement and compression of the fourth ventricle. Later leakage increased resulting in ACM, however, normal AF-AFP indicated CSF leaking probably not into amniotic cavity. Possible mechanism of CSF leakage in CSD explains exceedingly rare condition of dorsal enteric fistula opening into spinal canal which is associated with other malformation of viscera. This condition would correspond to our case.

OP08.08: Screening of spontaneous preterm delivery by obstetric history and second trimester ultrasound in an unselected Chilean population

matched controls. Additionally, the second purpose was to determine the relationship between the placental pathologies and uterine artery (UtA) Doppler findings. Methods: 172 patients with singleton pregnancies between 24 and 35 weeks who presented with signs of preterm labor and 169 healthy pregnant women with correlative properties who admitted for routine pregnancy visits were recruited for the study. UtA blood flows were evaluated with Doppler ultrasonography during uterine inertia for both patients having preterm labor signs and for the control group. Each patient followed until the birth and delivery in 48 hours/7 days/14 days were recorded. The placental pathologies were interpreted (Redline 2007) and the relationship between the Doppler findings and placental pathologies were investigated. Results: Placental pathologies were found to be higher in the study group compared to their controls (P = 0.002). According to placental pathology patterns; the study group had significantly higher subclinical chorioamnionitis (P = 0.014), maternal vascular maldevelopment (P = 0.000) and maternal vascular loss of integrity (P = 0.021) than the control group. In the study group, the patients’ who delivered in 48 hours/7 days/14 days, presence of abnormal placental pathologies were also found to be higher (P = 0.001/P = 0.000/P = 0.000) than the patients who did not deliver. The study group with abnormal placental pathologies had substantially higher UtA PI (0.98 ± 0.39) than the patients without placental pathologies (0.74 ± 0.21) (P = 0.001). Conclusions: An underlying abnormal placental pathology was found to be higher in patients showing preterm labor symptoms and in the patients particularly who deliver in early time periods. With this study, it’s shown for the first time that the placental lesions prosecuted for preterm delivery were associated with antenatal UtA blood flows.

OC09.04: Is there any role for first trimester cervical assessment and uterine artery Doppler as screening test for spontaneous early preterm delivery?

Objectives: There is no consensus on the best approach to cervical surveillance during pregnancy: should all women have a transvaginal (TV) scan or can this be restricted to women with a short cervix on initial transabdominal (TA) assessment? This study compares TA and TV assessment of cervical length at 16–41 weeks gestation. Methods: TA and TV ultrasound measurements of cervical length were made at 16–41 weeks gestation. Cervical length was measured from internal to external os using the landmarks described by the FMF. Bland-Altman plots and paired t-tests were used to look at differences in TA and TV measurement. The screening efficacy of initial TA assessment in defining a group for TV evaluation is also reported. Results: 367 women participated including 273, 84 and 10 presenting at 16–23, 24–35 and > 36 weeks respectively. Overall, the TA method underestimated cervical length by 2.5 mm (95% CI 1.7–3.4 mm). Bland Altman plots showed an inverse trend with shorter cervixes after 24 weeks. 17 women had a cervix < 25 mm on TV scan; including 1 (0.3%), 10 (11.9%) and 6 (60%) of those assessed at 16–23, 24–35 and > 36 weeks. The sensitivity and specificity of TA assessment of cervical length at 24–36 weeks gestation were 1/10 (0.10) and 70/74 (0.95) respectively; positive and negative predictive values were 1/5 (0.20) and 70/79 (0.89). At > 36 weeks the sensitivity was 0/6 (0.0) and the specificity was 2/4 (0.5). Conclusions: TA measurements do not reflect TV assessment accurately, particularly if the cervix is short (< 25 mm TV). At 24–34 weeks, a policy of proceeding to TV scan if TA measurement is < 25 mm will only detect 10% of affected pregnancies and has a poor negative predictive value so is of limited value as a predictive tool for women attending with symptoms and signs of preterm labour > 24 weeks gestation. There is no value in TA assessment of the cervix > 36 weeks.

OC17.01: Risk assessment for early spontaneous preterm delivery combining markers from the first and second trimester of pregnancy

with no evidence of LAM avulsion. 75% of women with evidence of LAM trauma at the first exam had normal LAM at the later exam. However, 10% of women with normal first exam were found to have evidence of LAM injury in the later exam. Women reporting three or more subjective complaints of pelvic floor incompetence were significantly more likely to have abnormal 3DTUS (44.4% vs. 13%, P < 0.02). Conclusions: 3DTUS examination of the levator ani should be deferred from the immediate post-partum for at least three-six months. Sonographic evidence of LAM injury is associated with subjective symptoms of pelvic floor incompetence.

P04.01: Value of including other ultrasound markers different to nuchal translucency to detect fetal aneuploidy at 11 + 0 to 13 + 6 weeks

S. Forys1, K. Janiak2, A. Zarkowska2, M. Slodki1, M. Respondek-Liberska1,2, A. Sysa3 1Department of Diagnosis and Prophylaxis of Congenital Malformations, Institute of Polish Mother Memorial Hospital, Lodz, Poland; 2Department of Diagnosis and Prophylaxis of Congenital Malformations, Institute of Polish Mother Memorial Hospital & Medical University, Lodz, Poland; 3Department of Pediatric Cardiology, Institute of Polish Mother Memorial Hospital, Lodz, Poland

OP37.01: First trimester maternal serum PP13 as screening test for preeclampsia and small gestational age

Methods: The Mod-MPI was measured prospectively between June 2009 and February 2010, in addition to the more commonly used indices of systolic cardiac function (EF) in 61 healthy fetuses (gestational age range, 16–37 weeks) and in 31 fetuses suspected of having cardiovascular dysfunction due to the presence of CCAM. An unsupervised classification analysis was conducted to identify groups of fetuses according to the location of the mass. Doppler flow-derived measures of Mod-MPI was performed as described by Hernandez-Andrate, and the ejection fraction was obtained from two-dimensional M-mode images in a transverse four-chamber view. Results: In the CCAM group, the systolic performance, as indicated by the ejection fraction, was decreased and the ventricular Mod-MPI was increased, thus suggesting diastolic dysfunction and poor filling secondary to cardiac compression. In the right-sided mass group, fetuses had abnormal EF and MPI, reflecting increased after-load on the ventricle with the vena cava as well as cardiac compression. In the left-sided mass group, fetuses had abnormal RV and LV MPI with isovolumic contraction time lengthening and preserved left systolic performance. Conclusions: In both rightand left-sided CCAM, diastolic dysfunction has a significant role in the pathophysiology of each disorder and precedes changes in systolic performance. Measures of ventricular performance can help to elucidate the poorly understood mechanisms of cardiovascular compromise in the developing fetus.

OC15.02: Twin pregnancy: screening test for spontaneous preterm delivery and preeclampsia during the second trimester of pregnancy

Methods: Patients with singleton pregnancies at term in the second stage of labor underwent serial sonographic examination. Obstetric management was decided on the basis of the clinical examinations. Results: Seventy-six patients (59 para 0) were enrolled. Of those that were delivered vaginally, 14 had a posterior occiput and were excluded from the analysis. In the remaining cases, serial examination revealed the passage of the fetal occiput below the symphysis in 36/44. In the infrapubic scan this resulted in a typical image (Figure 1). Vaginal examination performed at the time of this observation demonstrated in all these cases a station >+3 cms and a rotation < 45◦. In 24 patients spontaneous vaginal delivery occurred in 11 + 7 (range 3–25) minutes. In 12 cases a vacuum was applied, and this was always classified as outlet according to ACOG. Conclusions: Demonstration with an infrapubic scan that the fetal occiput is below the pubic symphysis is an objective sign of imminent vaginal delivery. If a vaginal extraction becomes necessary, the procedure can be classified as an outlet one, with virtually no added risk over that of a spontaneous delivery.