M. Brestak

Left ventricle shortening fraction: a comparison between euploid and trisomy 21 fetuses in the first trimester

Measurement of the shortening fraction of the left ventricle (SFLV) is an objective way to assess systolic performance. The aim of the study was to compare first trimester SFLV values in euploid fetuses to those in fetuses with trisomy 21.

Amniovacucentesis vs standard syringe technique for amniocentesis: experience with 1219 cases

OBJECTIVE The aim of the study was to compare amniovacucentesis to the usual syringe use for amniotic fluid aspiration. STUDY DESIGN We compared 2 groups of procedures: 1117 amniocenteses performed with the usual syringe technique and 1219 amniovacucenteses. RESULTS The numbers of needle insertions, unsuccessful amniocyte cultures, and miscarriage up to 21 days after the procedure were statistically not significant (P>.01) comparing the 2 techniques. CONCLUSION The vacuum tube serves as an automated aspiration tool alternative. The major subjective differences between the 2 methods are the operators comfort and dexterity during sampling and the absence of an extra manipulation of the amniotic fluid after aspiration.

Shortening fraction of the right ventricle: a comparison between euploid and trisomy 21 fetuses at week 11 to week 13 and 6 days of gestation

This study was designed to compare the first trimester shortening fraction of the right ventricle (SFRV) values between euploid fetuses and fetuses with trisomy 21.

Chorionic villus vacu-sampling in 377 consecutive cases

Chorionic villus sampling (CVS) is the method of choicefor obtaining fetal tissue for prenatal diagnosis before15 weeks of pregnancy. CVS can be performed usingeither a transabdominal or a transcervical approach.Transabdominal CVS is a technique very similar toamniocentesis, as a needle is inserted into the uterusthrough the abdominal wall under aseptic conditions,but instead of directing the needle to a free pocketof amniotic fluid, it is passed through the long axisof the chorionic tissues (Smidt-Jensen

OP01.23: Amnio‐vacucentesis—an innovative closed system of amniotic fluid aspiration

noted, the initial risk, which was based on maternal age and/or maternal serum screening, was multiplied by the LR of that marker. When more than one marker was found, then the initial risk was multiplied by the highest LR or 6.2. The absence of a marker had a LR of 0.5. After URAD, the patients were assigned into two groups depending upon whether their final calculated risk was greater or less than 1/270. The at risk group was further divided into an intermediate risk and high risk group (> 1/100 risk). Results: Group

OP07.05: Chorionic villus vacu‐sampling: an innovative method

For amniocentesis there were 202 karyotype anomalies (7.8%). 110 trisomy 13,18,21; 20 sex chromosome and 13 triploidy accounted for 71% of abnormal results. Rapid karyotype by FISH was selectively used in 580 cases (22.4%). FISH was used in 95/143 cases (66.4%) potentially diagnosable with standard FISH probes. FISH was ordered in 60% of trisomy 21 cases and 85% of trisomy 18. Long-term culture confirmed the FISH results in all cases. In 0.5% culture failed. In 0.3% there were insufficient cells for FISH. Conclusions: The selective use of rapid karyotype techniques in CVS and amniocentesis produces a high detection rate but results in a significant number of cases not identified until the long-term culture (34% of potentially detectable cases for amniocentesis). For CVS specimens, rapid diagnosis alone results in a small but significant number of discordant results.

Comparison of right ventricular measurements and SFRV in fetuses with and without tricuspid regurgitation at 11+0 and 13+6 weeks' gestation.

Abstract Objectives: To compare right ventricular dimensions and systolic shortening fraction of the right ventricle (SFRV) in fetuses with tricuspid regurgitation (TR [+]) to those without tricuspid regurgitation (TR [−]). Methods: Unselected patients presenting for first trimester screening between 11 + 0 and 13 + 6 weeks’ gestation were examined for the presence or absence of fetal tricuspid regurgitation using a standard approach. Only euploid fetuses without structural anomalies were included in the study. The heart was examined with the aid of M-mode using a previously described method. The right ventricular diastolic diameter (RVDD) and right ventricular systolic diameter (RVSD) were measured on stored M-mode images and the SFRV was calculated using the following formula [(RVDD−RVSD)/RVDD] × 100. Results: A total of 69 fetuses (n = 44 (TR [−]); n = 25 (TR [+])) were examined. The two groups were similar in maternal age, gestational age and nuchal translucency (NT) measurements. The SFRV was noted not to change with gestational age and there was no statistical difference between the two groups. Both the RVDD and the RVSD increased with gestational age. The calculated delta RVDD was statistically larger in the TR [+] group (mean: 0.29, CI 95%: 0.054–0.532) than the TR [−] group (mean: 0.013, CI 95%: −0.128 to 0.154) (p < 0.05). This was not true for the delta RVSD: TR [+] (mean: 0.17, CI 95%: 0.015–0.325) versus TR [−] group (mean: 0.035, CI 95%: −0.061 to 0.131). However, there was a trend towards larger RVSD in the TR [+] group (p = 0.13). Conclusions: The presence of TR appears to be associated with an increased RVDD in normal fetuses between 11 + 0 and 13 + 6 weeks’ gestation.

OC06.03: Shortening fraction of the right ventricle (SFRV)—a potential ultrasound marker of trisomy 21 between 11 and 13 + 6 weeks' gestation

P. Calda1, M. Brestak1, V. Tomek2, D. McKenna3, J. Sonek3 1Department of Obstetrics and Gynaecology, Charles University, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; 2Kardiocentrum and Centre for Cardiovascular Research, University Hospital Motol, Prague, Czech Republic; 3Department of OB/Gyn, Wright State University, Fetal Medicine Foundation USA, Dayton, OH, USA

OC052: Ultrasound at 20–22 weeks of pregnancy increases the rate of detection of Down syndrome above that of combined first‐trimester screening alone

treatment. The enhanced area of 62 lesions i 66.7% j was a bit larger than that of the 2D measurement. In 3 cases, the post-treatment CEUS showed no obvious ablated area within the tumor, who were given another HIFU treatment once with increased therapeutic dosage. The average ablation volume (without enhancement in CEUS) of the leiomyomas after HIFU treatment was 82.9% ± 19%. The mean volume of the tumors was 60.0% ± 29.1% (P < 0.05) decreased compared with that of the pre-treatment, 6 months later. Symptoms of all cases improved or disappeared after treatment. There was no serious side-effect of the treatment observed. Conclusions: CEUS can visualize the circulatory condition of the tumor and thus play an important role in HIFU treatment of uterine leiomyomas.

OP10.06: Risk of miscarriage and pregnancy outcome after multifetal pregnancy reduction (MFPR)

Objectives: To determine whether the risk of fetal loss following trans-abdominal multifetal pregnancy reduction (TA-MFPR) of a monochorionic twin pair is similar to the one in dichorionic pairs. Study Design: A retrospective review of all TA-MFPR performed in our institution (1999–2007) was conducted. The procedurerelated fetal loss, defined as pregnancy loss prior to completion of 24 weeks, in pregnancies involving reduction of a monochorionic pair i.e. ‘‘Mono group’’ was compared to the loss rate in all other TA-MFPR i.e. ‘‘Non-mono group’’. This comparison was further stratified according to the specific pre and post reduction number of fetuses. Additionally, association between the number of needle insertions performed and the procedure related fetal loss was sought. Results: 394 TA-MFPR were eligible for analysis and an overall loss rate of 2.5% (10 of 394) was detected. The procedure related loss in the ‘‘Mono’’ and ‘‘Non-mono’’ groups as well as the impact of the pre and post reduction number of fetuses on the fetal outcome is displayed in table 1. Information regarding number of needle insertions was available on 182 TA-MFPR of which in 22 ‘‘Nonmono’’ and 16 ‘‘mono’’ cases the same needle insertion was used to reduce more than a single fetus. The loss rate for single, two and three needle insertions was 3/165, 0/11 and 1/6 respectively (pnon significant). Conclusions: Fetal loss following TA-MFPR is independent of the chorionicity of the pair reduced. Additionally, we noted a trend suggesting an increased risk for fetal loss with increased number of needle insertions. Since monochorionic twins carry an increased pregnancy-related complication rate, it is our practice to attempt reduction of such pairs, preferably by using a single needle insertion. This can be achieved by a careful selection of the needle pathway to reach both fetuses.