Florida Institute for Fetal Dx and Rx, USA. Selective intrauterine growth retardation (SIUGR) occurs in approximately 12.5â25% of all monochorionic pregnancies ...
13th World Congress on Ultrasound in Obstetrics and Gynecology of severe brain tumors were terminated upon diagnosis. 3. Tumors associated with good prognosis were seldom associated with TOP. In some of them, an early decision for TOP was reversed after counseling. 4. In several cases, TOP was carried out opposing the teams counseling to continue the pregnancy. 5. Late TOP (beyond 24 week’s gestation) was carried out in most cases of fetal tumors. Conclusions: The natural history of and prognosis of most fetal tumors is well established. Ultrasound has made it possible to detect them early and to perform an accurate follow-up, thus allowing a right decision making process regarding TOP. Apart from intracranial tumors where the chances for the fetus are poor, other tumor location do not give a bad prognosis in advance.
OC097 Fetal MRI and CMV infection I. Simon, P. Sonigo and F. Brunelle Necker Enfants Malades, France Purpose: To evaluate the impact of fetal MRI in case of antenatal CMV infection. Material and Methods: We retrospectively studied 42 fetal brain MRI, (mean term: 33 weeks GA) performed because of maternal cmv seroconversion (n = 22) (systematic screening) or fetal cmv infection diagnosed on US findings (n = 20). In every case of maternal seroconversion an US study was performed prior to MRI. Correlation with fetal pathology (14/16) or paediatric follow-up (22/26) was obtained. Results: In case of seroconversion, US surveyed remain normal (n = 14) or disclosed fetal abnormalities (n = 8). When US was normal, MRI was normal in every case If brain damaged was present on US, MRI helped to assess its severity. When visceral anomalies were isolated on US, MRI showed brain anomalies in 40%. Among the living children, one presented bilateral deafness, although fetal US and MRI were normal. Conclusion: MRI did not confirm its role as a systematic screening test in case of normal fetal US. In case of US isolated CMV visceropathy, MRI helps to disclose cerebral damage but might underestimate encephalitic lesions.
Oral communication abstracts pregnancy outcome, the ethical and legal ramifications have not been completely discussed. By convention, laser therapy is only offered up to 26 weeks’ gestation, to limit the results to pre-viable pregnancies. The presentation will discuss the algorithm that can be used to manage patients with SIUGR.
OC101 The detection of endometrial polyps, the contribution of hysterosonography and colour Doppler D. Timmerman, T. Van den Bosch, M. L. Konstantinovic, P. Moerman, D. Van Schoubroeck, J. Deprest and S. Van Huffel University Hospitals, Katholieke Univ Leuven, Belgium Objective: Unenhanced transvaginal ultrasonography is not accurate in the detection of endometrial polyps. Currently second stage tests, such as saline contrast hysterosonography and office hysteroscopy are used for diagnosis of endometrial lesions. However, both these second stage tests have limitations and side effects. We previously proposed the ‘‘pedicle artery’’ at colour Doppler imaging as a sign of focal endometrial pathology. The objective of this study was to assess the value of this sign to diagnose focal endometrial pathology. Methods: A prospective observational study was undertaken in a teaching hospital in all consecutive patients referred to a single gynecologist in whom the endometrium and myometrium needed assessment with transvaginal ultrasonography and colour Doppler imaging, irrespective of the indication. Results: In 869 patients where a gold standard was available, 182 had one or more endometrial polyps. The ‘‘pedicle artery’’ test had an apparent sensitivity for endometrial polyps of 76.4%, a specificity of 95.3%, positive predictive value (PPV) of 81.3%, and negative predictive value (NPV) of 93.8%. When extending the test to the prediction of any focal intracavitary pathology the PPV was 94.2%. Conclusions: We conclude that the ‘‘pedicle artery’’ sign has a very high PPV for focal intracavitary pathology and we expect that in the majority of patients with an endometrial polyp the ‘‘pedicle artery’’ test may replace more invasive established second stage tests, such as saline contrast hysterosonography and office hysteroscopy.
OC099 Severe intrauterine growth retardation in a monochorionic twin at 28 weeks. Is fetocide justified versus extreme prematurity?
OC102 Assessment and embolization of uterine fibroids
R. A. Quintero
Hopital Ambroise Pare, Boulogne, France ˆ
Florida Institute for Fetal Dx and Rx, USA Selective intrauterine growth retardation (SIUGR) occurs in approximately 12.5–25% of all monochorionic pregnancies, and is associated with increased perinatal morbidity and mortality. Spontaneous demise of the SIUGR twin may result in concomitant demise of the appropriately grown (AGA) twin in up to 40% of cases, or in neurological damage of the AGA twin up to 30% of the time. The adverse effects of the spontaneous demise of the SIUGR twin on the AGA twin are mediated by peri-mortem fetofetal hemorrhage from the AGA to the SIUGR twin through patent placental vascular communications. Management of patients with SIUGR include serial ultrasounds and assessment of fetal well being and early premature delivery, termination of pregnancy, or surgical prevention of peri-mortem feto-fetal hemorrhage either through laser photocoagulation of the placental vascular anastomoses or selective fetocide via umbilical-cord occlusion. The optimal management strategy is unknown. Factors that may aid in the decision include gestational age at the time of diagnosis, presence or absence of abnormal umbilical artery Dopplers, nursery survival and morbidity statistics, as well as moral, religious and medico-legal considerations. Although selective fetocide may not necessarily be viewed as a termination of pregnancy, but rather as an attempt to improve
Although embolization has been increasingly employed by radiologists since the 1970 for many differing conditions, fibroid embolization is comparatively new, despite fibroids being a logical target for embolization. Before fibroid embolization is carried out it is particularly important that the radiologist and gynaecologist are confident in the diagnosis. Embolization should be offered only to symptomatic women complaining of heavy menstrual bleeding, pelvic pain or bulk-related symptoms. Preprocedure imaging should provide precise information on the number, type and size of fibroids with special attention paid to pedunculated subserosal and submucosal fibroids. Associated conditions such as adenomyosis or adnexal abnormality should be excluded. Results of embolization are generally similar with a success rate of over 85% for control of menorrhagia or bulk-related symptoms. The volume reduction of the dominant fibroid is larger than uterine volume reduction and varies between 40 to 70% for the fibroid and 25 to 50% for the whole uterus. Serious complications are mainly infections which have led to hysterectomy in approximately 5 : 1000 patients. Infective complications are more likely with large sub-mucosal or pedunculated subserosal fibroids. Four deaths have occurred following embolization, two from pulmonary emboli and two due to infection in approximately 40 000 cases (0.1 : 1000). A further documented complication of fibroid embolization is ovarian failure.
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Ultrasound in Obstetrics & Gynecology 2003; 22 (Suppl. 1): 1–69
J. P. Pelage
