M. Kuleva

Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis

BACKGROUND AND OBJECTIVE: Gastroschisis is a congenital anomaly with increasing incidence, easy prenatal diagnosis and extremely variable postnatal outcomes. Our objective was to systematically review the evidence regarding the association between prenatal ultrasound signs (intraabdominal bowel dilatation [IABD], extraabdominal bowel dilatation, gastric dilatation [GD], bowel wall thickness, polyhydramnios, and small for gestational age) and perinatal outcomes in gastroschisis (bowel atresia, intra uterine death, neonatal death, time to full enteral feeding, length of total parenteral nutrition and length of in hospital stay). METHODS: Medline, Embase, and Cochrane databases were searched electronically. Studies exploring the association between antenatal ultrasound signs and outcomes in gastroschisis were considered suitable for inclusion. Two reviewers independently extracted relevant data regarding study characteristics and pregnancy outcome. All meta-analyses were computed using individual data random-effect logistic regression, with single study as the cluster unit. RESULTS: Twenty-six studies, including 2023 fetuses, were included. We found significant positive associations between IABD and bowel atresia (odds ratio [OR]: 5.48, 95% confidence interval [CI] 3.1–9.8), polyhydramnios and bowel atresia (OR: 3.76, 95% CI 1.7–8.3), and GD and neonatal death (OR: 5.58, 95% CI 1.3–24.1). No other ultrasound sign was significantly related to any other outcome. CONCLUSIONS: IABD, polyhydramnios, and GD can be used to an extent to identify a subgroup of neonates with a prenatal diagnosis of gastroschisis at higher risk to develop postnatal complications. Data are still inconclusive on the predictive ability of several signs combined, and large prospective studies are needed to improve the quality of prenatal counseling and the neonatal care for this condition.

‘Flash study’ on chorionicity determination from ultrasound images at 11–14 weeks' gestation in twin pregnancies

Figure 1 Ultrasound images of the intertwin membrane junction obtained at 11–14 weeks’ gestation for three discordant cases labelled as dichorionic by the sonographer and confirmed as such after delivery. Only one image of intertwin membrane junction was submitted in each case. In two cases (a,b) neither fetal medicine specialist could determine chorionicity because of poor image quality. In one case (c) the first fetal medicine specialist was uncertain, whereas the second made a diagnosis of monochorionic pregnancy. The quality of this image is low. accuracy of the first-trimester scan1–4. However, the majority of these studies have been conducted in large tertiary centers, whereas in current practice most women with a twin pregnancy are first scanned by obstetricians and midwife sonographers in first-level ultrasound units and later referred to specialist centers for follow-up, notably in cases of monochorionicity. We report a ‘flash study’ on the re-evaluation of chorionicity using stored ultrasound images from scans at 11–14 weeks’ gestation, carried out by the Collège Français d’Echographie Foetale (CFEF) for a 1-month period. The concept of a ‘flash study’, recently introduced by one of the authors (L.J.S.) (CFEF 4th Scientific Meeting, Port-en-Bessin-Huppain, France, 1–3 October 2010), entails a study of short duration with wide coverage, without modifications in obstetric management, without additional cost and with an underlying educational message. Sonographers from private and/or public units and members of CFEF were recruited by e-mail. All consecutive women attending these units at 11–14 weeks’ gestation were included. Pregnancy data and digital ultrasound images were entered by the sonographer into a web-based database at the time of scan. Chorionicity was first assessed by the sonographer. One or two explicit sonographic images of the intertwin membrane junction for each twin pregnancy were required. Images were reevaluated by two independent fetal medicine specialists blinded to both the sonographer’s initial diagnosis of chorionicity and the other specialist’s subsequent diagnosis. Chorionicity was confirmed by pregnancy outcome, neonate sex or placental histology. Out of a total of 6970 ultrasound examinations, performed by 271 sonographers, there were 176 twin pregnancies, corresponding to a prevalence of 2.5% (95% CI 2.2–2.9). Of those, 134 (76%) and 41 (23%) were respectively labeled as dichorionic and monochorionic diamniotic by the sonographer. One monoamniotic pregnancy was excluded from the study. Requested images were submitted by the sonographers. There was concordance between the sonographer and the two fetal medicine specialists and between the fetal medicine

A standardized approach for the assessment of the lower uterine segment at first trimester by transvaginal ultrasound: a flash study

Abstract Objectives: To evaluate the reproducibility of a standardized approach to lower uterine segment (LUS) imaging by transvaginal ultrasound at 11–14 weeks. Methods: This was a “flash” study lasting for 1 month. Obstetrician-sonographers performing more than 50 first trimester ultrasounds per year participated. All consecutive women attending for their 11–14 weeks scan were included. A standardized, transvaginal approach to the imaging of LUS was defined. The sonographers recorded one or two images of the LUS. The quality of the images was assessed by sonographers and reviewed by an independent fetal medicine specialist using the same scoring system. Inter and intra-reviewer variability was assessed. Results: Seventy-one sonographers and 851 pregnant women participated. The mean (±SD) and medium (IQR) scores attributed by sonographer versus reviewer were 5.01 (±0.92) and 5 [4–6] versus 4.68 (±1.14) and 5 [4–5.24], p = 0.08. The mean [95% CI] difference of −0.33 [−2.6;2] was recorded. There was good, moderate and poor agreement in 74.4%, 16.7% and 8.9% cases, respectively. Variability in inter-reviewer and intra-reviewer was low with the mean [95% CI] difference of −0.1 [−1.6;1.4] and −0.1 [−1.4;1.2] respectively. Conclusions: A standardized approach to LUS imaging at 11–14 weeks is feasible and highly reproducible in a large population.

Clinical course and outcome of antenatally detected atrioventricular block: experience of a single tertiary centre and review of the literature

The objective is to study the course and outcome of fetuses with congenital atrioventricular block (AVB) in a single centre.

Fetal intra‐abdominal umbilical vein varix: retrospective cohort study and systematic review and meta‐analysis

To investigate the ultrasound characteristics and outcome of pregnancies with fetal intra‐abdominal umbilical vein varix (FIUVV).

P02.01: Glial peri-orbital heterotopia: a rare type of peri-orbital mass: a case report and a literature review: Poster discussion hub abstracts

Results: A total of 25 cases with postnatal CCHD diagnosis had fetal anatomy US performed between 2014-2018 with 13/25 (52%) performed by radiology providers, 8/25 (32%) by community perinatologists and 4/25 (16%) by community obstetricians. Postnatal CCHD diagnoses included: conotruncal defects (n=18), hypoplastic left heart (n=5) and single right ventricle (n=2). The majority (21/25) of the US were performed between 18-24 weeks’ gestation, however only 11/25 (44%) obtained adequate 4C and outflow tract imaging. Of the nine cases where the 4C heart was poorly visualised only two had further imaging. Conclusions: Despite updated guidelines for fetal heart screening, many providers continue to evaluate only the 4C view, without imaging the outflow tracts and further imaging is not performed if the 4C heart is poorly visualised. Standardised referral for further imaging when the heart is poorly visualised is a necessity. Furthermore, education for providers to improve appropriate image acquisition may contribute to an improvement in the prenatal detection of CCHD.

OC21.03: Relationship between the incidence of genomic microarray anomalies and first trimester nuchal translucency value

Objectives: The aim of the present study was to stratify the risk of detecting a pathogenic copy number variants (CNVs) by array comparative genomic hybridisation (aCGH) in relation to the first trimester Nuchal Translucency (NT) value. Methods: All women who underwent an invasive prenatal sampling for aCGH between 2008 and March 2017 were retrieved from the hospital database. Cases with genomic imbalances > 5MB were excluded because of their detectability by conventional karyotype. The first trimester NT values of the study population were reviewed and expressed in Multiple of Median (MoM) related to the Crown–rump length of the fetus. Maternal age, CRL measurement and NT values were compared between cases with and without aCGH anomaly. The incidence of aCGH anomalies in 5 sub-groups of NT value: ≥4; 3.0-3.9; 2.0-2.9; 1.0-1.9 and ≤1 MoM was evaluated. Additionally, Odds Ratio (OR) for a CGH anomaly was calculated for the foetuses with NT≥2 MoM compared to those <2MoM. Results: Over a 9-years period, a total of 2335 women received array CGH in our institution for different indications (structural ultrasound anomalies, positive screening for Trisomy 21, history of chromosomal anomaly). The overall incidence of pathogenetic CNVs was 4.9%. No differences were found in the distribution of maternal age and CRL measurement between women with or without aCGH anomaly, while NT values were statistically higher in the group with aCGH anomaly. The incidence of pathogenic CNVs among the different NT sub-groups was 9,0%, 7,5% 7,1% 4,7% 4,4% respectively (p=0.03). The OR for having a pathogenic CNVs in presence of NT values ≥2 MoM was 1.7 (95%CI 1,06-2,79; p=0.03) respect to NT values < 2 MoM. Conclusions: The results of the study suggest that the risk of aCGH anomalies increases exponentially with increasing the NT value.

P14.01: Reproducibility of chorionicity determination from ultrasound images at 11–14 weeks in twin pregnancies

5 (4.5%) skeletal dysplasias; 4 (3.6%) alteration of gastrointestinal system; 2 (1.8%) thoracic malformations; 1 (0.9%) and 20 (18.1%) other malformations. The mean maternal age was 28 years (ranged from 16 to 47), and average gestational age of delivery was 33 weeks. The mean fetal weight was 2390 g, Cesarian section was performed in 56% patients and 56% was male gender. Conclusions: Among the malformations during the year of 2011 in our department, the most common types were those involving the central nervous, cardiovascular and urinary systems. These findings are in accordance with previous reports.