L. C. Rolo

Evaluation of Placental Volume at 7–10 + 6 Weeks of Pregnancy by 3D-Sonography

The aim of the study was to establish normative data for placental volume (PV) at 7-10+6 weeks of gestation using three-dimensional ultrasound (3DUS). The cross-sectional study involved 70 healthy pregnancies between 7 and 11 weeks. The VOCAL (Virtual Organ Computer-aided Analysis) method with a 30 degrees rotation angle and six planes was used for volumetric calculations. Regression models were constructed to assess the correlation between PV and crown-rump length (CRL) adjusted by the determination coefficient (R2). The method proposed by Royston and Wright was used to establish the 2.5th; 10th; 50th; 90th and 97.5th percentiles (percentile=mean+KxSD). The intraclass correlation coefficient (ICC), Bland-Altman graphs and Students paired t-tests were used to assess intra- and interobserver variability. PV ranged from 1.7 to 42.6 cm3, with a mean of 13.6cm3 (+/-9.4cm3). There was a strong correlation between PV and CRL; the exponential equation was the model that best expressed the correlation between them (R2=0.76). For CRL between 9 and 40 mm, the mean PV increased 10.5 times, while CRL increased only 4.4 times. Inter- and intraobserver correlation were excellent (ICC=0.979 and 0.971, respectively). Bland-Altman graphs indicated a good reproducibility with a mean intraobserver and interobserver difference of 0.2 cm3 (95% CI: -0.7-1.2cm3) and -0.2cm3 (95% CI: -1.3-0.9cm3), respectively. Reference limits were generated for first trimester PV assessed by 3DUS using the VOCAL method. There is a strong correlation between PV and CRL. Placental volume obtained through this method was highly reproducible.

Predicting outcome in 259 fetuses with agenesis of ductus venosus – a multicenter experience and systematic review of the literature*

Abstract Objective: To evaluate prenatal predictors of postnatal survival in fetuses with agenesis of ductus venosus (ADV). Methods: This retrospective study reviewed our experience and the literature between 1991 and 2015. Prenatal findings were evaluated and perinatal morbidity and mortality was documented. Results: A total of 259 cases were included in the present analysis from our centers and 49 published studies (15 patients from our retrospective cohort review and 244 from literature review). The intrahepatic and extrahepatic shunts were present in 32.0% (73/226) and 67.7% (153/226), respectively. Cardiomegaly (n = 64/259, 24.7%), hydrops (n = 31/259, 12.0%) and amniotic fluid abnormalities (n = 22/259, 8.5%) were among the most frequent initial ultrasound findings. One hundred and forty-seven fetuses (56.8%) had ADV without structural anomalies while 112 (43.2%) had associated anomalies (cardiac anomalies (n = 66), extra-cardiac anomalies (n = 19) and both cardiac and extra-cardiac anomalies (n = 27)). The mean gestational age (GA) at ultrasound diagnosis was 22.9 ± 6.9 weeks while the mean GA at delivery was 34 ± 7.5 weeks. The overall neonatal survival was 57.1% (n = 148/259). The following factors were associated with survival: advanced maternal age, earlier GA at diagnosis, prematurity, increased nuchal translucency, pericardial effusion, associated cardiac defects (especially AVSD), chromosomal abnormalities, hydrops, hygroma and limb anomalies. Conclusion: Fetal hydrops, the presence of associated congenital anomalies and premature delivery are associated with poor prognosis in fetuses with ADV.

P09.15: Three‐dimensional sonographic volumetry of phantom objects: comparing rotational method Virtual Organ Computer‐aided AnaLysis (VOCAL) to multi slice method Extended Imaging (XI) VOCAL

obtain the values of EV: XI VOCAL method. Using a sequential section, the contour of each gestational embryo was drawn manually in the fifteen different rotation planes to obtain the 3D volume measurement. To evaluate the relation between EV and gestational age (GA), Person’s correlation coefficient (r) was used. The paired Student’s t-test (P) and ANOVA were used to compare the methods. Results: The study showed there was correlation between EV and GA (r = 0.83 for VOCAL 30 degrees, r = 0.83 for XI VOCAL and r = 0.80 for multiplanar). There was a strong correlation between EV measured by the XI VOCAL e multiplanar methods (RICC = 0,941) and XI VOCAL and VOCAL methods (RICC= 0,965). There weren’t difference statistics between EV measured by the VOCAL, XI VOCAL and the multiplanar by the paired Student’s t-test, but ANOVA showed differences between all methods (p < 0.001). Conclusion: We have demonstrated a strong correlation with the age gestational and embryo volume measurements obtained using the XI VOCAL, VOCAL and multiplanar methods in first trimester gestational. The methods were concordant, but there were differences statistics.

OC10.04: Analysis of fetal ear rotation by three-dimensional rendering mode using a novel method: the ear angle - preliminary results

R. Deshpande1,2, D. Anblagan4, N. W. Jones1,2, N. Raine-Fenning1, G. Bugg2, P. Mansell3, P. Gowland4, L. Leach3 1School of Clinical Sciences, Division of Human Development, University of Nottingham, Nottingham, United Kingdom; 2Deparment of Obstetrics & Gynecology, Queens Medical Centre, Nottingham, United Kingdom; 3School of Biomedical Sciences, University of Nottingham, Nottingham, United Kingdom; 4Sir Peter Mansfield MRI Centre, University of Nottingham, Nottingham, United Kingdom

EP03.06: Reference range for fetal tricuspid annular plane systolic excursion (TAPSE) measurement using spatiotemporal image correlation (STIC) M-mode in a Brazilian population.

G. Tedesco4,5, L.C. Bussamra4,5, L.C. Rolo1, F.S. Barros1, W.P. Martins4,3, L. Nardozza2, A.F. Moron4, E. Araujo4 1Department of Obstetrics, Federal University of São Paulo-UNIFESP, São Paulo, Brazil; 2São Paulo Federal University, São Paulo, Brazil; 3Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil; 4Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil; 5Department of Obstetrics, Medical College Science of Santa Casa of São Paulo (FCMSCSP), São Paulo, Brazil

P08.21: Analysis of the fetal ear position by three dimensional rendering mode using a novel method: the ear index—preliminary results

Objectives: To stablish normal ranges of Ear Index (EI) between 18 and 24 weeks of pregnancy, using three dimensional (3D) rendered mode sonography. Methods: This cross-sectional study involved 143 pregnant women with gestational age (GA) between 18 and 24 weeks. Voluson 730 Expert equipped with transabdominal transducer was used. Mean maternal age was 33.2 years (SD 10.2), 68 fetus were female and 75 male. A two dimensional coronal view of the ear was performed to make 3D reconstruction. Using rendered mode, a dotted line was traced through the comissure of the eye dividing the ear in two parts. The superior measurement divided by inferior was considered the EI (fig1). For analysis, Pearson Coefficient (r) was calculated. Results: No significant correlation between GA and EI was determined (r = 0.001), however, between 18 to 24 weeks, it could be considered a normal EI from 0.23 to 1.02. Percentiles of EI are shown in Table1. Conclusions: There is no correlation between GA and EI, but acceptable normal values could be observed within a normal range between 18 to 24 weeks (0.23 to 1.02). These values could be important as a new marker for chromosomal abnormalities. Further studies are needed for more conclusive data.

P28.06: Correlation between fetal ear position, analyzed by three‐dimensional rendered mode sonography, and biometric parameters: preliminary results

Objectives: The pituitary gland is critically important in the function of the endocrine axis. So far, antenatal demonstration of the pituitary gland was possible only by using Magnetic Resonance Imaging (MRI) modality. The objective of our study was to describe antenatal visualization of the pituitary gland using two and three dimensional ultrasound modality. Methods: Using a Voluson E-8 (E8 systems, GE Medical Systems, Zipf, Austria) ultrasound machine, equipped with transabdominal multifrequency 4–8-MHz probe, during the third trimester of pregnancy, two dimensional images and three dimensional volume acquisition were taken. Results: We identified the unique shape of the pituitary gland using two and three dimensional ultrasound modality, on axial plane of the skull, parallel to and slightly below the biparietal diameter plane, showing the circle of Willis. Four manipulated steps from the native volume were needed for 3D reconstruction of the gland using transabdominal sonography. The insertion of the stalk to the posterior part of the gland can be seen. The circle of Willis was found to be an excellent marker for the gland location. Conclusions: This is the first report to date indicating that prenatal visualization of the pituitary gland using ultrasound imaging is feasible. In cases with midline anomalies of the brain, face or cranium, the demonstration of the pituitary gland, which is an essential endocrine gland, is recommended.

P21.07: Reference curve of the aortic valve area by multiplanar method and render mode by STIC: a preliminary study

Objectives: Determine the correlation between measurements of aortic valve area (avAo) and gestational age (GA) by multiplanar (MPM) and render methods (RM) obtained by STIC (SpatioTemporal Image Correlation). Methods: In this cross-sectional study were included 50 pregnant women with GA between 18 and 33+6 weeks. Mean maternal age was 30.1 years (SD ± 4.9). The ultrasound device used in the study was Voluson (730 version Expert) equipped with transabdominal transducer. Offline analyses used 4DView software. The cardiac volumes were obtained at 4-chambers (apical or transverse) by STIC. Then, in the visualization technique of the great vessels, the aorta (the outflow tract) and its valve were identified. Manual measurements were then obtained from the aortic valve area (avAo) methods by multiplanar and render mode. By Pearson’s correlation coefficient (r), the correlation between GA and the measurements was obtained by the respective methods, estimating equations for each method, with P < 0.005. Results: There was a correlation between avAo measurements and GA in both methods, r = 0830 for the MPM and r = 0810 for the RM. In the MPM, the avAo increases of 0.11 mm2 in the 18th week to 0.47 mm2 in the 33th week of gestation. In RM, the avAo increases of 0.12 mm2 in the 18th week to 0.48 mm2 in the 33th week of gestation. The correlation was observed exponential in both methods, estimating the curves: 0.019(e)0.098 and avAo = 0.017(e) 0.0101, with P < 0.005. Conclusions: There is a strong correlation between GA and avAo from 18 to 33+6 weeks of gestation by MPM and RM, with the possibility of estimating the normal area for each gestational age, enabling early identification of abnormalities in outflow tract of the heart, such as aortic stenosis, complementing the screening by ultrasound during pregnancy. However, further studies will be needed for more conclusive data.

P21.10: Comparison of multiplanar method and render mode in the measurements of the aortic valve by STIC: a preliminary study

Objectives: Determine the correlation between measurements of aortic valve area (avAo) and gestational age (GA) by multiplanar (MPM) and render methods (RM) obtained by STIC (SpatioTemporal Image Correlation). Methods: In this cross-sectional study were included 50 pregnant women with GA between 18 and 33+6 weeks. Mean maternal age was 30.1 years (SD ± 4.9). The ultrasound device used in the study was Voluson (730 version Expert) equipped with transabdominal transducer. Offline analyses used 4DView software. The cardiac volumes were obtained at 4-chambers (apical or transverse) by STIC. Then, in the visualization technique of the great vessels, the aorta (the outflow tract) and its valve were identified. Manual measurements were then obtained from the aortic valve area (avAo) methods by multiplanar and render mode. By Pearson’s correlation coefficient (r), the correlation between GA and the measurements was obtained by the respective methods, estimating equations for each method, with P < 0.005. Results: There was a correlation between avAo measurements and GA in both methods, r = 0830 for the MPM and r = 0810 for the RM. In the MPM, the avAo increases of 0.11 mm2 in the 18th week to 0.47 mm2 in the 33th week of gestation. In RM, the avAo increases of 0.12 mm2 in the 18th week to 0.48 mm2 in the 33th week of gestation. The correlation was observed exponential in both methods, estimating the curves: 0.019(e)0.098 and avAo = 0.017(e) 0.0101, with P < 0.005. Conclusions: There is a strong correlation between GA and avAo from 18 to 33+6 weeks of gestation by MPM and RM, with the possibility of estimating the normal area for each gestational age, enabling early identification of abnormalities in outflow tract of the heart, such as aortic stenosis, complementing the screening by ultrasound during pregnancy. However, further studies will be needed for more conclusive data.

P27.14: Normal ranges of anterior bregma angle using three dimensional rendered mode—preliminary results

Objectives: 2D bar coding is one of the methods to enable the health /medical data portability for prior and existing health care record system. Several field trial of PHR (Personal Health Record) project has been carried out in Japan. For standardize CTG digital record for PHR, we proposed MFER for CTG and data expression by 2D bar code (QR code). Methods: 1) Digital CTG recording signal was formatted adding a special profile header for MFER. 2) Two types of waveform data description format for MFER ware proposed, row data mode and compressed mode. 3) Row mode contained 2ch of FHR signals at 250msec and 1ch of tocogram signals at 1 sec whereas compressed mode contained FHR of 1 sec and tocogram of 2 sec. 4) QR code format v.15 (cell size 77 × 77) of error correction level M was applied for this trial. 5) Based on the MFER proposal, experimental system of CTG QR code generator and viewer was developed. ref: QR code http://www.denso-wave.com/qrcode/index-e.html MFER http://219.127.129.30/ikiw/index.php?en Results: Using level v15 format QR code, 600 bytes of data were encoded to one cell. One cell of QR code included 113 sec of recording. Using consecutive 16 QR cells could handle 30.2 min of serial CTG recording. Using iPad, QR coded CTG was successfully replayed. Conclusions: CTG recording format for EHR/PHR by MFER was proposed. Further study was required to confirm clinical feasibility, QR code format of CTG should be one of the cost beneficial way for PHR/EHR.