Mohamad Kais

Sonographic fetal sex determination.

Although sonographic fetal sex determination is feasible in most pregnancies, in some cases, it may pose difficulties. An attempt to determine the fetal sex should not be made before 12-weeks’ gestation because this early, it is relatively inaccurate. After 13 weeks, it is accurate in 99% to 100% of cases without malformed external genitalia. Sonographic fetal sex determination in the late second trimester is based on direct visualization of the external genitalia, whereas in the late first and early second trimester, it is based mainly on the direction of the genital tubercle (the “sagittal sign”): downward direction of the genital tubercle indicates a female fetus and upward direction a male fetus. Other sonographic landmarks, such as the fetal scrotum, the midline raphe of the penis, the labial lines, the uterus, the descended testis, and the direction and origin of the fetal micturition jet in males may contribute to the correct determination of fetal sex. Inaccurate fetal sex determination may occur when the external genitalia are malformed. Three-dimensional ultrasound, although of generally limited diagnostic value for fetal sex determination, may aid in better definition of congenital malformations of the external genitalia. Target Audience: Obstetricians & Gynecologists, Family Physicians Leaning Objectives: After completion of this article, the reader should be able to select the appropriate sonographic finding for determining fetal sex according to gestational age, list indications for sex determination in the fetus, and name abnormalities of genitalia that may alter sonographic findings.

Prediction of abortion using three-dimensional ultrasound volumetry of the gestational sac and the amniotic sac in threatened abortion.

To determine whether gestational sac volume (GSV) or amniotic sac volume (ASV) and/or the difference between them can predict abortion in women with first‐trimester threatened abortion.

Gestational sac volume in missed abortion and anembryonic pregnancy compared to normal pregnancy

To compare gestational sac (GS) volume (GSV) between normal pregnancies and missed abortions and anembryonic pregnancies and to determine at what gestational age differences in GS volume become evident.

Symptomatic pelvic accessory spleen in a female adolescent: Case report.

Accessory spleens are congenital foci of healthy splenic tissue that are separate from the main body of the spleen. They occur in 10–30% of individuals; a wandering accessory spleen located in the pelvis is uncommon. Most patients are asymptomatic. We describe the case of a female adolescent presenting with acute abdominal pain who had a pelvic accessory spleen that mimicked an adnexal mass.

OP02.04: Prediction of abortion using three dimensional ultrasound volumetry of the gestational sac and the amniotic sac in threatened abortion

Objectives: To determine the variables associated with different outcomes for pregnancies of unknown location (PUL). Methods: Prospective observational study. Women in the 1st trimester of pregnancy presenting to the early pregnancy unit (EPU), between 2009 and March 2011, underwent a transvaginal scan (TVS). A PUL was classified on TVS if there was no intraor extra-uterine pregnancy. Data was collected from women with a PUL at the first TVS. More than 10 historical, clinical and 3-D ultrasonographic end points were collected for analysis. Women were followed up until the outcome was established: failed PUL, intrauterine pregnancy (IUP) and ectopic pregnancy (EP). Off-line 3-D processing of the uterine and ovarian volumes was performed using VOCAL in order to calculate endometrial volume (EV), mean gray index, vascular index (VI), flow index (FI) and vascular flow index (VFI). Univariate analysis was performed in order to establish the significant variables for the different PUL outcomes (ANOVA F-test and Fisher’s exact test). Results: 154 women were initially classified as a PUL. 143 women were included in the final analysis (11 cases lost to follow up). 69.2% (99/143) failed PULs, 23.1% (33/143) IUPs and 7.7% (11/143) EPs. The variables that were significantly associated with PUL outcomes were: gray index (P = 0.01), flow index (P = 0.01), hCG at 48hrs (P = 3.13E-07), log hCG at 48hrs (P = 1.89E-09), and hCG ratio (P = 4.34E-16). Conclusions: 3-D volumetric indices of the uterus and ovary may be useful in the prediction of PUL outcome. These results could result in the development of new mathematical models in management of PULs.

OP06.04: Gestational sac volume in missed abortion compared to normal pregnancies

persistence of vaginal bleeding after evacuation. We demonstrated that ultrasound is essential not only in diagnostic of HM but also in follow up and in definition of the high-risk population. Clinical use of such risk assessment permits individualization of follow-up according to the risk of developing subsequent GTN. Patients at high risk for GTN may undergo a closer monitoring whereas those at low risk may benefit of a smaller amount of visits. The extent to which these findings may allow an anticipated search of new pregnancy in low risk cases, remains to be determined.

OP12.01: Early pregnancy failure: Factors affecting successful medical termination

Methods: In this cross – sectional study, we prospectively enrolled hypertensive (Group1) and normal pregnancies (Group2) during antenatal, immediate postpartum or late postpartum period. Group1 included women with gestational hypertension, preeclampsia, eclampsia, chronic hypertension or superimposed preeclampsia. By transvaginal approach, bilateral uterine artery indices were measured and then mean values of bilateral indices were calculated. Nonparametric techniques were used for statistical analysis. Results: A total of 94 women were enrolled. In antenatal period, UA – PI of hypertensive pregnancies was higher than that of normal pregnancies. UA – PI of Group1 in immediate postpartum period was also higher than that of Group2, reaching statistical significance. Although it was not statistically significant, UA – PI of Group1 showed higher tendency than that of Group2 in late postpartum period.

P55Large yolk sac preceding increased nuchal translucency in skeletal malformations: report of two cases

Case 1