M. Nanni

Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery

To compare longitudinal changes in angle of progression (AoP) and midline angle (MLA) during the active second stage of labor according to the mode of delivery.

Maternal cardiac function in complicated twin pregnancy: a longitudinal study

To evaluate longitudinally a cohort of twin pregnancies and to assess whether the occurrence of adverse pregnancy outcome may be related to specific maternal cardiac findings.

Variability of Forebrain Commissures in Callosal Agenesis: A Prenatal MR Imaging Study

BACKGROUND AND PURPOSE: Agenesis of the corpus callosum, even when isolated, may be characterized by anatomic variability. The aim of this study was to describe the types of other forebrain commissures in a large cohort of randomly enrolled fetuses with apparently isolated agenesis of the corpus callosum at prenatal MR imaging. MATERIALS AND METHODS: All fetuses with apparent isolated agenesis of the corpus callosum undergoing prenatal MR imaging from 2004 to 2014, were evaluated for the presence of the anterior or a vestigial hippocampal commissure assessed in consensus by 2 pediatric neuroradiologists. RESULTS: Overall, 62 cases of agenesis of the corpus callosum were retrieved from our data base. In 3/62 fetuses (4.8%), no forebrain commissure was visible at prenatal MR imaging, 23/62 fetuses (37.1%) presented with only the anterior commissure, and 20/62 fetuses (32.3%) showed both the anterior commissure and a residual vestigial hippocampal commissure, whereas in the remaining 16/62 fetuses (25.8%), a hybrid structure merging a residual vestigial hippocampal commissure and a rudiment of the corpus callosum body was detectable. Postnatal MR imaging, when available, confirmed prenatal forebrain commissure findings. CONCLUSIONS: Most fetuses with apparent isolated agenesis of the corpus callosum showed at least 1 forebrain commissure at prenatal MR imaging, and approximately half of fetuses also had a second commissure: a vestigial hippocampal commissure or a hybrid made of a hippocampal commissure and a rudimentary corpus callosum body. Whether such variability is the result of different genotypes and whether it may have any impact on the long-term neurodevelopmental outcome remains to be assessed.

The hippocampal commissure: a new finding at prenatal 3D ultrasound in fetuses with isolated complete agenesis of the corpus callosum

The aim of this research was to determine the prevalence and sonographic appearance of the hippocampal commissure in fetuses with isolated complete agenesis of the corpus callosum by three‐dimensional neurosonography in the multiplanar mode.

The usefulness of volume NT software in measuring the fetal nasal bone at 11 to 13 + 6 weeks of gestation.

The objective of this study is to investigate the reproducibility of 3D ultrasound to measure the fetal nasal bone (NB) at first trimester.

P08.03: Post‐partum evaluation of maternal cardiac function in a cohort of severe pre‐eclamptic women

All fetuses were singletons and were followed-up to delivery to determine whether they had SGA complications. In total, 109 appropriate-for-gestational-age (AGA) fetuses and 21 fetuses with SGA were included. After analysis, 3D PD indices were calculated: Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index (VFI). These indices were compared among the study groups. Results: Our results showed 3D power Doppler indices (VI, FI, and VFI) of fetal upper arm can differentiate SGA fetuses from AGA fetuses well. The study showed that 3D power Doppler indices (VI, FI, and VFI) were significantly lower in the SGA group compared to controls. Conclusions: It appears that 3D PD US assessment of the fetal upper arm reveals significant differences in all indices studied (VI, FI and VFI) between fetuses with SGA and without SGA. Fetal upper arm assessed by 3D PD US can be applied to detect SGA prenatally. We believe those assessments using 3D PD US is a useful test in detecting fetuses with SGA.

OP18.05: Fetal head‐symphysis distance: a simple and reliable ultrasound parameter for the intrapartum assessment of the fetal head descent

(ITU) during the active second stage according to the mode of delivery. Methods: A 3DUS ITU volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 minutes thereafter (T2, T3, etc.). Following delivery, all 3DUS volumes were analysed and both AoP and MLA were measured. Both parameters were then compared between women who underwent spontaneous vaginal delivery (SVD, Group A) and those who underwent operative delivery (Group B). ROC curves were subsequently constructed for both parameters at different scan intervals to estimate their accuracy to predict SVD. Results: Among 71 women included in the study, 58 women underwent SVD, 8 were delivered by vacuum extraction and 5 underwent cesarean delivery. When compared with group B, group A had a significantly wider AoP only at T1 (140.9 ± 20.2◦ vs. 122.9 ± 16.7◦, P = 0.01) and T2 (149.7 ± 20.7◦ vs. 126.9 ± 17.5◦, P = 0.006). The ROC curves revealed an AUC ± SE of 0.731 ± 0.077 at T1 and of 0.785 ± 0.080 at T2. On the other hand, MLA was narrower in Group A only at T3 (21.2 ± 11.7◦ vs. 40.8 ± 27.9◦, P = 0.043), T4 (18.2 ± 15.0◦ vs. 47.4 ± 29.6◦, P = 0.020) and T5 (18.25 ± 6.0◦ vs. 34.7 ± 4.2◦, P = 0.034). ROC curves yielded an AUC at T3 of 0.750 ± 0.044, at T4 of 0.880 ± 0.089 and T5 of 1.000 ± 0.000. On stepwise forward multiple logistic regressions both AoP and MLA were associated with the spontaneous vaginal delivery (OR (exponential beta) 1.047 and 0.983 respectively)). Conclusions: Ultrasonographic assessment of fetal head descent in the second stage may play a role in the prediction of the mode of delivery.

OP18.07: Head progression in fetuses with persistent occiput posterior position at delivery: longitudinal assessment by 3D ultrasound in the second stage

Results: Of all 206 women, 9 had a cesarean for fetal distress and were excluded. The remaining 197 had a mean age of 28.6 (15–41). Most were nulliparas (n = 112; 56.9%). Mean gestational age was 40.8 (37–41). Major indications for labor induction were postdates pregnancy (n = 163; 82.7%), gestational diabetes (n = 29; 14.7%) and pre-eclampsia (n = 5; 2.6%). Cesarean section was performed in 31 cases (15.7%). Mean birthweight was 3485 g (2390–4650). ROC curves indicated that the best cut-off of cervical lenght for predicting Cesarean delivery was > 30 mm (sensitivity 68%, specificity 55%, positive predictive value (PV) 22%, negative PV 90%) and for Bishop score was < 5 (sensitivity 84%, specificity 48%, positive PV 23%, negative PV 94%). On univariate analysis nulliparity, cervical length > 30 mm and Bishop score < 5 were all significantly associated with Cesarean delivery (P values of 0.001; 0.023; 0.001 respectively). When patients were selected according to parity, there was found a significant association of Bishop score and cervical length with Cesarean delivery for nulliparas, but not for multiparas. Bishop score < 5 had 83% sensitivity, 39% specificity, 31% positive PV and 88% negative PV for Cesarean delivery (P = 0.027). Cervical length > 30 had 67% sensitivity, 58% specificity, 54% positive PV and 84% negative PV for Cesarean delivery (P = 0.034). Conclusions: Our results suggest that Bishop score and cervical length provide a significant contribution in the prediction of labor induction in postterm pregnancies.

OP18.03: The longitudinal changes of the angle of progression and the midline angle in the active second stage according to the mode of delivery

Objectives: Standard ultrasound biometry charts are derived from a European population. It is known that there is a difference in birthweight in babies born to mothers of different ethnic groups. The aim was to evaluate standard and novel ultrasound biometry measurements in normal pregnancy in different maternal ethnic groups. Methods: This was a longitudinal observational ultrasound study. Participants were healthy pregnant women whose primary ethnicity was European, Maori, Pacific Island or Asian Indian. Only pregnancies with normal outcomes were included (n = 74). Each participant was scanned at 4 weekly intervals from between 16 and 18 weeks to delivery. Ultrasound measurements were biparietal diameter, head circumference, humeral diaphyseal length, abdominal circumference and femur length. 3D ultrasound measurements were thigh circumference, partial thigh volume, arm circumference and partial arm volume. Neonatal measurements were birthweight, head circumference, crown-heel length and thigh circumference. Statistical analysis included multilevel linear mixed effects modelling, which accounts for correlation of longitudinal measurements. Results: Maternal characteristics were similar, except for weight (P = 0.03), between the ethnic groups. There were significant differences (P < 0.05) in the longitudinal growth of skeletal growth parameters – BPD, HC and HDL particularly with slower growth rate in the Indian fetuses compared to the referent NZE. Fetal soft tissue measurements showed different growth velocity compared to skeletal biometry from early third trimester. The differences were more marked in the heavier ethnic group (Pacific Island) (P < 0.001). Significant differences were seen in neonatal parameters. Conclusions: Appropriate ethnic characteristics should be included in customised biometry charts. Growth velocity of soft tissue may be useful to determine growth abnormalities, especially after 34 weeks. Soft tissue growth may help distinguish fetal growth restriction or SGA or if macrosomia is pathological in Pacific Island diabetics.

OP18.04: 3D ultrasound evaluation of progression angle, progression distance and midline angle changes in nulliparous women according to second stage length

(ITU) during the active second stage according to the mode of delivery. Methods: A 3DUS ITU volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 minutes thereafter (T2, T3, etc.). Following delivery, all 3DUS volumes were analysed and both AoP and MLA were measured. Both parameters were then compared between women who underwent spontaneous vaginal delivery (SVD, Group A) and those who underwent operative delivery (Group B). ROC curves were subsequently constructed for both parameters at different scan intervals to estimate their accuracy to predict SVD. Results: Among 71 women included in the study, 58 women underwent SVD, 8 were delivered by vacuum extraction and 5 underwent cesarean delivery. When compared with group B, group A had a significantly wider AoP only at T1 (140.9 ± 20.2◦ vs. 122.9 ± 16.7◦, P = 0.01) and T2 (149.7 ± 20.7◦ vs. 126.9 ± 17.5◦, P = 0.006). The ROC curves revealed an AUC ± SE of 0.731 ± 0.077 at T1 and of 0.785 ± 0.080 at T2. On the other hand, MLA was narrower in Group A only at T3 (21.2 ± 11.7◦ vs. 40.8 ± 27.9◦, P = 0.043), T4 (18.2 ± 15.0◦ vs. 47.4 ± 29.6◦, P = 0.020) and T5 (18.25 ± 6.0◦ vs. 34.7 ± 4.2◦, P = 0.034). ROC curves yielded an AUC at T3 of 0.750 ± 0.044, at T4 of 0.880 ± 0.089 and T5 of 1.000 ± 0.000. On stepwise forward multiple logistic regressions both AoP and MLA were associated with the spontaneous vaginal delivery (OR (exponential beta) 1.047 and 0.983 respectively)). Conclusions: Ultrasonographic assessment of fetal head descent in the second stage may play a role in the prediction of the mode of delivery.