I. Shapiro

Doppler flow velocity waveforms in fetal surveillance of twins: a prospective longitudinal study.

In 37 consecutive twin pregnancies, monthly Doppler sonographic measurements were made of blood flow velocity waveforms of the internal carotid and umbilical artery of each fetus. A total of 197 Doppler studies were performed. Of the 74 infants, 23 were small for gestational age (SGA). Thirty‐five of the SGA Doppler studies were abnormal, giving an overall sensitivity for predicting SGA fetus of 58% and a positive predictive value of 71%. These data are not as sensitive and specific as our earlier data; however, Doppler criteria preceded sonographic diagnosis of SGA by a mean interval of 3.7 weeks and demonstrated better sensitivity and specificity. A combination of these parameters improves sensitivity to 84%. We conclude that Doppler velocimetry complements real‐time ultrasonography for the early diagnosis of abnormal growth in twin pregnancies.

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.

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.

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.

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.

P40.01: Color and power Doppler imaging in diagnosis of pelvic gastrointestinal stromal tumor (GIST)

Uterine rupture during trial of vaginal birth after caesarean (VBAC) remains a rare but dramatic obstetrical emergency. Although several studies have shown that sonographic evaluation of the lower uterine segment (LUS) near term can predict uterine rupture, the best measuring technique and the cut-off values to be used remain controversial. While a large prospective study demonstrated that an abdominal measurement of the full LUS thickness over 3.5 mm had a strong negative predictive value, other authors suggested to measure the muscular layer only with a cut-off value of 1.5 to 2.0 mm. We report a case of uterine rupture in a healthy 31-year-old patient, which had a prior low transverse caesarean seven years earlier with a single layer closure of hysterotomy. At 36 weeks of gestation, the transvaginal sonographic measurement of the LUS was respectively 3.6 mm for the full thickness and 1.1 mm for the muscular layer only. At 39 weeks’, induction of labor for premature rupture of membranes was initiated with oxytocin. A fetal bradycardia occurred approximately 12 hours after the initiation of induction. The patient underwent an emergency caesarean for clinical evidence of uterine rupture. Operative findings revealed a large uterine lateral tear from the cervix to the uterine cornu with the infant lying in the upper abdomen. In this case, there was a discrepancy between the normal full LUS thickness and the thin muscular layer. As the myometrium measurement could be more representative of the LUS resistance, we should perhaps give more credit to result of the later before proposing a trial of VBAC. Evidently, other risk factors must be taken into account, such as the type of closure of the uterine segment at prior caesarean and the intrapartum assessment. This case emphasizes the need for a consensus on the measuring techniques and cut-off values of the LUS thickness and to investigate its role in estimating the risk of uterine rupture among other predicting factors.

OC061: Endometrial vascularization after intrauterine ozonated saline irrigation (OSI): Computerized power Doppler analysis and histological studies

Objectives: To evaluate the relationship between uterine arteries blood flow and endometrial and subendometrial volume and vascularity using three-dimensional (3D) power Doppler untrasonography in patients with recurrent miscarriage (RM). Methods: 40 women with unexplained RM were included in the study. All patients underwent an accurate screening in order to exclude all the etiological RM factors. Three-D ultrasound examination with power Doppler was performed in all cases in the midluteal phase of the cycle by Voluson 730 pro GE machine. Twenty patients showed increased resistance to uterine arteries blood flow whereas in 20 cases normal resistances were found. Endometrial and subendometrial volume, vascularization index (VI), flow index (VI) and vascularization flow index (VFI) were calculated using the VOCAL (Virtual Organ Computer-aided AnaLysis) software. Results: Endometrial and subendometrial volume and VI were found significantly lower in patients with increased resistance to uterine arteries blood flow. No statistically significant correlations between uterine arteries PI, endometrial and subendometrial FI and VFI were observed. Nonetheless, patients with increased resistances to uterine arteries blood flow showed lower 3D vascularization indices. Conclusions: 3D power Doppler ultrasonography study of uterine perfusion seems to reflect the actual blood flow to the subendometrium and endometrium. This technique represents a unique tool to examine the blood supply towards the endometrial and subendometrial regions providing the opportunity to identify women with RM in which appropriate therapeutic protocols may effectively improve the possibility for successfully pregnancy.