M. Momtaz

13–14‐week fetal anatomy scan: a 5‐year prospective study

To assess the potential value of an early (first‐trimester) ultrasound examination in depicting fetal anomalies by transabdominal (TAS) and transvaginal (TVS) sonography, to compare it with the traditional mid‐trimester anomaly ultrasound examination and to evaluate the degree of patient acceptance of early sonography by the transvaginal route.

Correlations of Urinary Biomarkers, TNF-Like Weak Inducer of Apoptosis (TWEAK), Osteoprotegerin (OPG), Monocyte Chemoattractant Protein-1 (MCP-1), and IL-8 with Lupus Nephritis

ObjectiveThis case-controlled study was designed to correlate urinary biomarkers, TNF-like weak inducer of apoptosis (TWEAK), osteoprotegerin (OPG), monocyte chemoattractant protein-1 (MCP-1), and interleukin-8 (IL-8) levels, with renal involvement in a cohort of systemic lupus erythematosus (SLE) patients to examine their diagnostic performance.Patients and MethodsIn 73 SLE patients, and in 23 healthy volunteers, urinary levels of TWEAK, OPG, MCP-1, and IL-8 levels were measured. Disease activity was assessed by total SLE disease activity index, and renal activity by renal activity index (rSLEDAI), and both were correlated with urinary biomarkers. Sensitivity, specificity, and predictive values of individual biomarkers to predict lupus nephritis were also calculated.ResultsSignificantly higher levels of urinary biomarkers were observed in SLE patients with lupus nephritis (LN) compared with those without LN (TWEAK, p < 0.001; MCP-1, p < 0.001; OPG, p < 0.001; IL-8, p < 0.032). Other significantly higher levels were observed in SLE patients with LN compared with control subjects (TWEAK, MCP-1, OPG, and IL-8 p < 0.001). Positive correlations were observed between rSLEDAI and TWEAK (r = 0.612 and p < 0.001), MCP-1 (r = 0.635 and p < 0.001), and OPG (r = 0.505 and p < 0.001).ConclusionsUrinary levels of TWEAK, OPG, and MCP-1 positively correlate with renal involvement as assessed by rSLEDAI with reasonable sensitivity, specificity, and predictive values to detect lupus nephritis while IL-8 was not significantly associated with global or rSLEDAI.

Intrapartum Prediction of Macrosomia: Accuracy of Abdominal Circumference Estimation

Objective: To evaluate the accuracy of abdominal circumference (AC) estimation of macrosomia early in labor and whether a cutoff value could be detected. Design: A prospective clinical trial. Setting: The Department of Obstetrics and Gynecology, Cairo University. Participants: One hundred pregnant females presenting in early labor with clinical impression of macrosomia were examined by ultrasound, and those babies with abdominal circumference more or equal to 35 cm were recruited for the study. Interventions: Every woman was considered as her own control, and fetal weight was calculated using the formula of Shepard et al. The accuracy of abdominal circumference in prediction of macrosomia was evaluated using the Receiver operating characteristic curve. Results: A cutoff value of AC ≧37 cm was found to have a sensitivity of 77%, a specificity of 75%, a positive likelihood ratio of 3.1 and a negative likelihood ratio of 0.3. Conclusion: Intrapartum ultrasonographic evaluation of abdominal circumference for suspected macrosomic babies in early labor is an easy, practical method that should be adopted in decision making.

Evaluation of offline analysis of archived three-dimensional volume datasets in the diagnosis of fetal brain abnormalities.

To retrospectively evaluate the reliability of offline manipulation of archived three‐dimensional (3D) ultrasound volumes in the assessment of the normal fetal brain and the diagnosis of fetal brain abnormalities.

OP19.08: Effect of prophylactic progesterone on incidence of preterm labour in spontaneous twin pregnancy, randomized controlled study

L. E. Romine1, M. Hwang5, N. Trivedi2, J. Wan4, Y. LaCoursiere2, P. Do4, K. Benirschke3, D. Schrimmer2, D. H. Pretorius1 1Radiology, University of California, San Diego, CA, USA; 2Reproductive Medicine, University of California, San Diego, CA, USA; 3Pathology, University of California, San Diego, CA, USA; 4School of Medicine, University of California, San Diego, CA, USA; 5School of Medicine, Vanderbilt University, Nashville, TN, USA

OC163: Transvaginal ultrasound guided needle aspiration in the management of patients with simple ovarian cysts

Objectives: To determine fetal and neonatal outcome in referrals with isolated abdominal fetal calcifications. Methods: We report 24 cases of prenatally diagnosis isolated abdominal calcifications referred to our centre over the period 1997–2007. The management included detailed fetal ultrasound imaging, maternal TORCH analysis, parental and fetal cystic fibrosis mutations analysis, fetal karyotype, and infectious investigations in amniotic fluid. Neonatal examination and postnatal ultrasound findings were collected and follow-up was obtained. Results: In 16 cases, abdominal calcifications were limited to one single organ (7 into the liver, 1 into the bowel, 1 into the spleen, 6 cases close to stomach and 1 behind the liver). In 2 cases, TORCH screening was abnormal (1 case of CMV and 1 toxoplasmosis) and in 1 case ureplasma urealyticum was found in amniotic fluid. Calcifications size remained stable during pregnancy for all cases excepted one with spontaneous antenatal resolution. In 8 cases, multiple abdominal calcifications were present. CMV infection was found in 2 cases and in 1 case Ureaplasma urealyticum was found in amniotic fluid. Postnatal outcome was complicated by neonatal peritonitis for one newborn and by chorioamnionitis ureaplasma for another one. For the others, postnatal outcome was uneventful and abdominal isolated calcifications were confirmed in postnatal US examination. No abnormal karyotype and no genetic abnormality of parental and fetal CF screen was evidenced. Conclusions: Abdominal isolated calcifications are frequently found at the 2nd trimester US. Our experience shows that when they are isolated to one single organ, neonatal outcome is uneventful but when they are present in multiple localisations, there is an increased risk of neonatal complications, as meconial peritonitis or chorioamniotitis. The prenatal management should include maternal TORCH screen and US Follow-up and amniotic fluid sampling should be discussed

OP17.07: Intermethod agreement between mid-sagittal and parasagittal measurements of the angle of progression in labour: Short oral presentation abstracts

Methods: In this prospective observational study, we included women in active first stage of labour for whom we obtained static and dynamic measurements (at uterine contraction and maternal bearing down) of AOP using 2D ultrasound, then vaginal examination was performed and degree of cervical dilatation recorded (US images stored, AOP measurement was done by second operator blind to examination and obstetricians conducting delivery were blinded to US). AOP were compared between women with Caesarean delivery (CD) and those with vaginal delivery. Receiver–operating characteristics (ROC) curves were constructed to assess the accuracy in the prediction of CD. Further classification was done to compare performance of AOP measured with cervical dilatation ≤5cm & >5cm, both static and dynamic. Results: 119 women were included in the study. 90 (76%) delivered vaginally while 29 had CD (24%). Women undergoing CD had significantly narrower AOP at rest (93 vs 104,P=0.001) and under maternal pushing (102 vs 118,P<0.0001). AUC for AOP prediction of CD was 69% (95%CI, 58-80%)(P=0.002) and 74% (95%CI, 64-84%) (P<0.001), for static and dynamic assessment, respectively. Comparing ROC curves for dynamic versus static assessment, the difference was not statistically significant p = 0.2. AUC for AOP measured at cervical dilatation ≤5cm was 72% (95%CI,57-86%)(P=0.005) and 64% (95%CI,48-80%)(P=0.1) for cervical dilatation>5cm. While in dynamic assessment, AUC for prediction of CD; for AOP measured at cervical dilatation ≤5cm was 78% (95%CI,66-90%)(P<0.001) and 64% (95%CI,46-81%) (P=0.1) at cervical dilatation>5cm. Comparing ROC curves for early versus late assessment, the difference was not significantly significant p = 0.2 both in static and dynamic measurements. Conclusions: Performance AOP in predicting CD, measured in first stage of labour static or dynamic, is not dependant on degree of cervical dilatation.

Therapeutic Plasma Exchange Outcomes in Cairo University Hospitals: 6 Years Experience: Cairo University Plasma Exchange Outcome

Therapeutic plasma exchange is used in treating different immunological and non‐immunological diseases. We analyzed the outcome of 308 patients treated by 1783 membrane plasma exchange sessions from January 2011 until January 2017 at Cairo University Hospital. Thrombotic microangiopathies were the commonest indication [73 (23.7%) patients] with response in 63/73 patients (86.3%), followed by systemic vasculitis with pulmonary‐renal involvement [40(13%) patients] with recovery in 32/40 patients (80.0%), Guillain‐Barré syndrome [39(12.7%) patients] with recovery in 30/39 patients (76.9%), myasthenia gravis [31(10.1%) patients] with response in 26/31 patients (83.9%), and catastrophic antiphospholipid syndrome [28(9.1%) patients] with recovery in only 6/28 patients (21.4%). Complications included hypotension [276/1783 (15.5%) sessions], hypocalcemia [26/308 (8.5%) patients], and 37/308 (12%) patients died. Sepsis caused mortality in 29/37 (78.4%) of patients. In conclusion, our therapeutic plasma exchange experience shows a favorable outcome for thrombotic microangiopathies, systemic vasculitis, myasthenia gravis, and Guillain‐Barré syndrome. Sepsis was the leading mortality cause.

The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial

Abstract Objective: To identify the role of bilateral internal iliac artery (IIA) ligation on reducing blood loss in abnormally invasive placenta (AIP) undergoing caesarean hysterectomy. Methods: In this parallel-randomized control trial, 57 pregnant females with ultrasound features suggestive of AIP were enrolled. They were randomized into two groups; IIA group (n = 29 cases) performed bilateral IIA ligation followed by caesarean hysterectomies, while Control group (n = 28 cases) underwent caesarean hysterectomy only. The main outcome was the difference in the estimated intraoperative blood loss between the two groups. Results: There was no significant difference between the two groups regarding the intraoperative estimated blood loss (1632 ± 804 versus 1698 ± 1251, p value .83). The operative procedure duration (minutes) (223 ± 66 versus 171 ± 41.4, p value .001) varied significantly between the two groups. Conclusions: Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.

Contraction of the levator ani muscle during Valsalva maneuver (co-activation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

Background: The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed. Objective: The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor. Study Design: Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary‐level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed. Results: In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r = ‐0.230, P = .021) and active second stage (r = ‐0.338, P = .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 ± 56 vs 28 ± 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158–3.752; P = .014). There was no significant difference between women who underwent operative delivery (n = 46) when compared with the spontaneous vaginal delivery group (n = 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P = .49). Conclusion: Levator ani coactivation is associated with a longer active second stage of labor.