R. Amster

Reproducibility of Transvaginal Ultrasonographic Measurements of Endometrial Thickness in Patients with Postmenopausal Bleeding

The aim of the study was to establish the reproducibility of transvaginal sonographic measurements of endometrial thickness in patients with postmenopausal bleeding (PMB). In a prospective blind study, two examiners measured the endometrial thickness in 48 patients presenting with PMB by transvaginal sonography on two separate occasions, 30 min apart. The analysis of variance performed at each endometrial thickness measured by the two examiners revealed no statistical difference. However, it was shown that the most accurate measurements are up to the level of 4 mm (mean deviation of 0.1 ± 0.2 mm, range 0.7). Once the endometrial thickness reaches 5–6 mm the mean deviation becomes 0.3 ± 1.2 mm with a range of variation of 4 mm. In conclusion, measurements of endometrial thickness in patients presenting with PMB can be repeated quite accurately up to a level of 4 mm thickness.

Transvaginal ultrasonographic measurements of endometrial thickness : A reproducibility study

The study was undertaken to assess the reproducibility of endometrial thickness measurements by transvaginal ultrasonography (TVS).

TYPHOID FEVER COMPLICATING PREGNANCY

Abstract. Typhoid fever in pregnancy may result in infection of the fetus, with consequent abortion. Currently, it is a rare complication of pregnancy in the industrially developed countries. This report documents a case of maternal typhoid fever with septic abortion, in which trans‐placental infection of the fetus caused its demise.

Effect of the Supine Position on Uterine and Umbilical Blood Flow during the Third Trimester of Uncomplicated Pregnancies in Multiparous Patients

We established the effects of the supine position on umbilical blood flow when measured during the third trimester in 30 multiparous, normotensive patients. Blood flow in the umbilical and uterine arteries and blood pressure in the brachial and popliteal arteries were blindly taken by two different observers: first in the lateral and 5 min later in the supine position. There was a significant difference in mean blood pressure between the two postures. However, there was no statistical difference in the pulse pressure or in systolic/diastolic ratio in the umbilical and uterine arteries between the two positions. Postural changes in normotensive multiparous patients do not affect uterine and umbilical blood flow during the third trimester of uncomplicated pregnancies.

P26.02: Unroofed coronary sinus ASD mistaken as criss‐cross heart

Objectives: To evaluate the frequency, gestational age of delivery or interruption and maternal characteristics of conjoined twins in the Fetal Medicine Department of the São Paulo Federal University (UNIFESP) – Brazil, from 2007 to 2012. Methods: This is a descriptive study based on patients records review. All data from the Fetal Medicine Clinics of UNIFESP from March of 2007 until March of 2012 were reviewed. All conjoined twins attended in our service were included in this analysis. We also described the types and respective incidence of conjoin, as well as the mother’s epidemiologic characteristics. Results: During this period there 10 conjoined twin cases were attended. Eight (80%) cases were thoraco-omphalopagus, and all of them had shared heart in different levels; 1 (10%) was craniopagus and 1 (10%) ischiopagus case. The mean maternal age was 26 years (from 16 to 36), 70% were Caucasian. Eight pregnant women were submitted to termination of pregnancy in the second trimester of gestation and 2 in the third trimester. A cesarean section was executed in 3 patients. 50% of twins were female, 20% were male and 30% did not have sex identified. There was one fetal reduction case in a quadruplet gestation (produced by in vitro fertilization), where two fetuses were conjoined. There was a triplet gestation which two of them were conjoined. Besides the heart malformations, the most common malformations were abnormal umbilical cord, liver conjoin and cystic hygromas. Conclusions: Among the conjoined twins attended in our service during the study, the most common types were the thoracoomphalopagus. We observed heart, liver and umbilical cord malformations as the most common abnormalities. This data is in accordance with previous reports.

P03.14: Diagnosis of severe Ebstein's anomaly at 14 weeks following increased NT

by measurement of combined lung to head ratio. At 38.GW the newborn was delivered by caesarean section on mother’s demand (weight 3400-g, umbilical artery pH 7.31). Due to symptomatic appearance, the decision for surgical repair was taken. Anatomical anomalies like tricuspid atresia or Ebstein malformation must be considered as a differential diagnosis of a right atrial enlargement. Surgical repair should be performed by centers of expertise in neonatal heart surgery.

P15.16: Sonographic measurements of fetal nuchal fold, cerebellum and cisterna magna, in normal fetuses at the early second trimester of pregnancy

Human small supernumerary marker chromosomes (sSMC) are present in 0.043% of newborn infants. They can be defined as additional centric chromosome fragments and generally are equal in size or smaller than a chromosome 20 of the same metaphase spread. Prenatal diagnosis of supernumerary marker chromosomes (SMC) is problematic because of the difficulty of predicting the phenotype. The assessment of phenotypic risk is based on the size, morphology and origin of the SMC. We found a sSMC in long term culture of chorionic villi performed for increased nuchal translucency in a 38 year old woman at 12+4 weeks gestation. Amniocentesis was performed at 15+5 weeks: GTGbanding analysis of amniotic cells confirmed the presence of the additional marker chromosome (karyotype:47,XX,+mar). Both parents had normal karyotypes. Fluorescence in situ hybridization (FISH) analysis using chromosomal specific alphoid satellite DNA probes and whole chromosome paint probes showed that the extra sSMC was derived from chromosome 14. Further characterization of SMC performed by centromere-near-specific multicolor FISH (subcenM-FISH) showed it was an inv dup(14)(q11.1). This region consist of heterochromatic material: SMC without euchromatic content are more likely to result in normal phenotypes. Maternal uniparental disomy for chromosome 14 (associated with precocious puberty, short stature and highly variable developmental delay) was excluded by microsatellite analysis. Pregnancy was continued. No morphological abnormalities were observed on any ultrasound examinations performed during pregnancy. No dysmorphic features were noticed at birth. At 1 year follow-up, the child was growing and developing normally. This case illustrates how a combination of ultrasound examination, FISH characterization and molecular analyses may enhance the accuracy of the information given (diagnosis and prognosis, risk estimates) during prenatal counseling.

P37.09: Fetal reduction in twin pregnancy - does it improve pregnancy outcome?

ultrasound early in gestation. Differential diagnosis is important because of avoiding unnecessary termination. We report here an epigastric heteropagus conjoined female twins case which was characterized by a completely formed fetus with an omphalocele and an adjacent second body consisting with a pelvis and two lower extremities. There was not a bowel or bony connections and there was a thin vascular pedicle between twins. The diagnosis was made with three dimensional ultrasonography at 18 weeks of gestation.

OP11.03: The prevalence of ultrasonic polycystic ovarian morphology in women with endocrinopathies presented with hyperandrogenism and anovulation

Objectives: Polycystic ovary syndrome (PCOS) is the most frequently encountered form of endocrinopathy in women, occurring in 4–7% of the population. Thus, it is important to assess the ultrasound morphology of the ovaries in patients with clinical presentation of anovulation together with the cardinal features of hyperandrogenism. We aimed to study the prevalence of PCOS morphology in a cohort of patients clinically presented with oligoanovulation and/or androgen excess. Methods: Two hundred and twenty-seven women between the ages of 17 and 41 were referred to our reproductive infertility clinic with symptoms of oligo-anovulation and/or androgen excess for endocrine evaluation. All the patients underwent clinical, endocrine and ultrasound investigations. The ultrasound criteria included at least one of the following: either 12 or more follicles measuring 2–9 mm in diameter, or increased ovarian volume (> 10 cm3). Results: PCOS was diagnosed in 165 patients, hyperprolactinemia in 25 patients, thyroid abnormality in 22 patients and non-classical adrenal hyperplasia (NCAH) in 15 patients. No significant difference was found in patients’ age. The patients with PCOS were found to have a significantly higher body mass index (BMI), compared to patients with hyperprolactinemia (P = 0.047), but not with thyroid abnormality or NCAH. Diagnostic rates of PCOS were found in150 (90.9%) of the patients with PCOS, 16 (64.0%) of the patients with hyperprolactinemia, 20 (90.9%) of the patients with thyroid abnormality and 10 (66.7%) of the patients with NCAH. Conclusions: PCOS morphology is common in patients with endocrinopathies who present with ovarian dysfunction and androgen excess. For them, PCO ultrasonic morphology is not sufficient for the diagnosis of PCOS. In order to establish the diagnosis of PCOS, it is important to exclude other diagnoses that may replicate symptoms of PCOS. Appropriate treatment should only be started following complete medical evaluation.

OC96: The role of ultrasound assessment in the diagnosis of polycystic ovary syndrome (PCOS) according to the 2003 Rotterdam ESHRE/ASRM consensus workshop

Methods: 3D ultrasound acquisition was performed in the mid part of the utero-placental unit, once in 29 patients undergoing normal pregnancies and 3 complicated pregnancies (pre-eclampsia and IUGR). Technique, in term of window, depth, Doppler parameters, was the standardized for all patients. Term of examination ranged from 11 to 39 weeks’ gestation. Volume and vascularization (VI: vascularization index, FI: flow index and VFI: vascularization flow index) measurements of placenta, myometrium and uteroplacental unit were realized using a rotational multiplanar technique (VOCAL). Results: Standard values for gestational age are reported in the table.