P35Duodenal atresia: prenatal diagnosis and ... - Wiley Online Library

4±7 October 2000, Zagreb, Croatia

Posters

Posters E A R LY P R E G N A N C Y P01 First trimester normograms for a wide variety of ultrasound, hemodynamic and serum parameters

P03 The value of ultrasound screening for fetal abnormalities in the first trimester

V. Serra-Serra, J. E. Serrano, M. J. Ballester, C. Lara, J. Bellver and F. Bonilla-Musoles Hospital Clinico Universitario and IVI Departamento POG, Facultad de Medicina, Universidad de Valencia, Spain

Â . Varga, A. G. KovaÂcs, G. Y. GodoÂ, A. TankoÂ*, G. Y. Steinmetz, A T. Marton and Z. Papp Z.² *Department of Obstetrics and Gynaecology, County Hospital KecskemeÂt, ²University Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary

Background: The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method: A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied. Results: An increasing trend with advancing gestation was evident for the mean gestational sac (MSD) and amniotic sac (AS) diameters, trophoblastic rim, CRL and serum progesterone. The uterine, umbilical and fetal cerebral arteries PI decreased with advancing gestation. The FM yolk sac (YS) diameter and b-hCG levels showed an initial rise and a final decrease. A great interindividual variation was evident for the b-hCG titer. The YS/CRL progressively approached to 0, whereas the MSD/CRL and the AS/MSD progressively approached to 1. The corpus luteum diameter, corpus luteum arteries PI, subehorionic arteries PI, complement levels (C3 and C4), platelet count and activated partial thromboplastin time experienced minimal changes. Conclusion: First trimester normograms for multiple clinical parameters are provided.

Objective: Evaluation of routine screening in the early pregnancy by transvaginal sonography (TVS) in an unselected population. Design and methods: A routine ultrasound examination was offered to every woman in the 12th week of her pregnancy. Besides a detailed survey of fetal anatomy, a measurement of nuchal translucency and karyotyping was performed as appropriate. Results: In a five-year period (from 1. Jan. 1995 ± to 31. Dec. 1999) 9556 women were examined. Fetal anomalies were diagnosed in 54 cases at the 12th week of pregnancy: 63 morphological abnormalities and 16 chromosomal aberrations. The detection rate for structural and chromosomal abnormalities in early pregnancy was 50.5% (54/ 107) of all anomalies, which were diagnosed antenatally. Conclusions: It is possible to detect fetal abnormalities very early in pregnancy. The ultrasound screening may increase the detection rate of chromosomal disorders. The interpretation of fetal anatomy in the first trimester requires comprehensive understanding of embryological development. The detection rate of fetal malformations is increased significantly by introducing an early pregnancy scan in addition to the mid-trimester scan. The fetopathological examination can add more information to the clinicians and to genetic counselling.

P04 Pre-abortion ultrasonography

P02 The first results of the ultrasound transvaginal screening in early pregnancies in Kazan city, Tatarstan, Russia

A. BalicÂ, D. BalicÂ, B. BalicÂ, S. BerbicÂ and I. ZukicÂ Department of Ob/Gyn, University of Tuzla, Health Centre, Bosnia and Herzegovina

L. Teregoulova, L. Bajazitova, A. Latypov and L. Shajhutdinova Republican Clinical Hospital of Ministry of Health of Tatarstan Republic, Russia

Background: The aim of this study was to audit prospectively the value of pre-abortion ultrasonography. Methods: All women who came in our Centre because of doubt unplanned pregancy in first trimester from March 1994 to March 1996 were underwent an exam by vaginal ultrasound before abortion. We analysed these data and compared them with complications after legal induced abortion. Results: During two years a total of 334 women were surveyed. Twenty-seven women (8.08%) were not being pregnant. In thirtythree cases (10.75%) the pregnancy was greater for two weeks than we expected on the basis of last menstrual period. Also we founded: 21 (6.84%) myoma uteri, 5 (1.62%) ovarian cysts, 5 (1.62%) multiple pregnancy, 4 (1.3%) anomaly of the uterus, 1 (0.32%) blighted ovum and 1 (0.32%) nuchal translucency greater than 5 mm. Conclusion: Pre-abortion ultrasonography increases security of this intervention by elimination some problems about induced abortion. Since the elimination is simple, fast and cheap we recommended it for routine use. We hope that is one of the way for decreasing of late complications after abortion like as infertility.

In 1 January 2000 in order of Tatarstan Health Care Ministry transvaginal first trimester screening was introduced in Kazan city. All pregnant women have to be examined in one of 5 the medical centers. We present the results of six month screening for all pregnant women between 10 and 14 weeks gestation. Method: Routine transvaginal ultrasound examination included the measurement of fetal crown-rump length, nuchal translucency and estimation of fetal anatomy. Results: A total 1620 pregnant women of 10±14 weeks of gestation were examined from January till June 2000. All abnormalities were detected at the 12±13 weeks gestational ages. The increasing of nuchal translucency thickness were found in 23 cases, 7 of them chromosomal defects had, in this group in 5 cases cystic hygroma with hydrops were identified. In 12 cases structural anomalies were found: 1-body stalk anomaly, 1 case-omphalocele with liver in it, 1-holoprosencephaly with proboshisis and microphtalmia, 1-encephalocele, 3-acrania, 5-anencephaly. In the cases of holoprosencephaly and encephalocele nuchal translucency measured at 10±11 week was normal. Conclusion: Even the first results of early pregnancy transvaginal screening show its great significance in our city. The most adequate period for transvaginal screening is 12±13 weeks.

Ultrasound in Obstetrics and Gynecology

P05 Use of prognostic biophysical test in the prediction of spontaneous abortion risk in early pregnancy K. Bøaszczyk, M. Wojcieszyn, A. èukasik, M. Biemat and R. Porqba IV Department of Obstetrics and Gynaecology, Silesian University School of Medicine, Katowice, Poland

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10th World Congress on Ultrasound in Obstetrics and Gynecology Background: The aim of the study was to introduce Prognostic Biophysical Test (PBT) in ultrasound diagnostic practice to evaluate spontaneous abortion risk in the first trimester of pregnancy. PBT consists of 3 routine USG parameters estimated together: Crown Rump Length and Yolk Sac (YS) measurement and visualization of Fetal Heart Rate (FHR). Method: USG examination with, 7.0 MHz transvaginal Bruel & Kjaer transducer was performed in 199 pregnant women between 5 and 12 weeks of pregnancy. YS diameter and cram-rump length were measured and compared to nomograms. FHR presence or absence was stated. PBT score was 1 point for correct value off each parameter, and 0 for incorrect one. PBT score of 3±2 points were considered to be good prognostic value, 0±1 points as poor prognostic value. PBT results were compared with pregnancy outcome. Results: PBT allowed prediction of spontaneous abortion with a sensitivity of 97%, specificity of 67%, false positive of 33%, false negative of 3% and positive predictive value of 72%. Conclusion: The test called by the authors PBT seems to be a simple and sensitive option in prediction of spontaneous abortion risk in the first trimester of pregnancy using ultrasound examination.

P06 Isolated hyperechogenic foci in the fetal thalamus in early pregnancy M. Bronshtein*, E. Z. Zimmer*, R. O. N. Auslander² and S. Blazer³ Departments of Obstetrics and Gynecology*, and Neonatology³ Rambam Medical Centre, and Departments of Obstetrics and Gynecology², Carmel Medical Centre, Faculty of Medicine, Technion±Israel Institute of Technology, Haifa, Israel Background: The purpose of this study is to describe the monographic features and outcome of fetuses with isolated hyperechogenic foci in the thalamic region. Method: A detailed monographic survey was performed in 46244 consecutive pregnancies. Both low and high-risk pregnancies were included. Transvaginal examinations were performed at 14± 16 weeks' gestation, while transabdominal examinations were performed after 18 weeks' gestation. Results: Isolated hyperechogenic foci in the thalamic region were observed in 7 fetuses. All cases were diagnosed at 14±16 weeks' gestation. Six fetuses had one hyperechogenic focus, and one fetus had two foci. The size of these foci ranged from 2 to 4 mm. A serologic work-up was negative in all these fetuses and their karyotype was normal. The hyperechogenic foci disappeared in mid-pregnancy in all cases, and fetuses were normal at delivery and on follow-up up to the age of 9 years. Conclusion: Isolated hyperechogenic foci in the thalamic region in the early pregnancy have probably a benign nature.

P07 Fetal gender determination in the first trimester using the transverse view: the importance of the third point D. A. L. Pedreira, A. Yamasaki and C. Czeresnia Clinica de Assistencia a Mulher, Laboratorio Fleury, SaÄo Paulo, Brazil e-mail: [email protected] Aim: To determine the accuracy of fetal gender determination between 11±13 weeks of pregnancy. Material and methods: Retrospective evaluation from October 1997 to July 1999. Transabdominal sonography using 3.5±5.0 MHz curvilinear probes. Fetal gender was evaluated at the transverse view of genital region. Male gender was considered when three hiperecogenic points, triangular in shape (probably corresponding to the escrotum (`two points') and falus (`third point') were visible. Female gender was considered when only two parallel white lines were observed (probably corresponding to the falus pointing to the caudal fetal region. Results: 166 singleton pregnancies had fetal sex determined after birth and/or after cytogenetic results. Total accuracy in determining fetal sex was 82.1%. The most frequent error was evaluating as female the male fetuses.

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Posters

Correct GA (weeks)

CRL (mm)

n

N

%

11±11 1 6 12±12 1 6 13±13 1 6 Total

43.8±55.3 55.4±67.9 68.0±81.7

46 74 46 166

35 60 43 134

76.1 81.1 93.5 80.7

Conclusions: Recent studies on fetal sex determination in the first trimester used mainly the longitudinal view of the fetus to this evaluation. In this study, we describe the presence of the `third point' as an important sign in the characterization of fetal gender, in the transverse view, during the first trimester.

P08 Case report: transvaginal ultrasonographic aspiration in the management of an ovarian cyst detected at the seventh gestational week B. Tekin, H. Hassa, T. SËener and I. SaracË Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Eski8ehir, Turkey Objective: To discuss a different approach, other than cystectomy, to an ovarian cyst detected at early gestation due to the risk of torsion. Case report: During ultrasonographic control of a pregnant at seven weeks of gestation, 30-year-old with two gravidity, one parity and one living child, a cyst with regular contour, measuring 150 130 mm with a wall thickness smaller than two mm was detected. By Doppler evaluation, vascular pattern could not be detected on the cyst wall. Ca 125, AFP, CEA levels were measured as 41.4 U/ml, 2.4 IU/ml, 1.2 ng/ ml, respectively. The cyst was aspirated by a 17 g needle through posterior fornix with the assistance of tranvaginal ultrasonography. In cytological evaluation of the cyst fluid, no malignant cells were found. The case was called for control at 12th week of gestation which was known as the week of the completion of luteoplacental shift. Conclusion: Since ca125 levels could be increased by pregnancy and there was no malignant feature except the dimensions of the cyst, the cyst was supposed to be benign and a conservative approach was planned. Corpus luteum is necessary for the continuation of pregnancy at these weeks of gestation so the anxiety about cystectomy was the termination of pregnancy due to corpus luteum deficiency. On the other hand, however, expectant management could not also be chosen, because the risk of torsion was high due to the texture, dimensions and mobile characteristic of the cyst. For this case who was at a younger age for ovarian malignancy the shrinkage of the cyst by aspirating it with the assistance of transvaginal ultrasonography without dysfunctioning corpus luteum, was decided. The management could be changed according to the cytological evaluation. In conclusion, at the early weeks of gestation, transvaginal cyst aspiration could be a way of management by decreasing the torsion risk without being a handicap for the continuation of pregnancy.

P09 Flow velocity waveforms in the spiral artery versus AFP and BHCG maternal serum concentration in pregnancy complicated by threatened abortion A. Persona-SliwinÄska, J. Brazert and R. Biczysko Department of Gynecology and Obstetrics, Karol Marcinkowski University of Medical Sciences, PoznanÄ, Poland Objectives: The aim of the study was to determine the values of resistance index (RI) and pulsatility index (PI) in the spiral arteries and to evaluate the maternal serum concentration of AFP and b-hCG trying to find correlation between these parameters in the patients in early pregnancy complicated by threatened abortion.


4±7 October 2000, Zagreb, Croatia Study methods: We have analysed 32 pregnant women between 5th and 12th weeks of pregnancy diagnosed as threatened abortion. In all patients TV ultrasound with pulsed color doppler was performed. The RI and PI were calculated for blood flow obtained from the spiral arteries. The concentration of AFP and b-hCG in maternal serum was evaluated by immunoassays. Results: 32 velocity waveforms from spiral arteries were analysed and blood flow indices were calculated. We have found statistically significant negative correlation between the values of both blood flow parameters (RI & PI) and successive weeks of pregnancy. In the tested group in 37.5% of patients the level of b-hCG was low. There was statistically significant correlation between serum b-hCG, AFP concentrations and blood flow parameters. Conclusions: Only the combination of Doppler blood flow analysis in spiral arteries and evaluation of AFP and b-hCG in the maternal serum performed in first trimester may be useful for the intensive fetal monitoring of high risk pregnancies.

P10 Development of cardiac size in early pregnancy P. Rosati and L. Guariglia Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy

Posters Background: The relationships between measurement of cardiac circumference, obtained by transvaginal sonography in early pregnancy, and other sonar fetal parameters ± crown rump length, biparietal diameter, head, toracic and abdominal circumference, femur, humerus and foot length ± were analysed in order to assess the role of these variables for the identification of fetuses at risk of abnormal cardiac development. Methods: Study population consists of 1435 euploid fetuses at 9± 16 weeks of gestation. Ultrasound examinations were performed using high-resolution apparatus (model SSA-270 A and SSA-340 A; Toshiba Medical Corporation, Tokyo, Japan) equipped with 5.0± 7.0 MHz transvaginal probes with a maximal angle of vision of 868 and 1218, respectively. au scans were performed by the authors. Nomograms were established for cardiac circumference vs. eight sonographic parameters. Results: Cardiac circumference demonstrates to be highly correlated with abdominal circumference (r2of 0.65) with narrow confidence interval of cardiac circumference ranging from 6 to 19%. Conclusion: Our results showed also a good correlation between cardiac circumference and the other variables suggesting that cardiac measurement in early pregnancy could be a screening tool for identifying fetuses at risk of disorders affecting heart growth.

P R E N ATA L D I A G N O S I S P11 Fetal scanning between 18 and 22 weeks is passeÂ M. Bronshtein Haifa, Israel Our study summarizes about 40000 early transvaginal examinations (14±16 weeks gestation). There were more than 1200 anomalous fetuses which demonstrated more than 1700 anomalies. We analysed the anomalies according to (1) early onset anomalies, (2) transient anomalies which disappeared toward the second trimester (nuchal findings, echogenic bowel, hypospadias., etc.), (3) anomalies which are much more easily detected in early pregnancy (vascular ring, rt. aortic arch, coarction, finger anomalies, kidney anomalies and others), (4) abnormalities which appear or manifest only in late pregnancy (lissencephalos, achondroplasia, etc.). Conclusions: The percentage of late onset abnormalities is lower than for transient abnormalities. Therefore, performing only one examination by an expert will detect 97% of the detectable abnormalities in early pregnancy. Performing only one examination between 18 and 22 weeks will reveal a lower rate of the detectable anomalies. Most of the late onset anomalies appear later than the 22rd week of gestation. Therefore, the 18±22 week scan is passeÂ and should give way to the 14±16 week TVS scanning in the search for fetal anomalies.

P12 High sensitivity of routine ultrasound scan at 20±24 weeks for detection of fetal anomalies S. C. Cha, O. T. Toma, G. Braia, M.B. Carvalho and D. L. Pedreira Fetal Medicine unit, LaboratoÂrio Fleury, SaÄo Paulo, Brazil Aim: To emphasize importance of experienced sonographer for detection of fetal anomalies. Materials and method: 2726 routine scans were performed at 20± 24 weeks for the detection of fetal anomalies between February 1997 and May 2000. All scans were performed by five sonographers with more than 10 years' experience and the duration of scan examination was 30±60 min. The scan protocol included not only visualization of fetal structures but also besides classical fetal biometry, we performed additional measurement of fetal structures such as cerebellar distance, ocular, cysterna magna, nuchal fold, length of nose bone, atrium of


lateral ventricule, cardiac and toracic area, renal pelvis, iliac angle, relation feet/femur length, length of femur, tibia, fibula, humerus, radius and ulna. Results: Ultrasound scans were able to detect 67 anomalies in a total of 74 malformations observed at delivery. The sensitivity of the method when performed by a highly skilled sonographer is 90%. A total of 7 anomalies were not diagnosed by ultrasound at 20± 24 weeks, including 2 esophageal atresia with distal fistula and 5 perimembranous interventricular communication. Conclusions: Ultrasound scanning for fetal anomalies is highly sensitive when performed by highly skilled sonographers. However, minor cardiac malformations for a low risk population is still the challenge for sonographers.

P13 The impact of transvaginal obstetric ultrasound scan in high risk pregnancy G. R. G. Benute, V. Wojciechowski, T. V. Dias, P. Cianciarullo, J. Quayle, Burlachini, V. Bunduki, R. Yamamoto, S. Miyadahira, M. C. S De Lucia and Zugaib Psychology Division and Obstetric Department, Hospital das ClõÂnicas, SaÄo Paulo University Medical School, SaÄo Paulo, Brazil Background: The acceptance of transvaginal ultrasound among Brazilian pregnant women is not yet established. Objective: To evaluate the level of acceptance of transvaginal ultrasound (US) among high risk pregnant women. Method: Psychological semi structured interview with 50 pregnant patients scheduled to undergo ultrasound exam. Results: 94% of the patients arrive without knowing they are going to undergo a transvaginal US and 80% believe they are going to undergo a regular abdominal US. Asked about the utility of transvaginal US, 46% didn't know; 70% didn't have any preferences about the sex of the ultrasonographist. After the exam, 76% of the patients referred no particular discomfort, but 46% would prefer to have an abdominal US scan if they could choose, but all emphasized they would undergo the exam again if the doctor said it was necessary. As far as sexuality, 12% mentioned some difficulty with the partner and 40% referred that it is hard for women to discuss subjects related to sex. Conclusion: The discomfort eventually associated to transvaginal US

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10th World Congress on Ultrasound in Obstetrics and Gynecology is not related to the sex of the examiner but to his attitude. Patients' fantasies play an important role in the emotional discomfort elicited by the situation where cultural aspects are deeply imbricated.

P14 Sonographic features of the cervix in the midtrimester as a predictor of preterm delivery T. Fukami, T. Sekiya, K. Yoshimatsu, T. Otabe, K. Tsukada, K. Ishihara and T. Araki Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan Background: The purpose of this study was to predict preterm delivery by transvaginal ultrasound in the midtrimester. Method: This prospective study was conducted on 568 outpatients with normal pregnancy up to 16 gestational weeks. After the patient's consent was obtained, serial transvaginal ultrasound scanning (TVS) was planned at 2±4 weekly intervals from 16 to 27 gestational weeks, and used to assess cervical length, cervical gland area and internal os dilatation. Results: (1) The preterm delivery (37 weeks gestation) rate of the patients was 3.0% (17/568). (2) Of the three predictive factors of preterm delivery namely shortened cervical length (30 mm), absence of cervical gland area, and internal os dilatation, the most useful monographic feature of the cervix was absence of cervical gland area examined at 16±19 weeks gestation. (3) The combination of these factors at 16±19 weeks gestation improved the predictive value (sensitivity 35%, specificity 99%, positive predictive value 88%, negative predictive value 96%). Conclusion: For the prediction of preterm delivery by TVS in the midtrimester, the most appropriate gestational period was at 16± 19 weeks, and the best predictive factor was a combination of the absence of cervical gland area with shortened cervix and internal osdilatation.

P15 Cervical cerclage: comparison of two techniques by transvaginal ultrasound P. Rozenberg, A. Gillet and Y. Ville University Paris-Ouest, Department of Obstetrics and Gynecology CHI Poissy-St Germain, France Background: Cervical cerclage can be performed using either the MacDonald technique or following an anterior colpotomy (Shirodkar technique). A randomized study comparing the two techniques would be impossible to run since 1900 patients would have to be included in each arm. Objective: To evaluate the benefit of performing a colpotomy prior to putting a cervical suture, by measuring the distance between the stitch and the external os. Design and methods: Retrospective case-control study (January 1997± January 1999). All patients having had cervical cerclage after anterior colpotomy and giving birth in our Institution were the study group. Each case was matched with the next patient giving birth in our Institution after having had a MacDonald cerclage. The indication was left to the surgeon's decision and each surgeon used only one technique. Obstetrical characteristics were recorded and ultrasound measurement of the cervix was performed within 8 days following the procedure. Results: During the study period, there were 15 cases in each group. There was no significant difference between the two groups in the obstetrical outcome. Cervical length was 36.6 mm and 35.4 mm, and the distance between the stitch and the external os was 16.1 mm and 13.5 mm in the Shirodkar and the MacDonald groups, respectively. Conclusion: Anterior colpotomy did increase the distance between the stitch and the external os by only 2.6 mm and does not seem to offer any clinical benefit.

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Posters

P16 Office ultrasonography in obstetrics: an eight year experience E. A. Assimakopoulos 1st Department of Ob/Gyn. Aristotle University of Thessalonki, Greece Background: We present an eighth year experience (1991±98) of ultrasonography in a private office, using a portable ultrasound unit, Aloca SSD-500. Method: Each pregnant woman underwent transvaginal ultrasound examination 7±8w in order to date pregnancy, to confirm fetal viability and the number of fetuses. At 17 weeks, a second trimester screening for Down syndrome was ordered by using BPD, maternal age and maternal serum AFP and free b-HCG. Later, at 20±22w a detailed scan was performed to all pregnant women in order to exclude fetal anomalies. Results: In 1019 consecutive pregnant women, 22 could not recall the date of their LMP and 59 had irregular cycles. By measuring the CRL, the expected date of delivery was accurately calculated. One hundred and seventy-six women underwent amniocentesis with no complications, and from these, there was only 1 case with trisomy 18. All pregnant women had level II scan. There were 5 cases with abnormalities (1 cystic hygroma, 1 diaphragmatic hernia, 1 with talipes, 1 anencephalic and two with hydrops). We couldn't diagnose prenataly 1 case with coarctation of the aorta, 1 anorectal atresia, 1 microcephaly and 3 with Down Syndrome. All the other women delivered babies with normal anatomy. As far as the cost is concerned, there was no extra charge for ultrasound examinations. Conclusion: Office ultrasonography is feasible after long-term training and experience. Acknowledgements: W. R. Lees and J. C. Hobbins.

P17 At what gestational age can the corpus callosum and cavum septi pellucidi be regularly seen at routine obstetrical ultrasound examination? A. Toi University Health Network, Toronto General Hospital, Toronto, Canada Background: Agenesis of the corpus callosum (ACC) is reported to be difficult to detect before 22 weeks gestation. However, the cavum septi pellucidi (CSP) develops with the CC and is seen by 15± 16 weeks. Thus, ACC should be detectable by 16 weeks. Purpose: To determine at what gestational age the cavum septi pellucidi and corpus callosum become regularly visible and hence ACC can be suspected if they are not visible. Methods: Fifty consecutive women referred for US for all indications between 25 June and 9 July 1999 were scanned trans-abdominally with specific attempt to see the cavum septi pellucidi (CSP) and the corpus callosum. Results: BPD ranged from 32 (15.6 week) to 81 mm (33.1 week). The CSP was visible in every fetus starting at BPD 34 mm (16.2 week). On mid sagittal views the CC was also visible starting at BPD 34 mm (16.2 week) in all but 3 fetuses due to fetal position. The CC was seen well enough to confidently measure its length in 27/49 (55%). Conclusions: At routine examination, the CSP was detectable by 16.2 week (BPD 34 mm) gestation and in every pregnancy after this age. Using only trans-abdominal scans, the CC was visible on sagittal views by exploiting access provided by sutures and fontanelles. Detection of complete agenesis of the corpus callosum should be possible by 16 weeks gestation.

P18 Fetal cerebral ventriculomegaly. An observational study R. Pinzano, J. Meir, R. Natale, G. C. Conoscenti, L. Fischer-Tamaro, G. P. Maso, P. Bogatti, M. A. Rustico and G. D'Ottavio Istituto per l'Infanzia `Burlo Garofolo', IRCCS, Trieste, Italy Background: The aim of this study is to review all the cases of FCV


4±7 October 2000, Zagreb, Croatia diagnosed in the Obstetric and Gynecology Unit of our Institution from 1990 to 1999 and to evaluate the neonatal outcome. Method: This is a retrospective study. The diagnosis of ventriculomegaly is according to Cardoza criteria and to atrial width $ 10 mm between 15 and 40 weeks gestational. For all cases we consider: progression and/or resolution; association with other fetal ultrasound signs of malformations and with chromosomal abnormalities; fetal infections (TORCH); pregnancy termination and follow-up by pediatric report. In cases of interruption of pregnancy we evaluate postmortem examination. Results: Among 165 cases of FCV, n 84 (50.9%) are associated with malformation of SNC, n 59 (35.76%) are isolated, n 22 (13.33%) are associated with other fetal malformations. In the group of isolated: 32 case are borderline (# 15 mm), chromosomal abnormalities are 4 among 40 evaluated (10%), favourable neonatal outcome is present in 22 cases of 29 born (75.86%). Conclusions: In this study the percentage of chromosomal abnormalities in the FCV isolated is higher than other series in the literature. The reproducibility of measurement of atria rather permits comparisons than other qualitative and quantitative signs.

P19 Evaluation of fetal lung maturity by the gray level histogram width M. Serizawa and K. Maeda Department of OG/GY. Hamamatsu Medical Center, and Department of OB/GY. Seirei Hamamatsu Hospital, Shizuoka, Japan Maeda has normalized gray level histogram width (GLHW) of fetal lung and liver. The fetal lung GLHW was less than 30% and smaller than the liver in 24±29 weeks. However the fetal lung GLHW was similar to the liver and over 30% after 30 weeks. We suggest this change of GLHW have relation to fetal lung maturity. Method: The histogram was described with Aloka SSD-1200, the 1250pixels were set at fetal lung and liver. GLHW is obtained by the histogram base length is divided by the full gray scale length. The 10 fetuses lung and liver were recorded in 24±31 weeks, and amniotic fluid samplings by transvaginal or amniocentesis were examined microbubble test. They were delivered during 1±3 days later, we diagnosed RDS or nonRDS by clinically. Result: The GLHW of fetal lung/liver was 32.45/34.03 in 5 fetuses less than 10 microbubble rate and nonRDS (Group 1), no significant difference. The GLHW of fetal lung/liver was 30.23/34.44 in 5 fetuses over 10 microbubble rate and RDS (Group 2), significant Ê AÊ0.016). The fetal lung GLHW was no significant difference (PA difference in group 1 and 2 (32.45/30.23) (P 0.064), however, in the over 30 fetal lung GLHW, 5 were nonRDS and 2 were RDS, in less than 30 fetal lung GLHW, all are RDS, significant difference (P 0.04). Conclusion: The fetus of fetal lung GLHW is smaller than liver and less than 30 is almost RDS, the case of fetal lung GLHW is larger than liver and over 30 is almost nonRDS.

P20 Early membrane funnelling may occur from 16 weeks onwards and carries a worse prognosis J. Bellver, G. Lberico, C. Lara, J. Ferro, J. RemohõÂ, A. Pellicer and V. Serra-Serra Instituto Valenciano de Infertilidad & Departamento POG, Facultad de Medicina, Universidad de Valencia, Spain Background: Sonographic screening for cervical incompetence during pregnancy is currently a routine procedure. However, no consensus exists on the optimal gestational age to perform such screening. Method: Serial transvaginal ultrasound examinations of the uterine cervix were routinely performed from 12 weeks onwards. The screening was considered positive when membrane funnelling was present or the cervical length was , 2 cm. Therapeutic measures included bed rest, antibiotics, tocolytic treatment and a modified McDonald's cervical suture (up to 25 weeks).


Posters Results: Membrane funnelling was detected between 16 and 22 weeks (group A) in 9 women (31%); between 23 and 28 weeks (group B) in 11 women (38%) and between 29 and 36 weeks (group C) in 9 women (31%). Two women presented with hourglass membranes at 20 and 23 weeks, respectively. Comparison between groups A and B showed similar women characteristics and risk factors (P NS). Delivery rate at # 28 weeks was higher in group A (62.5%) than in group B (9.1%) (P , 0.03). Only one woman in group A and three in group B delivered at term. Conclusion: This small series provides evidence to recommend serial monographic examinations of the uterine cervix, starting at 16 weeks. A greater risk of very premature delivery was evident when membrane funnelling was diagnosed before 23 weeks.

P21 Fetal liver volume in normal and reduced fetal growth S. Boito, P. C. Struijk, J. Laudy, H. R. Stijnen and J. W. Wladimiroff Department of Ob/Gyn, University Hospital Rotterdam, The Netherlands Background: To establish reproducibility and normal values for fetal liver volume and its significance in identifying fetal growth restriction relative to head (HC) and abdominal circumference (AC) according to a cross-sectional study design. Method: The measurements were obtained using a Voluson 530-D for volume scanning. The coefficient of variation (CV) for liver volume scans (t0, t20 min) and liver area tracings (t0: 2x; t20: 2x) was determined (n: 20; 23±36 weeks). Normal charts for liver volume, HC, AC were constructed (n: 60; 22±37 weeks) and related to data from growth-restricted fetuses (birthweight , P5) (n: 13; 23± 36 weeks). Results: CV is 2.9% for volume scans and 1.6% for area tracings. Mean liver volume (P50) ranges between 16.5 mL (^ 5.9 (SD)) at 22 weeks and 101.8 mL (^ 8.2 (SD)) at 37 weeks. In fetal growth restriction, liver volume, HC and AC expressed as percentage of the normal P50 is 45%, 91% and 83%, respectively. Mean difference in liver size between fetal growth restriction (FGR) and normal fetal development (Z score Liver volumeFGR ± P50normal/SDnormal) is 24.5 ^ 1.6 (SD), which is significantly different (P , 0.05) from HC: 2 3.2 ^ 1.5 (SD), but not from AC: 2 4.3 ^ 1.3 (SD). Conclusion: Acceptable reproducibility exists for liver volume determinations. Normal liver volume increases 6-fold at 22± 37 weeks. Fetal growth restriction: reduction is more pronounced for liver volume than HC and AC; liver volume is a better discriminator than HC, but not AC.

P22 The efficacy of IUGR treatment with argininÐthe ultrasound assessment: preliminary report P. Sieroszewski, J. Suzin, G. Surkont and A. Karowicz-BilinÂiska Madurowicz Hospital, Institute of Obstetrics and Gynecology, Medical Academy, University of èoÂdzÂ, Poland Objective: To study the efficacy of IUGR treatment with arginin with the use of ultrasound biometry measurements. Design and methods: A pilot study was performed on 45 pregnant women with IUGR fetuses (EFW , 10%ile). 30 patients were treated with arginin 2 g daily po during 20 days (I group). 15 patients were not treated (control-II group). After 3 weeks ultrasound measurements were repeated. Results: The increase in EFW was greater in I group (587 g vs. 321 g, P , 0.005). After delivery we noticed differences in weight between both groups, but they were not statistically significant (2753 g vs. 2495 g, NS). Percentage of IUGR newborns was higher in 11 group (29% vs. 73%, P , 0.005). Conclusions: 1. EFW (ultrasound assessment) is useful to supervise IUGR fetuses treated with arginin. 2. Arginin treatment of IUGR fetuses is often skuteczne. The project is ongoing. (KBN 4 P05E 01616).

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10th World Congress on Ultrasound in Obstetrics and Gynecology P23 Ultrasonographic weight estimation of the macrosomic fetus: the benefit of two examiners I. Gull, I. Wolman, J. Har-Toov, G. Fait, R. Amster, J. B. Lessing and A. J. Jaffa US Unit Ob/Gyn, T.A.M.C, Israel Background: Using two examiners to obtain more accurate estimation of fetal weight (EFW) in suspected macrosomy is commonly accepted. However, the real benefit of such routine has not been validated. Aim: To validate and calculate the benefit of using two examiners for increasing the accuracy and decreasing errors of more than 10% in EFW of macrosomic fetuses. Methods: Fifty term fetuses suspected for macrosomy were examined by two examiners. The accuracy and the number of errors of EFW of more than 10% were calculated for each examiner, and compared to an average estimation of both examiners. Results: The average birth weight was 4140gr. The estimation accuracy of the examiners was 5.83% and 6.18% (N.S.). Using an average estimation of both examiners the accuracy increased to 5.75% (N.S.). However, using two examiners decrease the number of errors of more than 10%. Twelve fetuses were estimated erroneously by at least one examiner. Only 6 fetuses were estimated erroneously when the EFW was based upon the average of the two examiners. Conclusion: Although the use of two examiners for EFW in macrosomic fetus doesn't increase the accuracy, it decreases errors of more than 10%.

P24 Fetal porencephaly as a rare complication of epignathus occluding blood flow in the internal carotid artery B. Lex*, C. Berg*, E. Reusche², D. Masson³ and U. Gembruch* Division of Prenatal Medicine* & Department of Pathology², University of LuÈbeck, Hamburg³, Germany Background: Epignathus is a rare benign congenital teratoma of the hard palate. Some of these tumors protrude bidirectionally involving pharyngeal as well as intracranial structures. The poor prognosis of the affected fetuses is due to consecutive airway obstruction and destruction of brain tissue. We report an unusual case of epignathus leading to compression of the internal carotid artery with subsequent porencephaly. In a 27-year-old gravida 1 at 25 weeks gestational age with polyhydramnios, ultrasound examination demonstrated extensive epignathus with displacement of adjacent structures, hydrocephaly and porencephaly. Neither brainstem nor cerebellum could be clearly identified. A steal effect was excluded as low tumor vascularisation and high resistance indices of the supplying vessels was demonstrated, therefore porencephaly was suspected to be caused by vascular compromise. Amniocentesis revealed a normal karyotype. The parents elected to terminate the pregnancy. Autopsy results were confirmatory. An immature teratoma of the hard palate measuring 95 42 32 mm compressing the left internal carotid artery was demonstrated, leading to colliquation necrosis of the left hemisphere. Additionally displacement of brainstem and infiltration of cerebellum led to cerebrospinal fluid block and consecutive hydrocephalus. Conclusion: Only few reports exist on the prenatal diagnosis of epignathus. We report the first case of epignathus causing extensive brain damage by vascular compromise.

P25 An alobar holoprosencephaly; a case report A. GuÈl Dept of Ob/Gyn, Turkey Alobar holoprosencephaly characterised by median malformations of the face and brain due to incomplete cleavage and morphogenesis of the fore brain. The alobar holoprosencephaly occur in about 0.6±1.9 of 10.000 deliveries. Median facial abnormalities consist of orbital hypotelorizm, cyclopia in combination with a flat nose or proboscis

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and oral deformities can be diagnosed with ultrasonographicaly at the early antenatal period. In this case report we introduced a fetus with an alobar holoprosencephaly diagnosed at 24 weeks of gestation according to BPD and FL measures. In obstetric ultrasonography, spinal cord, vertebras and spinal canal were normal in structure, but interhemispheric fissure, falx cerebri and corpus callosum were not visualised. There was single-chamber ventricle in semihiron shape that continued with a dorsal cyst filing the calvarium. Decision for pregnancy termination was made after the consultation with the pediatricians. In neonatal examination, there was no gross deformity of the trunk and extremities. As a facial deformity, cyclopia and 3 2 cm sized proboscis attacked above the insignificant nasal structure was detected and only one eye was present at the middle of the face.

P26 Congenital Rubella syndrome and fetal exencephaly ± case report J. Q. Andrade, S. Miyadahira, S. P. Curtis, C. A. Figueiredo, R. M. Yamamoto and Zugaib Departments of Obstetrics and Gynecology, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil (FMUSP) Exencephaly is characterized by a complete or partial absence of the skull'cap, follwed by abnormal development of the cerebral tissue. We report a case of a 31-year-old, white patient, on the 9th. week of her second gestation who presented with fever, coryza and myalgia. The gestational period was calculated based on the first ultrasonography, and the maternal sorology for rubella was positive (IgG and IgM). The patient was send to the department of Fetal Medicine-HCFMUSP for evaluation. Morphologic ultrasonography and another sorology for rubella were performed. On the 12th gestation week, ultrasonography revealed absence of the skullcap and the presence of cerebral tissue floating in the amniotic fluid. Maternal sorology still showed positive (IgG and IgM). The patient suffered a miscarriage and the maternal (fetus and placenta) was analyzed at the Virology Department of Adolfo Lutz Institute. The virus of rubella was isolated in all the examined organs, and the presence of congenital rubella was confirmed. Considering that the etiology of this malformation is still umknown and is associated with a severe congenital infection we speculate that is coul be a consequence of the massive fetal compromise caused by the rubella virus.

P27 Unusual fetal infection leading to early IUGR and hydrocephaly: case report D. A. L. Pedreira, D. Jasinowodolinsk, A. J. Rocha, R. Schultz, M. C. N. Zerbini and S. C. Cha LaboratoÂrio Fleury, SaÄo Paulo, Brazil. [email protected] LRK, 34 years-old, primigravida, had first scan done at 10 weeks 1 day with CRL compatible with 9 weeks 1 5 days. At 12 weeks 2 days, nucal translucency measured 1.0 mm, Doppler velocimetry of ductus venosus (positive A wave) showed posite A wave and CRL measured 46 mm (11 weeks 4 days). At 21 weeks 1 6 days the anomaly scan revealed dilatation of cerebral ventricles, asymmetric IUGR (measurement compatible for 17w 1 6d), oligohydramnios and severe placentomegaly. Amniocentesis showed normal karyotipe (46XX). MRI was performed at 22 weeks, using T2 sequence and single shot fast spin echo (SSFSE) without maternal or fetal sedation. Global dilatation of cerebral ventricles, without signs of obstruction or other CNS malformations. Delivery was induced after spontaneous fetal death at 23 weeks, a female stillborn weighting 240g showed no other malformation then those described in CNS. Anatomo pathologic evaluation of the brain revealed encephalitis and periventriculitis and placenta showed severe vilositis. Immuno-histochemistry of the brain/ placenta was negative for herpesvirus and CMV, but adenovirus was positive in both tissues. Maternal serology from the begining of pregnancy showed no antibodies against toxoplasmosis, HIV or syphilis and acquired antibodies to rubella, CMV, Hepatitis B. At delivery all this serologies were repeated and results remained the


4±7 October 2000, Zagreb, Croatia same. Maternal serology for adenovirus in a stored sample collected at 18 weeks showed a 1/8 titre. Discussion: Besides the usual torch infection, other infections can severely affect otherwise normal pregnancies. The identification of other possible infection agents may help to elucidate the so-called `idiophatic' causes of spontaneous fetal death. We suggest the inclusion of adenovirus in the infection screening of such cases.

P28 Prenatal diagnosis of schizencephaly: case report N. Lagos, C. GarcõÂa, R. Walton, I. Hoffmann and H. MunÄoz Hospital de Carabineros, Universidad de Santiago, Santiago, Chile Background: Schizencephaly is a rare congenital malformation of the central nervous system. It consists in the finding of unilateral or bilateral clefts in the cerebral hemispheres. Case report: 36-year-old patient, at week 22, an ultrasound showed hydrocephaly with a 19-mm atrium. At week 27, a 6-mm diameter defect was shown in the cerebral parenchyma of the right hemisphere, that was comunicated with the lateral ventricle, with normal atrium. The conclusion was Schizencephaly. Magnetic resonance imaging (MRI) also showed the parenchymal defect, with comunication to the lateral ventricle, and no hydrocephalus. Cesarian section was performed at week 38, with a 2780 g. Newborn: Postnatal echography and computed tomography showed no changes. Discussion: Two types of schizencephaly have been described: Type I, in which the defect is closed-lip, because the lips of the clefts are fused within a pia-ependymal seam that is continous with the ependyma of the lateral ventricle, and type II, in which the lips remain open, and the clefts are more extensive. Pathogenesis is unclear but anomalies of neuronal migration during the third to fifth gestational months are invoked. Clinically, patients have seizures, developmental delay and hemiparesias. In this case, diagnosis was suspected by ultrasound and confirmed by MRI, which is the best method. Ultrasound permited us to follow the defect and best decide when to interrupt pregnancy.

P29 The effectiveness of antenatal ultrasound in the detection of facial clefts

Posters present the earliest prenatal case of fetal seizures diagnosed by ultrasound during the 15th week of gestation. Method: A 34-year-old woman gravida 10, para 3, with 6 miscarriages and 2 healthy living children, was referred for targeted sonographic examination at 15 weeks' gestation because of her bad obstetric history. Normal fetal structures and biometry were revealed. Repetitive episodes of jerking movements of fetal body and limbs were detected. Limited flexion of the limbs was also observed. Results: Triple marker screening performed at 17 weeks' gestation was abnormal with a 1:13 risk for Trisomy 21, but the woman refused amniocentesis. The couple received extensive counselling, but refused further investigation and were lost to follow-up until delivery. At 36 weeks' gestation, the woman was admitted with prom and breech presentation. A female newborn weighing 2000 g with apgars of 8 and 9 and cord ph 7.32 was delivered by cesarean section. Several hours after delivery, the newborn developed apnea and seizures requiring anticonvulsive treatment. The neonatal investigation revealed mitochondrial disease. Conclusion: Fetal seizures can be diagnosed in early gestation. In this presentation, we will present the case and review the literature and differential diagnosis of fetal and neonatal seizures.

P31 Structural reorganization of the brain after perinatal damage ± US/MRI review T. Gojmerac, V. MejasÏki-BosÏnjak, J. Polak-BabicÂ and M. RadosÏ Children's Hospital Zagreb and Croatian Institute for Brain Research, Zagreb, Croatia Background: The aim of this study was to estimate structural reorganization of the brain after perinatal brain damage, diagnosed by ultrasonography (US) in the neonatal period, using magnetic resonance imaging (MRI). Methods: A follow up study was carried out on a cohort of 28 perinatal risk children who were ultrasonographicaly followed during the first 2 years of life. 22 children, who had intraventricular haemorrhage (IVH I and II), were in the investigation group and the other 6, who had continuous normal us findings, were in the control group. Follow up included high resolution 2T magnetic resonance imaging of the brain at 13±16 years.

C. Cash, P. Set and N. Coleman* Department of Radiology and Histopathology*, Addenbrooke's Hospital, Cambridge, UK Objective: The aim of this study was to assess the sensitivity and specificity of antenatal ultrasound in the detection of facial clefts in a low risk screening population. Design: This retrospective study covered a five year period from January 1993 to December 1997. From the study of antenatal, postnatal surgical and pathological records, a complete number of second trimestre fetuses with a cleft defect was identified. Correlation was made with the routine 18±20 week anomaly ultrasound examination in order to assess accuracy of diagnosis. Results: After necessary exclusions there were 26 fetuses with cleft defects out of 23 577 live and stillbirths. The defect was detected in 17 of these 26 cases (65%). In 12 of these 17 (70.5%) the antenatal diagnosis was completely accurate, in the remaining 5 cases part of the defect was not detected. Conclusion: In a low risk population it is possible to detect approximately two thirds of all fetuses with a cleft lip or palate. With the increasing emphasis on clinical governance, this study helps to set an achievable standard.

P30 Early prenatal diagnosis of fetal seizures S. Haddad, J. Younis, D. Peleg and Ben-Ami Ultrasound Unit, Department of OB/GYN, Poriya Government Hospital, Tiberias, Israel Background: Prenatal diagnosis of fetal seizures is rarely reported. We


MRI Results cases (n 22) controls (n 6)

US

IVH I (n 12) IVH II (n 10)

normal

PV1

CA2

ML3

9 4 4

0 3 2

2 1 0

1 2 0

1

PV periventricular tracks of haemorrhage; 2CA cortical atrophy; ML multiple lesions

3

Conclusion: Abnormal MRI scans are more frequently in the cases with IVH II, than in the cases with IVH I. We can conclude that structural reorganization of the brain can repair majority of mild perinatal intraventricular haemorrhage.

P32 Early prenatal diagnosis of axillary cystic limphangioma G. Sancho-Leza, P. Morales Utrillas, I. Guerra, J. M. MarõÂn Mesa and R. FernaÂndez SepuÂlveda Txagorritxu Hospital, Vitoria, Spain We present the rare occurrence of a progressive fetal axillary cystic limphangioma. A 37-year-old woman was referred at 13 weeks' gestation for fetal karyotyping because of the maternal age. At this moment the sonographic examination revealed a single live fetus with

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10th World Congress on Ultrasound in Obstetrics and Gynecology a 30 23 27 mm right axillary multilobulated mass without colour-flow imaging. At 15 weeks' gestation the amniocentesis was carried out. At this moment the size of the mass was 45 33 40 mm. Cytogenetic analysis revealed a normal 46, XY karyotype, At 18 weeks' gestation the ultrasound examination indicated progressive enlargement of the mass and its size was 78 80 80 mm. The patient was counselled regarding the diagnosis of limphangioma. Although the prognosis appears to be good the couple opt to terminate the pregnancy. Pathological examination confirmed the diagnosis of cystic limphangioma. The different types, the prognosis and management of the fetal limphangioma are discussed.

P33 Fetal diaphragmatic hernia: our experience of 43 cases A. Galindo, Carrera, J. Arbues, J. M. Puente, Benedicto, I. Cano and P. De La Fuente Department of obstetrics and Gynecology, Hospital Universitario `12 de Octubre' de Madrid, Madrid, Spain Aim: To review our experience with diaphragmatic hernia (DH). Methods: We review retrospectively 43 cases prenatally diagnosed and 7 postnatally between January 1990 and November 1999. Results: The incidence was 1/1496 deliveries. Sensitivity was 86%. Mean gestational age at diagnosis was 29 weeks. In 15 cases (38%), diagnosis was # 22 weeks; perinatal mortality rate (PMR) in these did not differ significantly from that in cases of later diagnosis (80% vs. 50%). In 36 cases (83.7%) there was left-sided DH and in 7 cases (16.3%) was right-sided without differences in PMR (58.3% vs. 71.4%). In 17 cases (39.5%) associated anomalies were observed; PMR was significantly higher than in isolated cases (94.1% vs. 38.5%). In 14 cases (32.5%) liver herniation was noted; PMR was also significantly higher than in cases without herniation (78.6% vs. 51.7%). The incidence of polyhydramnios was 30% (13/43); differences in PMR between subgroups were statistically significant (76.9% vs. 16.7%). A pseudohypoplasia of the left heart was observed in 9 cases (20.1%); PMR was significantly higher than the observed in cases without it (77.8% vs. 55.9%). Mean weight of the newborns was 2435 g. The PMR in cases , 2500 g was significantly higher than in newborns . 2500 g (75% vs. 26.3%). Overall PMR in cases prenatally diagnosed was 60.5% and in those postnatally diagnosed was 43% (not statistically significant). Considering only prenatally diagnosed isolated cases, the survival rate rose to 65.3% and excluding terminations of pregnancy to 85%. Conclusion: The prognosis of DH largely depends on the existence of associated defects but there are several prognostic factors associated with a worse outcome. However isolated cases may have a favourable outcome with `classical' management.

P34 Mechanical ileus diagnosed with transvaginal ultrasonography P. KlaricÂ, G. Grubisic, M. Zovak and N. TueÁkar University Hospital `Sestre Milosrdnice', Zagreb, Croatia Background: The aim of this work is to present a rare case of mechanical ileus diagnosed with ultrasound and confirmed on radiology. Thirty-six years old women underwent an operation because of an endometric cyst and left adnexectomy was done. Mechanical ileus occurred on the fifth postoperative day. A level of liquid in bowel was seen at radiology. At ultrasound we saw on left hemiabdomen distended bowel and a thin, wire-like hyperechogenic structure with no vascularization, thick about 5 mm. This structure was surrounded by the bowel. Laparotomy detected the bowel surrounded by a wirelike thin fibrinoid structure which was extended from uterus corn to the left pelvic wall and caused mechanical ileus. After release of this tissue the bowel was in normal condition and peristaltics was restored next day.

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Conclusion: It is possible to observe a localization of mechanical ileus with vaginal sonography.

P35 Duodenal atresia: prenatal diagnosis and perinatal outcome of 27 fetuses R. Has, C. E. M. Batukan, H. ErmisË, S. BasËaran, A. YuÈksel and Ibrahimoglu Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology Objective: To discuss the prenatal diagnosis, obstetrical management, and perinatal outcome of duodenal atresia, and investigate the incidence of associated malformations and chromosomal anomalies. Materials and methods: The data about 27 fetuses with duodenal atresia which were diagnosed on prenatal sonographic evaluation, and confirmed postnatally, among 20401 high risk pregnancies who were referred to Prenatal Diagnosis Unit of Obstetrics and Gynecology Department of Istanbul Medical Faculty between 1988 and 1999, are analyzed. Presence of polihydramnios, gestational week at diagnosis, associated malformations and chromosomal abnormalities, and perinatal outcomes were evaluated. Fisher's exact test is used for statistical analysis. Results: Duodenal atresia was diagnosed in 43 fetuses, but postnatal outcomes of 38 fetuses could be obtained. Ten of the fetuses had additional abnormalities in 27 cases whom diagnosis was confirmed. Nine chromosomal abnormalities (33.3%) including seven trisomy 21 (29.6%), one deletion, one translocation anomaly detected. The perinatal mortality of duodenal atresia is found 44.4% with 12 pre and postnatal deaths. Fifteen infants discharged in a healthy condition after operations. Conclusion: Duodenal atresia, especially in the presence of associated abnormalities has a high perinatal mortality. Establishment of diagnosis in prenatal period, even in the late stages of gestation, may contribute the obstetrical and neonatal management.

P36 Prenatally diagnosed duodenal obstruction: a report of 16 cases A. Galindo, J. Arbues, J. M. Puente, O. Villar, I. Cano, A. GranÄeras and P. De La Fuente Department of obstetrics and Gynecology, Hospital Universitario `12 de Octubre' de Madrid, Madrid, Spain Aim: To evaluate main ultrasound findings, associated anomalies and perinatal outcome of fetuses with duodenal obstruction (DO). Methods: Retrospective review from January 1990 to October 1998 of 16 fetuses with DO. Results: The incidence was 1 in 2771 deliveries. DO accounted for 53% (16/30) of all the small bowel obstructions. Sensitivity was 76%. Mean gestational age at diagnosis was 32.6 weeks. Associated anomalies were diagnosed prenatally in 5 cases (31.3%) and postnatally in 3 more cases, so associated anomalies were present in 50%. DO was an isolated finding in 11 cases (68.7%) and no chromosomal anomalies were observed in this group. These were diagnosed in 4 out of the 5 cases with associated anomalies. Polyhydramnios was quite common (93.7%). Taking into account also cases postnatally diagnosed, chromosomal defects rate was 33.3% (trisomy 21 represents 86% of all). Mean gestational age at delivery was 35.1 weeks. Mean weight at birth was 2315 g. Perinatal mortality rate for prenatally diagnosed DO cases was 31.2%, but this rate rose up to 62.5% in those cases with associated anomalies. No deaths were seen in isolated cases. DO resulted from atresia in 6 cases (37.5%), from web in 5 (31.2%) and from annular pancreas in 5 (31.2%). Conclusion: DO is most prevalent type of small bowel obstruction. Associated anomalies and chromosomal defects (Tr.21) are common and should always be ruled out. While isolated cases have good prognosis, outcome is worse with associated anomalies, the latter being the major prognostic factor.


4±7 October 2000, Zagreb, Croatia P37 Ileal atresia and thrombo-embolic liver calcifications, a possible complication after treatment with intrauterine laser coagulation therapy for twin to twin transfusion syndrome R. M. Van Zalen-Sprock, A. H. P. Schaap, W. J. Van Wijngaarden, J. M. Schnater, D. C. Aronson and O. P. Bleker Academic Medical Center, Amsterdam, The Netherlands Background: Two fetuses with complications after laser coagulation therapy for twin to twin transfusion syndrome (TTTS) are described. Case 1: In this patient laser coagulation of the connecting placental vessels was performed at 21 weeks of gestation. Two weeks after this treatment the donor twin had died. Sonography of the survivor showed progressive intestinal distension from 24 weeks onwards. After birth a laparotomy was performed and an ileal atresia was found. Case 2: In this patient laser coagulation was performed at 19 weeks of gestation. Premature rupture of membranes occurred at 21 weeks and both fetuses died. At autopsy thrombo-embolic calcifications were found in the liver of the smallest, donor twin. Discussion: Whereas duodenum atresia is considered a `true' congenital anomaly, jejuno/ileal atresia is thought to be caused by a mesenteric vascular accident during fetal life, which leads to necrosis. Intra-uterine laser coagulation therapy seems promising in the treatment of TTTS. Although it cannot be proven, this therapy must be regarded as one of the possible causes for the thrombo-embolic processes described in the two cases.

P38 Prenatal diagnosis of severe hypotonia and polihydramnius in a fetus with mitochondrial disorder J. A. De LeoÂn, R. PeÂrez FernaÂndez, M. Granados, M. GonzaÂlez, J. LoÂpez and J. Clavero `Gregorio MaranÄoÂn' General Hospital, Madrid, Spain Introduction: The diagnosis of polihydramnius is ultrasound and can be measure with a various test but finally the result is the increment of the amnioticus liquid. It is secundary from a differents pathological situations but severe hypotonia is a rare cause. The hypotonia is the result of a heterogeneous group of conditions including severe hypoxia, neuromuscular disorder, deposit disease, chromosomal, and mitochondrial pathology. Case report: A 30-year-old woman in the 40th week of gestation came to us referring a decrease in foetal movements during the last 24 h. The pregnancy curse had been normal. The foetal heart rate variability was pathological and the ultrasound study showed a decrease in respiratory movements, foetal movements and foetal tone with a abnormal amniotic liquid volume. The foetus was delivered by urgency caesarean section. A 3160-g male was born, Apgar 6/8, pH 7.32. The newborn was taken to nciu and the neonatal outcome was unfavourable. The newborn had a severe hypotonia, hyporeflexia, the eec was pathological. Finally the newborn died.

P39 Recurrent non inmune hydrops fetalis in parents with shared HLA DR and DQ R. PeÂrez FernaÂndez, J. A. De LeoÂn, P. Pintado, M. Orera, J. Carbone and L. Ortiz `Gregorio MaranÄoÂn' General Hospital, Madrid, Spain Introduction: Non immune hydrops fetalis (NIHF) is defined as the extra cellular accumulation of fluid in tissues and serous cavities, without evidence of circulating antibodies against red blood cell antigens. NIHF is the result of a heterogeneous group of conditions including cardiovascular, pulmonary, chromosomal, haematology, infectious disorders and deposit disease. A 34-year-old pregnant woman with obstetrical history of two prior perinatal deaths between 29th and 30th weeks of gestation, all associated with foetal hydrops. In the prior pregnancy we made a exhaustive study of the foetal blood, obtained by cordocentesis, and


Posters the parents' blood. This study included haematology, infectious serology, hormonal and immune disorders and it was detected a shared HLA DR and DQ. In the current pregnancy, the foetus has developed hydrops at the 20th week of gestation which has been diagnosticated by ultrasound. Once again the results of the research has been normal and we have tried to correct the hypoproteinemia with albumen infusion by cordocentesis. The following up has showed the increase of the hydrops concluding with cardiovascular failure and foetal death. Discussion: The mortality rate of recurrent NIHF is over the 80% of the cases and depends on the ethiology. The epidemiological studies had demonstrated the association between abortions and parents who shared HLA DR and DQ but the association with recurrent NIHF is not a proved fact. The diagnosis of hydrop fetalis is by ultrasound on detection of skin thickness greater than 5 mm with fluid accumulation in at least one of the serous cavities. It is also necessary to obtain a detailed ultrasound scan for structural defects, echocardiography and Doppler blood flow studies of mayor foetal vessels. Ultrasound is an important tool used in the following up of NIHF and it makes possible the use of the cordocentesis therapy in some cases.

P40 Fetal treatment for hydrops fetalis assisted by interventional ultrasound M. Tanemura and K. Suzumori OB/GYN, Nagoya City University Medical School, Nagoya, Japan Background: Fetal hydrops has many causes including hydrothorax and cardiac abnormality. Our fetal treatment experience with such disorders associated with hydrops fetalis is reviewed and the efficacy of new interventional ultrasound is presented. Methods: Case 1. A case of fetal lung tumor. Color Doppler analysis and MRI were introduced for differential diagnosis. Case 2. A case of severe pleural effusion. Detailed examination of intrathoracic fluid led to a diagnosis of congenital fetal chylothorax. Fetal treatment by intrapleural injection of OK-432 was introduced. Case 3. A case of fetal tachyarrhythmia. We introduced transmaternal-abdominal fetal ECG and administered transplacental medication. Results: Case 1. Color Doppler analysis revealed an anomalous arterial supply from the aorta to tumor, leading to a diagnosis of pulmonary sequestration. Only reduction amniocentesis was repeated, with the circulatory failure spontaneously improving. Case 2. The pleural effusion was reduced by adhesion of the intrathoracic space, with pulmonary hypoplasia successfully prevented by OK-432. Case 3. Transmaternal-abdominal fetal ECG led to a diagnosis of fetal PSVT. Transplacental propranolol stopped fetal PSVT quickly, while digoxin slightly improved fetal cardiac function. Conclusions: OK-432 may be considered as an alternate intrauterine therapeutic option to shunt insertion for severe fetal hydrothorax. Fetal ECG was also useful for the diagnosis of fetal tachyarrhythmia. Since some untreated cases show spontaneous improvement, the indications for fetal treatment should be reconsidered.

P41 Prenatal diagnosis of chorioangioma of the placentae: case report Nurwansyah*, K. Murti² and E. Taufik³ *Department of Feto-Maternal. Harapan Kita Children and Maternity Hospital, ²Department of Obstetrics and Gynecology, ASIH Maternity Hospital, ³Department of Patology, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia Background: Chorioangioma of the placentae are the most common primary tumors of the placentae, occurring in 1% of all pregnancies. In the past, the majority of patients' diagnosis is made after the delivery of the placenta. But, with the increasing use of ultrasound, prenatal diagnosis of these tumors is should become more common. Clinical implications of placental chorioangioma have been associated with adverse perinatal and maternal outcomes such as

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10th World Congress on Ultrasound in Obstetrics and Gynecology polyhydramnios, premature labor, fetal hydrops, fetal disseminated intravascular coagulopathy, fetal anemia, fetal cardiomegaly, fetal growth retardation, abruptio placentae, gestosis and maternal hemolysis. Case: A 25-year-old primigravid was admitted to the hospital in 35th week of gestation with premature rupture of the membrane (PROM). Ultrasound examinations were performed on two occasions. First, at 28 weeks gestation, ultrasound revealed placental tumor and no fetal abnormality. The second one, at admission, ultrasound revealed olygohydramnios caused by PROM, intrauterine growth retardation and large placental echogenic mass with anechoic parts. Diagnosis was made as placental chorioangioma. Conclusion: Demonstrating well-circumscribed placental mass with or without anechoic area and its clinical implications makes prenatal diagnosis of placental chorioangioma.

P42 Hydrops fetalis and hepatosplenomegaly in the second half of pregnancy as a sign of myeloproliferative disorder in fetuses with trisomy 21 J. Smrcek, U. Germer, A. Baschat and U. Gembruch Division of Prenatal Medicine, Department of Obstetrics and Gynecology, Medical University of LuÈbeck, Germany Background: Fetal hydrops and/or hepatosplenomegaly in the second half of pregnancy may be a sign of myeloproliferative disorder in fetuses with trisomy 21. Methods: In order to search for fetuses with myeloproliferative disorder a retrospective study was performed in fetuses with trisomy 21 and hydrops diagnosed in our prenatal unit. Three of these fetuses presented hepatosplenomegaly and myeloproliferative disorder. In addition, one fetus with sonographic signs of trisomy 21, where karyotyping was unfortunately unsuccessful, presented with hepatosplenomegaly, hydrops and myeloproliferative disorder. Results: The four fetuses reported presented with fetal hepatosplenomegaly and hydrops in the second and third trimester. Infectious serology was negative. The characteristics of blast cells in the peripheral blood smear revealed a myeloproliferative disorder. The diagnosis was confirmed by postmortem examination, since all four cases ended up in fetal demise. Conclusion: Fetal hydrops and/or hepatosplenomegaly in the second half of pregnancy, although suggestive of infectious aetiology, may be a sign of myeloproliferative disorder in fetuses with trisomy 21 or mosaic trisomy 21. It seems to be possible, that a myeloproliferative disorder is the most common cause of hydrops in cases of trisomy 21, at least during late second and third trimester. Furthermore, the incidence of myeloproliferative disorder in utero may be more frequent than realized.

P43 Endocardial fibroelastosis associated with nonimmune hydrops fetalis ± case report P. Dimcev, J. Stojkovski, M. Kapusevski, A. Sopova and V. Janevska Special Hospital for Gynecology and Obstetrics, Skopje, University Institute for Pathology, Skopje, Republic of Macedonia Over 30% of cases with nonimmune hidrops fetalis remain with idiopathic etiology. In cases with known origin, cardiovascular failure is on the first place with over 20%. We report case of 29-year-old primigravida, no previous risk factors, 32 second week of gestation. At her first admit to our Hospital, ultrasound examination (performed on SIEMENS Sonoline Versa Pro, 3.5 MHz abdominal probe) revealed obvious signs of severe nonimmune hidrops fetalis: ascites, hepatosplenomegaly, cardiomegaly, pleural and pericard effusion. Prenatal evaluation excludes immune, chromosomal, diabetic, urinary, gastrointestinal, metabolic origin and infection. As there was obvious sign of extreme fetal tahicardia, over 230 hbpm, we conclude that cardiovascular etiology is the main in patogenesis. Because we can not find any big cardiac anomaly, we tried to menage this condition with intravenous administration of digoxin to the mother. Unfortunately, after 3 days there was no proper answer of the therapy

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Posters

and baby died in utero after extreme tahiarithmia, 250 hbpm. Autopsy report maintain our prenatal diagnosis ± endocardial fibroelastosis. The conclusion is that early diagnosis and proper investigations in corresponding institution are very important for menagement of nonimmune hydrops fetalis.

P44 Fetal kidney biometry from 10 to 14 weeks of gestation Y. Spathopoulos, I. Chatzipapas, B. Whitlow and D. Economides Royal Free Hospital, Fetal Medicine Unit, London, UK Background: To determine fetal biometrical reference ranges for the fetal kidney from 1018 to 1416 weeks' gestation. Methods: A prospective cross-sectional study in a University Department of Obstetrics and Gynaecology, London. Four hundred and thirty-eight women from an unselected population underwent a detailed assessment of fetal anatomy at 10±14 weeks' of gestation (confirmed by crown-rump length) using transabdominal sonography, and transvaginal sonography (37.4%: 164/438) when necessary. Anterior-posterior (AP), transverse (T) and longitudinal (L) parameters for the kidney and renal pelvis were measured and charts for centiles derived using regression analysis and a model of best fit constructed. Results: Centiles were derived for each biometrical parameter. New charts for each biometrical parameter are presented and compared with previously published data. The 95th centile for the renal pelvis anterior-posterior diameter varied from 1.4 to 3.1 mm from 1018 to 1416 weeks, respectively. Conclusion: We have constructed new reference ranges for kidney dimensions including new data on the renal pelvis dimensions.

P45 Amnioinfusion and CFM in prenatal diagnosis of bilateral renal agenesis V. Ferianec*, M. HolaÂ² and K. Pohlodek* *2nd Department of OB/GYN, Comenius University, Bratislava, Slovakia, ²Children Faculty Hospital, Bratislava, Slovakia Background: Absence of ureteral bud formation during embryogenesis causes bilateral renal agenesis and occurs approximately 1:4000± 5000 births. Severe oligohydramnios causes difficulties in apparent visualization. To improve the sonographic conditions the amnioinfusion and CFM of the renal arteries permits the accurate diagnosis. Methods: We present the case report of 18 weeks' gestation fetus. Sonography was extremely difficult because of anhydramnion, but fetal cardiac arrhythmia was confirmed and congenital renal agenesis was suspected. In order to facilitate visualization transabdominal amnioinfusion ± instillation of cca 350 ml saline solution was successfully performed. Results: After amnioinfusion fetal cardiac arrhythmia disappeared, fetal movements appeared. Amnioinfusion enhanced sonografic resolution of renal fossae, which confirmed bilateral renal agenesis and bilateral adrenal hyperplasia. CFM did not confirm renal arteriae in abdominal part of aorta. Conclusion: Technique of transabdominal amnioinfusioin enable to define the specific cause of severe oligohydramnios or anhydramnios. Improvement in vizualisation after this procedure is very important for exact final diagnosis which can be enhanced by CFM.

P46 Differential diagnosis in fetal obstructive uropathy D. M. Paternoster and A. Stella Department of Obstetric Gynecology, via Giustiniani 3, Padova University, Italy Case report: A healthy 24-year-old secundigravida presented for a routine ultrasound examination at the 11th week of gestation. The scan showed a singleton pregnancy and the crown-rump length (43.8 mm) was compatible with the gestation calculated from the last menstrual period. The foetal abdomen was distended by the presence


4±7 October 2000, Zagreb, Croatia of one only cyst (12 7.4 mm), compatible with distension of the bladder. There was no other evident abnormality. Amniotic fluid volume was normal for the first trimester despite total urethral obstruction. At 14 weeks still birth was found and the patient delivered three days later. Diagnosis was confirmed at autopsy. Post mortem examination confirmed a phenotypically normal male foetus consistent with 14 weeks gestation and weighing 70 gr. The abdomen was distended and the abdominal wall was thin. Internal examination confirmed the presence of an enlarged bladder. There was urethral atresia, with associated dilatation of the bladder but the ureter and kidneys were normal. Internal genitals were male with normal testicles and penis. Chromosome analysis was performed on foetal skin and karyotype was 46, XY. Discussion: Cloacal dysgenesis sequence (CDS) is a rare cause of fetal obstructive uropathy (FOU). The prenatal differentition of CDS from other FOU is important because CDS is not amenable to in utero surgical intervention in the form of vescicoamniotic shounts. Differential diagnosis must be made with pathologies capable of determining cystic lesions localised in the inferior foetal abdomen, such as ovarian cysts, intestinal duplications, Hirschsprung disease, colic dilatation, imperforate hymen with hydrometracolps and megacystes± microcolon syndrome. Accurate prenatal diagnosis can be difficult and requires prolonged serial observations. The above-mentioned pathologies have characteristics of relative `fixity', while typical imaging of cloaca undegoes variations due to sequential filling in, or repletion, of the liquid contained in the urinary, genital and digestive components of the malformation. Moreover, intestinal obstruction is generally associated with polyhydramnios. In the first trimester diagnosis of cloaca anomalies are very difficult because there are no great changes in amniotic fluid volume and ascites rarely is present; serial examinations are required for enable definition of diagnosis.

P47 The functionality of renal kidneys. Can amniotic markers be used to diagnose renal pathologies? J. M. Troyano, M. T. Clavijo, C. M. Feo, Y. Marco and E. Laynez Ultrasound Division and Fetal Medicine, University Hospital of Canary Islands, Tenerife, Spain Background and method: Fetal urine was analysed for differences in renal functionality between physiological cases and pathological cases featuring dilatation of the excretory channels (hydronephrosis). Kidney samples were taken by means of aspirative nephrostomy under echographic monitoring, and 4 parameters were assessed in both amniotic fluid and urine, namely osmolarity, [Na1], [Cl2], [NAG] and [b2 microglobuline]. Results: A total of 51 cases (healthy group) presented hypotonic urine, medium osmolarity (200 mosm), low levels of Na1(, 100 mEq/ml), Cl2 (, 90 mEq/ml), NAG (, 2 U/l) and b microglobuline (, 5 ml/l), and a healthy postnatal evolution. In contrast, the remaining 19 cases (pathological group) had hypertonic urine, NAG and b2 microglobuline levels over 18 U/l and 26 ml/l, respectively, and evolved towards heavy renal disfunctionality after delivery. In the pathological group the concentration of NAG and b2 microglobuline in the amniotic fluid was significantly larger than in the physiological group, but no differences in amniotic Na1, Cl2 and osmolarity were observed between both groups. Conclusion: The concentration of liposomial proteins (NAG and b2 microglobuline) from the amniotic fluid is a sound indicator of heavy proximal tubulopathy. Invasive techniques such as puncturing can thus be avoided to diagnose fetal disfunctionality.

P48 Parameters of renal function by the obtention of fetal urine by intrauterine aspiration J. M. Troyano Luque, M. T. Clavijo, C. M. Feo, E. Laynez and M. GoÂmez Ultrasond Division and Fetal Medicine, University Hospital of Canary Islands, Tenerife, Spain


Posters Background: We have studied the fetal renal function by urinary biochimical analysis obtained by aspirative nephrostomy. Method: Since 1993 we have practiced in our ultrsound unite 51 aspirative nephrostomies in cases of over 15 mm hydronephrosis since the 20th week of pregnancy. We have determined the tubular dynamic of Na1, Cl2, K1, P1, the excretory response after overcharge of the NaCl, the tubular response to the aqueous diuresis, Calcium tubular dynamic, uric acid, glucose. Acid-base equilibrium. Results: Limited excretory capacity of Na1and Cl2. Excretory diminishing with Na1Cl2 overcharge. The diuresis aqueous decreases the reabsortion of Na1, Cl2, Ca1, P1, glucose and uric acid. In premature fetuses there is hypocalciuria with hyperphosphaturia. The excretion of uric acid is higher in premature fetuses (7.7 ^ 2.7 mg/dl) than in mature fetuses (5.2 ^ 1.6 mg/dl). The excretion of glucose is higher in premature fetuses. In all the cases a perinatal renal function was verifyed. In a 78.4% of the cases, reparatory surgery was needed. Dyalisis wasn't needed in any new-born. In two of the cases unilateral nephrectomy was needed. Conclusion: The theoretical renal obstructive prenatal problems are not always associated to renal disfunction. The neprhourological matureness presents important changes in tubular dynamic of Ca1, P1, glucose and uric acid, nevertheless it keeps the same tubular dynamic with Na1, Cl2 and potassium.

P49 Prenatal diagnosis of myelocystocele-cloacal exstrophy in a male neonate with a abnormal penis and urethra J. A De LeoÂn, P. Pintado, M. VinÄuela, E. Herrero, F. GarcõÂa, A. AguaroÂn and R. PeÂrez FernaÂndez `Gregorio MaranÄoÂn' General Hospital, Madrid, Spain Introduction: Cloacal exstrophy results from a migration failure of the lateral mesodermal folds of the infraumbilical anterior abdominal wall, and rupture of the resulting enlarged, persistent cloacal membrane before the eighth week of gestation. Myelocystocele is a defect of the medular channel characterizased by a cystic that contain dural and arachnoid layer and the ependymal lining layer, respectively. The association of persistent cloaca and caudal spinal anomalies is thought to be related to cell loss in the caudal cell mass, which affects caudal spinal column formation and cleavage of the cloaca by the urorectal septum. Cloacal malformation occurs in approximately 1 in 65 000 live male births. Prenatal ultrasound may lead to the diagnosis in selected cases. Case report: We report an unusual case of prenatally detected with a myelocystocele and cloacal malformation. Additional anomalies included an omphalocele and malformations of the upper urogenital tract, skeleton, and vertebral column. Labor was induced at 34 weeks' estimated gestational age. It finish by eutocical delivery. A 2154-g male was born, Apgar 6/8, pH 7.32. The newborn was taken to NCIU and the neonatal outcome was favourable.

P50 Ultrasonographic research of gonadas at a true hermaphroditismis A. S. Latypov, L. E. Teregoulova and I. G. Bubis Division of Medical Genetics of Republican Hospital of Tatarstan, Kazan, Russia Background: The differential diagnosis between the various forms of violation of a structure of gonadas at the patients with a female phenotype represents a problem, especially at a primary inspection. Method: We represent a case of ultrasonographic diagnostics an ovotestis at a true hermaphroditismis in our practice. There was used linear transabdominal and convex transrectal transducers on ultramark-9 device. Results: The young woman (17yo) who has addressed to the gynecologist concerning a primary amenorrhoea, was examined by ultrasound in the Hospital. There were detected a male's structure internal sexual ductuses and presence of gonadas located below usual position of ovaries with structure, estimated as a testicula. The Morris

77

10th World Congress on Ultrasound in Obstetrics and Gynecology syndrome was diagnosed. At the consequent inspection in center, specializing in genetic ultrasound, specific echostructure of the gonadas was detected, appropriated to their mixed structure (ovotestis), thus a true hermaphroditismis with a female phenotype was diagnosed. The consequent karyotyping (46XX/46XY (16:4)) has confirmed the preliminary ultrasonographic diagnosis. Conclusion: The sufficient qualification of the sonographist conducting a ultrasonic research, knowledge of a ultrasonographic picture of the this pathology, allows correct diagnostics already before lab stage of an inspection, using even the routine equipment and review.

P51 Prenatal detection of Fraser syndrome without cryptophthalmos C. Berg, A. Geipel, U. Germer and U. Gembruch Division of Prenatal Medicine, Department of obstetrics and Gynecology, Medical University, LuÈbeck, Germany Background: Fraser syndrome (cryptophthalmos±syndactyly syndrome) is an autosomal recessive multiple malformation syndrome whose major manifestations are cryptophthalmos, syndactyly, laryngeal atresia and urogenital defects. Enlarged hyperechogenic lungs contrasted by oligohydramnios, nonvisualization of the kidneys and microphthalmia were sonographic markers leading to the prenatal detection of this rare autosomal recessive disorder in earlier reports. Case report: Fraser syndrome was diagnosed at 16.0 weeks gestational age in a women whose previous pregnancy was terminated because of multiple malformations. Abnormal sonographic findings included agenesis of kidneys and bladder, dilated trachea and main bronchi suggestive for high airway obstruction, hyperechogenic lungs, syndactyly of the fingers, hepatomegaly, oligohydramnios and hydrops placentae. Strikingly, face and cerebral structures appeared normal. However these findings together with the previously affected child led to the diagnosis of Fraser syndrome. The parents elected to terminate the pregnancy. Autopsy results were confirmatory. No defects of the face could be demonstrated. Conclusion: Prenatal diagnosis of Fraser syndrome is possible in the hands of an expert, but due to the great variety of possible malformations the diagnosis will remain at doubt in most cases in which no previous child is affected.

P52 Ultrasonographic diagnosis of an approach to a case with intrauterine clitoromegaly B. Tekin, H. Hassa and T. SËenses Osmangazi University, School of Medicine, Department of Obstetrics and Gynecology, EskisËehir, Turkey Introduction: Adrenal androgens are one of the important determinants of sexual differentiation in fetal period. Increased circulating levels of adrenal androgens as seen in congenital adrenal hyperplasia, interact with genital skin androgen receptors and induce clitoral enlargement, fusion of labial folds and cause migration of the urethral-vaginal perineal orifice resulting in ambiguous genitalia. We are reporting a female newborn with clitoromegaly from a nulliparous mother at term pregnancy. Case report: The mother was followed up from 22 weeks of gestation with no signs of hyperandrogenism. Because of late application for antenatal follow up and since clitoromegaly was observed at 29 weeks of pregnancy, amniocentesis could not be done. During ultrasonographic evaluation at 29 weeks of gestation, clitoris with a size of 13 18 mm was detected and dexamethasone 1 0.5 mg orally was started to use. In reevaluation at 33 weeks of gestation clitoral size was measured as 4.8 6.8 mm and treatment was stopped. At 40 weeks of gestation a female neonate with 10±10 apgar scores, weighing 4040 g was delivered with caesarian section due to cephalopelvic disproportion. After delivery physical examination of the neonate revealed clitoral measurements consistent with clitoromegaly. Hyperandrogenic state of the case persists and evaluation of the newborn is going on in Pediatrics Clinic.

78

Posters

Discussion: Although adrenal androgen secretion starts at 6±8 weeks of gestation and dexamethasone therapy was shown to be effective in regression of virilization if it was used as early as 6±8 weeks of gestation, our case was diagnosed later in the course of pregnancy. But when similar regimen was applied similar result was obtained. So we propose that patients with intrauterine virilization signs like clitoromegaly and ones with risk of congenital adrenal hyperplasia should take glucocorticoid therapy whenever it is determined in order to ameliorate genital ambiguity in female fetuses.

P53 Repetition of osteochondro-dysplasia ± a rare hereditary disorder of bones S. Sipos, T. Marton, A. UjhaÂzy and J. RigoÂ Jr Dept. OB/GYN Semmelweis University Medical School, Budapest, Hungary Background: Osteochondrodysplasia with defective bone mineralization is a rare hereditary disorder. It is characterized by bone structure defects and a deficiency of bone/liver/kidney alkaline phosphatase activity in serum and tissues. Case report: Type 2a osteochondrodysplasia was detected in the first and second pregnancies of a 28-year-old woman. Fetal age was 20 and 17 gestational weeks, respectively. Ultrasonographical findings showed a soft, dilatated spine, narrow chest and short ribs as well as deformed bones and skull. An additional fetopathological finding ws hypomineralization of the skelet (diagnosed by hystopathology and XRay examination). The disorder proved to be Infantile Hypophosphatasia (congenital lethal type). Outcome: Both pregnancies were terminated after the diagnosis of the disorder. Conclusion: In order to detect this disorder, careful, repeated ultrasound exam should be performed in the first and second trimester. A Serum alkaline phosphatase level and elevated urinare phosphoethanolamine level of the family members may help to predict the disorder.

P54 A case of Gollop Wolfgang complex: prenatal diagnosis and pregnancy termination B. Tekin, H. Hassa, T. SËener and T. SËenses Osmangazi University, School of Medicine, Department of obstetrics and Gynecology, EskisËehir, Turkey Objective: To report a prenatal diagnosis of Gollop Wolfgang complex. Case history: This is a pregnant women of 29 years of age, G:2 P:1 Ab:0 with 23 weeks of gestation, has not any history of drug use nor infection during pregnancy. Her husband 29 years of age, has not any family history of anomaly nor medical illness of skeletal deformity as his wife. Ultrasound examination of this pregnancy at 16 weeks gestation showed pes equinovarus deformity and an absence of distal bone of right extremity. The family was informed about the problem. At the meantime ethical permission was obtained for termination of this pregnancy. At 23th weeks, after having family's consent for termination of pregnancy, careful ultrasound examination of the fetus was carried out; double distal femoral epiphysis with ipsilateral deficiency of distal bone (tibia or fibula) and pes equinovarus of the right lower extremity were diagnosed. After cervical priming and induction of labor, female fetus with 1-1-1 Apgar scoring at 1st, 5th and 10th minute was born. There was also hypoplastic right knee joint with bony prominence and flexion contracture at the right leg. X-rays of whole body were taken. There was also some other deformities and absence of some small bones. Conclusion: This is the first case of prenatal diagnosis of Wolfgang Complex. We showed the importance of a careful ultrasound examination of fetus in the first and second trimesters for the diagnosis of fetal malformation.


4±7 October 2000, Zagreb, Croatia P55 Large yolk sac preceding increased nuchal translucency in skeletal malformations: report of two cases M. Odeh, M. Kais, M. Wolfson, E. Ophir and M. Oettinger Department of Obstetrics and Gynecology. Regional Hospital of Western Galilee Nahariya, Israel Case 1: A 20-year-old secondegravida was screened at 20 weeks due to consanguinity. The fetus had extreme shortening of the limbs, cystic hygronia, hydrocephalus and tetralogy of fallout. The pregnancy was terminated. Missed abortion was diagnosed in her third pregnancy at 18 weeks. The fetus had extreme shortening of the limbs, spina bifida and cystic hygroma. In her fourth and fifth pregnancies she was first scanned at 7±8 weeks. A large yolk sac was detected (10 mm) and later the fetuses developed increased nuchal translucency short limbs and ascites. Both pregnancies were terminated. Twins were diagnosed in her sixth pregnancy. At 8 weeks one fetus had large yolk sac and this fetus developed the same features, including spina bifida and ascites and at 17 weeks heart activity was not detected. She delivered a healthy term female. Case 2: A primigravida was scanned due to consanguinity at 22 weeks. The fetus had fixed extension of four limbs and bilateral club feet the parents refused termination and a newborn with congenital arthrogriposis died a few days after delivery. In her second pregnancy she was first seen at 9 weeks and a large yolk sac was found and 2 weeks later increased nuchal translucency developed. Deformities of the limbs were first detected at 16 weeks and this pregnancy was terminated. The third and fourth pregnancies were normal. In her fifth pregnancy the same features developed. The parents refused termination and the baby died a few days after delivery.

P56 Antenatal diagnosis and separation of conjoined twins: case report E. CËelik, C. Sen, K. Kepkep, A. Vural and D. Yeker University of Istanbul, Cerrahpasa Medical School, Department of Obstetrics and Gynecology, Pediatric Surgery The incidence of conjoined twins is extremely small and ranges between 1:30 000 and 1:100 000 live births. Recent years, the prenatal diagnosis is possible in very early pregnancy and also detailed USG gives us an opportunity for making differential diagnosis in the case of well or poor prognosis. We present two cases with thoracophagus which were diagnosed at 19th and 25th week of gestation. First case was terminated because of severely conjoined (Shared hearth with single ventricule, two atrium, single aorta under the diaphragm. Second one was diagnosed at 25th week of gestation whom had just conjoined liver, attached pericardium on the ventricular walls and no other anomaly. After given counseling, the family opted to continue the pregnancy and the follow up of the pregnancy was uneventful and delivered at 38th week by cesarean section. They well tolerated in the neonatal period. The babies have gone operation at 10th months of age. They recovered after separation procedure and the outcome was uneventful. In recent years, defining the anatomical relationship of conjoined twins is greatly simplified by new technologies like 2D and/or 3D ultrasonography. Differential diagnosis of the cases with good or bad outcome in terms of shared organ and anomalies is important in clinical making decision for the termination or continuation of pregnancy.

P57 Twin pregnancy with a hemiacardiac fetus V. KosÏec and B. Hodek Department of Obstetrics and Gynecology CH `Sestre milosrdnice' Zagreb, Croatia Background: Fetal acardia is a rare anomaly occuring exclusively in monozygotic multiple pregnancies with an incidence of 1:35000 deliveries or in 1% of monozygotic twins. Since 1920, rudimentary developed heart of an acardiac twin, mostly called `hemiacardius' or


Posters `pseudoacardius', has been recognized in eigth cases. Four of them have been discovered during autopsy. We are showing a twin pregnancy of a 25-year-old woman with a hemiacardiac and a normal fetus, which was conducted in our Maternity Hospital. In the 22nd week of amenorea a suspicion of acardia of a deceased fetus with multiple malformations was expressed for the first time by ultrasound. With help of amniocenthesis we defined a normal male kariotype of a live twin and by ultrasound we carefully observed its morphology and growth. Furthermore, in the course of the pregnancy, mother's coagulation parameters were controlled weekly. In the 33rd week of gestation an extreme polyhydramnios developed, so amniodrainage was performed twice. The pregnancy was finished in the 36th week of gestation with a caesarian section: a live male child ± 2330/46 and a hemiacardiac fetus ± 2800 g with multiple malformations were born. The live twin was discharged from hospital three weeks later as a healthy baby.

P58 Fetal anemia, thrombocytopenia, dilatated umbilical vein and cardiomegally due to voluminous placental chorioangioma: a case report P. Calda, M. MaÂra, V. EretovaÂ, Z. ZÏizÏka, T. Binder, D. PavlisÏta and V. Sebron Department of Obstetrics and Gynecology, First Medical Faculty, Charles University, Prague, Czech Republic We present a rare case of voluminous placental chorioangioma diagnosed by ultrasound and color Doppler imaging at 20 weeks of gestation. The tumor size enlarged progressively up to 10 cm at 32 weeks. Further pathological findings, showing fetal intrauterine volume overload and blood cells consumption were observed (cardiomegally, umbilical vein dilatation, polyhydramnion, anemia and thrombocytopenia of the fetus). At 32 weeks of gestation the signs of uteroplacental insufficiency and fetal hypoxia appeared. Pregnancy was terminated by sectio Caesarea. The newborn, a girl, with birthweight 1870 g was dismissed in good condition after 48 days. Histopatological examination of placental tumor showed benign, vascular-type chorioangioma.

P59 Prenatal diagnosis of fetal rubella infection by ultrasoundguided cordocentesis J. S. Park, J. W. Roh, J. B. Moon, J. K. Jun, B. H. Yoon, S. Y. Moon, H. C. Syn and H. P. Lee Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea Objective: Our purpose was to compare the accuracy between rubellaspecific IgM and polymerase chain reaction (PCR) for the diagnosis of fetal rubella infection by ultrasound-guided cordocentesis. Method: 30 pregnant women with the evidences of rubella infection were enrolled. Fetal rubella infection was diagnosed by rubellaspecific IgM using microparticle enzyme immunoassay (MEIA) and rubella virus PCR with the blood obtained by ultrasound-guided cordocentesis after 21 weeks of gestation. Neonatal outcomes were evaluated by physical examination at birth and rubella-specific IgM if possible. Results: 20 cases were evaluated by IgM and PCR, and 10 cases only IgM. No fetus showed positive IgM antibody, and 8 of 20 cases showed positive PCR in cord blood, and 6 in amniotic fluid. One infant with negative rubella-specific IgM by cordocentesis before completed 22 weeks resulted in positive IgM at birth, low birth weight, strabismus and developmental delay. These findings were compatible with congenital rubella syndrome. No case showed congenital rubella syndrome in the fetuses with positive rubella PCR. Conclusion: (1) The incidence of fetal rubella infection may be very low in mothers with rubella infection. It is suggested that prenatal diagnosis should be performed even if maternal infection occurs in early pregnancy; (2) Cord blood rubella-specific IgM is more accurate than PCR for the prenatal diagnosis of congenital rubella syndrome;

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10th World Congress on Ultrasound in Obstetrics and Gynecology (3) Cordocentesis for rubella-specific IgM detection should be done after 22 weeks of gestation for accurate diagnosis.

P60 Effectiveness of treatment the fetal hemolytic disease by intravascular transfusions P. Puacz*, E. BrzezinÂska*, E. Sobczak², K. Drews* and Z. Søomko* *Department of Perinatology and Gynecology, ²Department of Neonatology, University of Medical Science, PoznanÂ, Poland Background: The aim of our study was to estimate the efficacy of treatment the fetal hemolytic disease by intravascular transfusions (IVT). Method: In the group of 71 immunized patients, after 21 weeks' gestation we performed amniocentesis. Results of the optical density at 450 nm in 2nd or 3rd zone in Liley's scale were an indication for cordocentesis, fetal blood sampling and in cases with low values of blood parameters ± intravascular transfusion with drugs administration. In some cases we chose elective preterm cesarean delivery. The management depended on the gestational age, fetal maturity, blood parameters, ultrasound examination and FHR patterns. Results: The number of 24/71 patients required IVT. We transfused 20± 90 ml of blood in 3±10 days intervals. The total amount of IVT was 78: 65/78 into a free loop of umbilical cord and 13/78 into its placental insertion. In 22/24 cases there were born healthy neonates, five of them required exchange transfusion because of hyperbilirubinemia. We observed one intrauterine death 10 h after IVT, probably due to cord hematoma and one death of hydropic neonate 48 h after delivery. Conclusion: The treatment of fetal hemolytic disease by IVT is associated with high perinatal survival rate and low perinatal mortality rate.

Posters

P61 The possible impact of storing fetal samples collected during prenatal invasive procedures: case report D. A. L. Pedreira, A. Yamasaki, M. L. Chauffaille, R. Muller and S. C. Cha LaboratoÂrio Fleury, SaÄo Paulo, Brazil MGB, 34 years-old, primigravida, conceived after IVF (still has 08 frozen embryos). At 21 weeks 1 2 days the anomaly scan showed mild dilatation of fetal cerebral ventricles and a multicystic right kidney with mild nasal bone hypoplasia. Fetal growth was considered normal (20 weeks 1 3 days based on biometry). Karyotipe obtained at 23 weeks showed a normal male (46, XY). By that time ventricular dilatation had increased but head circumference was normal for gestational age. Delivery occurred at 24 weeks. Postnatal examination showed smooth brain, ventricular dilatation, agenesis of corpus calosus and cystic dysplasia of right kidney. Lisencephaly was suspected and fish test targeting microdeletion of chromosome 17 was performed in the frozen cells obtained at amniocentesis, which showed negative results. Parents were counselled with the maximum risk of recurrence of an autosomal recessive disease for the next pregnancy. Discussion: The recent advances in the genetics field will soon offer us the possibility of diagnosing an increasing number of diseases that can have an impact in counselling. If we could diagnose de Mieller±Dieker syndrome in this fetus we could have changed the empirical risk of 25% recurrence in counselling for a future pregnancy. This is because, if none of the parents was found to be a carrier of the microdeletion, we could postulate that this was a `de novo' mutation (happens in 80% of the cases) and the risk for the next pregnancy should be negligible.

C H R O M O S O M O PAT H I E S P62 First trimester ultrasound measurement of nuchal translucency thickness in predicting chromosomal abnormalities. I. Normal ranges of nuchal translucency thickness P. Sieroszewski, J. Suzin, G. Surkont and A. Karowicz-BilinÄska Madurowicz Hospital, Institute of Obstetrics and Gynecology Medical Academy-University of èoÂdzÂ, Poland Objective: 1. To establish the usefulness of nuchal thickness to predict chromosomal abnormality. I. Normal ranges of nuchal translucency thickness.: Design and methods: After evaluating detailed length of pregnancy NT was measured. We included pregnancies which resulted in healthy borned babies. Results: 715 ultrasouns exams were performed between 9 and 15 weeks of normal pregnancy. Mean NT value in 9th week was 1.37 mm, in 15th week ± 3.09 mm (P , 0.005). Conclusions: 1. There is an increase in NT measurement with the progress of pregnancy. The project is ongoing (KBN nr 4 P05E 01817 i 4 P05E 05116).

P63 The effect of fetal neck position on nuchal translucency measurement I. Chatzipapas, Y. Spathopoulos, B. Whitlow and D. Economides Royal Free Hospital, Fetal Medicine Unit, London, UK Background: The aim of this study was to determine whether the position of the fetal neck has a significant effect on nuchal translucency measurement (NT). Method: A prospective cross-sectional study was carried out. One hundred and ninety-six women from an unselected population

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underwent transabdominal sonography. The nuchal translucency was measured in the mid-sagittal plane, with the fetal neck in the flexed, neutral and extended positions. Measurement was taken to the nearest 0.1 mm. Statistical analysis using a paired t-test for the differences in the extended and neutral position nuchal translucency [delta extended NT] and in the flexed and neutral position nuchal translucency [delta flexed NT] was performed. Results: On average the extended NT was 0.62 mm greater than the neutral NT value [95% confidence interval 0.53±0.70, T 14.33, P , 0.00001]. The flexed NT was on average 0.40 mm less than the neutral NT value [95% confidence interval 0.34±0.47, T 11.99, P , 0.00001]. The repeatability coefficient was lower in the case of neutral NT measurement [0.48] and was higher in the other groups [extended 1.04, flexed 0.70]. Conclusion: The effect of fetal neck position can make a significant difference on nuchal translucency measurement. Repeatability of measurements are more accurate with the fetal neck in the neutral position. These findings have important implications for clinicians using nuchal translucency to screen the general obstetric population.

P64 The newly calculated equations of nuchal skinfold thickness measurement in mid-trimester H. S. Won, M. K. Kim, P. R. Lee, I. S. Lee, A. Kim and J. H. Nam Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea Background: Use of nuchal skinfold thickness (NT) measurement as an ultrasound marker for Down syndrome has been limited due to a high false positive rate. We suggested that some variables, which influence on NT have been presented. The purpose of our study was to identify the variables that have effects on measured values of NT, and to make a regression equation based on those variables.


4±7 October 2000, Zagreb, Croatia Method: The data on gestational age (GA), cephalic index (CI), presentation (Pr; vertex or breech) and the presence or absence of nuchal cord (NC) were collected prospectively on 548 normal singleton fetuses between 16 and 24 weeks' gestation. We calculated independent correlation of those variables with NT by multiple regression analysis and made a regression equation based on GA, CI, Pr, and NC. Results: GA has positive correlation and CI has negative correlation with NT significantly. The nuchal skinfold was thicker among fetuses with breech presentation rather than those of vertex presentation and increased in the presence of nuchal cord. The all four variables (GA, CI, Pr, and NC) were independent factors to NT by multiple regression analysis. We calculated the expected NT through these observations; for fetuses presenting vertex, NT 5.608 1 0.243GA 2 0.066CI 1 NC* and for breech, NT 2.803 1 0.392GA 2 0.066CI 1 NC* (*if no NC, NC* equals 20.785 and zero for the other). Conclusion: This is the first report, which takes GA, CI, Pr and NC for correlation factors with NT as a whole. These equations may be considered as a screening method for the detection of aneuploidies.

Posters

Single markers

DR (%) S (%) PPV (%) NPV (%)

Chromosomal abnormalities NT . 95th c 75.0 FHR , 2.5th or . 97.5th c 15.3 UAPI . 95th c 19.1 DVPIV . 95th c 81.5 Autosomal trisomies1 NT . 95th c 89.9 FHR , 2.5th or . 97.5th c 15.2 UAPI . 95th c 16.3 DVPIV . 95th c 85.0 Biochemical risk . 1/2702 64.3

95.6 96.2 96.0 95.6

14.5 4.1 4.5 15.3

99.7 99.1 99.2 99.8

95.6 96.2 96.0 95.6 92.2

11.5 2.6 2.5 12.2 2.4

99.9 99.4 99.5 99.9 99.9

1

Referred to main autosomal trisomies (21, 18 and 13). 2Referred to trisomies 21.

single markers for CA. 5. Biochemical serum strategies should be reconsidered when we early scan unselected population.

P65 Feasibility and accuracy of NT measurement in twin pregnancies

P67 Analysis of fetal karyotypes after abnormal ultrasound findings

E. Dreazen, R. Maymon, Z. Weinraub and A. Herman Department of Obstetrics and Gynecology, Assaf Harofe Medical Centre, Zerifin, Israel

J. Auren, E. Ekholm and P. Palo Department of Obstetrics and Gynecology, University of Turku, Turku, Finland

Background: The aim of our study was to evaluate the feasibility and accuracy of nuchal translucency measurement (NT) in twin pregnancies. Method: We reviewed nt images of 66 pairs of twins (10.3±14 weeks gestation), matched with nt images of 66 pairs of consequent singleton pregnancies with similar gestational ages. Each of the inspected images was assigned a score, which classified it into one of four quality zones. Results: In the twins, as well as in the singleton control group, the vast majority of the nt images were in the excellent-reasonable zones (288%), and 10% in each of the groups had their nt images in the intermediate zone (11% vs. 12%). Less than 1.5% of the images were of unsatisfactory quality (1.5% vs. 0.8%), according to the strict criteria, required for reliable, comparable and reproducible results. (Hennan et al. Ultrasound Obstet Gynecol 1998; 12: 398±403). Conclusion: NT measurement in twin pregnancies is as feasible, accurate and reproducible as in singleton pregnancies. However, it provides a better DS risk assessment when compared with the second trimester triple test in twin pregnancies, as it evaluates DS risk individually for each of the fetuses.

Background: The aim of this study was to evaluate fetal karyotypes in pregnancies with abnormal ultrasound findings. The cases were obtained from the catchment area of the Turku University central Hospital between March 1993 and September 1999. In 48% of cases maternal age was below 30 years. Methods: 287 pregnancies with abnormal ultrasound findings were evaluated. Ultrasound examination was performed on average at 21 weeks of gestation (range 10±40 weeks). In 247 cases fetal structural abnormality was detected. In the remaining 40 cases ultrasound abnormality was fetal intrauterine death, small fetal size, and or oligohydramnion or polyhydramnion and partial hydatiform mola (two cases). Amniocentesis was done in 90% and villus biopsy in 10% of cases. Results: Fetal karyotype was found abnormal in 15% of pregnancies. Trisomy 21 was found in 10 cases. Six of these pregnancies were sent for evaluation because of increased nuchal translucency, the remaining because of fetal hydrops, ascites or pleural effusion. Nine fetuses had monosomy XO and ultrasonography revealed a cystic hygroma. Four fetuses with trisomy 18 and four with trisomy 13 were found due to structural abnormalities. Fifty pregnancies were terminated, 19 of these because of fetal chromosomal abnormality. Six pregnancies ended in spontaneus abortion. Three of these carried a chromosomally abnormal fetus. Moreover, eight fetuses died in utero later in pregnancy. Karyotyping was not possible in one case. Conclusion: Fetal karyotyping should be done also in young mothers in the first and second trimester when fetal ultrasound examination is abnormal.

P66 Early screening for chromosomal abnormalities: biochemical, ultrasonographic and Doppler assessment C. Comas, E. AntolõÂn, F. Figueras, K. EchevarrõÂa A MunÄoz and M. Torrents Carrera Jm. Institut Universitari Dexeus, Barcelona, Spain Objective: To evaluate the role of prenatal markers in screening for chromosomal abnormalities (CA) at 10±16 weeks' gestation. Methods: Biochemical serum assessment, nuchal translucency measurement (NT), fetal heart rate (FHR), umbilical artery pulsatility index (UAPI) and ductus venosus pulsatility index for veins (DVPIV) were prospectively evaluated. Results: A total of 7718 cases were evaluated, including 76 CA. The table summarises the effectiveness of each single parameter as a marker of CA. Detection rate (DR), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) are shown. Conclusions: 1. Early screening programmes for CA are, at least, as effective as later strategies. 2. NT is the most sensitive and specific marker for autosomal trisomies. 3. DVPIV is the most sensitive and specific marker for overall CA. 4. UAPT and FHR are not effective


P68 Chorionic villus sampling for prenatal diagnosis in Zagreb: experience with 3000 cases M. Podgajski, M. Podobnik, Z. Duic, S. Cigiar and B. Gebauer Dept. Ob/Gyn, University Hospital Merkur, Zagreb, Croatia Objectives: This study comprises data from 3000 women allocated to transcervical CVS (TC-CVS), transabdominal CVS (TA-CVS) and transvaginal CVS (TV-CVS). We have assessed the efficacy of transabdominal CVS compared with transcervical CVS and transvaginal CVS, and examined factors that have been implicated in causing spontaneous abortion. Method: Over a 10-year period, 3000 women underwent chorionic villus sampling at 9±12 weeks of gestation, by transcervical (500

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10th World Congress on Ultrasound in Obstetrics and Gynecology patients), transabdominal (2400 patients) and transvaginal technique (100 patients). Transvaginal color Doppler was used to investigate the uteroplacental and fetal vessels in 500 pregnancies between 11 and 12 weeks of gestation (400 TA-CVS and 100 TC-CVS) before and after CVS procedures. Results: Five hundred (16.7%) patients underwent transcervical CVS (TC-CVS) and spontaneous abortion after TC-CVS occurred in five cases (1.0%). Some 2400 (80.0%) patients underwent transabdominal CVS (TA-CVS) using a 20 gauge spinal needle and abortion after TACVS occurred in 10 cases (0.4%). One hundred (3.7%) patients underwent transvaginal CVS (TV-CVS) using a 20-gauge needle and abortion after TV-CVS occurred in three cases (3.0%). The spontaneous abortion rate after CVS procedures was 0.6%. Some 120 (4.0%) cases showed chromosomal aberration. The spontaneous abortion rate was lower among cases allocated to TA-CVS after 11 weeks of gestation. There were no significant differences in mean pulsatility indices (PI) between maternal, fetal and intraplacental circulation, before and after CVS procedures. Conclusions: Transabdominal CVS has lower fetal loss rate than transcervical and transvaginal CVS.

P69 Abstract withdrawn P70 Abstract withdrawn P71 Isolated choroid plexus cysts: a controversial morphologic sonographic marker for chromosomal abnormalities. Our experience in seven years (1993±1999) P. Totaro, A. Malvasi, G. Caringella, D. Baldini, V. Traina and M. Chiella Center of ultrasonography and Prenatal Diagnosis, Human Genetics UnitCasa di Cura `Santa Maria', Bari, Italy First reported by Chudleigh and colleagues in 1984 and considered `benign transient findings with no harmful sequelae', an association between choroid plexus cysts and trisomy 18 was described by several following publications. Later on further studies have also suggested a significant risk for other chromosomal abnormalities, trisomy 21 in particular, so that literature data report an association between choroid plexus cysts and chromosomal abnormalities in about 8% of cases, more specifically in 1% if isolated and in 46% if associated with other malformations. As a consequence there are now different opinions on clinical significance and management, with some authors advocating karyotyping and others not. The aim of this study was to define the incidence of choroid plexus cysts in an unselected population and describe their association with aneuploidy. In the years 1993±99 a total of 10743 women from an unselected population attending a routine second-trimester scanning were studied. Everyone underwent a detailed assessment of fetal anatomy by transabdominal sonography. In this period there were 27 fetuses in which choroid plexus cysts were the only sonographic abnormality, giving an incidence of 0.25% (in literature between 0.2 and 3.6%). Karyotyping was performed in only 12 cases, 11 normal and one trisomy 18. At birth the other 15 fetuses were normal. The incidence of aneuploidy was 3.70% (in according with literature review). We did not found association with other chromosomal abnormalities, trisomy 21 in particular. In the majority of cases the final risk remains small, but the presence of choroid plexus cysts increases the risk for aneuploidy, mainly trisomy 18. A need for further and wide studies about soft morphologic sonographic markers it's necessary to better define their association with chromosomal abnormalities and as a consequence to better select the patients who need karyotyping, not underestimating that they appear in a large percentage of normal fetuses. To combine all the well-known parameters (maternal and gestational age, serum biochemical screening, soft markers and nuchal

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translucency) seems to be the better way to adjust the risk of trisomy 21 and that of other chromosomal abnormalities, taking their different natural history into consideration.

P72 Prenatal assessment of the thymus in detecting fetuses with del.22q R. Chaoui, H. KoÈrner and C. Bommer Clinic Obstetrics, University Hospital Zurich, Switzerland; Institute of Human Genetics, Charite Hospital, Berlin, Germany Background: Some congenital heart defects (CHD) were found to be associated with a deletion 22q11 and grouped as catch-22 an acronym for Cardiac anomaly, Abnormal facies, Thymus hypo- or aplasia, Cleft palate and Hypothyreoidism with del.22q.11. It is still discussed whether all fetal CHD or only conotruncal anomalies (CTA) should get the targeted del.22q11 evaluation. Aim of the study was to find out the importance of thymus visualization in the prenatal detection of these affected fetuses. Method: During a period of 3 years only fetuses with CHD undergoing invasive procedure for determination of the karyotype and fish for del.22q11 were included in the study. Fetal thymus was visualized as the structure in front of the great vessels as seen in the three-vesselstrachea view. Results: 95 fetuses with different CHD were evaluated including 31 with conotruncal anomalies. Seven fetuses were found to have a del.22q11 (7.3% of all CHD, 22.5% of CTA). Six of these 7 (85.7%) had no or a hypoplastic thymus. A false positive result was found in two further cases. Conclusions: Fetal thymus can be assessed on prenatal ultrasound. In fetuses with CHD especially in CTA the absence or hypoplasia of the thymus can be a hint in the targeted examination for del.22q11.

P73 The value of sequential screening in avoiding invasive procedures when maternal age is considered advanced D. A. L. Pedreira, S. C. Cha and C. Czeresnia ClõÂnica de assisteÃncia aÁ Mulher, LaboratoÂrio Fleury, SaÄo Paulo, Brazil Aim: To evaluate the importance of sequential screening in the diagnosis of aneuploidies when maternal age is advanced, but invasive procedure is wanted only if screening tests are altered. Material and methods: We retrospectively analysed all pregnant patients aged 35 years or more at estimated data of delivery, from July 1996 to June 2000. For those in doubt about having an invasive procedure, we offered an alternative strategy of screening. Starting with nucal translucency (NT) (11±14 weeks), if altered we offer CVS, if normal, we offer an anomaly scan at 16±18 weeks targeted to soft markers of chromosomal abnormalities and major malformations. If altered, we then offer amniocentesis, if normal we repeat the anomaly scan at 22±24 weeks, targeting for other malformations (especially in the heart), uterine artery screening and cervical screening. Results: We evaluated 296 fetuses (280 pregnancies) patients mean maternal age 37.4 years-old (range 35±45). 39.9% patients (118) had invasive procedures (IP) with 3 abnormal karyotipe result (1 case T21, 2 cases 47XXY). One missed abortion detected at NT revealed T21. 122 fetuses (114 patients) had NT performed with Likelyhood Ratio increased in 11 cases (9.1%): 2 fetal malformation (skeletal dysplasia and acrania), 5 normal karyotipe after IP and 4 normal live-born babies. Among this 114 patients, 52 had one or two reassuring anomaly scans after NT and did not had an IP done. 17 pregnancies are still ongoing and all live-born babies so far were normal (94.8% follow-up). Conclusion: New studies about the psychological impact of later gestational age termination vs. early ones, showed no significant difference. We believe that sequential screening is a valid alternative for older pregnant patients, especially after IVF. The choice of having a later termination vs. the possible loss of a normal pregnancy after an IP must be given to patients.



Posters

SECOND AND THIRD TRIMESTER DOPPLER P75 Uterine artery Doppler velocimetry in low risk nulliparous women

P77 The usefulness of uterine artery Doppler velocimetry in the prediction of high risk pregnancy. I. Normal ranges

G. Daskalakis, D. Paouleskou, S. Kitmirides, N. Papantoniou, S. Mesogitis and A. Antsaklis 1st Department of Obstetrics and Gynaecology, University of Athens, Athens, Greece

P. Sieroszewski, J. Suzin, G. Surkont, and A. Karowicz-BilinÂska Madurowicz Hospital, Institute of Obstetrics and Gynecology Medical Academy-University of èoÂdzÂ, Poland

Background: The aim of this study was to assess how placental position and gestational age can influence the value of a diastolic notch of the uterine arteries as a screening test for pre-eclampsia, in a low risk population of healthy nulliparous women. Methods: Color Doppler ultrasound was used to examine both uterine arteries in 654 healthy nulliparas at four-weekly intervals between 20 and 32 weeks (wks). The only criterion for an abnormal result was the presence of an early diastolic notch. In each subject the placental position was also recorded. Results: Twenty-one out of 654 women developed pre-eclampsia (3.2%). The sensitivity of the test becomes lower as gestational age advances and ranged from 81% at 20 wks, to 71.4% at 32 wks. In contrast the specificity and positive predictive value increase significantly. Eleven out of 12 women who delivered before 34 wks had abnormal waveforms at 24 wks. In women with a full lateral placenta the predictive value of the test was extremely low. Conclusion: Pre-eclampsia can be more accurately predicted if along with the presence of a notch, both gestational age and placental position are taken into account.

Objective: 1. To establish the value of Doppler ultrasound of the uterine artery in identyfying high risk pregnancies. 2. To assess the efficacy of prophylactic aspirin treatment in high risk pregnancies (abnormal uterine artery Doppler velocimetry). 3. To show the efficacy of arginin treatment of IUGR fetuses in high risk pregnancies (abnormal uterine artery Doppler velocimetry). I. Normal ranges of uterine artery Doppler velocimetry: Design and methods: We studied 428 single normal pregnancies between 19 and 39 weeks. There were assessed S/D, RI & PI in both uterine arteries. We included results of singleton pregnancies where healthy babies were born. Results: We assessed decreasing of S/D, RI & PI values with the progression of pregnancy. We did not find statistically significant differences between right & left uterine arteries. Conclusions: 1. The uterine artery velocimetry depends on gestational age ± the values of S/D, RI, PI values decrease with the progression of gestation. 2. There are not significant differences between right and left uterine artery Doppler velocimetry. We continue our studies. (KBN nr 4 P05E 01616 i 4 P05E 01717).

P78 Second trimester uterine artery Doppler velocimetry in the prediction of poor perinatal outcome P76 Early diastolic notch of uterine artery Doppler velocimetry in relation to placental location C. H. Lee, Y. W. Park, J. S. Cho and S. S. Han Department of Obstetrics and Gynecology, College of Medicine, Yonsei University, Seoul, Korea Background: The aim of this study was to investigate the relation between types of early diastolic notch and placental location and to evaluate the difference in perinatal outcome. Method: We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however, we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta). Results: In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one (n 60, mean 3.22 VS 2.80, P 0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch. (t-test, mean 2.74, 1.92, P 0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches (P 0.003). Among the unilateral groups (ipsilateral: n 10, median: n 21, contralateral: n 58), there was no significant difference in perinatal outcomes. Conclusion: The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.


H. MunÄoz, D. Veloso, S. Leible, J. Jankelevich, R. Vonmullenbrock, M. Puga and S. Villa Fetal Medicine Unit, Clinical Hospital, Universidad de Chile, Santiago, Chile Background: The patients with an increase of resistance of uterine arteries in second trimester has between 5 and 8 times increased the risk of presenting adverse perinatal outcome. The objective is to evaluate the utility of uterine artery Doppler velocimetry in the prediction of poor perinatal outcome. Method: We performed a prospective study, in 512 consecutives pregnant women between 22 and 24 16 weeks of pregnancy. Uterine artery Doppler velocimetry was done in all patients using color Doppler duplex technique. The presence of notch or resistance index over 95 centile was defined as abnormal. Adverse perinatal outcome was defined as presence of preeclampsia, intrauterine growth retardation, and preterm delivery before 34 weeks of pregnancy. For statistical analysis non parametrics test and meta analisis model was used. Results: Uterine artery Doppler velocimetry was carried out in 512 patients, 198 was delivered. Resistance index was significantly higher in poor perinatal outcome group than in normal perinatal outcome group (Pulsatility index 1.38 vs. 0.9; P , 0.001). The relative risk of presenting adverse perinatal outcome was 3.8 times higher in patients with abnormal uterine artery Doppler velocimetry compared with those that has normal uterine artery Doppler velocimetry (ic 95%; 1.8±7.7; P , 0.0006). Conclusion.: Uterine artery Doppler velocimetry evaluated in the second trimester of pregnancy is able to identify high risk patients of poor perinatal outcome.

P79 Maternal ophthalmic artery Doppler velocimetry in type 1 diabetes during pregnancy K. Kanenishi, C. Yamashiro, H. Tanaka, A. Kuno, T. Yanagihara and T. Hata

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10th World Congress on Ultrasound in Obstetrics and Gynecology

Posters

Department of Perinatology, Kagawa Medical University, 1750±1 Ikenobe, Miki, Kagawa 761±0793, Japan

Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil

Background: Our purpose was to evaluate whether maternal ophthalmic artery pulsatility index (PI) in normotensive pregnancies with type 1 diabetes is different from that in normal normotensive pregnancies. Method: The ophthalmic artery in 15 normal normotensive pregnant women, and 13 normotensive pregnant women with type 1 diabetes was studied once with colour Doppler flow imaging and pulsed Doppler ultrasonography after 16 weeks gestation. The heart rate, mean arterial blood pressure, and ophthalmic artery PI were calculated in each group. Results: The PI (1.94 ^ 0.45) in normotensive pregnant women with type 1 diabetes was significantly lower than that (2.73 ^ 0.32) in normal normotensive pregnant women (P , 0.0001). There was no significant difference in maternal heart rate or mean arterial blood pressure between the two groups. Conclusion: These results suggest that vascular resistance in the maternal orbital circulation is reduced in pregnancies with type 1 diabetes that are normotensive. The lower PI in pregnant women with type 1 diabetes should be interpreted as orbital vascular vasodilatation, indicating orbital hyperperfusion or hyperaemia.

Background: A study of the relation between methods for assessment of fetal well-being and the occurrence of delivery before 30 weeks of gestational age in fetuses with ARED. Methods: A prospective study was conducted to assess the fetal wellbeing in 30 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of delivery before 30 weeks of gestational age (GA). All data were analyzed and compared using logistic regression. Conclusion: The probability of delivery before 30 weeks in AREDV fetuses was predicted by the ti between AREDV diagnosis and delivery and by the gravity of placental lesion estimated by the PI in the umbilical artery.

P80 Combined assessment of the fetal distress in diabetic pregnancy class R/F using uterine, middle cerebral, umbilical artery blood flow and fetal heart rate monitoring

Background: Description of pregnancies with fetal death following absent or reversed end-diastolic velocity (AREDV). Method: Between 1992 and 2000, 249 singleton high risk pregnancies with AREDV were followed. Twenty-nine cases of intrauterine fetal death (IUFD) were reviewed. All the patients were hospitalized after the AREDV diagnosis, and followed with intensive surveillance of fetal vitality. Results: The results are shown in the table:

M. Pietryga, E. Wender-Ozegowska, E. BieganÂska, J. Brzert and R. Biczysko Division of Obstetrics and Maternal Diseases, Department of Gynecology and Obstetrics, Karol Marcinkowski University School of Medical Sciences, PoznanÂ, Poland Background: Pregnacies complicated by diabetes mellitus cl.R/F are in higher risk of placentae insufficiency and poor perinatal outcome. Methods: We have investigated 15 diabetic pregnant women of class R/F after 26 weeks of pregnancy. We observed waveform `notch' in ascending uterine artery. Fetal distress was diagnosed when, in the nst silent oscilation or late decelarations appeared. Pathological blood flow in term pregnancy was diagnosed when RI and PI was abnormal and cerebro-placental ratio was above 1. AEDF and REDF were assessed as fetal distress. Newborns were estimated by Apgar score and pH value of umbilical artery. The mean diurnal glycemia ranged 110 mg/dl, and the HbA1c 6.2%, 8.0%. Results: Pathological condition acc. to the AS and pH A.umb. manifested 75% newborns, but acc. only to pH A.umb.values 15% of them. Positive predictive value of NST in fetal distress detection was 66%, of the DV 53%, uterine artery `notch' 66% when neonates condition was analysed by using AS and pH. The highest (80%) PPV was achieved all methods. False positive results in NST analysis were found in 19.8% of cases. False negative results was for methods together in 6.6%. When the neonates condition was analysed only by using pH A.umb.value, the PPV for NST was 66%, for DV 73%, for `notch' 73% and for all methods together 86%. False positive results for all methods NST, DV, `notch': and for all methods tohether, achieved the following values: 26%, 19.8%, 19.8% and 26%. False negative result in all methods was 6.6%. Conclusins: Blood flow measurements in fetal and maternal circulatory circles combined with FHR monitoring reaches very high prognostic values in detection of the fetal distress.

P81 Predicting delivery before 30 weeks in pregnancies with absent or reversed end-diastolic velocity (ARED) flow in the umbilical artery R. P. V. Francisco, R. M. Yamamoto, C. C. Chuba, S. Miyadahira and M. Zugaib

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P82 Fetal death in pregnancies with absent or reversed enddiastolic velocity waveforms in the umbilical artery R. M. Yamamoto, R. P. V. Francisco, K. Sakamoto, S. Miyadahira and Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil

AREDV diagnosis

19±24 week 25±28 week Total (n 14) (n 15) (n 29)

Fetal weight 454 1 180 694 1 194 578 ^ 221 GA at AREDV diagnosis 22.8 1 1.5 26.5 1 1.1 24.8 1 2.3 Interval AREDV-IUFD 12.4 1 12.2 6.3 1 6.4 9.2 1 9.9 (days) Reversed flow 7 (50%) 9 (60%) 16 (55%) Interval reversed flow-IUFD 5.0 ^ 4.1 4.8 ^ 5.5 4.9 ^ 4.8 (days) Conclusion: Pregnancies with severe placental insufficiency that presented fetal death showed a high incidence of reverse flow in the umbilical artery. The cases that presented early fetal death showed a higher time interval between the AREDV diagnosis and IUFD

P83 Fetal hemodynamic profile in pregnancies with absent or reversed end-diastolic velocity waveforms in the umbilical artery that presented fetal death R. M. Yamamoto, R. P. V. Francisco, D. S. Steinman, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil Background: A description of the fetal hemodynamic profile in pregnancies with absent or reversed end-diastolic velocity (AREDV) that presented fetal death. Material and methods: Between 1997 and 2000, 107 high risk pregnant women with AREDV were followed by the Fetal Surveillance Unit. Seventeen cases that presented fetal death (FD) were submitted to Dopplervelocimetry of the umbilical artery (UA), descending thoracic aorta (DTA), middle cerebral artery (MCA) and ductus venosus (DV).



Posters

Results: The results are shown in the table:

Conclusion: Higher values for the pulsatility index in the umbilical arteries reflect the gravity of placental lesions and the probability of occurrence of a very low birth weight.

AREDV diagnosis

19±24 week (n 10)

25±28 week (n 7)

Total (n 17)

GA at fetal death Reversed flow UA Doppler PI Abnormal DV DV Doppler ± PIV Abnormal DTA MCA PI , 5th p loss of redistribution

24.7 1 1.6 6 (60%) 5.0 ^ 3.1 10 (100%) 2.3 ^ 1.5 9/10 (90%) 6 (60%) 4 (40%)

26.3 1 1.0 7 (100%) 6.3 ^ 1.8 6 (86%) 2.3 ^ 1.3 3/6 (50%) 6 (86%) 1 (14%)

25.4 1 1.6 13 (76%) 5.5 ^ 2.7 16/17 (94%) 2.3 ^ 1.4 12/16 (75%) 12 (71%) 5 (29%)

Conclusions: The results show severe fetal hemodynamic profile abnormalities, revealed by Doppler studies conducted in AREDV cases that presented fetal death.

P84 Early neonatal death according to metabolic acidosis at birth in pregnancies with absent or reversed end-diastolic velocity flow in the umbilical artery R. M. Yamamoto, R. P. V. Francisco, D. Okatani, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil Background: An analysis, in pregnancies with absent or reversed enddiastolic velocity (AREDV) flow in the umbilical artery, of the relation between blood gas values at birth and the occurrence of early neonatal death (until 7 days after delivery). Method: Between 1992 and 2000, 146 high risk pregnancies with AREDV where it was possible to obtain blood gas analysis results at birth were studied. The criteria used for delivery included: fetal distress, fetal maturity, worsening of maternal condition and severe oligohydramnios. The umbilical arterial blood gas values at birth were compared to early neonatal death. Results: The results are shown in the table (*P , 0.05): Conclusion: Buffer base depletion (negative base excess-BE), and

pH , 7.15

pH , 7.20

BE , 210

pH , 7.15 and BE , 210

ND (# 7d) 10/43 (23%) 11/75 (15%) 13/56 (23%)* 9/30 (30%)* n 21 ND (total) 14/43 (32%) 19/75 (25%) 31/56 (55%) 20/30 (67%) n 36 when this variable is associated with low pH values (pH , 7.15 and BE , 210) showed a significant statistical correlation with early neonatal death.

P85 Pulsatility index in the umbilical artery Doppler studies for predicting birth weight in pregnancies with absent or reversed end-diastolic velocity flow (ARED) in the umbilical arteries R. P. V. Francisco, R. M. Yamamoto, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil Background: A study of the relation between methods for assessment of fetal well-being and birth weight. Methods: A prospective study was conducted to assess the fetal wellbeing in 30 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of birth weight above 1000 g. All data were analyzed and compared using logistic regression.


P86 Assessment of fetal well-being in patients with poor obstetric history: comparison between cases of absent or reversed enddiastolic velocity in the umbilical artery R. P. V. Francisco, R. M. Yamamoto, C. C. Leite, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil Background: A study of the assessment of fetal well-being and perinatal results in patients with poor obstetric history and absent or reversed end-diastolic velocity flow (AREDV). Methods: Between 1997 and 2000, 36 high risk pregnant women with poor obstetric history and AREDV were followed by the Fetal Surveillance Unit. Ten cases presented reversed end-diastolic velocity waveforms. Results: The results are shown in the table:

fhr with deceleration BPS below 6 Amniotic fluid index # 5 MCA PI , 5th p Perinatal death Birth weight , 1000g

AEDV n 26

REDV n 10

P

13/19(68.4%) 1/26(3.8%) 6/26(23.1%) 23/24(95.8%) 6/26(23.1%) 10/26(36.5%)

5/7(71.4%) 5/7(71.4%) 7/10(70.0%) 8/10(80.0%) 6/10(60.0%) 6/10(60.0%)

NS 0.004 0.025 NS 0.04 NS

Conclusions: The results show a higher incidence of abnormal BPS and AFI in red cases, with a high rate of perinatal death.

P87 Cardiotocography in pregnancies with absent or reversed enddiastolic velocity in the umbilical artery: a mathematical model for estimating the probability for fetal acidosis at birth R. M. Yamamoto, R. P. V. Francisco, C. C. Chuba, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil Background: A study of cardiotocographic (CTG) variables and acidosis at birth (umbilical arterial pH , 7.20) in AREDV. Methods: The last CTGs of 127 AREDV cases were studied. The variables analyzed by the Logistic Regression model were: baseline, accelerations, variability (variab.), sinusoidal pattern, bradycardia, late and variable (var.) decelerations (mild, moderate and severe). Results: The maximum likelihood estimates are shown below:

Variable

Parameter estimate

Standard error

P

Odds ratio

Intercept GA (weeks) variab. 5±9 bpm Variab. , 5 bpm Late decel. Mild var. decel. Mod. var. decel. Sev. var. decel.

22.1210 0.0329 0.5987 1.9443 1.4429 20.4138 20.2440 1.2156

2.0741 0.0654 0.5118 0.7576 0.4823 0.5239 0.6991 0.6260

0.3065 0.6150 0.2421 0.0103 0.0028 0.4296 0.7271 0.0522

± 1.033 1.820 6.989 4.233 0.661 0.783 3.372

Conclusion: The results made it possible to develop a mathematical model for estimating the probability of acidosis at birth, through the analysis of cardiotocographic variables.

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Posters

P88 Cardiotocography predicting buffer base deficit (. 10 mM) at birth in pregnancies with absent or reversed end-diastolic velocity in the umbilical artery Doppler studies

P90 Growth hormone and insulin- like growth factor 1, in smallfor-gestational-age pregnancies with increased pulsatility index in the umbilical artery

R. M. Yamamoto, R. P. V. Francisco, D. Okatani, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil

T. Larsen, K. Main, A. M. Andersson, A. Juul, G. Greisen and N. E. Skakkebaek Herlev Hospital, University of Copenhagen, Denmark

Background: A study of cardiotocographic (CTG) variables and buffer base deficit at birth in fetuses with AREDV. Methods: The last CTGs of 127 AREDV cases were correlated to buffer base deficits above 10 mM. The variables selected by the Logistic Regression model were: baseline, accelerations, variability (variab.), sinusoidal pattern, bradycardia, late and variable (var.) decelerations (mild, moderate and severe). Results: The maximum likelihood estimates are shown with the variables:

Variable

Parameter estimate

Standard error

P

Intercept GA (weeks) variab. 5±9 bpm Variab. , 5 bpm

20.4976 20.0195 0.5330 2.5275

1.8374 0.0590 0.4431 0.5804

0.7865 0.7407 0.2290 0.0001

Odds ratio 0.981 1.704 12.522

Conclusion: The analysis of cardiotocographic variables makes it possible to estimate the probability of a base deficit above 10 mM at birth, i.e. buffer base depletion. Low placental permeability to bicarbonate and buffer base is an advantage for studying these results, which are less influenced by acute events.

P89 A longitudinal study of computerized cardiotocography in pregnancies with absent or reversed end-diastolic velocity (AREDV) in the umbilical artery Doppler studies: preliminary results D. S. Steinman, R. M. Yamamoto, R. P. V. Francisco, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil Background: A study of computerized cardiotocography (CTG) results in pregnancies with AREDV. Methods: Forty-eight computerized CTGs of 13 AREDV cases were studied. All the patients were hospitalized after the AREDV diagnosis and submitted to intensive fetal vitality evaluation. Results: From the 48 exams performed, 25 (52%) met Dawes/ Redman's criteria, and the mean time of analysis was 31.7 ^ 15.3 min. fhr decelerations were found in 1 (4%) of the 25 cases where the criteria were met and in 9 (39.1%) of the 23 cases where the criteria were unmet. Fetal death occurred in 2 cases. The results of the last CTG are shown in the table:

STV , 4.0 Criteria unmet

pH , 7.20 or fetal death (n 5)

pH . 7.20 (n 6)

2 (40%) 4 (80%)

1 (16.7%) 3 (50%)

Conclusion: The preliminary results show that, in AREDV cases, Dawes/Redman's criteria were not met in 47.9% of the exams performed. A high incidence of abnormalities (80%) was found in the computerized CTG in cases that presented acidosis at birth or fetal death.

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Background: The aim of the study was to examine some endokrinological aspects of intrauterine growth retardation and, in particular, test whether low levels of GH and IGF-1 in maternal serum are associated with direct evidence of placental dysfunction. Method: Prospectively 48 singleton pregnancies with a SGA fetus and 28 with an AGA fetus were examined with maternal serum GH, IGF1, IGFBP-1 and 3, and fetal weight and umbilical artery pulsatility index at 33 weeks of gestation. Results: Serum IGF-1 was lower in the SGA group, which was accounted for in the subgroup of SGA with increased pulsatility index. Conclusion: A decreased maternal level of IGF-1 seems to be specifically related to placental dysfunction as diagnosed by increased Doppler flow pulsatility

P91 The influence of maternal exercise on placental blood flow measured by simultaneous multigate spectral Doppler imaging (SM-SDI) S. Degani, B. Feiner, Z. Leibovich, I. Shapiro and G. Ohel Bnai Zion Medical Center, Haifa, Israel Objective: To evaluate the effect of maternal isometric exercise on the placental blood flow as reflected by the velocimetric indices PI and RI derived from placental arteries. Subjects: Thirty-four healthy women with normal singleton pregnancies between 22 and 35 weeks of gestation. Methods: All subjects underwent an isometric handgrip exercise test. Maternal blood pressure and heart rate together with placental PI and RI were measured at rest, during the exercise and in the postexercise recovery phase. All Doppler measurements were obtained using the Simultaneous Multigate Spectral Doppler Imaging (SM-SDI) technique, a new ultrasound modality that enables a Doppler study of multiple locations to take place within a very short time. Results: There was a significant increase in the mean values of the maternal blood pressure and heart rate during the exercise, and a significant decline in the recovery phase. There was no significant change in the mean value of the Doppler indices throughout the examination. Conclusion: Maternal isometric exercise of a similar degree of effort does not affect the impedance of the placental circulation.

P92 Early second trimester low umbilical coiling index predicts small for gestational age fetuses S. Degani, Z. Leibovich, I. Shapiro, R. Gonen and G. Ohel Bnai Zion Medical Center, Haifa, Israel Objective: To evaluate the role of early second trimester Doppler velocimetric studies, umbilical coiling index and umbilical cord crosssectional area as a test for the prediction of small for gestational age (SGA) infants. Study design: Doppler blood flow studies in 147 singleton pregnancies at risk for delivery of a SGA newborn were performed at 15 ^ 1 weeks of gestation from umbilical artery, middle cerebral artery, inferior vena cava and ductus venosus. Pulsatility index (PI) values were calculated for the arteries and preload index (PLI) and S/A values for the veins. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. The umbilical coiling index was calculated using sonographic longitudinal views of cord vessels from several segments antenatally. SGA newborn was identified when the birth weight was below the 10th percentile for gestational age.


4±7 October 2000, Zagreb, Croatia Results: Among 147 pregnancies studied, 124 fulfilled the study criteria. 39 of the fetuses were SGA at birth (31.5%). The mean gestational age at delivery (^ SD) of the normally grown fetuses was 39.7 ^ 1.28 weeks and of the SGA newborns was 34.6 ^ 2.9 weeks (range 28±40 weeks). The best single predictor of a SGA infant was the coiling index with a sensitivity of 79% specificity of 86%, positive predictive value of 72% and negative predictive value of 90%. Conclusion: Umbilical coiling index measured in the early 2nd trimester is useful in predicting birth of a SGA infant and may be a marker of subsequent growth restriction.

P93 Comparison of renal artery blood flow velocity waveform and renal volume in normal and growth-retarded fetuses K. S. Lee, M. Y. Park and B. H. Woo Department of Obstetrics and Gynecology, College of medicine, Ewha Woman's University, Seoul, Korea Objective: The purposes of this study are to evaluate renal artery blood flow velocity waveform and renal volume in growth-retarded fetuses compared with normal fetuses. Method: Doppler flow velocity waveform of renal artery and renal volume measured by three-dimensional ultrasonography were obtained in 78 normal fetuses at gestational age from 25 to 39 weeks and 18 cases of IUGR fetuses weighted below the tenth percentile at birth. Results;: Fetal renal artery pulsatility index (PI) decreased throughout the gestational period (r 0.703, p 0.0001). In growth-retarded fetuses, although all of them had abnormal Doppler velocity waveform of middle cerebral artery, renal pi was not increased significantly. Fetal renal volume increased throughout the gestational period (r 0.834, p 0.0001). and in growth-retarded fetuses, renal volume of all was below the fifth percentile of normal fetuses. Conclusion: Fetal renal volume measured by three-dimensional ultrasonography may be the helpful parameter in the evaluation of growth-retarded fetus.

P94 Fetal cerebrovascular response to chronic hypoxia D. Jugovic, R. Laurini, M. JudasÏ, Ph. Arbeille, A. Kurjak and A. SalihagicÂ Objective: To study the cerebral and umbilical hemodynamics changes in hypoxic and growth-retarded fetuses. To determine if at long-term, fetal brain hyperperfusion with loss of cerebral vascular flow velocity variability is associated with brain damage and poor fetal outcome. Methods: The fetal blood flow redistribution was assessed by using Doppler cerebral-umbilical ratio in 8 growth-retarded fetuses, mainly every day. The evolution of the fetal hemodynamics was interpreted according to the clinical, anatomical and histological data. Results: All 8 fetuses had poor fetal outcome including fetal death (n 5). Fetal blood flow redistribution with brain hyperperfusion was detected in all fetuses during the whole period of observation. The early phase of fetal deterioration was characterized by the development of oligohydramnios and the disappearance of the cerebral flow velocity variability. During the later phase of deterioration, fetal heart rate decelerations and the increase of cerebral vascular resistance with reduction of brain perfusion were detected. Histological study of the brains showed hypoxic lesions. Conclusion: The loss of variability of the cerebral resistance index, in the cases of absent umbilical end diastolic flow, and the loss of variability of the cerebral-umbilical ratio in the other cases, identifies the beginning of the period of very high risk for the fetus. Such a pattern may be considered as a predictor of brain lesion and poor fetal outcome. These results also indicate the existence of two phases in the fetal cerebrovascular response to chronic hypoxia.


Posters P95 Doppler velocimetry in M1 and M2 segments of middle cerebral artery (MCA) in prediction of fetal hypoxia in normal and growth-restricted fetuses M. Bednarek, M. Dubiel and G. H. BreÃborowicz Department of Obstetrics and Gynecology, University of Medical Sciences, PoznanÄ, Poland Background: The aim of the study was to evaluate the prognostic value of the examination of PI of two segments of MCA in the prediction of hypoxia in normal and growth-restricted fetuses. Method: Doppler examination was performed in 98 normal and 64 growth-restricted fetuses. A combined color coded pulsed Doppler and two-dimensional real time ultrasound equipment with transabdominal 3.5 MHz transducer was used (Acuson 128XP). A fetal/ neonatal hypoxia was defined as: late decelerations during the delivery, Apgar score in 5 0 , 7, pH of umbilical artery below 7.15, neonatal respiratory disorders leading to artificial ventilation. Results: The prognostic values (sensitivity, specificity, positive and negative predictive values) of PI estimated during 7 days before delivery were as follow: for M1 ± 31%, 83%, 67%, 52% and for M2 34%, 88%, 75%, 55%, respectively. Using stronger criteria for the recognition of fetal/neonatal hypoxia (pH and BE of umbilical artery , 7,10 and , 2 12 mmol/l, respectively) the prognostic values of PI were as follow: for M1 ± 40%, 89%, 70% and 70%; for M2 ± 48%, 87%, 69% and 72%, respectively. Conclusion: PI of M1 and M2 segments of the MCA seems to be a good predictor of fetal hypoxia during the second half of pregnancy complicated by growth restriction.

P96 Abnormal trajectory of the anterior cerebral artery. A key finding to the diagnosis of the fetal lobar holoprosencephaly P. Zaarour, J. P. Bernard, M. V. Senat, B D. E. Keersmaecker, M. Molho and Y. Ville HoÃpital Poissy St Germain en Laye, France Background: The prenatal diagnosis of alobar and semi lobar holoprosencephaly is accesible in routine ultrasound. In contrast the diagnosis of lobar holoprosencephaly is still difficult. Prenataly differential diagnosis of lobar holoprosencephaly with septal defects is important for counseling. Case report: We describe the shape and trajectory by color Doppler of the anterior cerebral artery in a case of lobar holoprosencephaly. Results: The anterior cerebral artery runs under the frontal bones and is a key to the diagnosis of fusion of the two frontal gyri. This has already been described on angiography in children with holoprosencephaly Conclusion: This aspect in color Doppler of the anterior cerebral artery is particularly useful in the difficult diagnosis of lobar holoprosencephaly

P97 Elevated maternal midtrimester chorionic gonadotropin is associated with fetal cerebral blood flow redistribution R. Hershkovitz, O. Erez, D. Mankuta and M. Mazor Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel Background: Elevated midtrimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG and fetal arterial circulation and to determine the relationship between maternal and perinatal complications and elevated hCG. Methods: Pulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 72 consecutive patients with abnormal maternal serum hCG (. 2.5 MoM). Each patient had between two to four US scans during pregnancy. Patients

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10th World Congress on Ultrasound in Obstetrics and Gynecology with known structural or chromosomal anomalies were excluded from the study. Results: Out of 72 women with hCG . 2.5 MoM, 48% (35/72) had hCG . 3.5 and 24% (17/72) had. hCG levels . 4.5 MoM. MCA PI was lower in women with hCG . 4.5 MoM between 28 and 36 wks' gestation, but not between 18 and 27 wks' gestation (fig). No differences of MCA PI were found when the cutoff point of hCG was 3.5. PI of the UA was not different between the groups. Women with hCG levels . 4.5 MoM had a higher prevalence of PIH and preeclampsia, preterm deliveries and cesarean sections in comparison to women with hCG , 4.5 MoM. Birthweight was lower and the rate of Apgar score , 7 was higher. No differences were not found with cutoff 3.5MoM. Conclusions: Maternal midtrimester hCG . 4.5 mom is associated with cerebral blood flow redistribution and with higher rates of maternal and perinatal complications in comparison to maternal hCG of 2.5±4.5 MoM.

Posters

Number of case

W/VE/E (mg)

W/VE/E (mg)

W/VE/E (mg)

W/VE/E (mg)

1 2 3 4 5 6 7 8 9 10 11

305/11/start 15 305/1/start 15 332/11I/start 15 306/11/start 15 292/11I/start 50 313/11I/start 50 256/11/start 50 293/11I/start 50 293/11/start 50 265/11I/start 50 282/11I/start 50

306/1/15 334/1I/15 342/0/15 316/0/15 312/0/50 33/0/50 263/0/50 296/0/50 296/11I/100 272/0/50 29/0/50

34/0/15 34/0/15 352/0/15 35/0/15

36/0/15 37/0/15 36/0/15

355/0/50 302/1/0/50

311/0/50

W weeks. E vitamin E. 1 ve; 0 no ve. i inverse flow in the pMCA.

P98 Effects of maternal betamethasone administration on fetal Doppler flow velocity waveforms

P100 IUGR fetuses with abnormal umbilical artery Doppler and elevated S100B protein levels

C. Kaehler, E. Schleuûner, A. MoÈller, U. MoÈller and H. -J. Seewald Department of Obstetrics and Gynaecology, Friedrich-SchillerUniversity, Jena, Germany

M. Bruschettini, C. Grondona, E. Marinoni, R. Di Iorio, M. Lituania, P. L. Bruschettini, F. Michetti and D. Gazzolo

Background: To investigate the effect of maternal betamethasone administration on fetal arterial, venous and cardiac Doppler flow velocity waveforms. Method: Patients: 13 women with singleton pregnancies considered at risk of preterm labour received an intravenous dosis of 2 8 mg betamethasone. Study design: Prospective study. Main outcome measures: Doppler studies were performed from the umbilical artery, middle cerebral artery, both uterine arteries, from the ductus venosus, inferior vena cava, right hepatic vein, form the av-valves, right and left ventricular outflow tract and the ductus arteriosus before and after (30 min, 24, 48 and 72 h) betamethasone administration. Peak systolic velocities and maximum end-diastolic velocities were recorded. Calculation of the resistance index (RI) for the arterial system, the peak velocity index for veins (PVIV) for the venous system and the E/A ratio for the av-valves. Results: No significant variation was noted in the Doppler measurements before and after betamethasone administration. A slight and reversible increase of the peak systolic velocity of the ductus arteriosus and the right ventricular outflow tract was observed at 30 min after betamethasone administration. Conclusion: Betamethasone administration does not cause a significant change of the arterial, venous and intracardiac Doppler flow velocity waveforms in healthy fetuses.

P99 Effect of the vitamin E on the vasoconstrictor reflex C. LoÂpez RamoÂn y Cajal Unidad de DiagnoÂstico Prenatal, Hospital Xeral, Vigo, Spain. E-mail: [email protected]. Background: The vitamin E is an antioxidant agent used in the regulation of the vascular reactivity. We describe the use of the vitamin E on the regulation of the vasoconstrictor effect (VE) of the proximal segment of the middle cerebral artery (pMCA). Method: In 11 fetuses we performed a pressure test. First the VE was demonstrated using pulsed Doppler and then we administrate orally vitamin E to the pregnant (15±50 mg per day). Later, we repeat the pt to observe the response on the VE. Results: After the vitamin E the VE was decreased or abolished (see table at top of page). Conclusion: With vitamin E we can regulate the VE of the pMCA. This response could avoid some perinatal motor injury of intrauterine origin and best the neonatal vascular adaptation.

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Maternal and umbilical blood samples were collected in IUGR pregnancies with abnormal umbilical artery Doppler findings and in controls. S100B protein levels were measured by means of a specific radioimmunoassay and flow velocimetry waveforms were recorded from uterine, umbilical and fetal middle cerebral arteries. We studied the correlation between S100B protein, an acidic calcium binding protein previously demonstrated as a reliable indicator of brain lesion, and the degree of fetoplacental blood flow impairment to examine whether S100B could be helpful in the detection of brain sufference in intrauterine growth retarded (IUGR) fetuses. Mean S100B protein in umbilical plasma were higher (P , 0.05) in IUGR patients (113.5 ^ 65.9 fmol/mL) than in controls (52.7 ^ 34.8 fmol/mL), and particularly in those cases in which brain sparing was present (169.6 ^ 67.8 fmol/mL). Fetal S100B concentrations were correlated with middle cerebral artery PI (r 20.50, P , 0.05) and with umbilical artery PI/middle cerebral artery PI ratio (r 0.51, P , 0.05). This study provides evidence that fetal S100B protein is increased in IUGR and suggests that it may play.

P101 Doppler flow velocimetry in fetal and maternal circulation in relation to blood serum and amniotic fluid erythropoietin levels J. WeËgrzynowski and E. Ronin-Walknowska Department for Pathology of Pregnancy and Labour, Pomeranian Academy of Medicine, Szczecin, Poland Objective: To correlate arterial Doppler flow velocimetry with amniotic fluid and umbilical cord erythropoietin levels and umbilical cord gasometry. Material and methods: The study compromised 80 pregnant woman who delivered in cesarean section without prior uterine contractions. The AB, PI and RI indexes of fetal umbilical, cerebral arteries as well as uterine arcuate arteries was assessed max. 24 h before delivery. Amniotic fluid was collected during the cesarean section before the uterine incision and umbilical cord blood was retrieved after the delivery, 1 min after the cord was clamped. Results: The correlation was found between umbilical arteries AB ratio and amniotic erythropoietin levels, fetal serum erythropoietin levels as well as umbilical artery pO2 and apgar score 5 min after delivery. The correlation was also found between fetal blood and amniotic fluid erythropoietin levels. Conclusions: Doppler flow velocimetry of umbilical artery reflects the fetal and newborn well being. Umbilical cord and amniotic fluid erythropoietin levels reflect fetal oxygenation. Erthropoietin levels


4±7 October 2000, Zagreb, Croatia may be checked in amniotic fluid beceause amniocentesis is related to lower incidence of complications in comparisone with cordocentesis.

P102 Preterm newborns with normal flow velocimetry and elevated S100B blood cord levels C. Grondona, Bruschettini, D. Gazzolo, M. Lituania, P. Vinesi, E. Marinoni, R. Di Iorio, M. Marras, P. L. Bruschettini and F. Michetti S100B blood cord levels were significantly higher in the pretem group (1.31 ^ 0.64 vs. 0.47 ^ 0.35 g/L; P , 0.001), peaking in earliest weeks of gestation, and progressively decreased near term, being undetactable or at the limit of sensitivity in the term group. A significant correlation between S100B blood cord levels and gestational age was observed in all considered fetuses (r 20.69; P , 0.01). We investigated 58 pregnancies (30 at term and 28 preterm), with normal flow velocimetry waveforms, whose delivery was between 27 and 42 weeks' gestation. Exclusion criteria were: multiple pregnancies, IUGR, gestational hypertension, diabetes and infections, fetal malformations, chromosomal abnormalities, perinatal asphyxia, and distocia. At birth, all newborn infants showed normal clinical conditions and no neurological injury was observed at the discharge from the Hospital. As expected, gestational age at birth (32.2 ^ 3.1 vs. 39.4 ^ 1.4 weeks) and birthweight (1859 ^ 723 vs. 3250 ^ 210 g) were higher in the term group (P , 0.01 for both), while no significant differences were observed regarding delivery mode, Apgar score at 1st (8 ^ 2 vs. 9 ^ 1) and 5th min (9 ^ 1 vs. 8 ^ 1) and gender (preterm female/male: 13/15; term female/male: 16/14). S100B levels significantly higher in female preterm and term fetuses (preterm 1.65 ^ 0.48 vs. 0.99 ^ 0.61; term 1.14 ^ 0.69 vs. 0.75 ^ 0.51, respectively; P , 0.05 for both).

P103 Effect of uterine contraction on preload index1 in recipient fetus of feto±fetal transfusion syndrome: case report Y. Takahashi and I. Kawabata Department of ObGyn., Gifu University School of Medicine, Japan A case of monochorionic-diamnionic twin was diagnosed as feto-fetal transfusion at 19 weeks gestation. We performed amniocentesis to reduce the fluid and amnioseptostomy. The discodancy of amniotic fluid was remarkably dissolved for long period. At 25 weeks gestation, we started tocolysis by ritodrine and magnesium sulfate drip infusion. During the uterine contraction, we detected increased preload index on recipient fetus by evaluation of the flow of inferior caval vein and reverse end-diastolic flow of umbilical artery on donor fetus and these unfavorable findings disappeared a few minutes after the uterine contraction improved. These findings suggest that uterine contraction is absolute risk factor for feto±fetal transfusion syndrome because they worsen blood flow on both fetuses. (1) Kanzaki T, Chiba Y. Evaluation of the preload condition of the fetus by inferior vena caval blood flow pattern. Fetal Diagn Ther 1990; 5(3±4):168±74.

P104 Ultrasonic fetal and placental tissue characterization and the role of Doppler ultrasound in lung maturity M. Podobnik, M. Podgajski, B. Breyer and B. Gebauer Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia Objectives: The aim of this study is to known the relationship between the gestational age and quantitative assessment of ultrasonic signs of placental tissue, fetal lungs and liver tissue and to correlate Doppler parameters from main stems of the pulmonary arteries for determining fetal lung maturity in normal pregnancy and pregnancy with preeclampsia and diabetes. Method: The placenta, fetal lungs and fetal liver in 300 normal pregnancies, 100 preeclamptic pregnancies and 100 diabetic pregnancy were examined by ultrasound at 30±41 weeks of gestation. The coefficients of variation (the standard deviation divided by the mean value) were used to


Posters characterise the tissue in different groups during pregnancy. Doppler velocimetry was performed in the main stems of pulmonary arteries in normal pregnancies and pregnancies with preeclampsia and diabetes. Results: The coefficients of variation in mature foetuses were greater than 29% for placentas in-vivo, greater than 34% for placentas in-vitro, greater than 28% for liver tissue and greater than 30% for lung tissue. Placental, lung and liver tissue of diabetic pregnancy tended to have lower coefficients of variation throughout their pregnancies. We found in mature foetuses mean peak systolic velocity higher than 40 cm/sec. and PI lower than 3,00. In mature foetuses with preeclampsia we found higher mean peak systolic velocity in comparing with normotensive patients. Conclusion: The coefficient of variation values for placentas in-vivo and in-vitro, and fetal lungs and liver increase during pregnancy in normal and preeclamptic patients with increasing gestational age and decrease in diabetic patients.

P105 Umbilical vein blood flow changes in normal and growth retarded fetuses E. Di Naro, F. Ghezzi, L. Raio, M. Franchi, F. Romano, L. ClericoÁ, G. Lanzilotti, D. Bolla and D. Balestreri University of Bari, University of Insubria, Varese, Italy and University of Bern, Switzerland Background: The aim of this study was to assess whether changes of UV flow volume over time in late (third trimester) growth retarded fetuses (IUGR) are different than those in normal fetuses. Method: Umbilical morphometric characteristics and UV blood flow parameters of 15 women whose fetus was diagnosed to be IUGR without umbilical artery Doppler abnormality were compared to those of 30 women whose fetus was healthy. Gestational age and parity were used as matching criteria. Digital color Doppler velocity profile integration was used. For each patient, two scans were performed in a period of 3 weeks. Results: The umbilical cord area was significantly smaller in IUGR than in healthy fetuses at each examination (P , 0.05). The umbilical artery areas were not different between groups. The UV blood flow normalized for estimated fetal weight was lower in IUGR than in healthy fetuses 115 ^ 41 vs. 145 ^ 39, P , 0.05). The UV flow increase between two consecutive exams was significantly lower in IUGR than in healthy fetuses (P , 0.05). Conclusion: The umbilical cord area and the uv blood flow of IUGR were reduced in comparison to healthy fetuses. The normalized UV blood flow difference between IUGR and healthy fetuses increases with advancing gestation.

P106 Persistent right umbilical vein: incidence and significance in a low risk population I. Wolman, I. Gull, R. Amster, J. Hartoov, G. Fait, J. B. Lessing and A. J. Jaffa US Unit Ob/Gyn, T.A.M.C, Israel Objectives: Our purpose was to conduct the first prospective evaluation of the incidence and neonatal outcome of fetuses with persistent right umbilical vein (PRUV). This condition had traditionally been considered to be extremely rare and to forebode grave consequences for the babies, but later evidence raised some doubt upon the veracity of these contentions. Methods: Between August 1995 and November 1998, 8950 low-risk patients were prospectively evaluated at two medical centers. The ultrasonographic diagnosis of a persistent right umbilical vein was made in a transverse section of the fetal abdomen when the portal vein was curved toward the stomach and the fetal gallbladder was located medially to the umbilical vein. Results: Seventeen cases of fetuses with PRUV were detected during the study period among the 8950 study participants. Four of them had additional malformations of which three had been detected antenatally. Conclusions: We established that the incidence of PRUV in a low risk population is 1:526. We believe that the sonographic finding of this anomaly is an indication for conducting targeted fetal sonography and

89

10th World Congress on Ultrasound in Obstetrics and Gynecology fetal echocardiography. When the PRUV is connected to the portal system and after other anomalies are ruled out, the prognosis can generally be expected to be favorable.

Posters

Background: A study of the relation between methods for assessment of fetal well-being and umbilical artery pH at birth below 7.10. Methods: A prospective study was conducted to assess the fetal well-being in 61 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of umbilical artery pH at birth , 7.10. All data were analyzed and compared using logistic regression. Conclusion: The probability of umbilical artery pH below 7.10 in ARED fetuses could be predicted by means of the ductus venosus Doppler studies and the BPS. Knowledge of this probability can help to choose the best moment for delivery in these cases.

of the middle cerebral artery (MCA), with special reference to the etiology and pathogenesis of CI. We correlated the hemispheral localization and the distribution of the lesion with neurodevelopmental outcome of the children affected. Patients and methods: Two children were preterms and other eight were full terms. The diagnosis was obtained in all children by using cranial US, CT and MRI. Because of vascular etiology of lesion cerebral circulation was investigated by TCDD. Perinatal risk factors were assessed and patients underwent neurodevelopmental follow-up for 1±14 years. Results: Cerebral infarction involved the irrigational area of MCA. Asymmetric flow between the left and right MCA was the main finding on the TCDD. Lower velocities were found in the MCA on the affected side. These side-to-side differences were present at subsequent Doppler measurements. The lesion was more often found on left size. The distribution of the infarction was classified as the area of the lesion determines the neurological sequels. All infants had delayed psychomotoric development: contralateral hemiparesis, persistent seizures and language delay. The level of cognitive functioning was variable. Conclusions: Based on clinical and diagnostical follow-up the results showed no simple and clear connection between lesion parameters and neurodevelopmental outcome. We suppose that the time when lesion occurred is crucial for the possible neurodevelopmental outcome. The data indicates that beside brain US, CT and MR, TCDD can be useful method for identifying and following infants with suspected cerebral infarction.

P108 The importance of studying the ductus venosus for predicting acidosis at birth in pregnancies with absent or reversed enddiastolic (ARED) velocity flow in the umbilical arteries

P110 Neurodevelopmental outcome of children with intrauterine growth retardation and pathological antenatal color Doppler: a 1-year follow-up

R. P. V. Francisco, R. M. Yamamoto, K. Sakamoto, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil

R. Huzjan*, V. MejasÏki-BosÏnjak*, T. Gojmerac*, D. JugovicÂ², B. Grguric-KoprcÏina², J. Tumbri², J. Polak-BabicÂ³ and D. KalafaticÂ³ *Children's Hospital Zagreb, ²Sveti Duh General Hospital Department of Obstetrics and Gynecology, ³University School of Medicine Zagreb, Croatia

P107 The study of the ductus venosus for predicting umbilical artery pH at birth below 7.10 in pregnancies with absent or reversed end-diastolic velocity flow (ARED) in the umbilical arteries Doppler studies R. P. V. Francisco, R. M. Yamamoto, C. C. Leite, S. Miyadahira and M. Zugaib Hospital das ClõÂnicas, SaÄo Paulo University School of Medicine, SaÄo Paulo, Brazil

Background: A study of the relation between methods for assessment of fetal well-being and birth weight. Methods: A prospective study was conducted to assess the fetal wellbeing in 61 singleton pregnancies with ARED. The results of these methods were compared with the occurrence of umbilical artery pH at birth , 7.20 and , 7.15. All data were analyzed and compared using logistic regression. Conclusion: The pulsatility index for veins in the ductus venosus is the most important predictor for acidosis at birth. Once the ductus venosus pi is known, it is possible to estimate the probability of fetal acidosis in pregnancies with AREDV.

109 Transcranial-duplex-Doppler US findings and neurodevelopmental outcome of infants with perinatal cerebral infarction V. uranovicÂ, V. MejasÏki-BosÏnjak, B. MarusÏicÂ-Della Marina, R. DuplancÂicÂ, L. LujicÂ, J. Babic-Polak and R. Huzjan Children's Hospital Zagreb, Klaiceva 16, Zagreb, Croatia Objectives: We recorded cerebral flow velocities by TCDD in 10 infants diagnosed with cerebral infarction (CI) of the irrigational area

Objective: The aim of the study is to determine the neurodevelopmental outcome of children with IUGR due to placental insufficiency diagnosed by Color Doppler during pregnancy. Patients and methods: 25 children who were diagnosed with IUGR were included. The intrauterine growth was evaluated by repeated US and Doppler examinations and the resistance indexes in umbilical and cerebral fetal blood vessels were registered. The C/U ratio lower than one was considered pathological, implying the phenomena of fetal circulation centralization and brain sparing effect. All children underwent protocol that included the evaluation of other perinatal risk factors and extensive neurological follow-up with repeated brain US, electrophysiological tests, visual and hearing acuity testing, as well as developmental assessment. Results: The gestational age ranged from 30 1 6 to 41 gestational weeks. The follow-up period ranged from 2 to 16 months. None of the children has severe disorder. Some children have signs of dystonic syndrome (6 cases) or global neuroedevelopmental delay (2 cases). The nonoptimal outcome was always connected to neonatal complications and pathological brain US finding (PV-IVH or cortical brain atrophy). Further neurodevelopmental evaluation for assessment of higher cognitive functioning at later (even school age) age will be necessary.

F E TA L E C H O C A R D I O G R A P H Y P111 Bradyarrythmia in the first trimester, a predictor of pregnancy loss T. Vincze Department of Obstetrics and Gynecology, Markusovszky Hospital Szombathely, Hungary

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Background: To determine the prognostic of cardiac bradyarrythmia detected in the first trimester. Method: Cases in which bradyarrythmia was detected by ultrasound between 8±11 weeks were retrospectively reviewed. Results: Bradyarrythmia was founded in five cases of 1292 examinations. One week later was not detected cardiac activity in three, and 2 weeks later in two cases.


4±7 October 2000, Zagreb, Croatia Conclusion: The report suggest that bradyarrythmia is a poor prognosis in early pregnancy and associated with pregnancy loss

Posters CHD differs from that observed postnatally. Associated anomalies should be ruled out because of their high frequency, mainly in some specific heart defects.

P112 Early fetal echocardiography at 13±16 weeks of gestation J.M. Martinez, B. Puerto, A. Borrell, V. Cararach and A. Fortuny Obstetrics and Gynaecology, Hospital Clinic, Barcelona, Spain Objective: Our aim was to determine the potential value of fetal echocardiography at 13±16 weeks of gestation for early reassurance of normality or a prenatal diagnosis of congenital heart disease in high-risk pregnant women. Methodology: 92 pregnant women from 13 to 16 weeks with singleton pregnancies underwent fetal echocardiography because of a high risk of congenital heart disease. The main indications were: nuchal translucency . 95th centile, pregestational diabetes, family history, suspected cardiac anomaly at screening ultrasound, woman at risk of chromosomal abnormality declining invasive testing and fetus affected by a chromosomal abnormality. All the examinations were performed combining either the transvaginal or the transabdominal route, and were considered as complete when the four chamber view, and the origin and double crossing of the great arteries were correctly identified. Colour and pulsed Doppler examination were used to detect regurgitation or very high velocities suggesting valve stenosis. A further conventional transabdominal echocardiography at 20±22 weeks of gestation was performed in all aparently normal cases. Results: We were able to reassure normality in 84 of the cases and eight congenital heart anomalies were diagnosed. Conclusion: Fetal echocardiography at 13±16 weeks' is feasible and can be offered to high risk pregnants. It should be supplemented with the conventional 20±22 weeks' examination whenever normality is diagnosed in the early scan. Postmortem examination is essential to confirm its accuracy.

P113 Prenatal diagnosis of congenital heart defects: report of 263 cases A. Galindo, M. Carrera, M. Salvador, F. GutieÂrrez-Larraya, E. GoÂmez and P. De La Fuente Department of Obstetrics and Gynecology, Hospital Universitario `12 de Octubre' de Madrid, Madrid, Spain Aim: To evaluate the main characteristics of prenatally diagnosed congenital heart defects (CHD). Methods: Retrospective study of 263 fetuses with CHD diagnosed between January 1993±September 1999. In this period 133 more cases were born with a CHD not identified prenatally. Results: The incidence in the period reviewed was 1/148 deliveries (7½). 161 patients (61%) were referred from other Hospitals. Mean gestational age at diagnosis was 27.1 weeks (range: 13±41). 103 were diagnosed before 22 weeks (39%). Most common CHD were complete atrioventricular canal (CAVC) (49 cases, 18%), hypoplastic left heart syndrome (HLHS) (37,14%) and conotruncal anomalies (CTA) (31, 12%). Postnatally, most common CHD were ventricular septal defects (VSD) (70, 29%). Overall sensitivity was 66%, improving from 1993 (60%) to 1999 (80%). Sensitivity was higher for CAVC (86%), HLHS (90%), tricuspid atresia (93%). Sensitivity was poor in VSD (26%). Associated anomalies were seen in 105 cases (40%) more common in CAVC (37/49, 75%), VSD (16/22, 73%) and CTA (14/31, 45.2%). In 85 cases (32%) termination of pregnancy (top) was performed. This represents 82.5% of 103 cases diagnosed , 22 weeks' gestation. tops were more common in CAVC (39%) and HLHS (46%). Conclusion: Fetal echocardiography enables the diagnosis of a high number of CHD in the first half of pregnancy. Changes in the monographic visualization of the CHD over the pregnancy with potential progression of the lesion in utero, the small size of the defect and difficulties in monographic work-up are explanations for late diagnosis and false negative cases. The distribution of the different


P114 Fetal echocardiography in chromosomally normal fetuses with increased nuchal translucency. A preliminary report B. Puerto, J. M. Martinez, A. Borrell, V. Cararach and A. Fortuny Obstetrics and Gynaecology, Hospital Clinic, Barcelona, Spain Objective: To determine the value of first trimester screening for congenital heart disease by measurement of nuchal translucency at 10±14 weeks of gestation. Methodology: A transabdominal echocardiography at 20±22 weeks of gestation was performed in 104 singleton pregnancies with chromosomally normal fetuses and an increased nuchal translucency (. 95th centile) at 10±14 weeks. In the last 55 cases an early examination combining either the transvaginal or the transabdominal route at 13±16 weeks was also carried out. The heart evaluation was considered as complete when the four chamber view, with both atria, ventricles and atrioventricular valves, as well as the origin and double crossing of the great arteries were correctly identified. Colour and pulsed Doppler examination were used to assess blood flow through the aortic, pulmonic and atrioventricular valves, in order to detect regurgitation or very high velocities suggesting valve stenosis. The systemic and pulmonary venous return was also identified, and assessed by Doppler when possible. Results: Only one structural cardiac defect was detected in this population. It was a tricuspid atresia with ventricular septal defect detected at 14 weeks of gestation. Conclusion: Although the number of cases is too small to draw strong conclusions, the utility of nuchal translucency as a screening method for congenital heart disease in chromosomally normal fetuses is worth to be confirmed by further investigation.

P115 First trimester diagnosis of the Pentalogy of Cantrell A. Yamasaki, D. A. L. Pedreira, R. Muller, M. V. Machado, R. Schultz and S. C. Cha LaboratoÂrio Fleury, SaÄo Paulo, Brazil Case report: CATO, 31-year-old, 2G 0P 1 missed abortion (6 weeks). Ultrasound at 13 weeks gestation showed an opened fetal thoracoabdominal wall, with ectopia cordis and a large omphalocele, severe scoliosis was noticed, suggesting the diagnosis of Pentalogy of Cantrell. Nucal translucency measured 1.5 mm and Doppler velocimetry of the venous ductus showed a reverse A wave. At 15 weeks, a transabdominal echocardiography showed a complete ectopia cordis and a ventricular septal defect with mild dilatation of right atrial and ventricular cavities. Kariotype obtained by cvs at 14 weeks showed a normal male (46,XY). Spontaneous fetal death occurred at 18 weeks and after 4 days induced labor resulted in an uneventful vaginal delivery. The anatomopathologic study confirmed the diagnosis of Pentalogy of Cantrel: ectopia cordis, cardiac anomalies (IAC, IVC, truncus arteriosus), sternal agenesis, diaphragmatic defect and gastrosquisis. Discussion: Ectopia cordis is present in the Pentalogy of Cantrell, which is one of the thoraco-abdominal malformation syndromes. It is a rare disease with a relatively good prognosis in neonatal series. Nevertheless, during pregnancy, few cases have been reported making fetal counselling difficult. This anomaly seems to be a X-linked dominant inheritance, suggesting that male fetus can have worse prognosis.

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10th World Congress on Ultrasound in Obstetrics and Gynecology P116 The role of fetal echocardiography and detailed sonography in the prenatal diagnosis of the Edward's syndrome (analysis of the 30 cases) P. Kaczmarek, K. Janiak, A. KrasonÂ, G. Nowicki, E. Czichos and M. Respondek-Liberska Department of the Diagnosis of Fetal Malformations, Institute `Polish Mother's Memorial Hospital', èoÂdzÂ, Poland http://www.fetalecho.z.pl Background: The aim of this study a retrospective analysis from the video tapes fetuses with trisomy 18 (Edward's syndrome) who had detailed sonography and echocardiography. Method: Between 1994 and 2000 at our Department 30 cases of trisomy 18 were diagnosed. Results: Every fetus presented with congenital anomalies. The most common were: intrauterine growth retardation (96%) and fetal congenital heart defects (92%). Conclusion: The `genetic sonography' including fetal echocardiography allows a strong `suspicion' of trisomy 18, which later can be confirmed by cytogenetic analysis.

P117 Echocardiographic findings in fetuses with trisomy 18 M. Holan, V. Ferianec, K. Pohlodek, M. Kaldararova and M. Benedekova Children's Cardiology Centre, Children's University Hospital, Bratislava; IInd Obstetrics and Gynecology Clinic, Medical Faculty UK, Bratislava; Ist Paediatric Clinic, Children's University Hospital, Bratislava, Slovak Republic The aim of this study was to present our 4 cases of trisomy 18, with a congenital heart defect detected during the last 6 months. Results: Two complex congenital heart defects (CHD) with a very similar anatomy were found during a prenatal ultrasonographic examination ± Double outlet right ventricle (DORV) with complete atrioventricular septal defect (AVSDC) ± in the 20th and 38th week of gestation and in other two cases ± in the 19th and 21st week of gestation ± an isolated muscular ventricular septal defect (VSD) was proved. In All fetuses also noncardiac (central nervous, gastrointestinal and uropoetical) congenital malformations were present. Conclusion: Trisomy 18 (Edwards sy) occurs approximately in 1:7000 live births. 95±100% of these newborns have some form of CHD. Because of a very poor prognosis a surgical correction is usually not considered. Left to their natural course, death occurs at the age of one hour to 18 months, the median life expectance is 5±48 days, according to the presence of severe CHD and associated anomalies.

P118 The role of fetal echocardiography and detailed sonography in the prenatal diagnosis of trisomy 13 ± analysis of 11 cases K. Janiak, P. Kaczmarek, A. KrasonÂ and M. Respondek-Liberska Polish Mother Memorial Insitute, èoÂdzÂ, Poland http://www.fetalecho.z.pl The aim of the study was to show the importance of sonography and echocardiography at 2nd trimester of pregnancy on the ground of the retrospective analysis of cases with Patau syndrome. Materials and methods: From the database of 6430 fetuses examined throughout 1992 until 1999, aneuploidy in the form of patau syndrome was suspected in 11 fetuses (0,64%). Maternal, fetal and neonatal data were retrospectively evaluated. Results: The majority of cases come from low risk pregnancies. The full genetic antenatal diagnostic was performed in 7 cases. The mean apgar score was 1 and the mortality in analyzed group was 100%. During fetal echocardiography the congenital heart defect were diagnosed in 5 cases: 3xVSD, 1xVSD 1 aorta dextraposition, 1xVSD 1 bright spot 1 cardiomegaly 1 pericardial effusion. Trisomy 13 in analyzed group manifested by malformations of various organs and systems: congenital heart defects was the most common anomaly

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Posters

diagnosed prenatally (7/11), the second one were central nervous system and genitourinary system anomalies (6/11) and others. In the analyzed group the mean number of anomaly per fetus was 3. Prenatal diagnoses were confirmed at autopsy, additionally cleft palate was identified at 2 cases. Conclusion: Fetal detailed sonography and echocardiography in each case of trisomy 13 allows the visualisations of malformations at fetuses (min 1, max 5) and therefore this examination may be consider as `genetic sonogram'.

P119 Usefulness fetal echocardiography in the prenatal diagnosis of Down Syndrome (analysis of the 40 cases) A. KrasonÂ, P. Kaczmarek, K. Janiak, M. Piotrowicz, G. Nowicki and M. Respondek-Liberska Department of the Diagnosis of Fetal Malformations, Institute `Polish Mother's Memorial Hospital' èoÂdzÂ, Poland http://www.fetalecho.z.pl Background: The aim of our study was retrospective analysis of 40 cases fetuses with down syndrome (T21) who had detailed sonography and echocardiography. Method: Video tape analysis of 40 fetuses with T21 who had completed ultrasound and echocardiography examinations and completed neonatal follow-up in the same center. Results: In our study the majority of cases 26 (65%) were low risk pregnancies. High risk pregnancies were in 14 (35%) cases. Congenital heart defect (72%) (AV-canal in 13/18 cases) was the most common anomaly diagnosed prenataly in fetuses with T21. Functional cardiac anomalies with normal heart anatomy were recorded also such as: dyspoportion and hypertrophy in 4/12 cases, tricuspid valve regurgitation, bright spot and pericardial effusion in 3/12 cases. Extracardiac malformations (25%) were diagnosed in fetuses with T21 such as: dudenal atresia, femur length shortening, pyelectasis bilateralis, face anomalies, sceletal malformations, hydrops fetalis. Conclusions: 1. Congenital heart defect (72%) (AV-canal in 13/18 cases) was the most common anomaly diagnosed in fetuses with T21. 2. The most common extracardiac malformation was duodenal atresia 13/40 32.5% cases. 3. Fetal echocardiography can be usefull to identify in the group of low risk pregnancies, the potential patients for cytogenetic examinations of trisomy 21.

P120 Prenatal demonstration of polyvalvular disease in a fetus with trisomy 18 U. Gembruch, U. Germer, S. Denzel and K. Gloeckner-Hofmann Division of Prenatal Medicine, Medical University, LuÈbeck, Germany A polyvalvular disease of cardiac valves is a common finding in early trimester fetuses with trisomy 18 at autopsy (Hyett et al. Am J Med Genet 1997; 69: 207). Prenatal diagnosis of this disease, however, is very rare. Case report: Nuchal translucency screening was performed in a 26year-old gravida 1 at 13 1 5 weeks. IUGR (CRL 65 mm) with nuchal translucency thickness of 3.0 mm, retrogenia and cardiomegaly (CTR . 0.5) was shown. Umbilical artery Doppler indices were normal (PI 1.44), but in the ductus venosus a reversed blood flow during atrial systole was demonstrated (PIV 4.18, PVIV 2.9). Echocardiography showed `doming' of the pulmonary and aortic valves with poststenotic dilatation. Doppler echocardiography demonstrated severe stenoses of the pulmonary and aortic valves (maximal velocities: 1.8 m/s and 2.13 m/s, respectively) and holosystolic insufficiencies of tricuspid and mitral valves (maximal velocities: 2.12 m/s and 2.04 m/s, respectively). The CVS revealed trisomy 18 (47,XY, 1 18). 6 days later, fetal demise was diagnosed. Abortion was induced by an intra-amnial injection of Rivanol. Autopsy confirmed the severe stenoses of both great arteries without additional cardiac malformation. Conclusions: The case reports the option of Doppler echocardiogra-


4±7 October 2000, Zagreb, Croatia phy in early pregnancy to diagnosed severe stenosis of the great arteries and confirmed the data of autopsy studies, that fetuses with trisomy 18 in early pregnancy have polyvalvular diseases, presumably being a lethal factor.

P121 Pulmonary valve atresia. Fetal echocardiography findings in one case with intact ventricular septum C. GarcõÂa, N. Lagos, C. Diaz, N. Meneses, G. Castillo, R. Pazols, C. Benavides, I. Hoffmann, Astorga, P. Ortega and I. Ferres Hospital de Carabineros, Universidad de Santiago, Santiago, Chile Background: Right ventricular outflow obstruction with an intact ventricular septum leads to severe hemodynamic problems in the newborn, with hypoxemia and congestive heart failure due to tricusp regurgitation. Atresia of the pulmonary valve occurs in less than 3% of all congenital heart lesions, with a frequency of 1:25 000 of live births. Use of fetal echocardiography permits prenatal diagnosis of this and other congenital defects, for a better knowledge and therapy. Case report: 35-year-old pacient, with a previous newborn with an interventricular comunication. On her 30 week of pregnancy, a fetal echocardiography showed atresia of the pulmonary valve with an intact interventricular septum, severe tricuspid regurgitation, a right atrial dilatation, restriction of flow in the oval foramen of 8 m/seg and ductus arterioso with retrograde or bidirectional flow, from the aorta to the pulmonary circulation. Vaginal delivery occurred at 38 weeks, obtaining a female newborn, 2630 g, in good conditions. However she developed severe cardiac failure and died at day 4, in spite of pharmacologic with prostaglandins and surgical therapy. Conclusions: Echocardiography is the basis of prenatal diagnosis of congenital heart disease, like pulmonary valve atresia, and is of great help to understand and decide the best perinatal therapy.

P122 Fetus with partial hyperechoic cardiac walls J. A. Duyos ClõÂnica EcograÂfica, Santander, Spain Objective: To present a rare case of a fetus with very echogenic cardiac atrial walls, but with normal density in the rest of the heart, perhaps due to a viral infection. Case report: The first ultrasound examination at 17 weeks was normal, but in the next exam at 24 weeks we detected that the fetal cardiac atrial walls were very echogenic. However, the density of the atrioventricular valves and the ventricular cardiac walls were normal. The morphology of the heart was also normal. There was also an important amount of ascites. Doppler study of the atrioventricular valves was normal. Later examinations were similar but the quantity of ascites gradually decreased. At 34 weeks, the patient had a premature rupture of the membranes and a healthy infant was born. The ascites had disappeared and the baby's outcome was normal. Discussion: To prevent misdiagnosis of the density of the cardiac walls, we made exams of different fetal positions, but hyperechoic atrial walls were always seen. After consulting a neonatal cardiologist, we concluded that the cause of this alteration may have been a viral infection, which could have produced partial density alteration of the cardiac walls. The hyperechoic atrium may cause poor contractability and produce ascites. Conclusions: Despite the impressive aspect of the hyperechoic atrial cardiac walls and an important ascites, the infant's outcome was normal.

P123 Congenital complete heart block. Prenatal diagnosis and successful fetal therapy C. GarcõÂa, N. Lagos, R. Pazols, M. Carrasco, I. Hoffmann and P. Toledo Hospital de Carabineros, Universidad de Santiago, Santiago, Chile Objective: Congenital complete heart block (CCHB) affects 1:20.000


Posters live births. This condition reappears in 18±24% of future pregnancys. 50% of the fetuses have a structural cardiac anomalies. It may present isolated or in mothers with autoinmune disease, or positive anti-Ro (SSA) and anti-La (SSB) antibodies. Our purpose is to show the improvement in perinatal outcome using 2D echocardiografy and foetal Doppler to diagnose CCHB in the prenatal period. Case report: We present a 36-year-old female patient with 2 previous stillborns due to CCHB. She was positive for anti SSA and anti SSB antibodies and was evaluated for the first time at 22 weeks of her third pregnancy. An Echography showed foetal hydrops, and echocardiography showed an anatomically normal heart, with a complete heart block. The atrial rate was 120/min. and the ventricular rate was 60/min. Treatment was started with dexametasone 4 mg/day, salbutamol 12 mg/day and Sandoglubulin (Novartis) 400 mg/kg. Following sonographys showed resolution of fetal hydrops, improvement in cardiac function and cardiac rates. Cesarian section at 34 weeks, newborn 2420 g. At day 7 a permanent pacemaker was implanted. Conclusions: Fetal echocardiography is the best method to diagnose and treat CCHB in the prenatal period. The use of glucocorticoids, betamimetics and immunoglobulins has shown to be of benefit.

P124 S-shaped kinking and constriction of the fetal ductus arteriosus with pericardial effusion M. Y. Park, Y. J. Kim, B. H. Woo and H. S. Kim* Department of Obstetrics and Gynecology, Department of Pediatrics*, College of Medicine, Ewha Woman's University, Seoul, Korea Usually fetal ductus arteriosus (DA) closure or constriction is caused by maternal medication of prostaglandin synthase inhibitor or corticosteroid. Although it is a rare condition, idiopathic DA constriction in the human fetus has been also reported. In our case, the patient was reffered at 26 weeks gestation due to pericardial effusion. The mother had not been received any medication of nonsteroidal anti-inflammatory agents. The fetus had abnormally Sshaped kinking and constriction of the DA, right arterial enlargement, right ventricular hypertrophy, tricuspid valve regurgitation and constrictive foramen ovale. An amniocentesis had been performed due to abnormal triple test and the fetal karyotype was 46XY. There was no evidence of fetal infection and other congenital malformation. Cesarean section was performed at 313 weeks gestation due to fetal hypoxia diagnosed by Doppler sonography and biophysical profile, and the baby was born in poor condition. On follow-up, although the baby has right ventricular dysfunction for 2 month after birth, expected a good prognosis.

P125 Prenatal diagnosis of cardiac rhabdomyoma Â . Player and Z. Vasas L. HernaÂdi, M. ToÍrocsik, D. A County Hospital Eger, Hungary Background: Our aim was to present a case of cardiac rhabdomyoma diagnosed at 24 weeks of pregnancy. A 20-year-old woman, G2P0, was referred for sonographic examination because of the history of cystic hygroma in her first pregnancy. Karyotyping revealed trisomy 21 and termination was performed. There were no cardiac and neurologic diseases in her family history. For the present pregnancy routine ultrasound scans at 12 and 18 weeks showed normal fetal anatomy. Fetal echocardiography at 24 weeks revealed a large cardiac tumour protruding from the intraventricular septum into the right ventricle (12 mm). Colour Doppler showed blood flow around the tumour and the flow pattern was not suggestive for obstruction of the right ventricular outflow tract. No other fetal anomalies were noted. The patient was informed about the diagnosis of rhabdomyoma and the possibility of associated tuberous sclerosis. Termination of pregnancy was performed upon

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10th World Congress on Ultrasound in Obstetrics and Gynecology patient's request. Pathologic examination confirmed the diagnosis but found no sign for tuberous sclerosis. Karyotyping was normal. Her next pregnancy was uneventful resulting a healthy newborn. Conclusion: The natural history of intracardiac rhabdomyoma is not

Posters

known and usually detected in the second half of gestation. The prognosis depends on its influence on cardiac functions and the associated anomalies.

THREE-DIMENSIONAL POWER DOPPLER IN OBSTETRICS AND GYNECOLOGY P126 The three-dimensional ultrasound analysis of embryonal and early fetal development ± an improvement of prenatal diagnosis

the actual scanning time and provides an excellent way to store scanned data.

Z. MalyÂ and M. Koudelka Masaryk University Hospital, Department of Obstet. Gynecol., Brno-Bohunice, Czech Republic

P128 Impact of patient initiated three-dimensional ultrasound examination

Backround: There are two important trends in prenatal diagnosis ± to avoid invasive diagnostic procedures as much as possible and to find anomaly as soon as possible. Ultrasound evaluation is playing an essential role. The first trimester of pregnancy seems to be the suitable period for diagnosis for above mentioned purposes. Method: More than 450 first trimester pregnancies was evaluated with 3D sonography using its all computed features. The images which were obtained can be used also for educative goal. Results: We provided 3D ultrasound diagnosis of fetal anomalies from the moment of their development, up the 9th week of gestation (from LMP). The image quality allowed so precise analysis, that pictures are comparable with embryological reality and will be present. Conclusion: With 3D ultrasound the first trimester seems to be the most important period of prenatal diagnostics. 3D can display the same pictures in vivo, as invasive fetoscopy or embryological speciments in vitro. The technical limits disapear and the knowledge of embryology and of possible pathological fetal development remains the last limiting factor.

D. H. Pretorius, A. D. Hull, R. Newton, T. R. Nelson and G. James University of California, San Diego, La Jolla, CA, USA

P127 Assessment of fetal anatomy in the first trimester using two and three dimensional ultrasound G. D. Michailidis, P. Papageorgiou and D. L. Economides Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK Objectives: To study if a complete anatomical survey of the fetus at 12±13 weeks gestation can be achieved using stored volumes acquired by a 3D scanner. Subjects/methods: One hundred and twenty-two consecutive women at 12±13 weeks gestation who had a scan in our unit. A complete survey of the fetal anatomy was attempted by transabdominal and if needed transvaginal 2D scanning. Then using the 3D transvaginal probe (Kretz 530D) two volumes containing the fetus were acquired. A complete anatomical survey was attempted using the data from these volumes (excluding the anatomy of the heart). Results: A complete anatomical survey was achieved in 93% (113/ 122) of cases with the 2D scanning comparing to 71% (86/122) with the 3D volumes (statistically significant difference, P , 0.01). The nuchal translucency was measured in 97.5% of cases with 2D scanning and in 82% with the 3D volumes. The mean time to perform the 2D scan was 15 min (SD: 4 min) while the time to examine the stored volumes was 6.6 min (SD: 2.66). Using the stored volumes we obtained the required views in 8 of the 9 cases in which the survey was incomplete by the 2D scan. Discussion: Real time 2D scanning is still the best way to examine the fetal anatomy in the first trimester. However, 3D scanning can be a useful addition to clinical practice providing views not easily obtained by conventional 2D scanning. It can potentially minimise

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Background: News media and the internet have a significant impact on raising patient awareness of new care. Visualization of the fetal face made possible by 3-dimensional ultrasound (3DUS) is one such area that has encouraged many pregnant patients to initiate requests for these studies. The purpose of this project was to identify indications, reactions and benefits for these studies. Method: 3DUS examinations were performed on 35 consecutive patients requesting studies from our service. We require a physician to order the 3DUS exam in conjunction with conventional 2DUS. Patients had a targeted 3DUS to the area of interest as well as the fetal face. Comments by the parents were recorded at the time of the study and after delivery. Results: Medical indications for 3DUS studies were: patient reassurance (19), patients with prior anomalies (8), hospice patients carrying fetuses with fatal anomalies (2), patient with family history of anomaly (1), infertility (1), patient carrying a fetus with abnormal karyotype (1). Although most parents found the 3DUS to be a positive, reassuring experience (28), (7) found it to be extremely beneficial (previous children with anomalies or demise, fetuses with fatal anomalies, and infertile couples). Conclusion: Patient initiated 3DUS studies had a positive impact and reassured all families and were extremely beneficial to 6/35 families.

P129 The sonographic appearance of fetal micrognathia using a novel three-dimensional ultrasound system G. Malinger, T. Lerman-Sagie, A. Gomel and M. Glezerman The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Background: Fetal micrognathia is difficult to diagnose using conventional ultrasound and three-dimensional surface rendering may provide additional information when available. We present two fetuses with micrognathia in whom this technique helped in the diagnosis. Method: Three-dimensional ultrasound examination was performed with an add-on unit that fits any existing conventional ultrasound machine. The system contains a unique positional sensor and extremely powerful segmentation feature that allows to remove obscuring objects from the region of interest (BabyFace, Biomedicom, Jerusalem, Israel). In both fetuses the diagnosis was suspected during conventional ultrasound examination. Results: Good three-dimensional images of both fetuses were obtained at the first acquisition intent and provided additional information about the severity of the anomaly. Conclusion: We present a novel 3D ultrasound system, which is user friendly and cost-efficient. Its compatibility as an add-on to existing us


4±7 October 2000, Zagreb, Croatia equipment allows for immediate upgrades and increases diagnostic options in fetal imaging.

P130 Three-dimensional sonographic features of hydrops fetalis A. Kuno, M. Ueta, U. Hanaoka, Y. Tanaka, M. Akiyama, C. Yamashiro, H. Tanaka, K. Hayashi, T. Yanagihara, K. Hara and T. Hata Department of Perinatology, Kagawa Medical University, Japan Background: The aim of this study was to describe three-dimensional (3-D) sonographic features of hydrops fetalis. Methods: A total of 8 cases with hydrops fetalis from 15 to 32 weeks of gestation were studied with transabdominal 3-D sonography (3.5 MHz). Results: The image clarity of 3-D sonography was subjectively superior than those by 2-D sonography in all cases studied, and it was possible to obtain finer image quality of internal organs with 3-D sonography. Before around 20 weeks of gestation, the skin becomes a transparent-like structure, so internal organs can be clearly identified. After 25 weeks, skin edema, pleural effusion, hypoplastic lungs were clearly recognized. Conclusion: Our results suggest that 3-D sonography provides a novel means of visualizing hydrops fetalis in utero.

P131 Differential diagnosis between chorioangioma and chorionic villous haemorrhage by three-dimentional ultrasonography S. Kondo, Ninomiya, T. Takahashi, H. Soma and T. Hata Saitama Medical School, OB/GYN, Saitama 350±0495, Japan We had 2 cases of `placental tumor' with hydramnion and fetal anemia. Case 1: A 26-y/o G-1, P-1 was introduced to our hospital at 25w due to drastic enlargemnet of her lower abdomen. 3-D US exam revealed a tumor on her placental. Its volume was 137.8 ml and abundant bloodflow was observed in the tumor. The tumor and amnionic fluid volume were increased. At 26w, we performed C/S due to her dyspnea by hydramnion. A 1028 g male infant was delivered and was transferred to NICU immediately as an imature infant with his low Hb, 10.6 g/dl. The tumor was histologically diagnosed as

Posters chorioangioma. Case 2: A 26-y/o G-0, P-0 was admitted at 29w due to placental tumor. By 3-D US exam, we found a placental tumor. Its volume was 164.1 ml. C/S was performed because nst showed loss of variability. A 1982 g female infant was delivered. Her Hb was 9.1 g/dl. The tumor was diagnosed as chorionic villous hemorrhage. We could not differentiate those of `placental tumor' by 2-D US with color flow mapping. But using 3-D US, chorioangioma showed as a hyper-echoic mass although chorionic villous hemorrhage did as hypo-echoic. `Placental tumor' can be differentiated effectively by 3-D US.

P132 Three-dimensional ultrasound: A new diagnostic option monitoring cervical incompetence in higher order multiple gestation A. Strauss, I. Heer and S. Fuchshuber Department of Obstetrics and Gynecology ± Groûhadern, University of Munich, Germany Background: Preterm birth is the greatest threat to the infants of a multiple pregnancy. Incompetent cervix is still a diagnostic and therapeutic dilemma. Is three dimensional volumetry of the cervix uteri the key to predict preterm birth in higher order multiples? Method: From May 1999 to May 2000 we prospectively compared conventional measurements of cervical length to 3D-volumetry in 10 triplet pregnancies. Results: 29 volume scans as well as conventional length measurements of the cervix in 10 triplet pregnancies were analyzed. 2.9 examinations per patient (1±5) were done on a weekly basis. The mean cervical length was 27 mm (4±50). The mean cervical volume decreased with gestational age parallel to the two dimensional data. In three women length-assessment could not be obtained as the presenting part of the leading triplet obstructed a longitudinal scan of the cervix. In contrast, these anatomic difficulties did not present an obstacle in (transverse) 3D-scans which were possible in all patients. Conclusion: Transabdominal 3D-volumetry as compared to 2D cervical length measurements represents an exact and potentially superior method to monitor cervical incompetence. We believe it a valuable parameter to predict preterm birth.

U LT R A S O U N D I N G Y N E C O L O G Y P133 The endometrium after 50: sonographic-histologic correlation A. Joutindo, J. P. Lescrainier and C. Van Pachterbeke CHU Brugmann, Obstetrics and Gynecology Department, Place Van Gehuchten 4, B1020 Bruxelles, Belgium We wanted to test the accuracy of sonography in detecting endometrial pathology, in women over 50. Retrospectively, we enrolled 100 consecutive women over 50-year-old, who have had a monographic endometrial thickness measurement followed by a histological endometrial analysis, though endometrial biopsy, dilatation and curetage, or hysterectomy. The mean age was 64.3 years; 54% of the women presented metrorragies and 40% of them did not use hormonal replacement therapy (HRT). We found 6 endometrial cancers and 2 atypical hyperplasia (all of them were symptomatic); we found 7 simple hyperplasia (2 were asymptomatic) and 18 polyps (6 were asymptomatic). No serious endometrial anomaly (simple or atypical hyperplasia or adenocarcinoma) were found under 5 mm of double endometrial layer. The first endometrial cancer was encountered in an endometrial thickness of 10 mm, the first atypical hyperplasia at 9 mm, the first simple hyperplasia at 7 mm, and the first polyp in a 2-mm endometrial thickness. If we used the endometrial thickness cutoff level of , 5 mm for symptomatic women and for asymptomatic women without hormonal replacement therapy and the


endometrial thickness cut-off level of , 8 mm for asymptomatic women with HRT, we obtain a sensitivity in detecting any endometrial pathology of 85%, and a specificity of 41%; the false negative rate is low (5%) and represent in our study only small polyps.

P134 Uterus sonographic volume evaluation in post menopausal women and its variation F. F. A. Santos, M. R. M. Machado, M. S. J. Dertkigil and E. F. Marussi State University of Campinas, Campinas, Brazil Background: The aim of this study was evaluate the uterine volume in postmenopausal women considering parity, years since the last menstrual bleeding, abnormal vaginal bleeding and hormonal replacement therapy (HRT). Method: Uterine size was measured in 100 postmenopausal women by pelvic and/or transvaginal US, that had gone to routine examinations. Results: The mean age was 61.5 years (^ 9.3) and the mean menopausal age was 48 years (^ 5). Forty percent was under HTR and the mean parity was 4.0 (^ 3). Abnormal vaginal bleeding was present in 13% of the patients. The patients were divided into three groups: I (nullipara), II (1 or 2 deliveries), III (3 or more deliveries).

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10th World Congress on Ultrasound in Obstetrics and Gynecology The uterine volume was, respectively, 39, 45 and 47 cm3. Patients under HTR had the mean uterine volume 51 cm3 and the others 42 cm3. Patients with 5 or less years since menopause had a mean uterine volume of 51 cm3 and the women with 6 or more years had 44 cm3. The mean uterine volume in patients with abnormal vaginal bleeding was 62 cm3 (^ 35) and in the assynthomatic ones was 43 cm3(^ 21). Conclusions: The uterine volume had a tendency to be smaller in patients without HTR, low parity and more years since last menstrual period, but have no statistical significance. However the volume was significantly bigger in women with abnormal vaginal bleeding.

P135 Endometrial thickness ultrasound evaluation and its variations F. F. A. Santos, M. R. M. Machado, M. S. J. Dertkigil and E. F. Marussi State University of Campinas, Campinas, Brazil Background: The aim of this study was to evaluate the variations in endometrial thickness considering years since the last menstrual bleeding, abnormal vaginal bleeding and hormonal replacement therapy (HRT). It was also studied the histological diagnosis. Method: Endometrial thickness (ET) was measured in 100 postmenopausal women by pelvic and/or transvaginal US, that had gone to routine examinations. Results: The mean age was 61.5 years (^ 9.3) and the mean menopausal age was 48 years (^ 5). Forty percent was under HTR and abnormal vaginal bleeding was present in 13% of the patients. Endometrial thickness in patient with 5 or less years since menopause was 5.5 mm (^ 0.9) and 4.3 mm (^ 0.5 mm) in those with 6 or more years. Patients under HTR the mean thickness was 5.07 mm (^ 5.6) and without HTR was 4.35 mm (^ 3.9). Women with abnormal bleeding had mean endometrium of 6.9 mm (^ 6.2), against 4.2 (^ 4.3) from assyntomatic patients. The histological diagnosis from patients with ET $ 6 mm were: endometrial polyps (9); endometrial cancer (1); proliferative endometrium (1); submucous mioma (1) and endometrial atrophy (1). All histological studies from patients with bleeding and ET , 6 mm showed atrophic endometrium. Conclusions: The ET had no significant statistical variation when analised time since menopause and use of HRT. All patients with bleeding and ET , 6 mm had endometrial atrophy. 85% (11/13) patients with ET $ 6 mm had pathological finds in histological study, including one endometrial cancer.

P136 Color flow mapping and Dopplerometry of myometrial and endometrial arteries in patients with hyperplasia and polyps E. V. Fedorova, A. D. Lipman, I. D. Khokhlova and N. M. Pobedinski Moscow Medical Academy, Russia Background: The aim is to investigate the influence of the benign hyperplastic process of endometrium over the uterine blood flow resistance. Method: The transvaginal ultrasound with Color Flow Mapping and Dopplerometry was used for examination of 90 patients (28 with hyperplasia, 30 with glandular and 32 with fibroid polyps) and of 30 healthy women (in 1st phase of menstrual cycle). Arteries visualization rate and values of Doppler indices for myometrial (the main uterine, arcuate, radial) and endometrial (basal, spiral) vessels were assessed. Results: The main uterine and arcuate arteries were visualized in all cases. As crossing from feeding uterine vessels deeper to the endometrium, the tendency of reduction possibility of its visualization

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was marked. That probably corresponds with reduction of arteries size. The resistance indices were:

Uterine arteries Arcuate arteries Radial arteries Basal arteries Spiral arteries Polyp arteries

Healthy

Hyperplasia

0.88 0.78 0.71 0.57 ±

0.81 0.75 0.68 0.52 0.53

Glandular polyps

Fibroid polyps

0.83 0.73 0.67 0.51 0.50 0.58

0.83 0.73 0.63 0.52 ± 0.49

Conclusion: Benign hyperplastic process of endometrium was accompanied by lowering Doppler indices values in all arteries in comparison with normal condition, that show intensification of the blood supply.

P137 Ultrasound in the detection of endometrial pathologies in breast cancer patients with Tamoxifen treatment M. R. M. Machado, F. F. A. Santos, E. F. Marussi and V. M. Neder, S Universidade Estadual de Campinas, SaÄo Paulo, Brazil Background: The tamoxifen (TAM) is an antiestrogen that is widely used as adjuvant therapy for postmenopausal breast cancer patients with positive estrogen receptor proteins. It has been reported that the patients who have been treated for more than 12 months with TAM are at increased risk for endometrial carcinoma. The aim of this study was to investigate the relationship between histological endometrial findings in breast cancer patients and transvaginal ultrasound. Method: Medical records and sonograms of 238 women treated for breast cancer with TAM were reviewed retrospectively. We included all patients using adjuvant therapy for breast cancer patients with TAM 20 mg of Tamoxifen. The exam was performed using a transvaginal probe 7.5 MHz transducer on a TOSHIBA 140 SSA and ACUSON XP-4A ultrasonography set. Sonographic endometrial thickness was correlated to histologic findings and symptoms. Results: A hundred-55 (65.12%) had endometrial thickness of 8 mm or lower, measured by transvaginal ultrasound. We did not found any case of endometrial cancer, even with bleeding. From 51 patients with diagnostic hysteroscopy, the more frequent findings were: atrophic endometrium, endometrial polyps and insufficient material for histology exam. Conclusions: Transvaginal sonography is an useful tool for the followup of tamoxifen treated patients used as trial for invasive diagnostic procedures.

P138 A case of bilateral mature cystic teratoma with calcified elements in an old age postmenopausal woman Z. N. Kavak and A. BasËguÈl Department of Gynaecology, University Hospital, Marmara, Istanbul, Turkey Background: Dermoid cysts are interesting tumours in which all body tissues may be represented. Neither presence of calcified elements, nor postmenopausal age, nor bilaterality are usual for them. We present here, a case of postmenopausal woman in whom bilateral dermoid cysts were found with calcified elements. Ultrasonographic features, clinical presentation, differential diagnosis and treatment modalities of this rare case are presented and discussed. Case: 70-year-old woman gravida 0 para 0 was referred to our Department complaining of postmenopausal bleeding for the last two months. She was postmenopausal for the last 27 years during which she had never been treated with estrogen replacement therapy. On a gynaecologic examination, bilateral adnexal mass found. Ultrasonographic scanning demonstrated a normal sized anteverted uterus with


4±7 October 2000, Zagreb, Croatia an endometrial thickness of 4 mm with an hypoechoic ring around it. Transverse ultrasonogram showed bilateral adnexal highly reflective echogenic well circumscribed mass with solid and cystic components. Endometrial biopsy showed granulomatous endometritis. At surgery, a bilateral ovarian tumour measuring 4 5 cm in diameter was seen. A pathologic examination confirmed bilateral dermoid cysts with no malignant component. Peritoneal washing was also negative. Total abdominal histerectomy with bilateral salphingooopherectomy was performed. On discharging from Hospital, estrogen replacement therapy was given.

P139 Transvaginal color Doppler study of uterine blood flow in primary dysmenorrhea R. DmitrovicÂ Opca bolnica Nova GradisÏka, Croatia Background: The pain in primary dysmenorrhea is caused by excessive prostaglandin production that leads to vasoconstriction and uterine ischemia. Changes in uterine blood flow are important factor in patophysiology of primary dysmenorrhea. The aim of the study was to determine if vasoconstriction of the uterine vessels in patients with primary dysmenorrhea is detectable by transvaginal color Doppler ultrasound. Methods: Forty-two women with primary dysmenorrhea and 50 healthy controls were included in this prospective study. Women were examined with transvaginal color Doppler ultrasound on first day of the cycle, once in the follicular and once in the luteal phase. Measurements of pulsatility index in uterine, arcuate, radial and spiral arteries were performed. Student's t-test was used to establish statistical significance between groups. Results: Women in dysmenorrhea group had significantly higher uterine blood flow indices than healthy controls in all three measurements periods. This includes all vessels studied on the first day of the cycle, the radial and spiral arteries during the follicular phase and the arcuate, radial and spiral arteries during the luteal phase. Conclusions: We found that women with primary dysmenorrhea have elevated Doppler indices in uterine arteries not only on first day of the cycle but throughout the whole cycle. Therefore we postulated that primary dysmenorrhea is not only the disorder of menstruation but also a disease of a menstrual cycle in whole.

P140 A case of an old age postmenopausal woman with a giant myoma uteri Z. N. Kavak and A. BasËguÈl Department of Gynaecology, University Hospital, Marmara, Istanbul, Turkey Background: Since leiomyomas are estrogen dependent, the occurrence of myoma uteri in in a large size, in late postmenopausal years is unusual and should be evaluated carefully for underlying malignancy. We report here, a case of an old age postmenopausal woman with a giant myoma uteri. Ultrasonographic features, clinical presentation, differential diagnosis and treatment modalities of this rare case are presented and discussed. Case: 74-year-old woman gravida 4 para 4 was referred to our clinic with the complaint of genital bleeding and pelvic discomfort. On her gynecologic examination a pelvic mass was discovered. Detailed sonographic examination of her showed solid uterine tumor, measuring 10 12 10 cm in diameter in fundo corporal portion of the uterus. It has got typical whorled appareance with increased echogenicity compared with the uterus. Irregular sonolucent areas were seen within the tumor and thought as a possible myoma uteri with cystic degeneration. Endometrial lining was distorted and 4 mm in size. Endometrial biopsy revealed no evidence of malignancy. Since a tumor with such a size in a postmenopausal woman should be encouraged for early surgery. Surgery was performed and total abdominal histerectomy with bilateral salphingooopherectomy was performed. Laparatomy


Posters revealed a solid tumor on the uterine corpus and histologically was diagnosed as leimyoma of uteri. Postoperative follow up of her was uneventful and hormone replacement therapy was given.

P141 Benign mucinous ovarian cysts: transvaginal sonography with color Doppler features Ã .A. Pascual, F. Tresserra*, A. Ubeda, P.J. Grases, L. Hereter and M R. Labastida Institut Universitari Dexeus de Barcelona, Department of Obstetrics and Gynecology and Pathology*, Spain Aim: To evaluate the accuracy of transvaginal sonography with color Doppler (TVSCD) in identifying mucinous ovarian cysts. Material and methods: Five hundred 18 adnexal masses were diagnosed by TVSCD before surgery. We identified those adnexal masses in which an ultrasonographic diagnosis of mucinous ovarian cyst was done. This diagnosis was based on the presence of a cystic lesion with thin, grape-like appearing septa and diffuse internal echoes. This diagnosis was compared with the pathological features. Results: A total of 49 mucinous cysts were diagnosed by TVSCD, 26 of them were histologically confirmed. Twenty-three cysts were misdiagnosed (9 were serous, 4 were interpreted as malignant and one was an endometrioma). TVSCD was unable to diagnose 14 out of 40 mucinous cysts confirmed by histology. The ultrasonographic features most frequently seen as suspicious of malignancy were thin, grape-like appearing septa (84.6%) and diffuse internal echoes (53.8%). The sensitivity, specificity, and positive and negative predictive values and accuracy of TVSCD were 65%, 95.2%, 53.1%, 97%, and 92%, respectively. Conclusions: The accuracy of TVCD for the diagnosis of benign mucinous cysts is very high, being the most frequently cause of confusion simple serous cysts. Acknowledgements: The authors are grateful to the CaÁtedra d'InvestigacioÂ en ObstetrõÂcia i Ginecologia (Universitat AutoÂnoma de Barcelona).

P142 Endometrioma simulating ovarian cancer in a postmenopausal woman ± report of one case Z. N. Kavak and A. BasËguÈl Department of Gynaecology, University Hospital, Marmara, Istanbul, Turkey Background: External endometriosis is principally a disease of active reproductive life which is seldom found during postmenopausal years because of estrogen deprivation. Endometriosis is a great mimicker of other pelvic pathologies especially in postmenopausal years. We report here, a case of ovarian endometrioma in a postmenopausal woman simulating ovarian cancer. Ultrasonographic features, clinical presentation, differential diagnosis and treatment modalities of this rare case are presented and discussed. Case: 76-year-old woman gravida 3 para 2 presented with an asymptomatic pelvic mass discovered on gynecologic examination. An ultrasound examination was requested to investigate the nature of this mass. She was otherwise symptom-free surprisingly except for occasionally occuring bilateral pelvic pain. Longitidunal sonograms showed an irregular, partially solid and cystic mass in the right adnexal region. A transverse scan showed the presence of a complex right adnexal mass measuring 6 7 7 cm in diameter which was considered most likely to be malignant. CA-125 level of her was slightly elevated. Urgent laparatomy revealed no evidence of malignancy and the mass proved to be an endometrioma histologically. Most possibly, the presence of old blood within the tumor simulated a solid component. The patient was vigorously reassured and hormone replacement therapy was given in the postoperative follow up period.

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10th World Congress on Ultrasound in Obstetrics and Gynecology P143 Primary bilateral fallopian tube cancer ± case report M. Wojcieszyn, K. Bøaszczyk, M. Biernat, M. Krzystyniak and R. Poreba IV Department of Obstetrics and Gynaecology Silesian University School of Medicine, Katowice, Poland Introduction: Fallopian tube cancer is one of the rarest neoplasm of female reproductive tract. Primary, bilateral presence of the cancer is especially rare. Diagnostic difficulties cause, that it is often found in very advanced state. The authors have presented the case of primary bilateral cancer of the fallopian tube, qualified to surgical treatment on the base of sonographic examination. 57 years-old women was examined using transvaginal ultrasound due to increasing pain in the lower part of the abdomen and abnormal discharge out of the vagina. During the examination fluid in the uterus cavity and cystic, oblong, winding structures in both adnexa, looking like distended oviducts were found. Typical ovary tissue wasn't visible. On the base of history and examination laparotomy was ordered. During the surgery multiple adhesions in the pelvis and extended fluid filled fallopian tubes were found. The hysterectomy and bilateral adnexectomy was performed. Pathological examination revealed presence of bilateral papillary adenocarcinoma of the fallopian tubes. Out of the oviduct no neoplastic cells was found. Conclusion: Extended fluid filled oviducts found during sonographic examination may be the first sign of fallopian tube cancer.

P144 Color Doppler imaging of the testis in azoospermic subjects as a predictor of spermatozoa retrieval on testicular sperm extarction J. Har-Toov, G. Fait, R. Houser, I. Wolman, I. Gull, R. Amster, H. Yavetz and A. J. Jaffa US Unit in Ob/Gyn, Lis Maternity Hospital, Tel Aviv Medical Center, Israel Background: There are no clinical parameters for identification of spermatogenic tissue within the testis of azoospermic subjects. Consequently, multiple biopsies are performed until spermatozoa are found. The aim of this study was to evaluate whether testicular blood flow can be a predictor of spermatozoa retrieval on TESE. Method: Color Doppler ultrasound was performed in 13 azoospermic subjects affected by primary testicular pathology and in 7 fertile subjects. The PI, RI, and S/D ratio reflecting resistance to flow were measured in the mid-portion of the testis in the longitudinal view. All azoospermic subjects underwent TESE in which a biopsy was taken from the head, mid, and tale portion of the testis. The specimens were evaluated for structure and for the presence of spermatozoa. Results: Blood flow indices were similar in azoospermic subjects as compared to fertile subjects. (mean ^ SD; PI 0.99 ^ 0.64, RI 0.52 ^ 0.16, S/D 2.16 ^ 0.74; PI 0.99 ^ 0.19, RI 0.59 ^ 0.07, S/D 2.51 ^ 0.48, respectively). In seven patients, spermatozoa was found in one or more of the testicular specimens. Blood flow indices in this group were similar to the indices in azoospermic patients in whom spermatozoa was not found. Conclusion: At present testicular blood flow as evaluated by color Doppler can not serve as a predictor of spermatozoa retrieval on TESE.

P145 Ultrasound evaluation of ectopic pregnancy and laparoscopic approach S. SijanovicÂ, Z. Popovic, A. Lovric and Z. Hrgovic Department of Gynecology and Obstetrics, Clinical Hospital Osijek, Croatia In our department we prefer laparoscopic treatment ectopic pregnancy. In 1999 and 2000 years we were laparoscopically treated 70% ectopic pregnancy. For promtly and safely diagnosis we use

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clinical, ultrasound and beta choriongonadotropine hormon examination. In this period we treated 26 women with diagnosis of ectopic pregnancy. In 96% patients ultrasound examination was made. Ultrasound examination showed in 88% women adnexal masses or free fluid in Douglas space. In most cases ectopic pregnancy was in right tube (69%). Ultrasound evaluation in correlation with beta choriongonadotropin hormone creates early and safely diagnosis ectopic pregnancy and provides laparoscopic approach. Laparoscopic approach in treatment ectopic pregnancy is method of choice.

P146 Early detection of ectopic pregnancy with ultrasound M. Simic, M. Kopjar, T. Viskovic and M. Zadro General Hospital Zabok, Ob/Gyn Department, Zabok, Croatia Objective: To determine if the typical appearance of endometrium for late proliferative phase and early secretary phase could be used as a patognomonic sign for early detection of ectopic pregnancy in combination with other patognomonic signs for ectopic pregnancy. Methods: Over a period of four 76 patients were admitted at our department as a result of suspicion of ectopic pregnancy. Results: In three patients out of those 76 at the time of admission ectopic pregnancy was not visible neither on ultrasound nor on laparoscopy. One of them was a cervical pregnancy, and two others were cornual pregnancies. Sixty-six patients have had tubar abortions, including two pregnancies with live embryo in the tube. Conclusion: Typical late endometrial look for late proliferative phase and early secretary phase can be used as a patognomonic ultrasound finding for ectopic pregnancy especially in combination with other patognomonic ultrasound findings and in combination with serum progesterone measurement.

P147 Preoperative evaluation of endometriosis with transvaginal ultrasound M. Kopjar and I. Alvir General Hospital Zabok, Zabok, Croatia Objective: To show the use of transvaginal ultrasound in the diagnosis of endometriosis, and based on that in the decision on the choice of treatment. Patients and methods: Ultrasound finding of round shaped adnexal mass with thick wall and homogeneous, low level echo pattern was considered suspected for endometriosis. From 1995 to 1999 in women with chronic pelvic pain and palpable mass, transvaginal ultrasound confirmed the endometriosis, according to the above criteria in IS patients. Eleven patients were treated preoperatively with GnRH agonists (goserelin depot 3.6 mg) for 6 months. After the treatment operative laparoscopy was performed. In 7 patients laparoscopy was performed immediately, and patients received medicated treatment after the operations, also GnRH agonists for 6 months. Results: During the preoperative treatment with GnRH most patients reported a reduction of pain after 3 months of treatment, and with patients operated immediately reduction of pain was reported 2 weeks following operation. Operation was shorter in patients with preoperative treatment with GnRH. Conclusion: Disadvantages of preoperative treatment of endometriosis include changes in appearance of endometriosis, price of the medication, side-effects, dilate of accurate diagnosis, and dilate in eventual pregnancy. For some patients it can be useful to start the preoperative medicated treatment to suppress ovulatory activity, so functional cysts would not be misdiagnosed for endometriosis. Patients with chronic pelvic pain should be evaluated laparoscopically to diagnose mild endometriosis adequately.


4±7 October 2000, Zagreb, Croatia 148 Blood flow changes after uterine artery embolization in the treatment of adenomyosis and myomis: preliminary report E.-H. Lee, T. W. Sunwoo, C. S. Ahn, M.-H. Lee and W. H. Lee Pundang CHA Hospital, Sungnam, Korea Background: The aim of this study was to evaluate prospectively the changes of blood flow following permanent embolization of uterine arteries using polyvinyl alcohol in the treatment of uterine adenomyosis or myomas. Methods: From August 1998 to May 1999, 114 cases of uterine artery embolization were performed for the patients having symptomatic adenomyosis (n 63) or myomas (n 51). They were underwent baseline (n 114) and follow-up ultrasound on 1 week (n 106), 3 (n 102) and 6 months (n 23) after embolization. The peak systolic velocity (PSV) and resistive index (RI) were calculated in the isthmic portion of uterine arteries and intratumoral vessels. Results: One week after embolization, uterine blood flow was markedly decreased comparing with pre-embolization status. After 3 months, blood flow was recovered up to 56% of pre-embolization state but not increased significantly on 6 months examination. Color flow was not detected within the myomas after embolization.

Posters Table: Changes in PSV and RI

PSV (cm s21) RI

Pre

1 week

3 month

6 month

54.7 0.76

23.0 0.84

30.5 0.80

32.0 0.79

Conclusion: Uterine blood flow was markedly decreased immediately after embolization and increased up to the half level of preembolization status on 3 months examination.

P149 Ultrasound in the diagnosis and treatment of female stress urinary incontinence A. Lukanovic and B. Kralj Abstract not available.

MISCELLANEOUS P150 Illustration of a cervical pregnancy medically treated M. Guizani, V. Vernaeve and C. Van Pachterbeke C.H.U Brugmann, Brussels, Belgium A 26 year old woman, without any previous medical history and who has done two pregnancies interruptions, came at the visit for inquieries for a third pregnancy termination. She was in amenorrhea, the time elapsed from the last period was unknown. The patient had abdominal pain progressing since a few weeks. The clinical examination showed a painful cervix mobilisation. An ultrasound scan was performed showing a seven weeks nonevolutive cervical pregnancy. The uterine cavity was enlarged and filled with blood clots. To avoid hemorragic complications that could be life-threatening, the patient received a single intramuscular injection of 60 milligrams of methotrexate. We followed the evolution with ultrasounds scans and measurements of plasmatic bHCG and progesteron. The course of the diesease ended succesfully. The poster will summerise the clinical, biological and sonographic evolution during the four weeks following the medical treatment.

P151 Transvaginal ultrasonography in detection of cervical incompetency M. Podobnik, M. Podgajski, S. Ciglar and B. Gebauer Dept. Ob/Gy n, University Hospital Merkur, Zagreb, Croatia Objectives: To examine the relationship between transvaginal ultrasound cervical changes and pregnancy outcome in women at risk of cervical incompetency and preterm delivery. Method: In 100 pregnancies with clinical and ultrasonic signs of cervical incompetency, the length of the cervix, the thickness of the anterior wall of a lower uterine segment and the width of the endocervical canal have been evaluated ultrasonically. These parameters were followed longitudinally from the 10th to 36th gestational week in the healthy pregnancies and pregnancies at risk of cervical incompetency and preterm delivery. Results: In patients from 10 weeks to 14 weeks the cervix is significantly longer than in the 25±36 week group and the anterior wall of the lower uterine segment in the 10±14 week group is significantly thicker than in the 20±36 week group. In pregnancies at risk of cervical incompetency, cervical lengths and wall thickness were significantly different from those in comparable controls. Forty-five


percent of the patients in the at-risk group, with cervical cerclage, delivered at 37.5 weeks and 8.5% of pregnancies ended in abortion when the amnictic membrane herniated into the cervical canal. The frequencies of preterm delivery were 60%, 38% and 15% for cervical lengths of , 10 mm, 10±20 mm and 20±30 mm. Conclusion: A shortened cervix with decreased thickness of the anterior wall of lower uterine segment and dilatated endocervical canal shows a strong association with cervical incompetency and preterm birth.

P152 Post-cesarean sonographic evaluation of subfascial hematoma in Joel-Cohen and pfannenstiel laparotomies: 5 years of experience A. Malvasi, D. Baldini and V. Traina Department of Obstetrics, Center of Ultrasonography and Prenatal Diagnosis, Casa di cura Santa Maria, Bari, Italy Background: In this prospective randomized study, some elements of morbidity between Joel-Cohen laparotomy (J.-C.-l.) and Pfannenstiel laparotomy (P.-l.) have been evaluated. Using transabdominal sonography pathologic subfascial hematomas have been searched for in 258 cesarean section (c.s.) with J.-C.l. and in 292 c.s. with P.l. We've examined 238 first c.s. (83.50%) and 47 repeat c.s. (16.49%) carried out through J.-C.l., while 253 first c.s. (86.05%) and 39 repeat (13.26%) through P.l. Result: The abdominal wall of the patients who underwent c.s. was examined sonographically on the 3rd and 10th postoperative day, considering anechogenic areas, with clear wall, with interior echoes, both subfascial with a diameter more than 3 centimetres long. At c.s. through J.C.l. we have observed 3 subfascial hematomas (1.75%) (2 surgical treatment) compared to 5 (2.72%) through P.l., (3 surgical treatment) with no statistical significancy. On the contrary statistically significant differences have been observed whith regard to opening and closing time of abdominal wall; 4.9 min for J.-C.l. and 14.7 min for P.l. (P , 0.05), as all operating time. Conclusion: In conclusion, in our clinical and sonographic experience, at first c.s. P.l. does not cause a greater formation of abdominal wall hematomas compared to J.-C.l. as Stark refers, it is clear that surgical and anaesthesiological time lengthens, suture materials increase with P.l. At repeat c.s. stretching is not always easy, because of the cicatricial condition of the muscles besides an exaggerate manipulation of the tissues may favour subfascial hematomas. In the J.-C.l. the subfascial-hematoma occurs the blood invades the peritoneal cavity

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10th World Congress on Ultrasound in Obstetrics and Gynecology changing the clinical and sonographic situation compared to classic subfascial hematoma with closed peritoneum.

P153 Cerebral venous thrombosis and pregnancy: image diagnosis N. Lagos, C. GarcõÂa, G. Castillo, N. Luengo, I. Hoffmann, P. Ortega, Astorga and I. Ferres Hospital de Carabineros, Universidad de Santiago, Santiago, Chile Background: Thrombotic conditions are common complications during pregnancy. Cerebral venous thrombosis is also more frecuent in pregnant patients, with a prevalence of 4.5 per 1000 obstetric admissions. We present 3 cases that were managed in our unit. Patient 1: 38-year-old, epileptic, 10 week pregnant. She had occipital, pulsatil headache plus blurred vision. A Magnetic Nuclear Resonance (MNR) showed lack of flow, in the right transverse sinus, and yugular gulf. Patient 2: 32-year-old, with an haemolytic anemia and an occipital meningioma. She had a 34-weeks pregnancy and was admitted because of edema of the lower extremities. She has paresthesies and hypoesthesia of the right leg, which progresed to anesthesia. MNR showed her occipital tumor, measuring 10 12 mm, and thrombosis of the right transverse and lower sagital sinus. Patient 3: 30-year-old, 10 weeks pregnant, admitted because of a headache that did not respond to common analgesics. MNR informed thrombosis of the left transverse sinus, and the yugular gulf. All 3 patients were treated with low molecular weight heparin. Conclusions: The majority of cases of cerebral venous thrombosis involve the high sagital sinus. In the pregnant patient study by images is recommendable and the test of choise is MNR, which has a sensibility of 90%. Recommended treatment is anticoagulant therapy.

P154 Psychological stress and ultrasound screening in pregnancy: a risk-group comparison S. Fuchshuber and A. Strauss Department of Ob-Gyn, Grosshadern Hospital, Ludwig Maximilian University, Munich, Germany Background: We intended to assess the psychological stress experienced by mothers during ultrasound screenings in pregnancy. Methods: Between 1997 and 1999, 136 women (age 17±41, pregnancy week 9±41) were asked to record their stress level before, during and after the ultrasound exam on a scale from 1 to 10. 81 patients were generally concerned about their pregnancy, 22 were over age 35, 21 had specific pregnancy risks (family history, preeclampsia, first-trimenon medication-intake/infection, pathological ultrasound findings). Results: Women generally concerned or with known pregnancy risk report significantly more stress before the exam (mean 3.8 vs. 1.9 and 4.6 vs. 2.8; P , 0.01). However, during or after the exam, stress levels are equal in all groups (5.1 vs. 4.3, 2.9 vs. 2.3; P . 0.01). We also find no significant differences between women above or below age 35 (3.0 vs. 3.1 before, 4.3 vs. 4.4 during, 2.5 vs. 2.2 after ultrasound exam; P . 0.01). Overall, all women experienced the most stress during, and the least stress after the exam (P , 0.01). Conclusion: Or results show that we need to anticipate an equal level of anxiety in all women we examine. We cannot assume that a young mother without risk will experience the exam any more or less distressful than a woman with predisposed risk. The results cautions us to give adequate consideration to every individual patient, regardless of pregnancy risk.

P155 The pathological breast in gestation-puerperal period M. R. M. Machado, F. F. A. Santos, E. F. Marussi, S. L. Pereira and S. L. Vissotto Universidade Estadual de Campinas, SaÄo Paulo, Brazil Background: The aim of this study was to describe the appearance of breast tissue in a breast inflammatory disease and in the inflammatory

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breast tumour during gestational-puerperal period using ultrasound and to evaluate the contribution of this exam in differential diagnosis. Method: We will describe two cases with increase of volume breast, analysed by two-dimensional ultrasound, performed on an ACUSON XP4A using a 7,5 MHz linear, focused probe with Colour Doppler. Results: The two patients showed typical inflammatory characteristics, similar symptoms and the same appearance of breast tissue in ultrasound. The two exams appears as parenquymal disorganisation breast tissue, increase width skin, hypoechoic ill undefined masses with some internal echoes, thick walls and septations. Conclusions: In some cases, the differential diagnosis between breast tumours associated to inflammatory appearance and inflammatory diseases, during pregnancy and puerperal period are very difficult. The Doppler evaluation is helpful as well as clinical history and epidemiology. Sometimes, only the hystological aspects will provide the right diagnosis.

P156 Teaching in ultrasound ± new methods in training I. Heer, S. Fuchshuber and A. Strauss Department of Obstetrics and Gynaecology, Groûhadern, University of Munich, Germany Introduction: The purpose of this study was to evaluate a new training system for transvaginal ultrasound. Methods: We used a software-based 3D-ultrasound which allows offline re-evaluation of structures recorded in a 3D-voxelcube during an actual exam. The software assigns a specific plane to each possible position of the transducer within the 3D-cube. This allows virtual `rescanning' of recorded exams. In the teaching model, an vaginal ultrasound transducer is used to examine a life-size model pelvis. The transducer is linked to a computer which displays the virtual ultrasound scan. We tested the system on 30 Munich-University 3rd year medical students. None had previous ultrasound experience. All were shown an 8 minute teaching video. Each student was allowed a 1 minute practice period, then asked to find a proper plane and measure the endometrial thickness. Results: All students were able to find a proper plane for measurement within 30 s. The results of measurments varried between 5 and 9 mm (actual thickness 8 mm). All rated the session as an excellent theoretical introduction into the field of transvaginal ultrasound, and as extremely valuable skill-training. Conclusion: In this software based re-evaluation model, we believe to have found an optimal new training tool for transvaginal ultrasonound. As a consequence, we intend to establish a case-library for the future basic training of younger doctors.

P158 The representation of obstetric ultrasound scan among obstetricians and ultra-sonographers: a descriptive exploratory study J. Quayle, V. Wojciechowski, L. S. Ueno, V. Bunduki, S. Miyadahira, M. C. S. De Lucia and M. Zugaib Psychology Division and Obstetric Department, Hospital das ClõÂnicas, SaÄo Paulo University Medical School, SaÄo Paulo, Brazil Background: Ultrasound is one of the most known exams performed during prenatal period for diagnosis and screening, but little is known about obstetricians' perceptions associated to the exam. The aim of this study was to assess psychological representations related to obstetric ultrasound scan among obstetricians who were also ultrasonographists and those who were not. Method: Psychological interview with 54 obstetricians of our Institution with different level of specialization. Results: 55% believe that only a specific training is necessary to be an ultrasonographist, while 35% consider a title essential to perform the exam. Most of the subjects (98%) believe the exam has influences on the pregnant woman bonding with her baby, due to fetal visualization and the proximity feeling it favors. Almost all (93%) consider the possibility of early diagnosis the main feature of the exam while 20%


4±7 October 2000, Zagreb, Croatia mention the possibility of diagnostic mistakes and their repercussion. When asked to produce projective associations, content analysis points out to aspects associated to the qualities of the exam, particularly `fidelity', precision and power. Conclusion: There is a massive idealization of the exam and little difference between ultrasonographists and obstetricians. This should be approached during professional training to help them deal with the bonding aspects they themselves consider important.

P159 Three-dimensional ultrasound reconstruction and telemedicine. Image analysis O. Ferrer-Roca*, J. M. Troyano², J. Vilarchao-Cavia*, M. T. Clavijo², O. Y. Marco² and C. M. Feo² *CATA, UNESCO Chair of Telemedicine ²Ultrasound Division and Fetal Medicine, University Hospital of Canary Islands, Tenerife, Spain Background: In the present study the 3D US images reconstruction is combined with the distant consultation through internet or through an ISDN line.


Posters Method: Trial consists of explorations done during 1999/2000 in our US unit at the Obstetrics and Gynaecology Department. The equipment is integrated by: a standard Aloka-SSD 680 ultrasound device, a Dual Pentium II workstation with 256 Mb RAM memory and Windows NT operative system, a falcon framegrabber board, and the TeleInvivo 3D reconstruction and teleconsultation software by MEDCOM. Echograph images are acquired by the workstation through a falcon digitising board, and the TeleInVivo software generates a 3D volume. These volumes can be sent to a remote host via internet or via an ISDN line, allowing an on-line teleconsultation and telediagnosis. Results: During the trial we made 149 teleconsultations of different pathologies. 3d reconstruction was time consuming (20 min to 4 h) and of a limited diagnostic value, but of future relevance to reduce patient multiple explorations due image constraints such as sub optimal foetal position among others. The final volumes are sent wavelet lossless compressed through internet or an ISDN line, and for a normal size of 1.5 MB the time consuming is from 4 to 8 min to be transmitted. Conclusion: The use of internet or an ISDN line is a fast method for sending and consulting 3D ultrasound images, and it is possible due to the selected volume rendering techniques that provide an effective compression of the original data.

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