J. Carrillo

OP04.05: Assessment of fetal myocardial performance using standard and modified Tei index in normal population

M. Habli2,3, J. F. Cnota1, A. Divanovic1, T. M. Crombleholme3, M. Kinsel-Ziter1, R. Keller1, E. C. Michelfelder1 1Fetal Heart Program, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; 2Division of Maternal Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 3Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

P26.03: Persistent fetal tachycardia and decelerations after abrupt stomach extrusion in gastroschisis

F. Fuchs1, O. Picone1, M. Mabille2, A. L. Delezoide3, R. Frydman1, M. V. Senat1 1Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France, 2Service de Radiologie. Assistance Publique Hôpitaux de Paris, Université Paris Sud., France, 3Service d’Anatomopathologie, Assistance Publique Hôpitaux de Paris, Université Paris Sud., France

OP33.01: Which affect more birth weight—maternal pregestational BMI or weight gain? Prospective observational study

category of either late-onset IUGR or constitutional SGA, according to their risk of adverse outcome. Methods: At routine third trimester scan a cohort was created of consecutive singleton fetuses with an estimated fetal weight < 10th centile delivering > 37 weeks. A predictive model for the occurrence of emergency cesarean delivery for non-reassuring fetal status or neonatal acidosis was constructed using the Decision Tree Analysis CHAID algorithm (SPSS 17.0), from the following set of predictors: maternal age, body mass index, smoking, gestational age at delivery, labor onset (spontaneous s. induction), US estimated fetal weight centile, umbilical artery (UA) pulsatility index (PI); mean uterine uterine artery (UtA) PI, middle cerebral artery (MCA) PI and cerebroplacental ratio (CPR). Doppler measurements were performed within 1 week before delivery. Results: A total of 447 SGA fetuses were included. There were 120 (26.8%) cases of adverse outcome. Figure 1 shows the resulting algorithm, showing a sensitivity and specificity for adverse outcome of 81% and 57%, respectively. Conclusions: An algorithm combining cerebral and uterine Doppler with estimated fetal weight allows identification of those SGA atrisk of adverse perinatal outcome, setting diagnostic criteria for late-onset IUGR.

P32.01: Linear vs. traced measurement of the cervix at 22–24 weeks gestation: does it make a difference?

Introduction: survival of a normal fetus to term in the presence of hydatidiform mole remains an extremely uncommon occurrence. Prenatal diagnosis is possible by ultrasonography showing molar invasion of the normal placenta without clear margin. Antenatal detection of mole co existing with a viable fetus should warrant genetic analysis and search for gross malformation of the fetus. Case report: we report a rare case exhibiting molar pregnancy and a coexisting normal fetus. A 29 year, primigravida had an episode of vaginal bleeding at 18 weeks which suggested avascular lower placenta with multiple cystic area measuring 12 × 5 × 9 cm with normal fetus. She had two weekly growth scan and Doppler as diagnosis was not clear. It was thought to be multiple placental lakes. Growth and Doppler remains normal and had term SVD. Placenta was sent for histopathology which suggested normal placenta with an area of complete hydatidiform mole. It was difficult to differentiate from mosaic CHM, twin with normal co-twin and CHM. Discussion: coexistent live fetus and molar placenta has never been reported. Complications including pre-eclampsia, hyperthyroidism, vaginal bleeding, persistent gestational trophoblastic disease, preterm labour, miscarriage and anaemia increases. Several factors may influence the outcome in partial mole such as karyotype of the fetus, size of the molar placenta, the speed of molar degeneration and fetal anaemia.

P30.17: No association of postnatal gastroesophagic reflux and prenatal third trimester amniotic fluid index

Conclusions: Arhinencephaly and semicircular agenesis are the most specific and frequent features of CHARGE, although congenital heart disease and posterior fossa anomalies are also frequent. Therefore, brain MRI should be systematically performed in second trimester fetuses with CHD and/or CLP and in the third trimester when posterior fossa anomalies are detected with either CHD, microphtalmia or hydramnios in a eutrophic foetus.

OP22.02: Comparison of clinical and sonographic parameters at labor induction

Results: The mean age of the examined women was 27.7 years (16–42 years). The overall caesarean rate was 29.5%. The mean gestational age was 40+2 (38+4−42). In 91% of these cases the cervix was unfavourable (Bishop score < 5). Cervical length ranged from 14 mm to 49 mm (median 27.3 mm). In cases where the cervical length was < 27 mm (54%) vaginal delivery was achieved within 24 hours of induction in 80% (sensitivity 65%, specificity 60%). Women with positive fetal fibronectin result were more likely to deliver vaginally than those who had a negative result (sensitivity 73,3%, specificity 65%). Conclusions: In nulliparous women ultrasound cervical length (UCL) and fetal fibronectin (fFn) are useful predictors for vaginal delivery. On the other hand Bishop score cannot predict the mode of delivery. USLCxL and fFn were found to be independently associated with the total duration of labour. Bishop score failed to predict the total duration of labour.

OP16.07: Uterine artery Doppler during the second trimester of gestation in the screening for thrombophilic disorders

Objectives: Thrombophilia has been reported be more frequent in pregnancies affected by placental insufficiency. The aim of this study was to evaluate the usefulness of abnormal uterine artery Doppler at 22–24 weeks to identify patients with thrombophilia. Methods: Case-control study, involved pregnant women attending our Unit at 22–24 weeks gestation. Uterine artery (UA) Doppler velocimetry was routinely performed in this patients and the pulsatility index in uterine artery (UA-PI) calculated. We identified those patients with abnormal UA Doppler (UA-PI > 95th centile) to perform haematological test; 20 ml blood sample was obtained to investigate genetic and acquired thrombophilia. The control group were patients at 22–24 weeks gestation, with normal UA Doppler and complete study for thrombophilia. Results: There were 33 pregnant women included in the study. There were 18 patients enrolled with abnormal UA -Doppler and 15 patients in the control group. In 12 of 18 patients (67%) in the study group, and 9 of 15 (60%) in the other group, we found haematological changes characteristic of thrombophilia; there was no a statistically significant difference between both groups in the frequency of thrombophilic conditions. The most frequent thrombophilic conditions observed in the study group were: Protein S deficiency and elevated fibrinogen levels. Combined thrombophilic changes were observed more frequently in the study group: 6 patients (33%) versus 1 patient (7%) in the control group (t student; P < 0.06). Conclusions: Our study suggests that an abnormal uterine artery Doppler at 22–24 weeks of gestation could identify pregnant patients with increased risk of combined thrombophilia, but we believe the number of cases was too small to show a statistically significant difference. This situation could be clinically relevant and be associated to increased risk of perinatal complications associated a thrombosis. It is necessary largest studies to definitive conclusions.

OC16.10: Reliability study of bladder volume measurement with 3D VOCAL

Objective: To evaluate the correlation between fetal renal volume (FRV), determined by three-dimensional ultrasonography (3DUS), and two-dimensional biometric parameters. Methods: A longitudinal prospective study was conducted on 57 women between 24 and 34 weeks of a healthy pregnancy. The volumes of both fetal kidneys were measured with 3DUS using the VOCAL (Virtual Organ Computer-aided AnaLysis) method with a 300 rotation angle. Correlation between FRV and biometric parameters biparietal diameter (BPD), cranial circumference (CC), femoral length (FL), abdominal circumference (AC) and estimated fetal weight (EFW) was evaluated using polynomial regressions, with adjustments made by the coefficient of determination (R2). Results: FRV was highly correlated with all fetal biometric parameters and all equations were of the linear type: FRV= 0,27 × BPD − 11,57 (R2= 0,70); FRV= 0,07 × CC − 12,36 (R2= 0,74); FRV= 0,31 × FL − 8,99 (R2= 0,69); FRV= 0,063 × AC − 73,22 (R2= 0,67); FRV= 0,004 × EFW + 2,76 (R2= 0,61). Conclusions: FRV assessed by 3DUS using the VOCAL method was highly correlated with two-dimensional biometric parameters.

OP18.07: Characteristic discordance of umbilical vein flow (UVF) in twin-twin transfusion syndrome (TTTS) is absent in normal twins

Methods: This was an observational study of 75 consecutive monochorionic twin pregnancies complicated with amniotic fluid discordance (AFD) which did not meet the criteria for TTTS (polyhydramnios and oligohydramnios) at initial presentation. AFD was defined as mniotic fluid volume of both fetus did not meet oligohydramnios and polyhydramnios (2cm < MVP ≤ 3cm, 7cm ≤ MVP < 8cm). Fetoscopic surgery was applied for TTTS progressing before 26 weeks’ gestation. The population was subdivided into two groups (normal Doppler: ND, abnormal Doppler: AD) by presence of abnormal Doppler studies of umbilical artery or ductus venosus in either twins. Results: Forty six of 75 cases (61%) showed presence of abnormal Doppler blood flow. Twenty seven of 46 cases (59%) progressed to severe TTTS and 8 cases of those (30%) progressed to TTTS after 26 weeks’ gestational age. Survival rate without neurological problem of cases progressed to TTTS after 26 wks 63% (ND) was 24% (AD). And survival rate without neurological problem in cases without progression to TTTS was 88% (ND) and 47% (AD). Cases with abnormal Doppler study in either twins showed poor prognosis. Conclusions: Our data suggest that amniotic fluid discordance in monochorionic diamniotic twin pregnancies in combination with abnormal Doppler study represents an extremely high-risk constellation for adverse pregnancy outcome. Fetoscopic laser coagulation of vascular anastomoses can be considered as a therapeutic option for this group.

OC043: Seeking the optimal number of shots for proper fetal diuresis measurement by 3D vocal technique

Objectives: Diagnosis of cleft lip and palate remain a challenge with 2-D ultrasound particularly when clefting involves only the secondary palate. The utility of 3-D ultrasonography (3DUS) has enhanced our ability to detect clefts of the secondary palate. We report our experience with a modification of the flipped face technique to aid in the diagnosis of clefting of the secondary palate. Methods: Ninety-two volumes of fetal faces were evaluated. Of these, 36 volumes were acquired prospectively. The remaining 52 volumes had previously been acquired and included 8 with clefting of the secondary palate. Volumes were obtained using the Voluson 730 Expert (GE) and the IU22 (Phillips) and reviewed by four blinded readers on personal computer workstations. Volumes were manipulated so that an upright profile was visualized. The palate was then rendered utilizing a thin, curved render box. Statistical analysis was performed using Fisher’s exact test for categorical data. Intraclass correlations were computed to assess inter-rater agreement. Results: The mean gestational age of image acquisition was 22 + 5 weeks. Image quality of the secondary palate was obtained and rated as adequate by at least two reviewers in 34% (31/92) of volumes. The sensitivity of cleft detection ranged from 33–63% and the specificity ranged from 84–95%. The low sensitivity was mainly due to artifact/shadowing. The interrater reliability was 0.62 (95% CI 0.47,0.76). After review of the data, an additional 10 fetuses were studied and the secondary palates successfully visualized. These volumes were acquired slightly obliquely from the inferior aspect of the maxilla, pointing upward. Conclusions: 3DUS can be utilized to diagnose clefts of the secondary palate. However, this evaluation is limited by plane of acquisition and artifacts from shadowing of adjoining structures. Pseudoclefts can be created and optimal imaging cannot be obtained in all fetuses.