O. Cavicchioni

Placental vascularization measured by three‐dimensional power Doppler ultrasound at 11 to 13 + 6 weeks' gestation in normal and aneuploid fetuses

To establish the potential role of three‐dimensional (3D) power Doppler evaluation of the placental circulation in aneuploidy screening at 11 to 13 + 6 weeks of gestation.

Low cardiac output to the placenta: an early hemodynamic adaptive mechanism in intrauterine growth restriction

A low combined cardiac output (CCO) to the placenta (placenta/CCO fraction) has been reported in growth‐restricted (IUGR) fetuses, but the temporal sequence of these modifications in relation to other changes in the fetal circulation is unknown. The aim of this study was to evaluate the placenta/CCO fraction in relation to other hemodynamic changes in fetuses at risk of developing IUGR.

Examination of the fetal heart by four-dimensional ultrasound with spatiotemporal image correlation during routine second-trimester examination: the 'three-steps technique'.

Objective: To prospectively analyze theaccuracy and rapidity of four-dimensional (4D) ultrasonography with spatiotemporal image correlation (STIC) in the assessment of four-chamber view and outflow tracts in unselected fetuses and in fetuses with congenital heart defects (CHD) at 19–23 weeksof gestation. Materials and Methods: 112 consecutive pregnancies undergoing routine second-trimester ultrasonographic scan and 10 pregnancies with fetuses with CHD affecting the great arteries formed the study group. From the four-chamber view, volumes of the fetal heart were acquired by the STIC technique and stored for a later offline analysis that was performed by two examiners blinded to the characteristics of the fetuses. Offline analysis was performed using a simplified multiplanar approach based on 3 different steps and one rotation finalized to visualize the four-chamber view and the left and right outflow tracts. Results: Adequate recognition of four-chamber view and outflow tracts was obtained in more than 80% of the volumes. There were no false-positives and only one observer had a false-negative (interrupted aortic arch classified as normal). The mean time required to interpret 4D volumes was 3.7 min. Conclusions: The standard fetal cardiac anatomy survey can be performed in the second-trimester fetus by 4D STIC in both normal and abnormal hearts. This approach may reduce the operator’s dependency in diagnosis of CHD.

Application of automated sonography on 4-dimensional volumes of fetuses with transposition of the great arteries

Objective. The purpose of this study was to assess, in second‐trimester fetuses with transposition of the great arteries (TGA), the performance of software (sonographically based volume computer‐aided analysis) that automatically retrieves diagnostic cardiac planes from a 4‐dimensional volume of the fetal chest obtained with spatiotemporal image correlation. Methods. We retrospectively evaluated the 4‐dimensional spatiotemporal image correlation volumes of 12 fetuses with TGA (complete TGA, 10 cases; correct TGA, 2 cases). The data were analyzed to determine whether the target diagnostic planes, that is, cardiac plane 1 (left ventricle outflow tract) and cardiac plane 2 (right ventricle outflow tract), were correctly identified in at least 1 of the 7 automatically generated tomographic sonographic image displays and whether they allowed diagnosis of TGA. Results. In 9 of 10 fetuses with complete TGA, target diagnostic cardiac plane 1 showed a branching arterial vessel (pulmonary artery) arising from the left ventricle, whereas in 7 of 10 fetuses, the aorta arising from the right ventricle was shown. In both cases with correct TGA, the pulmonary artery starting from the morphologic left ventricle was shown, whereas in 1 of 2, the connection of the aorta with the morphologic right ventricle was found. In all of the fetuses with TGA, a ventricular arterial connection anomaly was shown in either cardiac plane 1 or 2. Conclusions. This automatic approach shows good retrieval of diagnostic cardiac planes in fetuses with TGA, which may improve diagnostic efficacy for this disease.

OC170: Can four-dimensional ultrasound with spatiotemporal image correlation be used in the measurement of fetal aortic and pulmonary valve sizes in normal and abnormal hearts?

real-time 3D/4D imaging, which has achieved adequate resolution for measurement of fetal ventricular volumes. Methods: We studied the fetal hearts in 30 pregnant women (range, 21–34 years) with STIC (GE Kretz, Voluson 730, Vocal) and 37 fetuses (16–36 weeks’ gestation) using a 3-MHz (x3-1/iE33, Philips Medical Systems, QLab/3DQAdvanced) or a new 7-MHz (x7/iE33, Philips) 2D matrix array transducer. Full 4D volumes were acquired, some with an internal HR trigger in the system. End-diastolic and end-systolic RV and LV volumes and ejection fractions were measured for both ventricles. Results: Measurements of one or both fetal cardiac ventricles could be successfully obtained in all STIC cases and in 27 of the 37 fetuses analyzed using the matrix array system. For the latter, a total of 115 ‘full cardiac volumes’ (between one and 11 per fetus) were analyzed. Between 20 and 36 weeks’ gestation fetal ventricular volumes in ED and ES increased from 0.4 mL to 4 mL and 0.2 mL to 1.7 mL for the RV, and from 0.4 mL to 3.3 mL and 0.3 mL to 1.7 mL for the LV. Conclusions: Similar results for chamber growth and function have been observed in our study using the two 4D methods for fetal cardiac imaging. It is likely that these measurements are definitive and universal.

OC124: Intrauterine fetal demise (IUFD) following laser treatment in twin to twin transfusion syndrome (TTTS)

Objective: To evaluate the incidence, risk factors and consequences of intrauterine death of one twin, in TTTS treated by laser. Methods: All pregnancies with TTTS treated by laser coagulation of chorionic anastomoses between 1999 and 2004 with IUFD of one twin not related to PROM or preterm delivery were analysed. Staging of the disease, estimated fetal weight, fetal Doppler, placental insertion, interval from procedure to IUFD, surgical complications, intrauterine transfusions and neonatal outcomes were reviewed. Results: 120 cases of TTTS were treated by laser between 1999 and 2004. IUFD of one twin occurred in 45 cases (33%) 8 hours to 85 days after the procedure. These were 29 donors and 21 recipients. This occurred within 24 hours of the procedure in 60% of the cases and within a week in 75%. The second twin also died in utero in 5 cases (11%) within 24 hours following the death of the first twin. 17 of the 22 (77%) donors that died had severe IUGR and 14 of the 45 fetuses (31%) that died had abnormal ductus venosus and/or umbilical artery Doppler. Late miscarriage occurred in 2 cases (5%) within 2 weeks. Brain lesions developed in 2 survivors and termination of pregnancy was carried out. The surviving twin was anaemic and intrauterine transfusion was given in 5 cases within 24 hours of the death of one twin. There were 2 neonatal deaths. 2 babies had severe and moderate neurodevelopmental delay at 36 months and at 1 year of life respectively. 32 of 36 liveborn babies are neurologically normal at 1 to 44 months of life. Conclusion: IUFD of one or both twins occurred in 45 of 120 cases of severe TTTS treated by laser at a mean gestation of 20 weeks and 5 days. The prognosis of the co-twin was poor in 8/40 (20%) of the cases. Separation of the 2 placental circulations was incomplete in at least 10 cases (25%) where the co-twin either died, developed in utero cerebral lesions or was anaemic following the death of its co-twin.

OC251: Evidence of early changes in the distribution of cardiac output to the placenta in fetal growth restriction

Objectives: To examine the relationship between smallness, assessed by customized standards, and the predictive value of a normal umbilical artery Doppler. Methods: A cohort was created of 7645 singleton pregnancies without congenital anomalies. Fetuses suspected antenatally of being small for gestational age were referred for assessment by umbilical artery Doppler. The associations with adverse outcome were assessed for small-for-gestational age babies who had normal and abnormal Doppler, compared with neonates who were not small for gestational age. Perinatal outcome indicators were collected, including fetal distress requiring Cesarean section and neonatal morbidity (neonatal intensive care > 14 days, neonatal seizures, intraventricular hemorrhage Grade III or more, periventricular leucomalacia, hypoxic–ischemic encephalopathy, or necrotizing enterocolitis). Results: Of the 369 small-for-gestational age fetuses which had been identified antenatally, 70 (19%) had an abnormal umbilical artery Doppler and the babies from these pregnancies had an elevated risk of fetal distress requiring Cesarean section (OR 5.89; CI, 2.64–11.84) and neonatal morbidity (OR 3.99; CI, 1.04–11.03). However the 299 fetuses (81%) with normal umbilical artery Doppler also had elevated risk of fetal distress (OR 4.49; CI, 2.96–6.66) and neonatal morbidity (OR 2.26; CI, 1.04–4.39). Because of the higher prevalence, many more instances of adverse outcome were attributable to this group than to the group with abnormal Dopper (fetal distress – population attributable risk (PAR): normal Doppler 8.6 vs. abnormal Doppler 2.7; neonatal morbidity – PAR: normal Doppler 4.0 vs. abnormal Doppler 2.2. Conclusions: Smallness for gestational age according to customized weight standards defines a group of pregnancies with significantly elevated risk of adverse perinatal outcome. Normal antenatal umbilical artery Doppler cannot be taken as an indicator of low risk in these pregnancies.

P31.19: Are there any changes in placental vascularity assessed by three‐dimensional power Doppler ultrasonography in fetal aneuploidies?

was assigned male gender if the angle was > 30◦, and female gender if the genital tubercle was parallel or convergent (< 10◦) to the horizontal line. The intermediate angle (10–30◦) meant gender not determined. Fetal sex was confirmed at the 22 weeks sonogram. Results: Fetal gender assessment was possible in 88.5% of cases, with accuracy rates of 90%, above 12 weeks. The accuracy of male gender assignment was 95–100% at all gestational ages, and that of female gender assignment between 56.4% (at 11 − 11 + 6 weeks) and 98% (at 13 − 13 + 6 weeks). Conclusion: Prenatal gender assignment by early ultrasound is possible and has a high accuracy, particularly above 12 weeks of gestation.

OC159: Three‐dimensional ultrasound in examination of the fetal head: its role in basic and advanced examination of the fetal brain during the second trimester

provided clinically/prognostically important information in five cases and additional clinically irrelevant information in four. In the former group, the ultrasound diagnoses were: MCM + inferior vermis defect (MRI: isolated MCM), hydrocephalus + partial ACC (MRI: hydrocephalus), borderline ventriculomegaly + craniosynostosis + hemimegalencephaly (MRI: borderline ventriculomegaly), hypoplasia of the CC splenium (MRI: normal CC) and corpus callosum lipoma (MRI: + lissencephaly). Overall, the prognosis of the lesion was changed by the MRI examination in 5/92 cases (5.4%), while it increased the confidence of the diagnosis in 21/92 cases (22.8%). Conclusions: Expert neurosonography is able to reach a conclusive diagnosis in most CNS abnormalities referred to a tertiary center. The use of MRI as a second-line diagnostic procedure has a specific place in the evaluation of selected fetal anomalies, following specific queries raised by the expert neurosonologist.

OP12.01: Examination of the fetal heart by four‐dimensional ultrasound with spatiotemporal image correlation: potential for second‐trimester screening of congenital heart disease

7 mm or the maximal JZ was > 10 mm, and in Group B the mean JZ was < 7 mm or the maximal JZ was < 10 mm. Results: The 29 patients in Group A had a mean age of 38 (range, 23–42) years, mean parity of 0.57 children and nulliparity of 52%. The 31 patients in Group B had a mean age of 38 (range, 32–42) years, mean parity of 0.58 children and nulliparity of 58%. In Group A, 15 patients had IVF with their own eggs with a 6% pregnancy rate by cycle (3/49 trials). In Group B, 19 patients had IVF with their own eggs with a 33% pregnancy rate by cycle (19/57 trials). The mean hyperechoic halo between the endometrium and myometrium was 10 mm in Group A and 5.8 mm in Group B. The number of cysts was 5.8 in Group A and 2.6 in Group B.