V. Schiffer

P02.04: Diagnosis of Herlyn-Werner-Wunderlich as a result of fetal anomalies in the second trimester scan: Poster discussion hub abstracts

normal, with increased amniotic fluid volume (AFI 40.4 cm). On the basis of the ultrasonographic findings the postulated diagnosis was 29-30 weeks, Agnathia-otocephaly, with polyhydroamnios. Ultrasound examination performed by Philips, XP5Q and GE, Voluson E8. Three times amnioreduction was done to reduce mother’s discomfort due to polyhydroamnios, total amount 2600 ml of amniotic fluid. Amniocentesis showed a normal karyotype (46 XY). Medical team together with the parents decided to the deliver in face of the maternal risks of the polyhydramnios and the poor fetal prognosis. Delivery occurred at 34 weeks by labor induction after cervix preparation by acupuncture. A male newborn with 1700g with large amount of 5l amniotic fluid. Death occurred spontaneously after a minutes of the birth. In postmortem X ray revealed absent mandible. The autopsy findings confirmed the prenatal ultrasonographic diagnosis of isolated otocephaly. No other malformations were uncovered on postmortem analysis.

EP02.02: The effect of placental location on uterine artery Doppler measurements: Electronic Poster Abstracts

Objectives: Optimum uterine blood flow is of pivotal importance needed for adequate implantation of the embryo and further development of the fetus. We hypothesise distribution of blood supply to the pregnant uterus is not uniform and dependant on placental location. Methods: A total of 62 singleton pregnancies reporting at the Prenatal Diagnostic Centre of the MUMC+ between September 2012-February 2018 and having their placenta located on either the right or left side of the uterus, were evaluated retrospectively. Experienced sonographers determined the location of the placenta in relation to the midline. Left and right uterine artery (UtA) pulsatility index (PI) were measured using a 4-8 mHz abdominal transducer. Percentiles of the PI corrected for gestational age (GA) were calculated offline. A minimum of two measurements per patient was performed during all pregnancy trimesters. Statistical analysis was performed using Student T-test. Results: In total, 184 uterine artery measurements were recorded between 10-38 weeks of gestation. The placenta was located right-sided in 77 cases (41.6%) and left-sided in 107 cases (58.4%). Mean left UtA-PI with a left-sided placenta was 1.1±0.6, compared to 1.4±0.7 with a right-sided placenta (p=0.002). Mean right UtA-PI with a left-sided placenta was 1.3±0.6, compared to 1.1±0.5 with a right-sided placenta (p=0.006). Furthermore, if we used the UtA-PI percentiles to correct for GA, differences remained statistically significant. Mean left UtA-PI showed in both leftand right-sided placenta a decrease of 0.04/week, compared to a mean right UtA-PI decrease of 0.03/week in both leftand right-sided placenta. No significant differences were found in birthweight or gestational age at delivery between rightor left-sided placentas. Conclusions: These findings indicate a raised resistance in contralateral uterine arteries when compared with their ipsilateral counterparts in case of placenta laterality. Further research is needed to answer the principal question if this finding is already a preconceptional occurrence leading to placental laterality.

OP21.02: Placental structure and vascularisation in IVF/ICSI- pregnancies compared to naturally conceived pregnancies: Short oral presentation abstracts

Methods: Interrectus distance (IRD) was measured at four locations (at the umbilical level, 3 cm above the umbilicus, 6 cm above the umbilicus, and 3 cm below the umbilicus) in 100 healthy nulliparous females and 99 postpartum females, while they remained relaxed and performed a head lift to activate the rectus abdominis muscles. Normal IRD values of the two groups were generated and subsequently compared. 99 postpartum females were subject to ultrasonographic examination of pelvic floor functions, thereby generating the hiatal area of the levator ani muscle and scores of pelvic floor dysfunction. The correlation of these values with diastasis recti was then examined. Results: We established ultrasonographic diagnostic criteria for diastasis recti as follows: IRD > 2 mm at 3 cm below the umbilicus, > 19 mm at the umbilicus, > 13 mm at 3 cm above the umbilicus, and > 7 mm at 6 cm above the umbilicus. The results revealed that IRD was positively correlated with body mass index (BMI) in the control group (r = 0.286) and the subject’s age in the patient group (r = 0.23). The incidence of pelvic floor dysfunction was approximately 82.8% among the patients with diastasis recti. Our data indicated that as the abdominal-pelvic pressure increases, IRD and pelvic floor dysfunction also increases. However, once the pressure achieves a certain threshold, pelvic organ prolapse relieves abdominal pressure, reducing the IRD. Conclusions: The IRD can be considered normal up to a width of 2 mm at 3 cm below the umbilicus, up to 19 mm at the umbilicus, up to 13 mm at 3 cm above the umbilicus, and up to 7 mm at 6 cm above the umbilicus in nulliparous women. The nonlinear correlation between diastasis recti and pelvic floor dysfunction may represent a dynamic balance of abdominal-pelvic biomechanics.

OP21.06: Placental examination during routine ultrasounds in a Dutch academic hospital: Short oral presentation abstracts

Conclusion A lack of knowledge on clinical relevance and the amount of ultrasound scans/week seem to be an important feature in poor placental examination. Morphology, umbilical cord insertion and thickness are generally ignored during routine ultrasound. Furthermore, participants are unable to discriminate different placental lakes or calcification grading. V. Schiffer 1, M. van der Wiel 1, M. Spaanderman 1, S. Al-Nasiry 1 OP21.06

OP17.04: Predictive value of serial sFlt-1, PlGF and sFlt-1/PlGF ratio measurement in predicting the development of placental syndrome in women at high risk: a pilot study

in the first trimester. We aimed to explore pregnancy outcomes in women with a positive PE screening test using the Fetal Medicine Foundation (FMF) algorithm. Methods: We conducted a prospective cohort study of Canadian pregnant women with singleton fetus recruited at 11-14 weeks. Lethal anomalies and medical termination of pregnancies were excluded. Maternal age, body mass index, methods of conception, personal history of PE, ethnicity, mean arterial blood pressure, PAPP-A, PlGF and mean uterine artery pulsatility index were submitted into the online FMF algorithm. Simple imputation was used for the treatment of missing values. Pregnancy outcomes, including PE, small for gestational age (SGA) <3rd centile and fetal death, were reported for women with a positive preterm PE screening test (≥1/70) and compared to women with a negative (<1/70) screening test. Results: We included 6067 participants, including 672 (11%) with a positive FMF screening test. The latter were at greater risk of PE (13.4% vs. 3.4%), preterm PE (3.7% vs. 0.3%), PE<34 weeks (1.3% vs. 0.09%), SGA<3rd centile (4.1% vs. 1.4%), preterm SGA<3rd centile (0.7% vs. 0.04%), fetal death (1.2% vs. 0.4%; p=0.004), miscarriage at 14-20 weeks (0.6% vs. 0.2%; p=0.04), or any of the above complications (16.8% vs. 5.0%) than women with negative screening test (all with p<0.0001, except if otherwise specified). Thirty (4.5%) women with a positive test developed one of the severe complications (preterm PE, preterm SGA, fetal death) compared to 31 (0.6%) women with a negative screening test (p<0.0001) after exclusion of miscarriages. Conclusions: Women with a first-trimester positive FMF preterm PE screening test are at high-risk of severe pregnancy complications that are preventable with low-dose aspirin in early pregnancy.