S. Degani

Expectant management of pregnancy-related high-velocity uterine arteriovenous shunt diagnosed after abortion

To assess sonographic and clinical outcome in women with pregnancy‐related uterine arteriovenous malformations (AVMs) diagnosed after abortion.

Evaluation of Fetal Cerebrovascular Circulation and Brain Development: The Role of Ultrasound and Doppler

The human fetal brain is protected from pressure changes by autoregulation of the cerebral circulation. However, antenatal intrauterine cerebrovascular events are found to play an important role in the pathogenesis of perinatal brain damage. Changes in placental vascular resistance, cardiac contractibility, vessel compliance, and blood viscosity alter the normal dynamics of fetal cerebral circulation. The introduction of various sonographic techniques and the collection of data from the arterial and venous cerebral circulation provide a powerful tool for the evaluation of physiological and pathological hemodynamic events. Anatomic and physiological considerations of cerebral vasculature in healthy and disease states are relevant in studying brain development and variations in fetal brain blood perfusion. The major role of ultrasound and Doppler modalities in the evaluation of fetal cerebrovascular circulation is enabled by implementation of these considerations. Changes in flow characteristics in fetal cerebral vasculature can be used for clinical decision making in situations of fetal compromise, such as growth restriction and anemia.

Prospective randomized comparison between an open and closed vaginal cuff in abdominal hysterectomy.

Objective: To compare an operative and postoperative course of open vaginal cuff hysterectomy and closed vaginal cuff hysterectomy, and to correlate the length of stay, febrile morbidity and the incidence of pelvic fluid collections to the type of surgery. Participants: One‐hundred women scheduled for hysterectomy were prospectively randomized into two groups that underwent either a closed or an open vaginal cuff technique. Results: The open vaginal cuff technique took on average 19% more time than the closed vaginal cuff operation (P<0.05, t‐test). The incidence and size of pelvic fluid collections was significantly higher after the closed vaginal cuff hysterectomy than after the open technique (P<0.01, t‐test). However, the postoperative length of stay, febrile morbidity and the rate of complications were similar. Conclusions: Both techniques of hysterectomy produced a similar postoperative course despite the fact that the closed vaginal cuff technique resulted in a higher incidence of pelvic fluid collections. Therefore considering a shorter operation time for the closed vaginal cuff hysterectomy, this technique seems slightly preferable.

Variations of the origin of renal arteries in the fetus identified on power Doppler and 3D sonography

To investigate anatomic variations of renal arteries (RAs) using 2‐dimensional (2D)/3D power Doppler sonography (PDUS) in normal fetuses and in fetuses with renal anomalies.

Three‐dimensional power Doppler in the evaluation of painful leiomyomas and focal uterine thickening in pregnancy

Objective: To determine the usefulness of 3‐dimensional (3D) power Doppler ultrasound in distinguishing painful leiomyomas from focal myometrial contractions or nonpainful leiomyomas in pregnancy. Methods: A 2D section of the area of interest in the uterine wall was first obtained in 29 patients to determine whether the pain originated from a myoma or a uterine contraction. Then, volume acquisition was activated and Doppler indices (vascularization index, flow index, and vascularization–flow index) were calculated for thickened and normal uterine wall. Results: Of 15 patients found to have uterine myomas, 11 had multiple tumors and 4 had single tumors. In the remaining 14 patients the painful uterine thickening proved to be a focal contraction. Painful segments of uterine thickening were associated with lower Doppler indices. Painful myomas were found to have significantly lower indices than normal uterine wall (P = 0.008, 0.03, and 0.01 for VI, FI, and VFI, respectively, vs. 0.001, 0.003, and 0.01). However, the differences in indices between nonpainful myomas and uterine wall on the one hand, and nonpainful myomas and focal uterine contractions on the other, were not statistically significant. Conclusion: Three‐dimensional power Doppler ultrasound may be a sensitive and reliable tool for distinguishing painful uterine myomas from focal myometrial contractions and nonpainful myomas.

Complication of Laparoscopic Detorsion of Adnexal Mass

Detorsion of an ischemic adnexal mass has recently been advocated for most cases of twisted adnexa. Usually, the affected ovary regains some or all of its vitality and function. However, when the ovary is completely necrotic, it may form an abscess if it contains tissue components that cannot be eliminated by the peritoneal immune system. We report a case of pelvic abscess formation in a detorsed ovary that previously contained an unsuspected dermoid cyst. We call for an extensive inspection of the detorsed ovary before ending the laparoscopic operation, and if it remains necrotic and is suspected of containing a dermoid cyst, it should be removed promptly.

OP33.01: Effect of harmonic imaging, SRI-II, CRI, FFC and coded excitation B-mode features on fetal bowel echogenicity, studied by computerized image analysis

aimed to explore quantifiable sonographic approaches to evaluate uterine involution after vaginal birth. Methods: Eighty-one women who vaginally delivered a singleton at term were recruited. Weekly uterine examinations were performed until 7 weeks after the delivery. Uterine volumes were assessed manually, followed by twoand three-dimensional sonographies. Doppler studies of uterine and arcuate arteries were also carried out. Results: Analysis was achieved in 71 women with uncomplicated postpartum course and complete follow ups. Longitudinal normogram of uterine volumes was created from 497 observations. It demonstrated a steady involution from week 1 to 7 after the delivery. The volume measured by two and three-dimensional sonographies are well correlated (r > 0.7), but not with the manual estimation (r < 0.3). Continuous thinning of endometrial stripes and gradual elevation of uterine artery resistance indices were not correlated with the uterine volume (r < 0.1, and < 0.2, respectively). Resistance indices of the intramural arcuate artery were unchanged for the whole postpartum course. Involution was not affected by parity (r < 0.2). Conclusions: In contrast with traditional belief, the involution process may not be completed yet at 7 weeks after delivery. Uterine involution normogram might facilitate the diagnosis of postpartum uterine complications. Broader applications are expected with the normogram created from two-dimensional data. Additional predictive claims could be achieved with endometrial stripe and uterine artery Doppler indices, since their sequential changes are independent to that of uterine volume.

Fetal eyeball volume: relationship to gestational age and biparietal diameter.

To measure and determine normal values of the fetal eyeball volume between 14 and 40 weeks of gestation.

Instability of doppler cerebral blood flow in monochorionic twins

Objective. The purpose of this study was to evaluate Doppler flow velocity changes in cerebral vessels of monochorionic twins with twin‐twin transfusion syndrome (TTTS). Methods. Repeated Doppler umbilical and cerebral blood flow studies were performed in 7 twin pairs with TTTS. Eight monochorionic twin pairs and 11 dichorionic twin pairs served as control groups. The following Doppler parameters were assessed: umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio, delta PI between the umbilical artery and MCA, and peak systolic velocity (PSV) in the MCA. Results. Significant variations in PSV in the MCA and cerebral indices were found in the study group of monochorionic twins with TTTS. Periods of high PSV with low PI in the MCA were followed by lower PSV in the same fetus. Repeated measurements in the comparison groups were stable without significant variations. The delta cerebroplacental ratio was significantly higher in the study group (0.38 versus 0.09 and 0.19 in the comparison groups; P < .02). Conclusions. Significant changes in Doppler flow velocity and indices suggest instability of cerebral blood flow with episodes of “hyperperfusion” in monochorionic twins with TTTS. Further studies are needed to elucidate the relationship of these transient changes to neurologic sequelae in the neonate.

P17.15: A case of Meckel‐Gruber syndrome: the evolution of the sonographic features from 8th to 13th gestational weeks

ultrasound showed the cystic structure to be a vascular anomaly 20 × 16 mm in size. The lesion demonstrated high blood flow and the presumed diagnosis was that of Vein of Galen aneurysm. No other intracranial anomalies were found (with special attention to possible altered brain structure, edema or ventriculomegaly). The only associated finding was slight cardiomegaly, but there were no apparent signs of cardiac overload (normal ventricular function, no A-V regurgitation, and no pericardial effusion). Dopplers were normal. A fetal MRI was performed to confirm the character of the lesion, as well as the otherwise normal brain structure. The findings were consulted with the department of neurosurgery and radiology to plan appropriate management, and the high-risk character of the lesion and uncertain prognosis were explained to the parents. The patient was followed weekly to assess the growth of the lesion, cardiac function, and possible signs of worsening. An elective cesarean section was performed eight weeks after the diagnosis, leading to the delivery of a male infant, 2770 g, showing no signs of cardiopulmonary compromise immediately after birth. The infant soon underwent endovascular embolization with an uncomplicated postoperative course.