N. Fries

French fetal biometry: reference equations and comparison with other charts

To construct new reference charts and equations for fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL), using a large sample of fetuses examined at 15–40 weeks in France, and to compare them with previous references.

Nuchal translucency measurement: are qualitative and quantitative quality control processes related?

Two types of quality assurance processes for nuchal translucency (NT) measurement have been described: qualitative through review of images and quantitative comparison of operators specific NT distribution to reference distributions. The aim of this study was to assess the results of these two approaches.

‘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

Online evaluation of fetal second-trimester four-chamber view images: a comparison of six evaluation methods.

To compare six online evaluation methods for auditing routine second‐trimester four‐chamber view still images.

Implementing the INTERGROWTH‐21st fetal growth standards in France: a ‘flash study’ of the College Français d'Echographie Foetale (CFEF)

To assess potential differences in fetal size between the French population and the international population from the INTERGROWTH‐21st (IG‐21st) Project and to measure the impact of switching to the IG‐21st reference standards for fetal size.

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.

The impact of insonation angle on four-chamber view image quality: an observational study on 2866 routine scans

To determine insonation angles achieved in routine screening practice and their impact on image quality.

Effect of Cell-Free DNA Screening vs Direct Invasive Diagnosis on Miscarriage Rates in Women With Pregnancies at High Risk of Trisomy 21: A Randomized Clinical Trial

Importance Cell-free DNA (cfDNA) tests are increasingly being offered to women in the first trimester of pregnancies at a high risk of trisomy 21 to decrease the number of required invasive fetal karyotyping procedures and their associated miscarriages. The effect of this strategy has not been evaluated. Objective To compare the rates of miscarriage following invasive procedures only in the case of positive cfDNA test results vs immediate invasive testing procedures (amniocentesis or chorionic villus sampling) in women with pregnancies at high risk of trisomy 21 as identified by first-trimester combined screening. Design, Setting, and Participants Randomized clinical trial conducted from April 8, 2014, to April 7, 2016, in 57 centers in France among 2111 women with pregnancies with a risk of trisomy 21 between 1 in 5 and 1 in 250 following combined first-trimester screening. Interventions Patients were randomized to receive either cfDNA testing followed by invasive testing procedures only when cfDNA tests results were positive (n = 1034) or to receive immediate invasive testing procedures (n = 1017). The cfDNA testing was performed using an in-house validated method based on next-generation sequencing. Main Outcomes and Measures The primary outcome was number of miscarriages before 24 weeks’ gestation. Secondary outcomes included cfDNA testing detection rate for trisomy 21. The primary outcome underwent 1-sided testing; secondary outcomes underwent 2-sided testing. Results Among 2051 women who were randomized and analyzed (mean age, 36.3 [SD, 5.0] years), 1997 (97.4%) completed the trial. The miscarriage rate was not significantly different between groups at 8 (0.8%) vs 8 (0.8%), for a risk difference of −0.03% (1-sided 95% CI, −0.68% to ∞; P = .47). The cfDNA detection rate for trisomy 21 was 100% (95% CI, 87.2%-100%). Conclusions and Relevance Among women with pregnancies at high risk of trisomy 21, offering cfDNA screening, followed by invasive testing if cfDNA test results were positive, compared with invasive testing procedures alone, did not result in a significant reduction in miscarriage before 24 weeks. The study may have been underpowered to detect clinically important differences in miscarriage rates. Trial Registration ClinicalTrials.gov Identifier: NCT02127515

OP07.01: Are qualitative and quantitative NT quality‐control processes related?

Objectives: A significant subset of patients presents with new-onset maternal tachycardia (heart rate > 100 beats per minute) 24 hours after laser coagulation of placenta anastomoses for twin-to-twin transfusion syndrome (TTTS). The clinical and pathophysiologic implications of this tachycardia are unknown. We thus investigated the relation between maternal clinical, surgical and laboratory findings and postoperative maternal tachycardia after fetoscopic laser for TTTS. Methods: Demographic data, surgical characteristics, maternal perioperative vital signs as well as hematologic, coagulation and biochemistry blood work were retrospectively reviewed in 311 patients undergoing fetoscopic laser ablation of placental anastomoses for TTTS. Results: Fifty-four women (17.4%) had new-onset persistent tachycardia 24 hours after laser. Simultaneously, a significant drop of both systolic (9mmHg) and diastolic (−8 mmHg) blood pressure (BP) was observed (P < 0.001) compared to pre-operative values. When preand post-laser values where compared, a significant drop (P < 0.001) was observed for hemoglobin (−17.2 g/L), hematocrit (−5%), platelets (−37.3 × 109/L), albumine (−6 g/L) and, osmolality (−2.4 mOsm/kg). Electrolytes, urea, creatinine, uric acid and liver function tests were not significantly affected by the laser procedure. Using logistic regression analysis, we identified: amnio-reduction > 3,000 mL (Odds Ratio [OR] 2.0, 95% Confidence Interval [95% CI] 1.1–3.9) and indomethacin use in the post-laser period (OR 0.3, 95% CI 0.1–0.6) as the only variables independently associated with maternal postoperative tachycardia. Maternal tachycardia did not lead to any changes in clinical management. Conclusions: Feto-maternal volume shifts as well as changes in intraabdominal pressure after fetoscopic laser cause a drop in maternal BP and an increase in maternal HR. These changes may be affected by the use of Indomethacin through its effects on maternal pain and diuresis.

P26.18: Online audit and feedback improve fetal second-trimester four-chamber view images: a randomized controlled trial

Case story: Primigravida, 34 years, IVF patient (both egg and sperm donation). At first trimester scan at local hospital a large nuchal translucency was found, and the patient was referred. We diagnosed a partial ectopia cordis (fistula from the right ventricle to the umbilicus, picture 1) and dextrocardia associated with a complex intra-cardiac defect (common atrioventricular valve with single right ventricle, double outlet right ventricle, DORV). Additional malformations were found: sternal cleft and 7 mm septate nuchal cystic hygroma. A striking hypercoiling of the umbilical cord was also seen. The patient opted for termination of pregnancy. The autopsy confirmed the prenatal findings. Fetal DNA was sent for array CGH, Agilent 180K. Prenatal, autopsy and array CGH findings will be presented. There seems to be a strong correlation between the PC and umbilical abnormalities, in particular in cases with ectopia cordis. Atypical coiling pattern of the umbilical cord has previously been descibed.