N. Palai

Fetal weight estimation in gestational diabetic pregnancies: comparison between conventional and three‐dimensional fractional thigh volume methods using gestation‐adjusted projection

To evaluate the accuracy of gestation‐adjusted birth‐weight estimation using a three‐dimensional (3D) fractional thigh volume (TVol) method in pregnant women with gestational diabetes mellitus (GDM), and to compare it with the conventional two‐dimensional method of Hadlock et al.

OC26.02: Fetal weight estimation in pregnancy complicated by obesity: comparison between conventional and a new 3D ultrasound method

Rose &McCallum, Schild (2 formulae), Scott, Shepard, Siemer, Thurnau, Weiner (2 fomulae) and Warsof). To assess the accuracy of the formulae the differences between FBW and EFW (expressed as grams, as percentage of FBW and as absolute percentage (|FBW − EFW|/FBW) were calculated. To assess whether the accuracy changes with increasing FBW a linear regression analysis was performed. Results: 193 pregnancies fulfilled the inclusion criteria with a mean FBW of 1001g. The mean differences between FBW and EFW were within 10% with the formulae from Hadlock I and III, Scott, Hadlock IV, Hadlock II and Masal (absolute percentage of FBW: 9.2%, 9.2%, 9.3%, 9.4%, 9.9% and 9.9%). Of those, EFW and FBW was within 10% of the FBW in more than 60% of the cases with the formulae from Hadlock I and III and with the Scott formula (64.2%, 61.1%, 60.6%). Linear regression showed that with the Hadlock I and III formulae the accuracy did not change with increasing fetal weight (r=0.936 and p=0.938, p<0,0001, intercept and slope not significantly different from 0 and 1). With these weight estimation formulae, the 95% limits of agreement between FBW and EFW were −19% to 19% (Hadlock I) and −17.3% to 20.1% (Hadlock III) of the FBW. Conclusion: Of the 23 commonly available weight estimation formulae, the Hadlock I (BPD-HC-AC-FL) and III (BPD-AC-FL) formulae were most accurate in estimating fetal weight in fetuses with a birth weight of 1500g or less.

OC03: Fetal weight estimation in gestational diabetic pregnant women: comparison between conventional and a new three‐dimensional ultrasound method

Objectives: Term prediction has traditionally been done with indirect methods based on small numbers of observations, implying that gestational age and a date for the last menstrual period (LMP) are estimated mainly on the basis of the biparietal diameter (BPD) measurement. Measuring femur length (FL) as well appears to give valuable additional information, and FL-based term prediction is a reasonable alternative in situations where an optimal BPD measurement is unachievable. A new direct prediction method, eSnurra, is a population-based model developed at NCFM, including about 40 000 ultrasound examinations. eSnurra calculates median remaining time of pregnancy and is independent of LMP. Given equal measurement practice, the method should be applicable to other populations nationwide. Methods: eSnurra was evaluated on FL measurements from Stavanger University Hospital. We included approximately 8800 fetal FL measurements from singleton pregnant women with a liveborn child, whose fetus had a BPD in the range 38–60 mm. Elective Cesarean sections and inductions of labour for reasons other than postmaturity were not included. FL measurements from the routine scan were applied to predict term according to eSnurra. In the evaluation of the quality of the prediction we assessed these parameters: median difference between the true and predicted date of delivery (bias), proportion of births within ± 14 days of the predicted day, and proportions of preterm (< 259 days) and postterm (> 295 days) deliveries. Results: The analyses show that eSnurra performs precisely over the full range of inclusion for FL measurements. The median bias was on average −0.48 days, and 86.1% of the births occurred within ± 14 days. 4.8% delivered preterm and 3.4% post-term. Conclusions: Our study confirms the strength of a newly developed population-based prediction model, and that it performs well on a different population. We found the FL predictions to have nearly the same quality as the BPD predictions.

OC71: Isolated mild ventriculomegaly (10–12 mm): very long-term prognosis

Methods: We considered 58 consecutive single pregnancies referred to our Centre for Prenatal Diagnosis with a lateral ventricle measurement between 9.5 and 9.9 mm. For all cases we obtained perinatal and long-term follow-up (> 24 months). Results: In 14 cases (24%) associated malformations were present: four aneuploidies (two trisomy 21, one trisomy 13 and one triploidy), one complex malformation, three spina bifida with myelomeningocele, one transposition of great arteries, two Beckwith syndromes, one Zellweger syndrome, one case of epilepsy associated with liver dysfunction, one renal pelvic dilatation. Among the 44 cases of isolated ventriculomegaly, one pregnancy was terminated because of psychiatric indication, 42 infants (97%) were healthy at more than 24 months of life, and only one newborn showed severe neurological dysfunction (neurodevelopmental delay and motor deficit) caused by a demyelinating disease of the white matter not diagnosable in utero. Conclusions: These data, comparable to those obtained for ventriculomegaly between 10 and 12 mm, suggest that the cut-off for mild ventriculomegaly should be lowered to 9.5 mm.

P12.08: Prenatal appearance and prognosis of hyperechoic lung lesions

uvula by its distance to the epiglottis, proof of soft palate’s integrity, using a common view: the profile. We evaluated it’s feasibility. Method: Embryologic reasons leads to have an uvula’s growth in a posterior and inferior way as to be very closed to the epiglottis in normal conditions. From a cranial view of a profile we turn around keeping the same plan as to avoid bony shadow, allowing the visualization of the uvula and the epiglottis separated by an anechogenic zone highlighted by the posterior contour of the tongue. Until now, 500 examinations have been performed. Results: This distance has always been possible to get, in 50% in less than 10 seconds, 80% in less than 2 minutes, but sometimes it took quite a lot of time. The distance was between 2 and 4 mm with a mandible’s neutral position. In soft palate’s cleft we examined (2 cases) this distance was more than 1 cm. This distance appears simple to get (80% in less than 2mm) and could be obtained in all cases with more time. In our results normal fetus has a very shorter distance than in cleft problems, accordingly to embryologic development where distance can’t be theoretically increased. This normality can be proved with only one common static view. Conclusion: Using the posterior wall, hard palate’s integrity is not so difficult to visualize, even in routine, with a very good sensitivity and specificity. Uvula-epiglottis distance appears to be the best sign to be sure of soft palate’s integrity as for secondary bony palate, and can be also quite easily evaluated using only one 2D profile static view. These first results are very encouraging and have to be confirmed.

P17.11: Abdominal wall defects: a retrospective study on neonatal outcome

Introduction: Fetal subdural hematoma (SDH) is a rare event. With advances in obstetric ultrasound however it has been recognized that SDH may occur in utero before the onset of labor. We present a unique case of atraumatic SDH diagnosed in the second trimester. Case Report: A 31-year-old woman was referred to our institution for the investigation of a brain anomaly detected in an anomaly scan, at 22 weeks and 4 days of gestation. The woman had an uneventful pregnancy so far. A rounded hyperechogenic mass was detected in the posterior fossa, measuring about 2 cm, between the skull and the brain producing only a mild midline shift to the right. A strong suspicion of a fetal subdural hematoma was brought to mind among others. We suggested fetal brain MRI and this confirmed our suspicion of atraumatic spontaneous subdural hematoma of the posterior fossa. Medical consultation was given to the parents stating the scarcity of the condition and the poor prognosis that is referred to the literature. The parents chose the termination of the pregnancy, which took place with misoprostol leading to the delivery of a dead female fetus weighing 596 gr. The pathology report, confirmed the ultrasonographic and MRI diagnosis. Conclusion: Spontaneous fetal subdural hematoma is an extremely rare condition with a poor prognosis and it has never been reported before in literature to occur and be diagnosed at the time of the midtrimester scan. Ultrasound and other imaging techniques such as CT and MRI, and use of Doppler techniques for detecting cerebral hemodynamic abnormalities, might help in earlier diagnosis and perhaps lead to more accurate management and prognosis.

OP27.08: Late intrauterine growth restriction in HIV pregnant women in developed countries

A. J. Talmor1, A. Daemen4, E. Murdoch5, B. De Moor4, H. Missfelder-Lobos1, D. Timmerman2, T. Bourne3,2, C. Lees1 1Department of Fetal Medicine, Obstetrics and Gynaecology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; 2Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, Belgium; 3Imperial College London, Imperial College London, Hammersmith Campus, Du Cane Road, London, United Kingdom; 4Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium; 5Department of Neonatology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom

P38.14: Corpus callosum: comparision between bidimensional and volumetric ultrasound

for mild unilateral ventriculomegaly (1.14 cm). A rescan was done at 22 weeks, 26 weeks, 28 weeks and 30 weeks, respectively. It only revealed mild unilateral ventriculomegaly. We arranged MRI at 22 weeks’ gestation and 32 weeks’ gestation, respectively. There was just multicystic encephalomalacia at 32 weeks’ gestation. Finally, she decided to termination of the pregnancy after feticide. Discussion: Prenatal sonography are valuable tools for the early finding of intracranial lesions and need fetal MRI to confirm the brain lesion. We suggest the fetal MRI optimal time for brain lesion may be at 30–34 weeks.

OP13.08: Corpus callosum abnormalities: 2D, 3D ultrasound and MRI

S. Boito1, A. Righini2, L. Ramenghi3, L. Mandia1, P. Ficarazzi1, R. Fogliani1, G. Pardi1 1Obstetrics and Gynecology Inst., IRCCS Policlinico, Mangiagalli and Regina Elena Foundation, University of Milan, Italy, 2Radiology and Neuroradiology, IRCCS Policlinico, Mangiagalli and Regina Elena Foundation, University of Milano, Italy, 3Neonatal Intensive Care Unit, IRCCS Policlinico, Mangiagalli and Regina Elena, University of Milan, Italy