L. A. Caicedo

OP34.08: Cervical cerclage in asymptomatic twin pregnancies with short cervix does not increase the admission to delivery interval

The prevalence of subsequent acute histologic chorioamnionitis was in 8% (11/145) and that of spontaneous preterm delivery was 5% (7/138). Women who were initially diagnosed a short cervix at 28–30 weeks were significantly more likely to have subsequent histologic chorioamnionitis and spontaneous preterm delivery than those who were not. The mean cervical lengths at 20–25 weeks and 28–30 weeks were significantly shorter in women who delivered preterm than in those who delivered at term. Conclusions: In twin gestations, a short cervix initially detected by transvaginal ultrasound at 28–30 weeks is associated with an increased risk of the subsequent histologic chorioamnionitis and the occurrence of spontaneous preterm delivery. Our findings support the hypothesis that a short cervix in asymptomatic pregnant women predisposes to ascending intrauterine infection.

OC06.02: Cervix measurement in spontaneous labor prediction in a large population of twins from a metropolitan hospital from Santiago, Chile

K. Klein1, L. Rode2,3, K. Nicolaides4, E. Krampl-Bettelheim1, H. Larsen5, A. Holmskov6, K. Riis Andreasen7, N. Uldbjerg8, J. Ramb9, B. Bødker10, L. Skibsted11, L. Sperling12, S. Hinterberger13, L. Krebs14, H. Zingenberg15, E. Weiss16, I. Strobl17, L. Laursen18, J. Tranberg Christensen19, I. Vogel20, B. M. Hansen21, A. Lando21, A. Tabor2,3 1Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; 2Department of Fetal Medicine 4002, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 3Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; 4Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom; 5Department of Obstetrics and Gynecology, Aalborg Hospital, Aalborg, Denmark; 6Department of Obstetrics and Gynecology, Viborg Hospital, Viborg, Denmark; 7Department of Obstetrics and Gynecology, Hvidovre Hospital, Hvidovre, Denmark; 8Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark; 9Department of Obstetrics and Gynecology, Sønderborg Hospital, Sønderborg, Denmark; 10Department of Obstetrics and Gynecology, Hillerød Hospital, Hillerød, Denmark; 11Department of Obstetrics and Gynecology, Roskilde University Hospital, Roskilde, Denmark; 12Department of Obstetrics and Gynecology, Herlev Hospital, Herlev, Denmark; 13Department of Obstetrics and Gynecology, General Hospital of Klagenfurt, Klagenfurt, Austria; 14Department of Obstetrics and Gynecology, Holbæk Hospital, Holbæk, Denmark; 15Department of Obstetrics and Gynecology, Glostrup Hospital, Glostrup, Denmark; 16Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria; 17Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria; 18Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark; 19Department of Obstetrics and Gynecology, Gentofte Hospital, Gentofte, Denmark; 20Department of Clinical Genetics, Aarhus University Hospital Skejby, Aarhus, Denmark; 21Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

OP19.10: Can we trust in sonographic diagnosis of discordancy (> 20% in EFW)?

the presentation is the same vertex at mid-3rd trimester (98.9% vs. 87%, P = 0.01)). The different chances of being vertex presentation at birth was statistically significant when comparing group [2] with group [4] (38.5% vs. 14.3%, P = 0.045). Conclusions: Almost all twins with vertex presentation at 3rd trimester is unlikely to be non-vertex at birth. We concluded that twins with vertex presentation at mid-3rd trimester had different chances of becoming a vertex-presenting twin at delivery according to presentation at early-3rd trimester. Inversely we can explain a mother with non-vertex presenting twin at mid-3rd trimester that the baby’s position is more unstable when it had vertex presentation at early-3rd trimester.

OP29.08: Effect of different charts for PEG diagnosis of neonatal morbidity

and the Spearman correlation coefficient calculated. The random selection of data points from each curve was repeated 1000 times. Median correlation coefficients and P-values are reported. Results: There was a highly significant negative correlation between UAPI and AC, normalised for gestation using Z-scores (median correlation coefficient = −0.2892/median P-value = 2.272e-5). Conclusions: In gastroschisis, there is a clear relationship between the degree of smallness of the baby’s abdominal circumference for gestation and the umbilical PI. This is not the case for normally grown babies, and implies that fetuses with gastroschisis may have small AC not simply because of the external displacement of the abdominal viscera but instead possibly mediated by hypoxia.

OP38.05: Impact of maternal diseases—hypertension, pregestational diabetes and addictions—in birth weights should be considered in normal charts

and different amniotic fluid parameters are associated with birth weight. Methods: 210 patients with singleton pregnancy and gestational age between 15+0 and 17+6 weeks were included in our study. Fetal biometry with regard to biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) was routinely performed. Placental volume and vascularization were assessed by 3D ultrasound and 3D power Doppler. Placental volume (PV), four placental ratios (PR1 = PV/BPD; PR2 = PV/HC; PR3 = PV/AC, PR4 = PV/FL) and vascularization indices (VI, FI, VFI) were calculated. Visfatin, leptin, endoglin, VEGF and PIGF were measured in the amniotic fluid. Results: While in linear regression analysis both PV, the four placental ratios, VI and VFI had a significant influence on birth weight only FI significantly predicted birth weight below the 10th percentile in logistic regression analysis. Leptin and Visfatin in the amniotic fluid were significantly associated with birth weight in linear regression analysis. The same applied to VEGF and PV/FI. Conclusions: Second trimester placental volume and vascularization parameters correlate with birth weight. Additionally, leptin and visfatin in the amniotic are associated with fetal development. Placental volumetry and vacularization may be early markers for fetal growth anomalies.

P24.12: In vitro Doppler measurements of flow (ml/min) depends on angle and diameter

Objectives: To study fetal heart rate (FHR) patterns in pregnancies complicated by maternal epilepsy, and to analyze the influence of antiepileptic drugs on FHR and Doppler exams. Methods: Pregnant women presenting epilepsy were studied prospectively at 36–40 weeks, between December 2007 and March 2010. Eighteen fetuses whose mothers were taking anticonvulsants were compared with 25 fetuses of control group (pregnancies without maternal or fetal morbidities) at the same gestational age. The computerized cardiotocography (System8002, Sonicaid) was performed during 30 minutes and the FHR parameters were studied. Doppler exams were performed at the same day and the following vessels were studied: umbilical artery and middle cerebral artery. Results: The mean maternal age at the study group was 25.0 years (SD = 4.8) and in the control group (n = 25) was 27.3 years (SD = 6.0). No significant difference was found between the groups. The FHR parameters analyzed by computerized cardiotocography in the group with maternal epilepsy did not differ from control group, respectively: mean basal FHR (135.4 ± 14.3 bpm vs. 134.2 ± 13.8 bpm, P = 0.779), mean number of fetal movements per hour (85.3 ± 97.8 vs. 52.4 ± 48.4, P = 0.152), mean number of FHR accelerations > 10 bpm (7.7 ± 4.7 vs. 8.2 ± 4.6, P = 0.733), mean number of FHR accelerations > 15 bpm (4.7 ± 4.1 vs. 5.3 ± 3.7, P = 0.667), high variation episodes duration (13.1 ± 9.6 min vs. 14.9 ± 8.5 min, P = 0.521), low variation episodes duration (4.2 ± 6.7 min vs. 4.12 ± 5.7 min, P = 0.953), and mean short term variation (9.1 ± 2.8 vs. 10.6 ± 4.2, P = 0.188). No differences were found in the Doppler results. Conclusions: This study suggests that maternal epilepsy is not associated with abnormal FHR parameters evaluated by computerized cardiotocography. The Fetal heart rate parameters are not influenced by exposition to antiepileptic drugs at the term of pregnancy.

P09.10: Bilateral upper amelia and extreme microcephaly mimicking anencephaly: a case of XK‐aprosencephaly

Klippel Trenaunay syndrome is a rare congenital disease that is characterized by a triad of cutaneous capillary malformations, varicose veins and hypertrophy of bone and soft tissue, usually asymmetric in its presentation (a single extremity). This disease tends to be sporadic, with very few familiar occurrences and postulated to be related to a somatic mutation for a critical angiogenetic-vasculogenetic factor during embryonic development. The prenatal diagnosis of this syndrome has been scantly referred. We present the case of a 29 year old pregnant woman, with two previous normal pregnancies and babies, who came to our unit for a routine morphologic scan at 18.4 weeks. First trimester scan had not been performed. The fetus was structurally normal, with a choroid plexus cyst and single umbilical artery. The most striking findings were the presence of cystic and heterogenous images affecting both legs, from the gluteus to below the knee, with predominance of the left one. A significant asymmetry between both legs, specially in thickness, was seen. An additional cystic image was found below the left kidney. Angiopower color Doppler demonstrated increased vascularisation of the mass. Karyotype by amniocentesis shown to be normal 46XX. In view of all of these findings, with asymmetric limb hypertrophy and the presence of multiple hemangiomas, and arteriovenous fistulas, a very likely diagnosis of Klippel Trenaunay syndrome was suggested to the parents. After extensive counselling, parents opted for termination of pregnancy at 20.4 weeks. Pathological examination results confirmed the diagnosis.

P09.09: Berry shape vault in a Pallister‐Hall fetus: a report

Klippel Trenaunay syndrome is a rare congenital disease that is characterized by a triad of cutaneous capillary malformations, varicose veins and hypertrophy of bone and soft tissue, usually asymmetric in its presentation (a single extremity). This disease tends to be sporadic, with very few familiar occurrences and postulated to be related to a somatic mutation for a critical angiogenetic-vasculogenetic factor during embryonic development. The prenatal diagnosis of this syndrome has been scantly referred. We present the case of a 29 year old pregnant woman, with two previous normal pregnancies and babies, who came to our unit for a routine morphologic scan at 18.4 weeks. First trimester scan had not been performed. The fetus was structurally normal, with a choroid plexus cyst and single umbilical artery. The most striking findings were the presence of cystic and heterogenous images affecting both legs, from the gluteus to below the knee, with predominance of the left one. A significant asymmetry between both legs, specially in thickness, was seen. An additional cystic image was found below the left kidney. Angiopower color Doppler demonstrated increased vascularisation of the mass. Karyotype by amniocentesis shown to be normal 46XX. In view of all of these findings, with asymmetric limb hypertrophy and the presence of multiple hemangiomas, and arteriovenous fistulas, a very likely diagnosis of Klippel Trenaunay syndrome was suggested to the parents. After extensive counselling, parents opted for termination of pregnancy at 20.4 weeks. Pathological examination results confirmed the diagnosis.

OP27.06: A second blinded operator does not improve accuracy in macrosomy diagnosis

Objective: Birth weight is an important predictive parameter for neonatal morbidity and mortality. Accurate estimation of fetal weight is therefore a valuable tool for determining further obstetric management. Commonly used weight formulae have a lack of accuracy. The aim of this study was to develop and to evaluate new formulae specifically designed for different ranges of fetal abdominal circumference (AC). Methods: This study included 5314 pregnancies. Inclusion criteria were singleton pregnancy, ultrasound examination with complete biometric parameters within 7 days before delivery, and absence of structural or chromosomal malformations. With regard to sonographic AC measurements, four subgroups were built (AC: ≤ 290 mm; AC: 291–330 mm; AC: 331–359 mm; AC: ≥ 360 mm). For each population, best-fit formulae were derived by forward regression analysis with standard biometric measurements as independent variables and birth weight and log(birth weight) as dependent variables, respectively. Finally, accuracy of the new formulae was compared with commonly used weight equations. Results: In all subgroups, except for AC measurements between 331–359 mm, the new weight formulae demonstrated significantly improved accuracy compared to commonly used formulae. Conclusion: Especially in the lower und upper ranges of AC measurements, specifically designed equations help to improve fetal weight estimation.

OC143: Comparable estimated fetal weight from biometries of preterm and term singleton pregnancies support the use of birth weight charts for normal fetuses

Objectives: To evaluate the correlation between fetal head rotation and direction sonographically detected during the second stage of labour. Methods: A group of unselected women in the second stage of labour underwent serial digital examinations followed by translabial ultrasound. In a sagittal section of the maternal pelvis, the direction of the head was categorized as downward, horizontal or upward. In the transverse plane the angle between the midline of the fetal brain and the anteroposterior diameter of the pelvis was noted and the rotation of the head was established (< or ≥ 45◦). Clinical and ultrasound data were compared using Somer’s d test. Results: Sixty women were included in the study group with a total of 168 and a median of 3 ultrasound and clinical examinations performed for each fetus (see table 1). When rotation was sonographically undetectable on the axial plane (28/168 or 16.6%), fetal head was always directed downward on the sagittal plane (28/28). With a rotation ≥ 45◦ (75 cases), fetal head direction was mostly horizontal (44 or 58.7%), while a rotation < 45◦ was usually associated with upward direction of fetal head (45/65 or 69.2%). Rotation < 45◦ and upward direction of the head were more strongly correlated if only cases with occiput anterior were considered. In these cases, the probability of a clinically established low station (≥ 3 cms) was particularly high when an upward direction of the head was seen in combination with a rotation of < 45◦ (40/42 examinations or 95%). All comparisons demonstrated a statistically significant relationship with P < .0001. Conclusions: Fetal head rotation and direction as sonographically determined in the second stage of labour show a significant correlation with each other as with clinically established station, particularly in fetuses with occiput anterior.