Giselle Darahem Tedesco

Reference Range of Fetal Renal Volume by Three-Dimensional Ultrasonography Using the Vocal Method

Objective: To establish reference values for fetal renal volume by three-dimensional sonography using the VOCAL (Virtual Organ Computer-Aided Analysis) method. Methods: This prospective longitudinal study involved 57 healthy pregnant women who were examined between 24 and 34 weeks of pregnancy. Each fetal kidney was evaluated separately using the VOCAL method with a 30° rotation angle. For each gestational age, the following measures were obtained for the right and left kidneys: mean, standard deviation, minimum and maximum values, and the 5th, 10th, 25th, 50th, 75th and 90th percentiles. Polynomial regression models were constructed to assess the relationship between renal volume and gestational age, adjusted by the determination coefficient (R2). The Wilcoxon test was used to evaluate the concordance between the right and left renal volumes. Bland-Altman graphs were used to assess intra- and inter-observer variability. Results: The right renal volume increased from 4.5 ± 1.3 cm3 at 24 weeks to 12.1 ± 1.5 cm3 at 34 weeks. The left renal volume increased from 4.6 ± 0.8 cm3 at 24 weeks to 11.9 ± 1.1 cm3 at 34 weeks. There was a strong correlation between both the right and left renal volumes and gestational age (R2 = 0.975 and 0.970, respectively). There were no significant differences between the right and left renal volumes. The mean difference between repeated measures by the same examiner was –0.07 cm3 (–0.88 to 0.75) for the right kidney and –0.21 cm3 (–0.95 to 0.75) for the left kidney. The mean difference between repeated measures obtained by two different examiners was –0.07 cm3 (–1.25 to 1.12) for the right kidney and 0 cm3 (–1.53 to 1.53) for the left kidney. Conclusion: Reference values were generated for fetal renal volume assessed by three-dimensional ultrasonography using the VOCAL method.

New anatomical landmarks to study the relationship between fetal lung area and thoracic circumference by three-dimensional ultrasonography

Objective: To evaluate the relation between total lung area (TLA) and thoracic circumference (TC) ratio by three-dimensional (3D) ultrasonography applying new anatomical landmarks as the fetal aorta and inferior angle of the scapula. Methods: A longitudinal prospective study was conducted with 56 uncomplicated pregnancies between 24 and 32 weeks of gestation. Polynomial regressions were used to evaluate the correlation between TC and gestational age (GA) as well as TC and estimated fetal weight (EFW). A simple linear regression was used to evaluate the correlation between TLA and Total thoracic area (TTA) and GA. The intraclass correlation coefficient (ICC) was used to assess the intra and interobserver variability. Results: 127 examinations were performed. TC values ranged from 150 to 174 mm (mean 166 mm) at 24 weeks and 215–248 mm (mean 231 mm) at 32 weeks. The TLA/TC ratio ranged from a mean of 0.64 at 24 weeks (range 0.56–0.70) to 0.90 at 32 weeks gestation (range 0.79–1.01). The intraobserver variability using the ICC was of 0.919 for TC; 0.916 for TTA; 0.860 for right lung area (RLA) and 0.910 for left lung area (LLA). Interobserver reproducibility was with an ICC of 0.970 for TC; 0.984 for RLA and 0.910 for LLA. Conclusions: Measurement of fetal TC and the relationship between TLA and TC by 3D-ultrasonography applying new anatomical landmarks shows good reproducibility and allows a new assessment of thoracic and lung growth.

P28.02: Nomogram of fetal lung volume by three‐dimensional ultrasound using the VOCAL method

Objective: To compare the multiplanar and VOCAL (Virtual Organ Computer-aided Analysis) methods in the assessment of embryo volume in the first trimester of pregnancy. Methods: An observational cross-sectional study was performed in 74 pregnant women between 7 and 10 weeks of gestation, using SONOACE 8000 LIVE (Medison, Seoul, Korea) with a multiple frequency endocavity transducer (3D5-8EK). Embryo volume was measured on three-dimensional ultrasound by the VOCAL method using 300 rotational angles (the contour was drawn manually) and by the multiplanar method using sequential sections of the embryo obtained at intervals of 2.0 mm. To evaluate the relation between embryo volume and gestational age, Pearson’s correlation coefficient (r) was used. The intraclass correlation coefficient (ICC) and paired Student’s t-test (P) were used to compare both methods. Results: There was strong correlation between embryo volume and gestational age (r = 0.814 for VOCAL and r = 0.803 for multiplanar). There was a strong correlation between embryo volume measured by the VOCAL and the multiplanar methods (ICC = 0.985, CI 95% [0.977; 0.991]). Conclusion: The VOCAL and multiplanar methods are correlated in the assessment of embryo volume in the first trimester of pregnancy.

Assessment of free fetal DNA concentration in maternal plasma during the first trimester of pregnancy: comparative study between EDTA and PPT tubes – pilot study

Abstract Objective: To compare ethylenediamine tetraacetic acid (EDTA) tubes and plasma preparation tubes (PPT) for evaluating maternal plasma during the first trimester of pregnancy. Methods: A cross-sectional study was conducted on 24 male fetuses in women between 6 and 14 weeks of pregnancy. Blood samples (10 mL) were collected and stored in EDTA and PPT tubes. Subsequently, the samples were centrifuged and sent for free fetal DNA extraction by means of the polymerase chain reaction (PCR) technique. The reactions were performed in a real time PCR machine for detecting the amplification products. The genome region chosen for performing the PCR reactions was a target specific for the Y chromosome, in which the DYS-14 marker was amplified only when the DNA was of male sex. The free fetal DNA concentration was given by the threshold cycle (TC). To compare the tubes, the paired Student t-test was used. Results: The mean gestational age was 11.08 ± 2.30 weeks (range: 6–14). The mean TC for PPT was 30.08 ± 1.05 (range: 27.08–32.61) and for EDTA, 30.23 ± 0.96 (range: 28.01–32.09), but without statistical significance (p = 0.357). Conclusion: We did not observe any statistically significant difference in free fetal DNA concentration between the EDTA and PPT tubes.

Prenatal Diagnosis of a Fetus with Ring Chromosomal 15 by Two- and Three-Dimensional Ultrasonography

We report on a prenatal diagnosis of ring chromosome 15 in a fetus with left congenital diaphragmatic hernia (CDH) and severe intrauterine growth restriction (IUGR). A 31-year-old woman, gravida 2 para 1, was referred because of increased nuchal translucency at gestational age of 13 weeks. Comprehensive fetal ultrasound examination was performed at 19 weeks revealing an early onset IUGR, left CDH with liver herniation, and hypoplastic nasal bone. Three-dimensional ultrasound (rendering mode) showed low set ears and depressed nasal bridge. Amniocentesis was performed with a result of a 46,XX,r(15) fetus after a cytogenetic study. A 1,430 g infant (less than third percentile) was born at 36 weeks. The infant presented with respiratory failure and died at 2 h of life. Postnatal karyotype from the umbilical cord confirmed the diagnosis of 15-ring chromosome. We described the main prenatal 2D- and 3D-ultrasound findings associated with ring chromosome 15. The interest in reporting the present case is that CDH can be associated with the diagnosis of 15-ring chromosome because the critical location of the normal diaphragm development is at chromosome 15q26.1-q26.2.

P12.10: Relationship between fetal chest size and biometric parameters by three‐dimensional ultrasound using the multiplanar method

women were referred for fetal cardiac screening, the remainder for suspected abnormalities. Fetal Cardiac abnormalities were diagnosed in 16/375 (4.3%) of ‘high risk’ screened women. They included 3/61 (5%) screened women with maternal cardiac disease, 9/166 (5.4%) previous child/sibling? with CHD, 4/34 (11.8%) of screened women with diabetes mellitus. Fetal cardiac abnormalities were identified in 18/375 (4.8%) women who had multiple risk factors. There were no obvious fetal cardiac defects among screened groups with a history of paternal CHD, previous child with CHD, maternal antibodies, and history of drug intake. Conclusions: The rate of antenatally diagnosed cardiac defects is higher than expected among our screened population. However, subgroup analysis revealed that it may vary between groups. Future studies are required to evaluate the implication of implementation of routine fetal cardiac screening policy on the antenatal detection rate of CHD and its management.

P08.18: Relationship between lung area to chest size ratio in normal fetuses by three‐dimensional ultrasound using the multiplanar method

of 21 chest size. The Bland-Altman analysis was used to compare the measurement agreement and bias for a single observer. Results: One hundred and twenty seven examinations were perfomed. The chest size ranged from 15.0 to 17.3 cm with mean of 16.6 cm (±0.7 cm, SD) on the 24th week to 21.5 to 24.8 cm with mean of 23.1 cm (±0.8 cm) on the 32nd week. The intra-observer variability study utilizing the intraclass correlation coefficient was of 0.919. Conclusions: The fetal chest measurement by multiplanar method of 3-dimensional shows good reproducibility and can be utilized to quantify the thoracic circumference.

P08.17: Reference range of fetal chest size by three-dimensional ultrasound using the multiplanar method

Objectives: To determine the prevalence of the aberrant (right or left) subclavian artery in chromosomally normal and abnormal fetuses. Methods: The study was performed at two referral centers for CHD. Fetal echocardiography was performed prospectively in the first and second trimester to identify the subclavian artery and to determine whether this was normal or aberrant. Results: Over a period of a two years we were able to identify an aberrant subclavian artery in 0.9% of chromosomally normal fetuses and in 10% of chromosomally abnormal fetuses. Conclusions: The presence of the aberrant subclavian artery is more common in chromosomally abnormal than normal fetuses.

Contents Vol. 25, 2009

R. Achiron, Tel Hashomer N.S. Adzick, Philadelphia, Pa. L. Allan, London A.A. Baschat, Baltimore, Md. K.J. Blakemore, Baltimore, Md. T.-H. Bui, Stockholm F.A. Chervenak, New York, N.Y. T. Chiba, Tokyo Y. Chiba, Osaka W.H. Clewell, Phoenix, Ariz. F. Crispi, Barcelona J.E. De Lia, Milwaukee, Wisc. J.A. Deprest, Leuven G.C. Di Renzo, Perugia J.W. Dudenhausen, Berlin N.M. Fisk, Brisbane A.W. Flake, Philadelphia, Pa. W.D.A. Ford, North Adelaide U. Gembruch, Bonn P.D. Gluckman, Auckland M. Hansmann, Bonn M.R. Harrison, San Francisco, Calif. J.C. Hobbins, Denver, Colo. L.K. Hornberger, San Francisco, Calif. E.R.M. Jauniaux, London M.P. Johnson, Philadelphia, Pa. C. Jorgensen, Copenhagen J.-M. Jouannic, Paris H.H.H. Kanhai, Leiden A. Kurjak, Zagreb P.M. Kyle, London O. Lapaire, Basel S. Lipitz, Tel-Hashomer Y.M.D. Lo, Hong Kong S. Mancuso, Roma G. Mari, Detroit, Mich. M. Martinez-Ferro, Buenos Aires P. Miny, Basel K.J. Moise, Houston, Tex. K.H. Nicolaides, London L. Otaño, Buenos Aires Z. Papp, Budapest R. Quintero, Tampa, Fla. G. Ryan, Toronto J. Rychik, Philadelphia, Pa. G.R. Saade, Galveston, Tex. H. Sago, Tokyo W. Sepulveda, Santiago P. Stone, Auckland D.V. Surbek, Bern M. Tanemura, Nagoya S. Tercanli, Basel J.-L. Touraine, Lyon B.J. Trudinger, Westmead J.M.G. van Vugt, Amsterdam S.L. Warsof, Virginia Beach, Va. C.P. Weiner, Kansas City, Kans. R. Zimmermann, Zürich Clinical Advances and Basic Research

P28.05: Reference range of fetal renal volume by three‐dimensional ultrasound using the VOCALTM method

Objectives: The purpose of this study is defining the reference range of fetal renal volume by three-dimensional ultrasound (3D-US) using the VOCAL (Virtual Organ Computer-aided Analysis) technique. Methods: A prospective longitudinal study was performed in 54 singleton pregnancies between 24 to 34 weeks gestation. The volume of both kidneys was obtained separately using the VOCAL method with a 30◦ rotation using Sonoace 8000 Live (Medison, Seoul, Korea). The mean, maximal and minimal volumes were determined for each kidney. Polynomial regression models were used to determine the correlation between gestational age and fetal renal volume, and adjusts were done with the coefficient of determination (R2). The Wilcoxon test verified the differences between the volume of right and left kidneys. Results: The right kidney mean volume grew from 4.48 cm3 (2.23–6.74 cm3) at 24a weeks to 12.07 cm3 (9.15–14.99 cm3) at 34a weeks. The left kidney mean volume grew from 4.66 cm3 (3.03–6.28 cm3) at 24a weeks to 10.61 cm3 (7.93–13.31 cm3) at 34a weeks. A strong correlation was found between the gestational age and kidney volume (R2 = 0.98 for right kidney and R2 = 0.96 for left kidney) In addition, there were no differences between the volumes of bilateral kidneys (P > 0.08). Conclusion: The reference range of fetal renal volume by threedimensional ultrasound using the VOCAL method was determined